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Straumann Innovation…taking clinical practice to a new level
Quality and product safety

Smaller suppliers are increasingly present in the market for dental implants, with cheap implant products and an aggressive marketing that is targeted at price. Some of these companies would not even exist without premium suppliers.

Price comparisons: SLActive® as an example
It is not uncommon for low-price players to promote their products with price differences by comparing their products against the most expensive, high-end premium solutions. For instance, one cheap manufacturer may compare the price of its undocumented, second-generation surface with the price of Straumann’s third-generation hydrophilic SLActive® surface. Endorsed by more than 25 and ongoing studies, SLActive® is one of the best investigated implant surfaces on the market.

The crucial factors of a premium implant solution
Without clinical substantiation, low price implants simply have no claim to equivalence. Even when it comes to simple design features and finish, the claim that a cheap implant is an equivalent alternative must be based on comparative long-term data to support it, which often is not the case. If a comparison is made between Straumann’s value option, the SLActive® surface, and a cheap manufacturer, the difference in the overall cost of the treatment is negligible. However, the Straumann solution offers great flexibility, for example in terms of prosthetic range and planning – with simple handling and workflow. These are just two of many elements in our value proposition, which, together with the following factors, explains why Straumann is a premium implant solution.

Lasting quality and service
Look-alikes give the clinicians the impression that they are saving money but they don’t talk about the long-term consequences. As in other fields, the rule applies: saving money at the wrong end can become costly later. A recent comparative study conducted by the University of Connecticut reveals how quality standards between premium implants and look-alikes can differ (see text box). The consequences and costs that may result from the usage of such products should therefore be taken into consideration in advance.

Table 1: Higher risk of mechanical failure in look-alike implant systems

An implant is more than a screw
Not only should the dental implant perform functionally and be reliable, it should also last on a long-term basis – which means that the bone and soft tissues around it need to be maintained. Comprehensive long-term clinical studies published in peer-reviewed journals and presented at international scientific meetings have always been important to Straumann and the Straumann® Dental Implant System is backed by ongoing studies assessing aesthetic parameters over the long term. In 2004, an ongoing cohort study was presented at the 13th Scientific Meeting of the European Association of Osseointegration (EAO), which included 12-year data on aesthetic parameters of Straumann implants. Nine-year data were published in 2003. Some manufacturers of cheap implants were not even in the business then and still have no clinical programme in place.

The question of choice
The implant itself makes up only a fraction of the overall treatment costs. The last thing a patient wants is to risk failure or jeopardise long-term outcome by trying to save one or two hundred pounds. In a consumer market, people have a choice as to whether they purchase a premium or a cheap product. In dentistry, patients rarely get to choose which manufacturers’ products are put into their mouths. So the patient is unable to make a qualified choice and has to rely on the prescriber to receive the best treatment and materials possible. Thus, if the supposed savings are put in relation to the overall costs of the treatment or to the costs resulting from implants or abutments which do not work properly, it becomes evident that cheap implants are only supposedly cheaper than premium products.

Clinical substantiation
Further more, Straumann conducts thorough preclinical and clinical tests on its products prior to market introduction. The results of these studies are presented at international scientific congresses and in peer reviewed journals, endorsing the quality of the research. Straumann currently has 18 studies running in 139 centres in 17 countries and involving 2061 patients.

Attention has been drawn to the lack of clinical evidence and long-term data to support cheap implant products. A search for literature in PubMed, which includes 18 million citations from 5,000 journals in MEDLINE, and in Google Scholar, has lead to the result that, for certain manufacturers, there are no peer-reviewed studies on implants at all in these two databases.

The costs behind the development and scientific testing of a next-generation implant surface
Straumann products are backed by clinical studies before they are launched. For example more than 1,400 implants had been documented in clinical trials before our new generation bone level implant range was put on the market. It took 4 years and cost approximately CHF 20 million for Straumann to develop and test the SLActive® surface technology prior to market introduction.

Table 2: Roxolid™: clinical trials with more than 400 patients and 60 centers around the world

Table 3: Research and development at Straumann: still heading the list of priorities even in the recession

Scientifically grounded products:  the best investment for doctor and patients
The innovations of Straumann are a response to the needs of the steadily developing implant dentistry practice. As the Roxolid™ example shows, an innovative product can signify an expansion of the range of indications for the dentist working in implant dentistry, that is, the possibility of reaching new groups of patients in whom implant therapy was not possible previously for various reasons or would have involved risks. This expansion of the range of indications also signifies corresponding growth for their practice. Straumann customers are among the first who will benefit directly from the innovative, scientifically founded products that are designed to last – the outcome of years of intensive and accordingly expensive research.

Training and education: an important element in the marketing mix
Basic training in implant dentistry now features in under- and postgraduate education. However, there is a huge need for further education, specialisation and refresher courses to ensure practising dentists, technicians, nurses and other dental professionals are able to offer the latest standard of care to patients. Premium companies like Straumann offer a large variety of courses worldwide every year. These are a major contribution to raising treatment quality and enhancing the standard of patient care. Although course participants usually pay a course fee, the companies incur considerable costs for the organisation, teaching materials, etc.

Direct access to the customers and intense communication
Because Straumann sells directly to dentists and dental laboratories, a close interaction with the customers to understand their requirements is possible. In addition to providing important information on new products and techniques, Straumann offers networking and hotline services. Our customers thus have access to specialists who can help with irregularities and difficult cases. In conjunction with the ITI, broad opportunities for customers to train further and to develop new skills are offered.

The risk of obsolescence
In times of economic uncertainty, smaller low-margin companies face greater challenges to survive than established players with large customer bases. Saving on an implant increases the patient’s exposure to having an unserviceable implant in the future. Thus, an important question patients should ask is: ‘Is the implant system guaranteed?’

The risk of mixing
Cheap implants often do not offer flexible solutions for technical matters. But making compromises is not worth even the cheapest price. Several low cost manufacturers sell copycat components intended for use on premium brand implants instead of the more expensive original components. Here again, there is no clinical evidence to support the claimed compatibility. There is no assurance of the same precision or material quality. Furthermore, the original manufacturer’s liability for the product is voided and the dentist is responsible for mixing systems. As soon as components are mixed the Straumann Guarantee becomes void.

The Straumann Guarantee
Quality, education and accountability come at a price. Short-term savings can prove painful in the long term, and although premium solutions may appear expensive initially, they could well work out cheaper in the long run. The question is: can patients really afford  the drawbacks of cheap alternatives?

Table 4: Disadvantages and risks you may encounter when using cheap implants:

Table 5: Your benefit when using Straumann products:

Product Highlights

Straumann has developed a new and stronger metallic material with superior osseointegration properties. Roxolid™, an alloy of titanium and zirconium, is the first material to be designed specifically for the needs of dental implantologists.

Roxolid™ is 50% stronger than pure titanium, the current material of choice for implants. Exciting preclinical study results presented at the EAO 2008 in Warsaw showed better osseointegration of Roxolid™ in comparison with pure titanium.

The combination of enhanced strength and osseointegration enables a new generation of small diameter implants to be produced; these are advantageous, especially in situations where space is limited. Visit www.straumann.com for more information.

Straumann® CADCAM can produce an unbeatable array of restorations including bridges of up to 16 units, Maryland bridges, inlays/onlays, telescopic crowns, Hader bars, precision attachments, veneers and much more. All these restorations can be produced in a choice of high-tech materials including Straumann® CADCAM IPS, Straumann® zerion, a metal-free and biocompatible material for superb natural aesthetics, a choice of bio-alloys in Straumann® ticon™, Straumann® coron™ and Straumann® polycon™, ideal for temporary restorations.  Straumann® CADCAM is a restorative system that will meet and exceed clinical expectations.

CADCAM Meets Digital Impression Systems
In addition Straumann has recently established an agreement with Cadent Inc. of NewJersey in the US to digitally connect Cadent’s iTero digital impression systems directly into the Straumann® CADCAM workflow.  Laboratories using Straumann® CADCAM are able to receive and process digital data directly from Cadent iTero intra-oral scanners to design prosthetics, which are then manufactured in Straumann’s central milling facilities. This all-digital workflow offers a number of benefits including higher productivity for dental labs and access to Straumann’s broad range of proven solutions for dentists using Cadent digital impression systems.

ROXOLID™ and Straumann® CADCAM demonstrate Straumann’s commitment to further developing products that have a significant impact on improving both clinical competency and patient satisfaction.

For information about Straumann products and services call Straumann on 01293 651230 or visit www.straumann.co.uk

References

1. Norm ASTM F67 (states minimum tensile strength of annealed titanium), used for all Straumann titanium and Roxolid™ implants, data on file

2. Gottlow J et al. Preclinical data presented at the 23rd Annual Meeting of the Academy of Osseointegration (AO), Boston, and at the 17th Annual Scientific Meeting of the European Association for Osseointegration (EAO), Warsaw.