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SECTION 1 – THE PARAGON IMPLANT SYSTEM
Q: Paragon claims that its system is simplified, but still provides many designs to choose from. What is it about the new Advent that you think will simplify treatment for me? Where would I use the Micro-Vent vs. the Screw-Vent? A: In today's dental practice, implant dentistry must be relatively simple and economical for both the surgeon and the restorative dentist. One-stage implants reduce patient trauma, shorten chair time and lower costs by eliminating the second-stage surgery. Reducing the number of surgical instruments needed to prepare the implant site and refining the implant packaging will also simplify and shorten surgical time. For simplified prosthetics, reducing the number of implant platforms and designing abutments for cemented restorations without shoulders will reduce the number of abutment options needed. These design criteria must be weighted against the versatility and esthetic issues needed to meet the demands of varied clinical applications. The evolution from the old to the new designs may cause some concerns about too many options. However, below is a description of the newer designs and the benefits to clinicians in making the transition. ADVENT IMPLANT The AdVent" implant features self-tapping, triple lead threads that make seating three times faster. Implant Extender packaging provided with the AdVent allows it to be placed via a one- or two-stage procedure, which the surgeon can decide at the time of placement. One-stage implants in edentulous jaws can be immediately splinted cross-arch to provide adequate stability for immediate loading with overdentures. A simple ball screw converts the top of the implant into a ball overdenture abutment and friction-fit straight and tapered abutments can also be attached for cemented restorations. The tapered body of the AdVent creates compression in soft bone for increased initial stability, a fundamental requirement to achieve osseointegration. This patented insertion procedure also will expand narrow ridges, eliminating the need for 3.3mm small diameter implant. The 3.7mmD and 4.7mmD AdVent implants have the same platform for the ultimate in abutment selection simplicity. TAPERED MICRO-VENT2 IMPLANT A tapered implant is particularly suited for immediate replacement of extracted teeth. The tapered Micro-Vent2 implant, available in diameters of 3.7mm, 4.7mm and 5.7mm, features Paragon’s patented internal hex and a unique tap-in/screw-in surgical protocol. The tapered design is also helpful for placement between convergent tooth roots and in ridges with labial concavities. The Micro-Vent2 has a rounded, closed bottom that facilitates sinus elevation procedures. The implant features Paragon’s patented Dual Transition Selective Surface, which provides 1mm of smooth, machined neck, with 2mm of a blasted zone between the smooth neck and HA or TPS coated body. The apical end is also machined to allow efficient self-tapping of the final 3mm of the implant’s insertion. Because only the apical 8mm of the Micro-Vent2 is tapered, one drill can be used to place all four implant lengths. The Micro-Vent2 also features new Fixture Mount/Transfer packaging that allows stage-one transfer impressions. SCREW-VENT The Screw-Vent implant, introduced in 1986, was the world’s first implant to have an internal, anti-rotational connection. It is self-tapping, with the standard Branemark threads spaced every 0.6mm apart. It has both an apical cross-vent, and a vertical vent coming up from the apex that connects with the cross-vent. The straight body of the Screw-Vent is offered in three surfaces, HA, TPS and SBM (blasted), all with a relatively smooth, machined apical end for improved self-tapping. TAPERED SCREW-VENT IMPLANT The Tapered Screw-Vent implant features the same tapered body and triple lead threads available on the Advent implant. It is available in 3.7mmD, and 4.7mmD as is the Advent, but offers an additions 6.0mmD implant option that has the same platform as the 5.7mmD Micro-Vent. The Tapered Screw-Vent also features the same rounded end found on the the Micro-Vent2, which facilitates sinus elevations. It is also available with either an blasted SBM surface, or an HA Dual Transition Selective Surface that features a 2mm SBM section between the HA and the 1mm machined neck. The Tapered Screw-Vent will offer the advantages of the Advent body design, but with two-stage Fixture Mount/Transfer packaging that allows stage-one transfer impressions. The Tapered Screw-Vent also provides a variety of platform dimensions, which allow greater control of emergence profile for esthetics in narrow or very wide ridges, and to fill extraction sockets. It will offer the advantages of the tapered Micro-Vent2 but with the advantages of triple lead threads and bone expansion from inserting a tapered implant into a straight socket. IMPLANT-ABUTMENT CONNECTION All of Paragon’s internal hex implants and tapered external hex implants come with a five-year guarantee against loose prosthetic screws when used with Paragon's patented friction-fit abutments. Paragon's implants and friction-fit abutments create a virtual cold weld that eliminates abutment rotation and tipping, which are the major causes of screw loosening in two-piece systems. When used together, restorations with Paragon products are covered by the industry's only 5-year guarantee of no loose screws under cemented bridges. The tapered Advent and Tapered Screw-Vent implants together offer the simplicity and versatility needed to meet all clinical applications and surgical protocol options. By using common surgical drills and drilling protocols, simplicity and versatility can be combined for the ultimate in clinical success. The Screw-Vent, Micro-Vent and Micro-Vent2 implants were evolutionary steps on the Core-Vent Bio-Engineering path to a new millennium of implants.
Q: For 10 years I used only two-stage implants. For the past three years, I have used single-stage implants. I am very pleased with the results that I have been getting and patients are obviously getting off better by only having to have one surgery as opposed to two. Our success rates have remained above 95% with single-stage implants, as well. I find the restorative aspects of treatment to be much easier with a single-stage system. I was wondering if anyone out there is having similar experiences? I really think that this is the future of implant dentistry. Many of the manufacturers are making single-stage implants (some aren't on the market yet), such as 3i, Imtec (in the works), etc.
A: You are right about the advantages of single-stage implants. Straumann’s recent addition of an internal octagon to the ITI internal conical connection further suggests that a non-hexed (or non-octagon) abutment connection, without the ability to do transfers, had distinct limitations in the esthetic zone. Still, the ITI system will not be manufacturing abutments that cover the implant shoulder so that the dentist can prepare the margins to follow the contours of the tissue. However, this could be accomplished with custom-cast abutments that are now possible, because of stage-one surgery transfer capabilities. The problem Straumann now has, with its new design, is that it violates Paragon's internal anti-rotational patent that has been successfully enforced against Steri-Oss, Lifecore, 3i, Calcitek and four other companies. Paragon has initiated litigation against Straumann in Los Angeles Federal Court. In 1993, Paragon sued Straumann for infringing its Core-Vent patent on an implant design that features a basket and threads — and won. Straumann was enjoined to stop selling its most popular implant for six months until it signed a licensing agreement. 3i copied Straumann's original conical connection and I anticipate that Lifecore's new one-stage implant will do the same. Due to previous litigation, both of these companies are locked into the old design. Straumann apparently is willing to risk its entire U.S. market by switching to the new design with an internal octagon and subject themselves, once again, to an injunction that could stop them from selling the very implants they are now marketing as the next generation of ITI implants. Since the patent covers the abutments that fit into an internal wrench-engaging surface, Straumann may be stopped from even selling abutments for the new connection —including implants that will have already been sold and placed. Paragon is starting production of ITI implant clones and abutments in anticipation of this outcome. Packaged together with the cover screw and abutment/transfer, Paragon's clone represents a 70% savings compared to buying ITI’s implants, cover screws, abutments and transfers separately. If you are interested in improved designs, Paragon's new AdVent one-stage implant deserves your attention. It offers the same fluted neck design as the ITI implant, with an internal hex for attachment of preparable, friction-fit abutments that fit flush to the outside of the implant. It is packaged with a cover screw that eliminates the need to buy Straumann's 1mm cap screw ($20), and also is packaged with a 2 mm Implant Extender (Patent Pending) that eliminates the need to buy Straumann's 2mm-5mm cap screws ($40). The AdVent's design, surgical protocol and packaging allow the surgeon to place the implant 1mm above the crest for two-stage surgery or 2mm–5mm above the crest for one-stage surgery. The AdVent’s body has Paragon's patented triple lead threads for three-times faster insertion compared to the standard threads on Branemark, Screw-Vent, 3i, Lifecore, Calcitek and other implants. AdVent’s patented insertion protocol allows insertion of a tapered implant into a straight hole for bone expansion/compression in soft bone and added stability in dense bone. Unlike the ITI, AdVent is self-tapping, which further saves chair time.
The AdVent implant from Paragon provides the advantages of a one-stage procedure with none of the prosthetic limitations attributable to a one-piece implant design. It is fully explained on our free CD-ROM that can be ordered over the Internet at www.paragon-implant.com, or by contacting Paragon at 800-877-9991.
Q: I met with two of your representatives today. They were both really nice guys and knowledgeable, as well. The AdVent implant looks great...no question. The dilemma that I spoke to them about has to do with the fact that referring general dentists, for the most part, are already "lost" when it comes to implant restorative concepts. Most have been inundated with various systems, abutments, and impression techniques. Due to the lack of Continuing Education specific to particular implant systems, they are often baffled by the various techniques employed by the different systems. I'm not saying that many of these dentists are good dentists, in fact, quite the opposite. Because of the simplicity that the ITI system affords, the average general dentist in our area is quite reluctant to switch again to a new system due to difference in restorative procedures and the fact that many of these dentists have already purchased lab analogs, impression transfers, torque wrenches, and on and on. The problem of educating all of these referral doctors, getting them finally comfortable with a simple system and equipped is nothing short of a monumental task. Even though I can see some definite advantages to the AdVent system, I really feel compelled to stay with this status quo because everybody is happy! On the other hand, I'm very eager to see Paragon’s ITI clone. I mentioned to the two sales guys that it would really be nice if this clone has the same threading and taper as the AdVent. Is this the case? A: The clone implant, which is called the SwissPlus, has better packaging than the ITI implant. Its fixture mount engages the octagon and can be used for both a transfer and for insertion (and easy removal of the fixture mount without counter-torque). The fixture mount fits flush with the outside diameter of the implant shoulder, and is tapered so that it can also be used as an abutment. Margins can be prepared in the abutment to follow the contour of the soft tissue. SwissPlus implants are available in 8 mm, 10 mm, 12 mm and 14mm lengths, and in 4.1 mm and 4.8 mm diameters that share a common standard-diameter platform. The implants have our SBM surface that creates similar roughness to ITI's SLA surface, but without as much rounding of the threads. They also have a self-tapping groove in the apical end to further simplify insertion. All of Straumann's drills and abutments fit the SwissPlus implant. SwissPlus IS PRICED AT ONLY $165, which includes a 2mm cap screw and the fixture mount that serves as a transfer and abutment. If you attach the abutments for your restorative dentists, they don't even need a torque wrench or hex tool. They will not have to buy protective caps for the Octabutments, because the SwissPlus comes with a healing collar. They won't have to buy transfer jigs and abutment analogs, because they can take an impression of the Fixture Mount/Transfer and pour it in dental stone. This provides additional savings of laboratory charges which, combined with the surgical design advantages (i.e. self-tapping, bone compression, fast insertion and free cap screw/healing collar with 1-5mm adjustable heights), makes the SwissPlus a compelling product. If the surgeon attaches the abutment, the 5-year guarantee against loose screws must be a serious consideration. It is the job of our sales representatives to make your restorative dentists feel comfortable. We will exchange any unused Straumann parts they have for Paragon prosthetic components free of charge.
Q: Paragon is now selling a clone of the new ITI implant with the internal octagon and abutments that fit both the clone and the ITI implant with the internal octagon platform. If doctors uses abutments from one system with implants from another, who are they going to blame if the abutment fails after loading? The warranty problem with all these clones is a difficult one for the dentist! You save some dollars in the beginning. However, if you get in trouble later, nobody wants to take responsibility for it! A: My company guarantees against fractures of all its components for 10 years. We would aslo do so with the SwissPlus abutments, whether used with our implant or ITI’s. Paragon provides a 5-year guarantee against abutment screw loosening and the consequential need to remake a fixed prosthesis for cases that use our implants and friction-fit abutments. This includes paying any associated laboratory costs. Furthermore, in the U.S., Germany, Canada and Israel where we do not sell through distributors, we will also pay $100 per abutment to compensate for lost chair time. That is how sure we are that a fixation screw on a friction-fit, two-piece abutment will not come loose. We are the only company in the industry that makes such a guarantee, because we are the only one with a friction-fit, anti-rotational connection for both our internal and external hex implants. The SwissPlus abutments provide the stability of an internal, anti-rotational connection, but are not friction-fit, because the fixture mount must be easily detached in order to serve as both a transfer and an abutment. Therefore, it can not be covered by Paragon’s "No Loose Screw" guarantee. The titanium Fixture Mount/Transfer engages the internal octagon, and is tapered so that it can be used as a transfer or as the final preparable abutment with margins to the outside of the implant. We would not want a fixture mount to be frictionally fit, or it could disturb the initial stability of the implant on removal. With the conical connection of the ITI implant, abutment loosening with multiple-unit splinting has not been a problem. With single tooth replacements, however, it should be a concern, as with any system that does not provide anti-rotational resistance through mating hexes. With ITI’s introduction of an internal octagon, stability will be a consideration for the engagement of two-piece, screw-retained, custom-cast abutments. The abutment must slip into the internal conical shaft to engage the octagon, and then be held in place by the screw. In contrast, one-piece abutments are tightened down with intimate contact along the internal tapered shaft. The ITI two-piece angled abutment has similar limitations to stability, as evident from the manufacturer's instructions not to grind on this abutment in the mouth, because vibrations will loosen it. The SwissPlus is a complete system that includes the implant and abutment together in one package at a price that saves as much as 60% of the ITI costs—that is better for the user! It provides a Fixture Mount/Abutment that engages the internal octagon and does not need counter-torque for removal—which is better for the user! The Fixture Mount/Abutment is tapered and designed for use as a transfer—which is better for the user! It can also be used as the abutment with a diameter that extends to cover the shoulder of the implant. This allows the dentist to prepare margins to follow the soft tissue contour, and then make a conventional impression — that is better for the user! If one wants to still buy ITI-type solid abutments, Octabutments, transfers and abutment analogs, they are all compatible with the SwissPlus. Paragon’s solid-type abutment for the SwissPlus is available in the most popular height and sells at half the price of the ITI abutment — which is good for the user! I have decided to take this action because Straumann decided to clone my patented connection. They are now being sued in Los Angeles Federal Court for cloning my internal connection. Straumann made the decision to do this because they finally realized that an internal connection is necessary for the prosthetic versatility with their system. I am cloning the ITI implants because I recognize the concerns of surgical dentists who are confronted with the dilemma of having to switch systems on their referring dentists. The SwissPlus from Paragon will serve as a transition implant. However, considering the following advantages, a change to AdVent is well worth any slight inconvenience of ordering from a different company:
So what do you want — the original design from ITI, the SwissPlus clone from Paragon with design, price and packaging advantages or the AdVent Implant, with all of its surgical and prosthetic advantages?
Q: Guess what, Jerry? The external hex works! Look at the market distribution in the states. If the internal hex is so great, how do you account for the popularity of external hex implants? A: The high number of companies selling external hex implants or external splines is due primarily to my success in enforcing the internal hex patent. Steri-Oss, 3i, Lifecore, Calcitek and five other companies have unsuccessfully attempted to produce internally hexed implants that did not infringe. Straumann and Friatec, the most popular implant in Germany and perhaps Europe, both have an internal hexes/octagons and are now in litigation for probable infringement. Astra added an internal hex below its internal threads and has been warned of possible infringement. All these companies can’t be wrong about wanting and needing an internal hex/octagon (or any other shape of anti-rotational) connection. I don't doubt that using stronger screws and greater torque, along with greater attention to occlusal forces, have reduced the number of screws loosening. But why not just eliminate the cause of loose screws and then move on to solve other problems in implant dentistry. Wobbling between mating parts can't be a good thing! By going internal, especially with a lead-in bevel and an internal hex that extends 1.5 mm below the bevel, 2 mm of interdigitation is achieved. Imagine an external hex that projected up 2 mm — it would be next to impossible to bury the implant or restore it with angled abutments. The internal hex allows for narrower necks on the implant and eliminates the need for countersinking. The other half of the equation to a good connection is the design of the abutment. With the internal hex, Core-Vent designed and patented a tapered male hex that friction-fits into the implant and eliminates all rotational and tipping movements. In fact, Paragon guarantees no loose screws for 5 years under cemented restorations. We also make an implant with a tapered external hex (Taper-Lock) so that we can get the same friction-fit that guarantees no loose screws. If you were going to start a long flight from New York to England in a 747, you would not want to start out with one dead engine. Sure, you can fly there with three good engines, but you never know when you are going to lose another engine and need the back-up of the one that was not working before you took off. It’s the same with implant restorations. Why start out with an unstable connection and depend on the torque or material of the screw to hold it together for the next 10-20 years? The literature is full of articles documenting loose screw complications. Ask yourself why, for example, if 3i solved the problem of loose screws by the use of a gold screw or by using their claimed tighter tolerances "ZR" abutments, are they now introducing narrow implants with a wide platform they say is necessary to reduce screw loosening? Loose screws were listed by a panel of dentists in a 1994 issue of JOMI (Volume 9 Supplement) as the "number one problem" in implant dentistry. You may not be experiencing screw loosening in the short-term by changing to a stronger screw, but metal fatigue is a time-dependent factor and you may just be delaying the problem. Surgeons that work with restorative dentists have no idea whether the screw will be adequately tightened, whether the prosthesis will fit passively or if the occlusion is acceptable. For this reason, loose screws may be a bigger problem in the Team Approach than when one dentist is doing both surgery and prosthetics. When you find an absolute solution to one problem in implant dentistry, such as friction-fit abutments that end loose screws, or the use of titanium alloy implants of adequate diameter to end breakage, incorporate it into your procedures and move on to discover other problems that need solutions. Otherwise, your problems become cumulative. While Steri-Oss is an alternative to Lifecore, one must first ask what problems are not being met by the Lifecore system and which system addresses these problems. In other words, you may be trading one set of problems for another. This is what it means to be discerning!
Q: After seeing many of the large-diameter implants with small, standard external hexes placed, I have noticed either rounding or distortion to the hex. Wouldn’t be be more effective to increase the size of the hex to prevent this from happening? I believe that a larger hex could also offer more to work with prosthetically. A: The rounding of the external hex is not due to its size as much as the metal used in the implant. Paragon's Taper-Lock external hex uses work-hardened commercially pure Grade 4 titanium with a Minimum Tensile Strength of 132 ksi. Grade 3 Ti (used by 3i and Lifecore) only offers 65 ksi and Grade 1 Ti (used by Nobel Biocare) has 35 ksi. The advantage of the smaller standard hex (0.7mm on a 4.1mmD platform) is that it works for smaller diameter implants. Paragon's Taper-Lock uses this standard platform for its 3.3mmD, 4.1mmD and 4.7mmD external hex implants. The patented friction-fit created by tapering the external hex provides stability without the need to use a wide platform.
Q: Is there any truth to the rumor that Friatec lost to Paragon and will leave the states? A: Friatec (now called Friadent) and Paragon are currently in litigation. The matter is in the final stages where Paragon has filed a motion that could lead to Friadent being enjoined from selling its products in the U.S. within the first few months of the year 2000. Friadent is claiming the patent is invalid, based on one patent that was disclosed to the patent office when the patent was first filed. Judges in the Calcitek case ruled this was not prior art. Nothing is a sure thing with the legal system. For a patent to be declared invalid, however, Friadent must meet the high standard of proving "by clear and convincing evidence" that every element of Niznick's patent was disclosed in prior art. Q: Wouldn't the new implant from Dr. Kirsch (IMZ) also infringe on Dr. Niznick's patent? A: Yes, the claims of the patent include any wrench-engaging surface that can be used to twist, turn or hold the implant, lying within an internal shaft that also has threads. Camlog, the German Company established to sell this implant, has been put on notice of infringement of sales in the U.S. We have no patents in Germany. Q: How about this new implant from Steri-Oss, the "Replace Select," with it's internal anti-rotation feature? I heard this patent covered both the anti-rotation properties of any internal geometry, as well as the use of this area to attach a driver when placing the implant. A: To quell customer concerns of possible infringement, some Steri-Oss employees are apparently claiming that Steri-Oss was given a license by Core-Vent that would cover the internal connection of the Replace Select implant. Core-Vent/Paragon denies that it ever agreed that Steri-Oss was free to infringe its patent. Paragon’s attorney has put Nobel Biocare on notice to withdraw this product from the market because it infringes the Niznick Patent. The parties have agreed to proceed with arbitration on the issue. Federal judges in two previous patent suits have interpreted the claims of the Niznick patent to encompass anything internal that can be used to twist, turn or hold the implant, if lying within the internally threaded shaft of the implant. The decision by Nobel Biocare/Steri-Oss to launch new products that clearly infringe the Niznick patent is an acknowledgment of the advantages of the internal connection implant products that Paragon has sold since 1986.
Nobel Biocare also recently introduced an internal "Stargrip" in their Mk III and Mk IV implants. This is nothing more than squaring off the points of the hex. In doing so, it violates the Niznick patent, as it is an internal wrench engaging design within the internal shaft of their external hex implant. Infringement by the Stargrip feature is also an issue that will be resolved by arbitration, shortening the time that it would take compared to litigation in Federal Court. This "innovation" by Nobel Biocare merely confirms the value of the internal wrench-engaging design, first introduced in 1986 by Core-Vent. With this internal wrench engaging design, Nobel Biocare can now carry the implant to the prepared osteotomy without having to attach a fixture mount. This is no different than what was done with Core-Vent's internal hex implants between 1986 and 1990, prior to developing the first fixture mount packaging. Nobel’s new advertisement states that the Replace Select implant provides what "every dentist wants...an internal connection." One can only then assume that Nobel/Steri-Oss have been selling what every dentist doesn’t want... an external hex connection. Furthermore, Nobe/Steri-Oss refers to the Replace Select implant in its recent advertisement as being a one-stage implant. To accomplish this, they must leave the neck of the implant 2 mm above the crest, which brings the HA and TPS coated threads almost to the crest of the ridge, increasing the risk of exposure to the oral cavity. Nobel Biocare/Steri-Oss must then sell its customers a healing collar to extend through the soft tissue. Paragon’s Advent is a true one-stage implant with a 3mm neck extension and an optional implant extender to accomodate for different tissue thickness. FRICTION FIT The internal implant connection is only half the story in terms of achieving stability and preventing screw loosening. Paragon has a patent on friction-fit abutments created by tapering the male hex 1-degree. It requires 30 Ncm to seat the abutment and in so doing, the parts are cold-welded together, as demonstrated in an article by Binon (Postgraduate Dent 1996;3[1]), available on Paragon's web site or in hard copy by contacting the company. Nobel Biocare's advertisements for the Replace Select state that now they are giving dentists what they want—an internal connection! Does this mean Nobel Biocare/Steri-Oss has been very successful in selling dentists what they don't want—external hex implants? I believe that dental professionals are waking up to the fact that they should not only want, but need an internal connection implant for increased stability, reduced height and better tactile sense when seating the abutments. It should be obvious that dental professionals and manufacturers are waking up to the advantages of using an internal connection implant. Straumann recently added an internal octagon to its conical connection, calling it synOCTA and referring to it as the "Next Generation Implant." Their tradeshow booths portray them as innovators in a world of imitators, but they have already lost one patent suit to Core-Vent (threaded basket implant in 1994), and are now being sued for infringing the Niznick internal connection patent. Although they added an internal octagon, their fixture mounts still do not engage it for insertion. This design was most likely made under the false assumption that it avoids infringement. They still use the solid abutment, and leave the shoulder exposed to complicate impression procedures. Paragon has introduced an implant called SwissPlus, which clones the infringing ITI platform. This implant can be put in with all of ITI's drills and will accept ITI abutments. Unlike, syn-Octa, SwissPlus is self-tapping and comes packaged with a preattached Fixture Mount/Transfer that engages the octagon and covers the implant’s shoulders. This allows it to also be used as a transfer and a final preparable abutment for cemented restorations. Astra added a 12-sided double hex and has been put on notice of infringement. Calcitek, Lifecore and 3i have all been stopped from selling internal connections by previous Core-Vent litigation. In an act of desperation, Nobel Biocare decided to finally give dentists what they want instead of continuing to manipulate them into using the external hex implants through paid opinion leaders and purchased university endorsements. Core-Vent has been the lone voice in the industry for over a decade, educating dentists to the advantages of a well designed internal connection. Just as Calcitek's attempt at marketing a short octagon didn't work, only time will tell if Nobel Biocare's Replace Select internal connection, which looks like a silhouette of Mickey Mouse with his big round ears, in fact proves to also be a "Mickey Mouse" connection.
When I was at the IPS meeting in Chicago in August there was a table clinic showing Kirsch's new implant design that does look similar to the new Steri-Oss internal connection. I asked Steri-Oss about the possible infringement on Niznick's internal connections and they informed me they have a patent already on this design so there is no worry about any patent infringement concerns. My personal objection on this design since it is essentially a triangular connector you are limited in the rotation possibilities when truing to align the abutment head. Kirsch, who for years promoted the intramobile element in his IMZ implant design, was asked several weeks ago at a meeting in Germany (sponsored by his new company) whether a hex, with its 6 flat sides, would have been a better design. He commented that it would, but Niznick's patent in the U.S. prevented him from doing so if he wanted to sell in this country. CamLog has now been put on notice that their 3-groove design also infringes. Paragon recently won summary judgment and obtained an injunction against a company called GIS that had three pointed grooves to insert the implant.
In conclusion, It should now be apparent that the industry is being forced to play catch up with Paragon Implant Company (formerly Core-Vent Corporation) in implant designs, but are finding a mine field of patents to contend with. The disputes may settle with the payment of royalties that allow these companies to sell designs that provide internal connections that fall short of achieving the stability of Paragon's internal hex and friction-fit abutments. They may get blown up in this mine field and have to withdraw their products after telling dental professions that internal connections are really needed for transfer capabilities (Straumann) or better in stability and ease of use (Nobel Biocare). Time will tell, but dental professionals should resist being manipulated once again by these manufacturers who are trying to rapidly evolve their product lines to give "what every dentist wants," according to Nobel Biocare's latest ads. Paragon has been providing discerning dentists with internal hex implants since 1986 and, along with friction-fit abutments, has stood the test of time in thousands of dental offices worldwide— and now with documented success in a multi-center study of 2800 Paragon implants conducted in dental clinics at 30 U.S. Veterans Administration hospitals and two universities.
Q: Some companies focus on price while others focus on providing marketing support in order to get new customers. What is Paragon's marketing strategy? A: Paragon's mission is to provide the best products at the lowest possible prices, and to add value by developing multi-use parts, such as fixture mounts that are transfers and/or abutments. Our goal is also to design systems that minimize the number of necessary ancillary parts. In contrast, other systems add complexity in order to sell more parts at higher prices. Paragon decided to compete on innovation and value, not on giveaways, practice promotion support and paid opinion leaders. Paragon has redefined customer support with our case registration program that bridges the communication gap between surgeons and restorative dentists by providing customer support on a case-by-case basis. Surgeons register their cases, then Paragon contacts their restorative dentists and provides them all the product and technical support that they need. Alternatively, Paragon has developed "click-to-chart" ordering that allows surgeons to easily identify and, if desired, order the prosthetic components for their restorative dentists, or for the surgeon's own use in attaching the abutments. Surgical specialists need to look at whether the same amount of new business could have been generated by using Paragon's CD-ROM program to promote their practices one-on-one or in small groups without a whole-day, hands-on lecture. Paragon's "Paradigm Shift" concepts demonstrated in the CD-ROM teach surgical specialists the "how" and "why" of attaching the abutments for their referring dentists, which can be an effective means of practice promotion. If the surgeon attaches the abutment, all the restorative dentist needs to do is make an impression using conventional procedures. That doesn't require a hands-on course! THE ECONOMIC ADVANTAGES OF USING PARAGON PRODUCTS If a surgeon contemplates switching $20,000 of his or her business from Paragon to 3i, for example, because 3i offers to support a training course, the surgeon will ultimately pay for the speaker in higher product costs. Here is the reality: 1. Introducing a new system to the office adds to inventory expenses and product confusion. 2. Surgical specialists need to identify the cost differences between the system they are currently using versus the new system they are considering. In addition, they must consider the costs of exposing their referring dentists to the new system. If surgical specialists pay the current price of $230 for 3i's Osseotite® or Steri-Oss' Replace® external hex implants, 100 implants would cost them $23,000 compared to $12,100 for Paragon's Taper-Lock external hex implants (current price is $125 per implant). The difference represents a savings of $11,100, which is enough for a surgical specialist to sponsor three courses at $3000 each, plus travel expenses. 3.Systems need to be evaluated by surgical specialists for the likelihood of clinical success. 3i's smooth Osseotite® surface is less likely to be clinically successful in soft bone than Paragon's SBM™-blasted (medium rough) or HA-coated (rough) surfaces. If surgical specialists use an implant that is more likely not to achieve osseointegration or to lose it after the referring dentist has cemented the bridge, that will hurt their implant referral business much more than the cost of paying for a lecturer. NOT ALL IMPLANTS WORK EQUALLY WELL! 4. Systems need to be evaluated by the surgeon from the standpoint of complexity. Paragon has simplified the abutment selection process by redefining the emergence profile question (i.e. 3i and Steri-Oss have produced many variations in emergence profile healing collars, abutments and transfers, which adds complexity and cost for the restorative dentist). Paragon recognized that, where one would use a narrow implant, a narrow abutment is most likely indicated, and vise versa. Therefore, Paragon has developed components with a "standard" emergence profile for every implant platform, which is 1.0 mm wider than the platform itself. In addition, Paragon also offers "narrow" emergence profile components that match the implant platform diameter, as well as "wide" emergence profile components that are 2.0 mm wider than the platform. This simplifies the selection process and reduces the complexity and confusion for the restorative dentist. 5. Paragon has preparable, full-contour abutments compared to 3i, Steri-Oss and Friadent, which feature premachined margins. This also translates into less confusion and inventory in selecting abutments. It also further promotes the Paradigm Shift concept by allowing the surgeon to attach an abutment at second-stage without worrying about what cuff height to select, since the final tissue height can not be determined until after recession.
6. Paragon offers significant cost savings on abutments in comparison to 3i and Nobel Biocare/Steri-Oss. If surgical specialists are paying for the abutment, then their savings in not having to pay for a speaker will rapidly disappear. If it is restorative dentists who are paying for the abutment, then the lost profits from the higher parts cost will discourage future referrals. Straight abutments for cemented restorations on Taper-Lock implants cost only $55, about half what other major companies cost. ONLY PARAGON'S TAPER-LOCK EXTERNAL HEX IMPLANT OFFERS: 1. TRIPLE LEAD THREADS for three-times faster insertion at 12% less torque. 2. A SINGLE PLATFORM for lower inventory costs of prosthetic components. 3. FIXTURE MOUNT PACKAGING that is multifunctional- it can also be used as a stage-one transfer and as a temporary abutment. 4. TAPER-LOCK EXTERNAL HEX IMPLANT INCLUDE A 5-YEAR GUARANTEE OF NO LOOSE SCREWS. 5. SELECTIVE SURFACE™ for increased bone attachment and efficient, self-tapping insertion. 6. STRONGEST GRADE OF COMMERCIALLY PURE TITANIUM reduces the risk of implant fracture or of stripping the implant's hex during insertion. Rounding of the hex during insertion can lead to a poor abutment fit...which can result in screw loosening...which can lead to the restorative dentist having to remake the case...which can lead to an unhappy referring dentist...WHICH WILL LEAD TO FEWER REFERRALS. — All of which defeats the whole point of having the paid lecturer in the first place! ONE-STAGE IMPLANT ADVANTAGES FROM PARAGON SAVE THE SURGEON CONSIDERABLE TIME AND MONEY: 1.If one wants to use 3i's external hex implant for a one-stage procedure, the surgical specialist must buy a 2-piece Healing Collar, which adds to the cost. If the surgical specialist wants to use 3i's TG® one-stage clone of the old ITI implant, it lacks an internal hex for transfers. That is the reason Straumann changed the ITI implant to the new synOcta® implant, which is licensed under Paragon's patent. 2.If surgical specialists want to use Steri-Oss' Replace Select® implant in a one-stage procedure, they need to leave the collar of the implant extended above the crest of the ridge, which brings the threads and coated surfaces too close to this region. Surgical specialists still need to buy a healing collar to extend through the soft tissue for one-stage healing. 3. All this is eliminated with the AdVent, because it has a 3.0 mmL neck extension and a 2.0 mmL implant extender. Furthermore, the dentist can attach a $35 screw that converts the top of the AdVent into a tapered abutment platform for screw-retained cases. For the $35 price, a ball screw converts the implant top into a ball abutment, which saves up to $100 per abutment over the other systems. SIGNIFICANT ADVANTAGES OF USING OUR INTERNAL HEX IMPLANTS OVER EXTERNAL HEX IMPLANTS TRANSLATES TIME AND COST SAVINGS: 1. The increased stability of our internal hex connections and friction-fit abutments reduces costly remakes. That is why we are the only company with a guarantee against screw loosening! 2. The increased risk of referring dentists not getting the transfers or abutments fully seated with external hex implants can result in prosthetic remakes that reduce profitability and increase the stress, thereby reducing referrals. 3. A recent article comparing the uncovering of an internal connection (Astra) vs. external hex (Branemark) implant showed a 20-minute savings in chair time per implant with the internal connection (Clin Implant Dent and Rel Res 1999;1[1]:17-26). Consider that, for every 100 external hex two-stage implants surgical specialists place, they could be spending over 30 hours more during the uncovering procedures alone than would be spent with internal hex implants! IF SURGICAL SPECIALISTS PLACED ONE-STAGE IMPLANTS, THEY COULD BE SAVING ABOUT 50 MINUTES PER IMPLANT OR APPROXIMATELY 80 HOURS OF ADDITIONAL TIME, ACCORDING TO THE STUDY. If this is used as a basis for calculating the cost of chair time, savings with Paragon's internal hex Screw-Vent, at $400 per hour, translates into $12,000 in savings by using an internal hex instead of an external hex two-stage implant. Using Paragon's one-stage AdVent implant amounts to over $30,000 in savings compared to using a two-stage external hex implant. CONTRAST THAT WITH GETTING A FREE SPEAKER AND SAVING $3000! THESE SIGNIFICANT COST SAVINGS NEED TO BE UNDERSTOOD BY SURGICAL SPECIALISTS SO THEY CAN SEE THAT GETTING A FREE SPEAKER AND LOCKING THEMSELVES INTO A SYSTEM OTHER THAN PARAGON WILL ULTIMATELY COST THEM MUCH MORE THAN JUST PAYING FOR THE SPEAKER THEMSELVES. IF SURGICAL SPECIALISTS JUST USE PARAGON'S FREE CD-ROM WITH A RENTED VIDEO PROJECTOR, THEY CAN DO THEIR OWN LECTURING AND PROMOTION. BECAUSE OUR SYSTEM IS SO SIMPLE, NO HANDS-ON IS NEEDED, IF SURGICAL SPECIALISTS ATTACH THE ABUTMENTS, AS DESCRIBED IN OUR CD-ROM. Q: I feel we should start a movement to hold the implant companies to higher standards. Any well documented claims of defective product from any company should be reported to the FDA. What is Paragon's position on this issue? A: Since 1989, implant companies have been required by federal law to report all implant fractures to the FDA in what is known as a Medical Device Report (MDR). Based on what has been reported to Core-Vent/Paragon, there have been approximately 400 fractures for every 1,000,000+ implants that we have sold. Most of these fractures relate to our former small-diameter Screw-Vent® implants that were made of commercially pure titanium and featured a 3.5mmD neck. In 1994, we changed from Grade 3 to Grade 4 commercially pure titanium to substantially increase the strength of the implants. In contrast, Nobel Biocare reports a much higher number of fractures, which may be due to the use of soft, Grade 1 commercially pure titanium. In 1990, we began offering the Screw-Vent implant in both commercially pure titanium and titanium alloy. Six years later, we widened the neck of the small-diameter Screw-Vent from 3.5mmD to 3.7mmD, which required the incorporation of a countersink section at the top of each length-specific drill. Core-Vent/Paragon has also have offered wide-diameter, internally threaded implants with 4.5mmD necks since 1986. To date, we have not received a single fracture report with these wide-diameter implants. To maximize strength, Paragon has offered all diameters of the Screw-Vent implant only in titanium alloy since 1997. The technical specifications for all of Paragon's internal and external hex implants are posted on our website for public access at ../index.html. They are excerpted here for your convenience: TAPER-LOCK™ ; EXTERNAL HEX IMPLANTS FROM PARAGON ../online-store/extSubCont/extTaptoc.html Taper-Lock implants are made from Grade 4 CP Ti with a tensile strength of 112 ksi. The external hex can withstand 19 in/lbs of torque for self-tapping insertion into dense bone (vs. 9 to 11 in/lbs for Grade 1 and Grade 3 CP Ti implants, respectively). Under 30-degree compressive force, the 4.0mmD implant body and titanium alloy fixation screw can withstand 408 lb. (vs. 158 to 284 lb. for Grade 1 and Grade 3 CP. Ti implants, respectively). Taper-Lock's superior strength thus minimizes implant and screw fractures and allows the addition of an apical vent to harvest bone chips during self-tapping insertion. This apical vent design also preserves thread surface in contrast to the multiple deep apical grooves used by some competitors. TAPERED SCREW-VENT® AND ADVENT™ ; DESIGN AND MATERIAL FOR OPTIMUM STRENGTH ../TechnologyPages/Tech_ScrewVent/Page2.htm AdVent and Tapered Screw-Vent implants are made from surgical grade titanium alloy that provides a minimum tensile strength of 152 ksi, over four times that of Grade 1 CP titanium. Under 30-degree compressive force, the smallest diameter AdVent (3.7mmD) can withstand 415 lbs. of pressure and its internal hex can withstand 32.2 in-lbs of torque. The 3.7mmD Tapered Screw-Vent can withstand 378 lbs. at 30 degrees and 18.7 in-lbs of torque. Q: If there is an inherent defect in an implant design that manufacturers are aware of, it is their ethical responsibility to inform us and recall the defective product. How would you address this issue, Dr. Niznick? A: The minute number of fractures among small-diameter Paragon implants after years of function is more indicative of occlusal overloading than an "inherent design defect." Every shipment of Paragon implants includes a warning against possible causes of occlusal overloading, such as adverse crown-to-implant ratio, excessive cantilevers, an insufficient number of implants to support the restoration, bruxism, improper occlusal interferences, use of non-Paragon abutments (e.g. custom cast from plastic patterns), splinting implants to mobile natural teeth, non-passive frameworks, etc. It is impossible for any implant manufacturer to be assured that one or more of these factors have not contributed to or directly caused the fracture. All a responsible manufacturer can do is try to minimize the potential for fracture by selecting the strongest available materials and by incorporating all possible safeguards within the design of the implant (e.g. widening the neck of the 3.3mmD Screw-Vent). In cases where there is limited available bone and the dentist chooses not to graft the site to allow placement of a wider diameter implant, a small-diameter implant with an increased risk of fracture may be the only alternative. To this end, by Paragon uses only titanium alloy with a minimum tensile strength that exceeds 150 ksi. In contrast, many other implant manufacturers (e.g. Lifecore, 3i, Nobel Biocare) use Grade 3 CP Ti, which has a minimum tensile strength of 65 ksi.
The design of the one-stage Complete™ Implant introduced by Paragon in 1997 allowed placement of the internal hex within the wider supracrestal portion of the implant. This added considerable strength to the small diameter, 3.3mmD implant at the crest of the ridge. In 1999, Paragon replaced this design with the AdVent™ Implant, which features a tapered body that is inserted into a socket prepared with a straight drill. In the narrow ridge, the implant receptor site for a 3.7mmD implant can be prepared with what would normally be the final-sizing drill for a 3.25 implant. The ridge is then slowly expanded by screwing in the tapered 3.7mmD implant. This patented method of insertion, now also available with the Tapered Screw-Vent, enhances initial stability through increased surface contact. The use of a wider diameter implant also provides greater strength for the restoration. Q: I am not a regular user of Paragon. However, through the years I inherited four cases where the implants were "flowering." I have attributed this to the weaker metal, pure titanium, and the friction of the tapered internal hex. Also the thickness of the metal at the base of the hex is extremely thin. What can I do about these cases, other than core the implant out, and will the company stand behind their product by reimbursing us for the poor design? A: The dilemma facing both clinicians and implant manufacturers is how to make an implant small enough in diameter to be useful in narrow ridges, yet strong enough to withstand not only normal occlusal loads, but also the type of overloading that inevitably occurs in clinical use. Paragon does stand behind fractured implants by replacing them with new implants. We cannot stand behind the treatment plans or restorations of our customers, however, since there are so many variables that can cause fractures. Considering the small number of fractures among the huge number of our internal hex implants placed since we first introduced them in 1986, as well as the strength of our products on static and cyclic load tests, an implant fracture after 5-7 years of function does not mean that the implant was defective. Q: The question as to whether an implant company will "reimburse us and stand behind their product" is a good one. So far, all I get is the standard replacement policy where they will give us a new implant for each one that fails within 10 years. I find this to be a bit short, because I also believe there is a design problem. The new implant is only a fraction of the cost of dealing with these cases. I have been told by the company that this is a minor problem. Have any of you also encountered this difficult situation? If so, how did you handle it? A: I have developed a better solution to remove a fractured implant than to bore it out or to bury it. We now have a reverse thread tool that will allow you to unscrew the implant. This will leave a threaded bone crypt that can then receive another implant in the exact same position. If the site is expanded during removal, reinsert the next wider implant diameter. Paragon will provide one of these tools and a replacement implant at no charge (one tool per dentist). Q: I have inherited two cases with a total of 3 fractured Screw-Vents in the last 6 months. The case with two fractured implant odies (6 years old) was an overdenture with a very tall Hader bar. The second case was a 3-unit bridge with the implant in the second molar area (7-8 years in function) splinted to the second bicuspid in a heavy bruxer. Wouldn't your agree that both cases had moderate to severe overload? A: This type of report is typical of the history of fractured implants: 6-to-8 years in function with "a very tall Hader bar" or crown length, and "splinted to a second bicuspid in a heavy bruxer." Perhaps the tooth has become more mobile over the years, which would shift more of the load to the implant. Perhaps the overdenture settled and was not relined, which put torque on the anterior implants. Perhaps the bar was not a passive fit to begin with, or possibly a solder joint or fixation screw fractured, transferring load to the implant. I HAVE ALWAYS TRIED TO OVERENGINEER THE IMPLANTS, BUT THERE IS NO WAY TO ANTICIPATE EVERY OVERLOAD SCENARIO. Implant innovation as stronger materials and better designs are developed to meet expanding clinical demands. Implant fractures are well documented with many implant systems. A prominent NY periodontist/prosthodontist is currently being sued for failure to provide the patient with proper informed consent after six Branemark® implants fractured in one lady. He is accused of failing to advise the patient that other systems offer stronger materials. Nobel Biocare is included in the suit for misinforming dental professionals about the advantages of using Grade 1 commercially pure titanium. External hex implants have a well documented history of screw loosening and implant fractures from overloading. Wider implants, gold fixation screws and use of torque wrenches have reduced these problems. Straumann had to recall a number of abutments and pay for retreatment of patients after a series of abutments broke in a way that was not retrievable. Technological advancements and demands of the marketplace are making products more reliable. The continuing challenge is to create a connection so stable that all occlusal forces are transmitted to the implant, rather than to the screw. This must be achieved without overloading the implant itself, especially if small-diameter implants are used. I am convinced Paragon has come closer to this ideal than any other system today. However, there is no substitute for good treatment planning and properly designed restorations.
Q:If an implant design includes an external bevel and an abutment that fits over it, doesn't the fully seated abutment help to hold the hex walls together?
A: In essence, that is what Paragon's new SwissPlus™ ; and Advent™ ; implants feature. The beveled shoulders of the ITI® and SwissPlus implants work the same way as the internal bevel of the Screw-Vent to provide stability against lateral forces. ITI, SwissPlus and Advent platforms are 4.8mm in diameter. At this dimension, the width of the implant platform provides superior strength. The beauty of the Tapered Screw-Vent®'s internal bevel is that so much strength can be achieved in such a small platform (3.7mmD). Where this small platform is needed, such as between natural teeth and in narrow ridges, the strength is more than adequate, if the prosthetic design is reasonable. Under compressive load-to-failure at 30 degrees, the new 3.7mmD Tapered Screw-Vent® will fracture at 378 lbs, and fracture will occur in the internal hex. The 3.7mmD Advent, with the same body but with a 4.8mmD platform, will fracture at approximately 10% greater force, with fracture occurring through the body of the implant. External hex implants made of grade 3 CP Ti fracture below 300 lbs, which occurs through the body of the implant. If a smaller diameter implant is needed for support of a lower, freestanding molar in this high-risk area, consideration should be given to splitting the ridge and widening it so that a wider implant body, such as the 4.7mmD Screw-Vent or Advent, can be used. Where a 3.7mmD body is absolutely required for a molar area, the Advent is the ideal design, because it provides the narrow diameter implant (without the walls having to be thin near the crest to accommodate the internal hex), but with a 4.8mm platform in the tissue where there is no restriction on the diameter. But remember, all that you are getting is 10% more strength before fracture.
The Advent has both an internal and external bevel. If a narrow abutment is needed, it will follow the line of the external bevel so that the margin of the restoration can actually end on the implant, covering the junction. If a wide abutment is needed, it overlaps the outside bevel to allow for a wider emergence profile, and then encompasses the top of the implant. Yes, this would provide greater strength to the implant's hex. With smaller diameter Advent implants, the fracture occurs in the body, not the hex. The 4.7mmD Advent is ideal for lower single molar replacement, especially when used with the wider abutment that overlaps the outer bevel of the platform.
Paragon can now provide you with instant technical support through our website at www.paragon-implant.com. Every Paragon representative is intimately familiar with the wealth of information available on our website, and can direct you via e-mail to the appropriate information pages in response to your clinical questions. Following is a typical e-mail response that you can obtain simply by directing your question to a Paragon Territory Account Manager.
SAMPLE RESPONSE: Dear Doctor: This letter is in response to your phone call regarding which abutments to utilize for a Bar Overdenture restoration on Paragon internal hex implants. For this case, the Tapered Abutments are recommended, which have a product code of "ACT." Tapered Abutments are selected according to tissue height and the specific implant platform (i.e. diameter of internal hex platform, in this case). However, all of the components provide a common abutment top, regardless of the underlying implant type, and utilize the same series of transfers and laboratory components.
Tapered Abutments feature a collar that is available in various heights for differences in tissue thickness, and a tapered screw that anchors the collar to the implant. The tapered screw also receives the fixation screw that holds the bar in place. As an alternative, this abutment configuration is also available in a one-piece design for simplicity. However, the two-piece design provides Paragon’s patented friction-fit connection for maximum stability and is covered by a 5-Year Guarantee of No Loose Screws! Inside the head of the tapered screw and below its internal threads is a 1.25mmD hex used for carrying and inserting the abutment. 30 Ncm of torque is required to fully seat the two-piece abutments. The gold, titanium or plastic copings for these one- and two-piece abutments become incorporated into the framework of the bar and sit on the abutment collar's periphery without contacting the top of the tapered screw. The tapered top design allows for a larger diameter fixation screw than with the BranemarkÒ Standard Abutment. This enables splinting between the abutment platforms without concern for parallelism. The catalog for the internal hex Tapered Screw-Vent implant contains all the prosthetic components for the other internal hex implants, including the Micro-Vent2ä and Bio-VentÒ Implants. It can be viewed and downloaded from our website at: ../download/AdvTsv/AdventScrewVent.htm Paragon offers another type of screw-receiving abutment with a tapered top, called Spectra-Cone, which is designed for an esthetic, screw-retained or fixed prosthesis. However, this abutment is not what you need for a bar that will be covered by an overdenture. The Spectra-Cone Abutment System offers a 20-degree angled abutment to redirect the fixation screw. If an angle correction is needed for the bar construction to provide more labial space for esthetic setting of the teeth of the overdenture, you might consider the Spectra-Cone Abutment as a solution. More information on this abutment can be found in the Tapered Screw-Vent Catalog at: http://www.parawebdesign.com/download/AdvTsv/page22.pdf A recent mailing provided all of our customers with a new catalog. If you do not receive a copy soon, or if you wish to have Paragon’s sales representative visit your office to provide an overview of the components, you can locate the name of your Paragon representative under the "Contact" section of our website, or contact a Paragon Territory Account Manager at 800.877.9991 to set up an appointment. Our phone system is now capable of identifying your area code and directing your call to your inside sales representative. The particular page of the catalog that has the Tapered Abutments can be viewed or downloaded at: http://www.parawebdesign.com/download/AdvTsv/page23.pdf Paragon's abutment selection guide provides a flowchart of components for every clinical application. The flowchart page for the Tapered Abutments can be viewed or downloaded at: http://www.parawebdesign.com/download/prostheticpdf/prthcpage6.pdf The flowchart page for the Spectra-Cone Abutments can be viewed or downloaded at: http://www.parawebdesign.com/download/prostheticpdf/prthcpage4.pdf Paragon’s restorative manuals are also available on our website and are divided into different clinical applications. The sequence for bar overdenture restorations can be viewed or downloaded at: ../cgi-local/SoftCart.exe/store/downloadlists/baro verdenture.html?L+scstore+dvyc2534+958539055 Paragon offers a "click-to-chart" ordering program on CD-ROM along with an inventory control program that will guide you through the selection of the restorative components for the particular implant platform you are restoring. You can then print the order and fax it to Paragon or e-mail your order directly. Paragon is the only U.S. implant company to offer Shopping Cart Ordering online. It is located on our website by selecting "Products" on our homepage at www.paragon-implant.com. Just select the implant system you are using. In this case, it is the internal hex implant. Scroll down the page past the implant options until you find a graphic Table of Contents for the Bar Overdenture clinical application. Both the one-piece and two-piece Tapered Abutments are available. If you click on the two-piece Tapered Abutment in the row of components beside the graphic of the Bar Overdenture, you will be taken immediately to the ordering page of the Shopping Cart System. This is, in effect, an electronic catalog. Once you select the item you want, the order program will ask you how many you want. To order related prosthetic and laboratory components for the Tapered Abutment, return to the catalog page by using the "Back Arrow" at the top of your computer screen, then scroll down from the abutments until the items you want are located. From the page listing your selected items, if you click on "Return to Shopping" instead of the "Back Arrow," you will return to the Quick Order Page that directs you to the start of ordering for any particular implant system Paragon offers. Upon completion of filling your shopping cart with Paragon parts, select whether you would like to e-mail the order in and have them charged to your account or if you want to charge them to a credit card. ITS THAT SIMPLE! To connect to the exact page for ordering the Tapered Abutments, copy and paste this address on the top bar of your computer screen while online: ../cgi-local/SoftCart.exe/online-store/InternalHex /TaperCollarAbut.html?L+scstore+lhfl2170+958536494#abcolltap Paragon is not only the leader in implant technology, but also sets the industry standard for customer service through web communications, as evidenced by the technical and ordering support we can offer online. Regards, Gerald Niznick, DMD, MSD
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