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Inside Dentistry
June 2024
Volume 20, Issue 6

Versatile Implant System Enables Highly Esthetic Results

Dentsply Sirona’s MIS® Implant system, MIS® CONNECT™ abutments, and OSSIX® membranes improve tissue quality around implants

Adam Foleck, DMD, a well-respected lecturer and implant specialist, has built a multidisciplinary dental practice where patients can receive all of their treatments in-house, all while allowing himself to focus on implant cases and soft-tissue grafting. Although he started small as a general practitioner, he has since expanded his practice to encompass four offices located in the Hampton Roads area of Virginia, which employ about 10 clinicians who specialize in nearly every area of dentistry. "We now have clinicians who focus on orthodontics, cosmetics, endodontics, sleep medicine, and more," Foleck says. "My primary goal in building a multidisciplinary practice was to create an internal referral system to generate more implant cases for myself, but it has really benefited our patients to be able to receive all of their treatment in one practice. We do a lot of full-mouth rehabilitations now because I can create a treatment plan that includes placing two or three implants as well as performing a couple of root canal treatments, placing crowns on other teeth, and performing any other needed restorations, and patients are able to get everything done in just a couple of appointments, all in the same office without having to worry about travelling back and forth between different locations."

Even with such a large practice, Foleck strives to maintain a small office mentality that emphasizes treating each patient as an individual. "We take a lot of time with our health histories," he says, "and we recommend that patients see their physicians whenever we notice conditions that are concerning." Furthermore, all of the clinicians in the practice have their own individual teams, and the patients are always appointed to see their own dentist unless they need specialized treatment. "Making patients feel special is the most important thing," Foleck says. "One of the reasons that I got into dentistry was because I wanted to be able to create life-long relationships with the people I served, and creating beautiful smiles-and more importantly, functional, healthy mouths-really allows us to do that."

According to Foleck, he was lucky to be able to hone his skills in implant dentistry early in his career, and this can largely be attributed to the way that the dental school was set up where he did his residency. "Implants were still fairly new to that geographical area, and the dental school did not have a specialty program," he says. "So, essentially all of the procedures that the dental students couldn't do were referred out to those of us in the residency program. This meant that I had a lot of opportunities to place implants and perform bone grafting procedures."

After Foleck completed his residency, his mentor further encouraged his interest in implants. Then, when Foleck took over the practice, he was able to explore many options and got to know the implant systems of multiple manufacturers before finally settling on the MIS® implant system, which he still uses today. "I first tried the MIS implants back around 2008, but at that time, I was still really just trying different things out," he says. "However, at some point around 2017, I was talking to the company's president, and he wanted to show me some of the new design features that they had been working on since they were acquired by Dentsply Sirona in 2016. So, I went up to New Jersey to see what they had to offer, and I was very intrigued by the conical connection, platform switching capability, and collar design as well as by the thread design." Foleck soon switched over to the MIS system as his primary implant system, and most often, he uses the MIS C1 and MIS V3 implants.

Although the MIS implant system has more recently become a part of Dentsply Sirona's implant solutions portfolio, it has more than 25 years of research behind it, which has resulted in the development of a comprehensive range of innovative dental implants, superstructures, tools, and kits with exceptional quality. The MIS C1 is a conical connection implant that provides a versatile solution for all indications and offers optimized biologic benefits and esthetic results. The MIS V3 is a conical connection implant with a triangular neck that was engineered to improve bone integration and a concave abutment emergence profile that was designed to optimize soft-tissue preservation and ingrowth for enhanced esthetic results.

"I use the C1 implant as my workhorse implant," Foleck says. "I find the conical connection to be the strongest connection, as evidenced by the literature, and the platform switching helps to reduce crestal bone loss. In addition, the collar design does not put a lot of pressure against the crest during placement, and the thread design has condensing threads toward the coronal aspect and more aggressive threads toward the apex, which I really like." Foleck adds that the V3 implant is a great option for immediate implant placement because it is more aggressively threaded at its apex. "The collar design on the V3 is also interesting because it looks like a tri-load, which only contacts the osteotomy at three points, but it is actually a conical connection with microthreads, and the space between the edge of the collar and the osteotomy is designed to fill with blood, which then turns over into bone."

Beyond the implants themselves, the MIS® CONNECT abutments also impressed Foleck with their tight fit and the fact that they come in different heights, which allows him more flexibility when he needs a transmucosal abutment. "That is what I use now in almost every situation in the anterior esthetic zone," he says. "It improves bone volume with the conical connection while allowing me to control the height of the transmucosal abutment, which provides wonderful esthetic results."

To support his use of the MIS implant system, Foleck also utilizes Dentsply Sirona's OSSIX® membranes for grafting procedures. "It took me a little while to understand how the OSSIX membranes actually worked because the GLYMATRIX® sugar molecule is such a unique feature," he says. "But once I started to see the results, these became my primary membranes unless I needed a non-resorbable one," he says. Foleck notes that the OSSIX Volumax matrix is great for transitioning soft tissue from a thinner biotype into a thicker biotype. "I use OSSIX Volumax in several situations," he says, "including placing it over my graft materials for ridge augmentations and in tunneling procedures at the apex of where I've placed my implant. I can just make an incision into the mucogingival tissue, lift the periosteum off the bone, and place the OSSIX Volumax to see great results with the soft tissue around an implant, and over a period of time, there's also ossification into bone." Foleck also mentions that he uses the OSSIX Plus, but it requires more technique-sensitive suturing, and that the new OSSIX Agile is quickly becoming one of his favorites. Because OSSIX Agile is a pericardium membrane, it can be tacked down into place over a larger area to stabilize it. "OSSIX membranes have become such an important part of my practice," he says. "They are what I use in situations that could otherwise result in complications so that the tissue heals healthily and with good volume."

With his own office focused on treating patients' whole mouths, Foleck understands how challenging it can be to bring together many different systems and specialties, but he believes that Dentsply Sirona has done a great job of finding well-respected, high-quality products to add to its portfolio that really stand out from the other options and offer different opportunities. "The MIS implant system is designed to keep things simple, and it really delivers everything that you need in the box, including fresh drills," he says. "It is what I consider to be an esthetic implant system, and it allows me to provide anything that my patients need. Whether it is in the esthetic zone, in the posterior region, or a full arch restoration, the MIS system can do it well."

Key Points

The MIS C1 is a conical connection implant that provides a versatile solution for all indications and offers optimized biologic benefits and esthetic results.

The MIS V3 is a conical connection implant with a triangular neck that was engineered to improve bone integration and a concave abutment emergence profile that was designed to optimize soft-tissue preservation and ingrowth for enhanced esthetic results.

MIS CONNECT abutments are designed to maximize the tissue-level restoration concept and reduce micromovements and microleakage of bacteria at the bone level.

OSSIX membranes, which feature the proprietary collagen cross-linking GLYMATRIX technology, are designed for clinical flexibility, ease of use, and solving common regenerative challenges.

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