External versus internal implants: Survey of opinions and decision making

Objectives: Internal connection implants have been attracting attention in recent years leading to their being adopted for many implant systems and an increase in market share over other connections. However, internal connection implants have only been used clinically for a short period of time resulting in few clinical studies investigating outcomes and a lack of comparative clinical evidence to support their use over external hex systems at this time. Given the fact that clinical evidence is lacking regarding implant connection performance comparisons it's important to understand what information clinicians use to choose between systems. Therefore, the purpose of this study regarding implant decision-making was to ask clinicians to provide subjective evaluations of internal connection implants, in comparison with external connection implants.

Methods: The survey was constructed to cover four aspects (total of 31 questions) of interest; general responder information, surgical procedures and experience, prosthodontic treatments and outcomes, and implant complications.

Results: The dentists' responses indicated that internal connection implants are as user-friendly as external hex implants with respect to implant surgery, but they are favored for prosthodontic handling because impression coping and abutment placement is felt to be easier. In addition, it was revealed that dentists strongly feel that there is a lack of clinical evidence (complications and predictability) and prosthodontic evidence (biomechanics and mechanical engineering) to support the use of internal connection implants.

Conclusions: The findings reveal the responding clinicians recognize that they often make decisions without compelling evidence to favor one system over another. Decisions are often based on perceived ease of use or third party (colleague or manufacturer) input.