Thoughts about TRI Matrix. First abutmentless implant system

[zero_zero]

One other problem I see with this system other than what is mentioned above, that it requires for you to have a very accurate scan and milling process. If something goes wrong, you wont have a passive fit, specially for longer span restorations, whereas gluing in a Ti base allows for quite a bit of error. Also the interface doesn't seem to have a long enough taper to provide stability, it looks like the screw would bear the lateral stresses. To have a good seal, it needs very precise machining and finish, plus you need a flat end tool to cut the screw seat... it needs a CAM software which allows that, many watered down dental versions can't touch that.

 

[leonlazic]

you have to pay, and you have to be prepared to prove that you can do it with samples and data showing your consistency of milling. the process can take several audits and well over 6 figures of money to complete.

Wohoa! That is absolutely crazy. Talk about high cost of entry.

Our lab isn't big enough to justify the cost and time of going through the 501k clearance process. That is the only way you can mill an interface that goes into an implant in the USA(pretty sure this is correct). Our mill(Ivoclar PM7) can mill Ti abutments, but we don't use it for that purpose because of that reason.

From what @CoolHandLuke said I completely understand. I have a small lab with a single mill as well.

 

[leonlazic]

One other problem I see with this system other than what is mentioned above, that it requires for you to have a very accurate scan and milling process. If something goes wrong, you wont have a passive fit, specially for longer span restorations, whereas gluing in a Ti base allows for quite a bit of error. Also the interface doesn't seem to have a long enough taper to provide stability, it looks like the screw would bear the lateral stresses. To have a good seal, it needs very precise machining and finish, plus you need a flat end tool to cut the screw seat... it needs a CAM software which allows that, many watered down dental versions can't touch that.

For measuring just the interface precision they do provide you with a special tool. As for the passive fit it, yeah it can be bad but it can be totally fine or even easier achievable than with Ti-bases. With Ti-bases you rely on the precision of your model while gluing them in the framework. That is why many labs don't mill zirconia prettau bridges and glue Ti-bases in them but rather, a titanium bar on which they glue a zirconia prettau bridge. To avoid the imprecision of gluing the Ti bases on the digital models, and work directly form the intraoral scan.
The connection does look scarry small you should look at the non engaging it's even smaller. But from the tests they showed it's not inferior and when the failiure occured it was never the broken screw but broken zirconia resotration. And that was at 1000 + Newtons of force as well at 30 ° angle.
You are right, screw seats may be a little problematic with labs with very simple equipment and strategies. And the angled ones make the situation even more complicated.

 

[zero_zero]

Another thing, how can you ensure milling the interface in-house will give you a tight seal ? Specially for their bone level version...you want to avoid having a microgap at all costs.

 

[npdynamite]

For measuring just the interface precision they do provide you with a special tool. As for the passive fit it, yeah it can be bad but it can be totally fine or even easier achievable than with Ti-bases. With Ti-bases you rely on the precision of your model while gluing them in the framework. That is why many labs don't mill zirconia prettau bridges and glue Ti-bases in them but rather, a titanium bar on which they glue a zirconia prettau bridge. To avoid the imprecision of gluing the Ti bases on the digital models, and work directly form the intraoral scan.
The connection does look scarry small you should look at the non engaging it's even smaller. But from the tests they showed it's not inferior and when the failiure occured it was never the broken screw but broken zirconia resotration. And that was at 1000 + Newtons of force as well at 30 ° angle.
You are right, screw seats may be a little problematic with labs with very simple equipment and strategies. And the angled ones make the situation even more complicated.

If you can't cement a Ti base accurately you should switch jobs. Working from an intra-oral scanner is not more accurate. If you are making a bar from an intraoral scan you damn better be sure your test fitting it on a verified cast. There are ways to ensure higher precision from an intra oral scan, but in 11 years I have only encountered one doctor who invested the time and money to be able to do this.

The tests don't matter, they aren't real world. Yes, testing is necessary, but again, every company trying to make this product have done test, and they all still fail. This system is taking the same bad idea and then making it worse by allowing the labs to do their own milling, which truly makes their testing bogus because it isn't being done with results from the mills these would actually be milled on. Also yes, of course the zirconia failed, it always fails when you use it for the connection.

 

[leonlazic]

If you can't cement a Ti base accurately you should switch jobs. Working from an intra-oral scanner is not more accurate. If you are making a bar from an intraoral scan you damn better be sure your test fitting it on a verified cast. There are ways to ensure higher precision from an intra oral scan, but in 11 years I have only encountered one doctor who invested the time and money to be able to do this.

The tests don't matter, they aren't real world. Yes, testing is necessary, but again, every company trying to make this product have done test, and they all still fail. This system is taking the same bad idea and then making it worse by allowing the labs to do their own milling, which truly makes their testing bogus because it isn't being done with results from the mills these would actually be milled on. Also yes, of course the zirconia failed, it always fails when you use it for the connection.

Well I tell you right now that the only way I can really accurately cement a Ti base on a long span or full arch bridge, is on a stone cast model that was poured and the impression taken with all of the protocols of precision. Custom tray, connected impression transfers, model system, ... Gluing Ti-bases in hand is not and cannot be accurate. The space needed for cement simply won't allow you to do that and every high quality technician in Europe agrees.
The 3d printed models have their distortions and inaccuracies. So whenever I get a intraoral scan the only reference of implants I ever use is the intraoral scan and never a printed model with scanbodies. So now you have a patient with full arch implant restoration, that was scanned. You can't glue Ti bases on the 3d model, you can't glue Ti bases in hand without the model. The only thing you can do is mill a metal bar with the multi-unit seats in one piece and then do a suprastructure.
As for the precision of the intraoral scans that is a whole topic for itself. I am aware of the systems like ICam4D. Those are expensive for the narrow application they have. There are also simpler methods like connecting the scanbodies with some resin so the scanner has a hard tissue to follow along with the gingiva and that also prevents the warping of the scan.
I think the test do matter to some extent but they for sure don't tell the whole story. Just for the info there is a small print I just found stating that under equivalent testing conditions and Astra Tech zirconia abutment reached 216 N so about a 1/4.

 

[leonlazic]

Another thing, how can you ensure milling the interface in-house will give you have tight seal ? Specially for their bone level version...you want to avoid having a microgap at all costs.

That part I am really skeptical and would have to try and see it for my own, to believe ti.

 

[Affinity]

So tell us Leon, after all this discussion, what is the advantage of this system, if any? I fail to see anything new or innovative about this product. Not saying that you think there are any, I know you are just asking everyone what they think.. but sounds like the consensus so far is

 

[leonlazic]

So tell us Leon, after all this discussion, what is the advantage of this system, if any? I fail to see anything new or innovative about this product. Not saying that you think there are any, I know you are just asking everyone what they think.. but sounds like the consensus so far is

Yeah I see much valid skepticism in the zirconia-titanium interface. I understand why. Also I had no idea you need a certification from FDA (510k) to mill an implant interface. So for small labs in USA this concept with the current legislation just doesn't make sense. To me the thing still looks interesting and I would still like to try it but at the end of the day it's not the technician, but the implantologist who decides what implant system thery're going to place and our job is to do it best we can on the system we get.
It would be really ironical, if technicians would start milling titanium abutments for TRI matrix and then cement a zirconia crown on it. Adding back the abutment functionality.

 

[npdynamite]

Well I tell you right now that the only way I can really accurately cement a Ti base on a long span or full arch bridge, is on a stone cast model that was poured and the impression taken with all of the protocols of precision. Custom tray, connected impression transfers, model system, ... Gluing Ti-bases in hand is not and cannot be accurate. The space needed for cement simply won't allow you to do that and every high quality technician in Europe agrees.
The 3d printed models have their distortions and inaccuracies. So whenever I get a intraoral scan the only reference of implants I ever use is the intraoral scan and never a printed model with scanbodies. So now you have a patient with full arch implant restoration, that was scanned. You can't glue Ti bases on the 3d model, you can't glue Ti bases in hand without the model. The only thing you can do is mill a metal bar with the multi-unit seats in one piece and then do a suprastructure.
As for the precision of the intraoral scans that is a whole topic for itself. I am aware of the systems like ICam4D. Those are expensive for the narrow application they have. There are also simpler methods like connecting the scanbodies with some resin so the scanner has a hard tissue to follow along with the gingiva and that also prevents the warping of the scan.
I think the test do matter to some extent but they for sure don't tell the whole story. Just for the info there is a small print I just found stating that under equivalent testing conditions and Astra Tech zirconia abutment reached 216 N so about a 1/4.

The point I was getting at is, if you want to get an accurate fit, you have to do the additional work to ensure the accuracy and if you don't know how to do that, you don't have business messing with these products. Now clearly you do understand that, though I will have to disagree with using resin to connect scan bodies. You either have to use something like the ICAM or something similar, or create a verified cast, which can be done from either a traditional or a printed model.

Now to return to the initial point, this product does not make any of this easier or require less work. All of these solutions; Ti bases, Ti bars, or this silly implant system are all going to be equally accurate in the hands of a skilled technician. Wait I'm sorry, this implant system won't be, but a Ti bar or Ti bases will be.

 

[Affinity]

At the end of the day, If I dont want to work on a 5hitty implant or case, then the Dr can send it elsewhere. I dont accept every gimmick the Dr falls for, and they fall for many.