Which country are Ankylos implants from?

The idea for Ankylos was born in Munich in 1985. Georg-Hubertus Nentwig, who was then working at the oral and maxillofacial surgery clinic in Munich, and Walter Moser, an engineer working at the institute of metallurgy, set out to design an implant that would work well both technically and biologically. A patent application was filed in 1986, and in 1987 the system was used clinically for the first time, together with Krupp Medizintechnik. At that time the system was known as the 'NM-System', after the developers' initials.

When Krupp's medical technology division was broken up, the dental division of the German company Degussa took the system over and launched it under the name ANKYLOS; the manufacturer's brochure gives this date as 1993; according to a 2016 article based on the designer's account, Degussa took the system over in 1993 and marketed it from the beginning of 1994. In 2001 Degussa's dental division in Hanau merged with the dental division of Friadent in Mannheim to form a new company called DENTSPLY Friadent. About ten years later, DENTSPLY Friadent and Astra Tech Dental were brought together under the DENTSPLY Implants umbrella. In 2016 Dentsply and Sirona Dental Systems merged and today's Dentsply Sirona came into being; the group's headquarters are in Charlotte, North Carolina.

So the answer to the question of which country it is from has two layers. The system's design, development and, for many years, its production were in Germany; its current owner is a US-based group. In the long-term study published in 2013, the manufacturer of the implants is given as 'DENTSPLY Implants Manufacturing GmbH, Mannheim, Germany'. Where any single implant you are given is made today is stated most definitively by the label on its box.

What sets Ankylos apart from other systems is its connection. The top part seats on the implant not with a screwed hexagon but with a deep, conical connection; the manufacturer calls this connection TissueCare and says that, by locking through friction, it eliminates micro-movement between the two parts and reduces the risk of bacterial build-up. The size of the connection is the same across all implant diameters: the manufacturer explains this as meaning that every top part fits every Ankylos implant and the number of parts is reduced.

The second feature is platform switching, meaning that the top part is narrower than the implant body. As a result, the junction between the implant and the top part moves inwards from the outer edge of the implant to a more central position. Ankylos is one of the systems that has carried this idea since its first design in the 1980s; the manufacturer states that the implant is designed so that it can be placed slightly below bone level, that is, subcrestally. The current version is called Ankylos C/X: the same conical connection can be used with an index that orients the top part (/X) or without an index (C/).

What platform switching achieves has been studied separately. In a 2021 meta-analysis that brought together randomised studies with at least 3 years of follow-up, the average bone loss around the implant was 0.33 mm in implants with platform switching and 0.66 mm in those without. Implant survival, however, was almost identical in the two groups: 98.12 per cent and 98.05 per cent. So this design can preserve the bone margin better, but on its own it does not change whether the implant stays in the mouth.

The best-known data on Ankylos comes from the University of Frankfurt. 12,737 Ankylos implants placed in 4,206 patients between April 1991 and May 2011 were followed; at 204 months, or about 17 years, cumulative survival was found to be 93.3 per cent. Most of the losses were seen in the first year, before the prosthesis was fitted; losses were significantly more common in the lower jaw and in hard bone. This is registry data from a university clinic, not a randomised comparison; the system's two designers are among the authors.

Even so, the brand is the smaller half of the question. Whether an implant stays in the mouth over the years is determined more strongly by planning, how the load is spread, factors such as smoking and uncontrolled diabetes, and regular maintenance. Ankylos is a conventional two-piece system: it sits in the inner part of the bone and needs enough volume there. The implant used in the protocol of fixed teeth in 72 hours with the Ihde method belongs to another class: a one-piece corticobasal implant that anchors in the hard outer layer of the jaw.

The points below concern the implant design that sits inside the bone, has two pieces and needs a healing period; points specific to Ankylos are noted separately.

If the answers are short and clear, there is a considered choice behind the plan. Every answer that stays vague is a gap you will have to fill in later.

1. 1

   Which length and diameter, and why?

   It should be possible to explain the choice in terms of the width, height and density of your bone. If a single implant is planned in the molar area, discuss the choice of diameter and the load on the top part too.

2. 2

   Indexed or non-indexed?

   In Ankylos C/X the top part can be seated with an index (/X) or without one (C/). Knowing which was used will help you later when a new top part is being made.

3. 3

   Will the implant be placed below bone level?

   Ankylos is designed for subcrestal placement. Having the planned depth, and its effect on the gum and the bone margin, explained to you shows that the plan has been thought through in detail.

4. 4

   Can I see the barcode on the label?

   Medical devices put on the market in Turkey must be registered in the Product Tracking System (ÜTS). The number on the label shows the product's manufacturer and its record; this is a more concrete check than anything you hear about the brand.

5. 5

   What happens if the top part breaks?

   In Ankylos the top part locks into the implant through a conical connection. Asking from the outset how the remaining part would be removed if it broke, how long the part takes to arrive and what the procedure involves is a normal request.

If the first four points below are in place, the difference between brands narrows; if they are not, no brand makes up for the shortfall.

A few misleading shortcuts circulate around a brand that has changed hands several times and sits under the same roof as a sister system.

Nobody asks for these documents today; but years from now, in another dentist's chair, they are the first thing you will be asked for.

1. A detailed implant card

   The card should say more than just 'Ankylos'; it should show the C/X version, diameter, length, lot number and the area where it was placed. If anything is missing, ask the clinic that did the treatment to complete it.

2. The type of top part

   Which top part was used, and whether it was indexed or non-indexed. With this information, finding the right spare goes faster when a fracture or renewal calls for one.

3. A copy of the barcode

   The barcode on the product label carries the number that identifies the implant in ÜTS. Keep it with your card.

4. The X-ray from day one

   The X-ray showing where your bone level was at the start. With an implant placed subcrestally, how the bone margin changes over the years can only be read by comparing against this X-ray.

The name of the implant alone does not determine the difference in a quote. The total is made up of these items:

Unit cost of the system

There may be a difference between a long-established system from an international group and a younger or domestic one; but in a plan with several units, this is often not the item that determines the total.

Choice of top part

The choice between a ready-made part, a custom-made one or a compatible one can move the quote more than the implant body. Check which one the quote states.

Preparatory procedures

If a graft, a sinus procedure or extractions are needed, these are separate items, and they come up often in conventional plans. They also extend the timescale.

Repairs over the years

With a system whose parts are easy to find, replacing a screw or top part stays a small job. This is the item that does not appear on the bill but can end up costing the most in the long run.