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Have also long wondered . . . wouldn’t the implant posts have a more solid foundation if the bone were drilled maybe 3 smaller or 4 smaller holes around the eventual site but very close . . . allowed to heal etc.

My dentist is one of the top implantologists in the world... he was the keynote speaker at the Indian Society of Oral Implantolgists in Pune, India in January where he gave a talk on the Custom Osseous Integrated Implant (COII) system that he was instrumental in helping develop. He also presented a class on them and gave a presentation on the spirochetes.

These COII implants heal in bone, not in scar tissue like the older sub-periosteal implants that are now considered to be failures at placement and should be removed. Sub-periosteal implants have a survival rate of 50% at ten years. The COIIs our office place (now over 120) have shown a 100% survival rate at 10 years because they heal in bone. . . unfortunately, these Custom Osseous Integrated Implants are virtually indistinguishable on an x-ray from a subperiosteal implant so an uninformed dentist on seeing one in a radiograph is likely to advise its immediate removal thinking it's a subperiosteal implant!

Most dentists who call themselves implant dentists, know only one or two screw implant systems. This system is far beyond that.

The head dentist at our office has an alphabet of letters behind his name... he's a:

Fellow of the American Academy of Implant Dentistry
Diplomat of the American Board of Oral Implantology / Implant Dentistry
Fellow of the International College of Implantology
Fellow of the American Association of Oral & Maxillofacial Surgeons
Examiner for the California State Dental Board for I.V. Sedation License
Was a Professor of Dentistry at UCSF School of Dentistry
Taught implant dentistry since the mid-eighties, working closely with Dr. Larry Lum, the University of California Maxi courses, as well as several post-graduate courses and study clubs.
Conducts ongoing research in subperiosteal and Custom Osseous Integrated implants in conjunction with the University of Alabama's Department of Biomaterials.
Being named a Professor at the University of Alabama Mobile, so he can give two lectures a year on the COII Implants.
Designed of a number of dental implant systems.
Partner in Quantum Implant Systems.

And several more added to the alphabet soup I don't recall right now... and IIRC, he's been elevated to Diplomate status from Fellow status on a couple more of those listed. He's been doing implants for 32 years and counting the 120+ COIIs, he's placed over 600 implants in that time.

His most recent scientific research was published in The Journal of Biomedical Materials Research—"Bone properties surrounding hydroxyapatite-coated custom osseous integrated dental implants" where they reported the findings that the bone did indeed integrate to the implants in the COIIs in three jaws recovered from three of my dentist's patients (one of which was my ex-wife's mother), contrary to the claims of all other dentists that it could not and would not happen!

In any case, my ex-wife's mother had a jaw that had only 1/16" left at the time of the placement of a raymus frame titanium full lower jaw implant system. This was a pre-Vitalium custom made implant that was built on a CADCAMed jaw model made from a CAT scan of her jaw. She had reached the point that relines of her dentures would no longer work at all. There literally was no jaw under the gums to support anything because the forces of chewing were not being transferred from the denture and the body had reclaimed the calcium of the jaw. As mentioned, there was only 1/16" of her jaw left. She came in for the surgery after the implant was engineered and manufactured by the dentist. It was a single surgery that opened her gums, the implant mounted on her jaw with some screws, and then closed. Her existing denture was modified to fit the titanium bar that went around her gum line above the gums... and clamped on to it. Where before, her denture would fall out of her mouth, it now literally had to be pried out of her mouth with a spoon. At that time, she was allowed to go home and eat a steak that night! We no longer allow that because we now know better for best results.

Eleven years later, she died at age 95, having lived far longer than she would have done if she had to live eating pablum. She was able to eat apples, steak, anything she liked. She had given permission to have her jaw taken for research purposes. The dentist went to the mortuary and removed her lower jaw and it was sent to the University of Alabama for histology study.

There it was found that not only had the implant survived, but her jaw had regrown to full size and function in the eleven years... and not only that, the bone had grown to and into the implant at the microscopic level... down to the electron microscopic level... basically molecular level! The implant had integrated with the bone! The implant had transferred the stresses of chewing back to the jaw and the body had responded by regrowing the bone and put the calcium it had reclaimed back!

We now have, I believe 11 cases, including several from other doctors doing the same type of implants, showing the same thing... and zero cases where this has not happened! We have to wait for more patients who no longer need their implants to check more. . . however, there is a statistical model that says when we reached seven, we had enough data to conclude that every case would show the same results, and each additional would extend the degree of confidence toward certainty.

Now, we heal implants like broken bones... we don't load them for six weeks. We still do the single surgery and we can do bone grafting with HydroxyApatite (a manmade material that bones are made of) at the same time... in a method that sort of works like aggregate and cement where the HA works like the aggregate, the patient's own blood acts like the cement, and the body heals the mix into natural bone! We can pack this mixture around the implant, use no screws into the bone, unless absolutely necessary, and keep the load off the implant, and allow the implant/bone to heal naturally like a broken bone. After six weeks, we progressively load the implant with soft to harder foods until totally healed and the patient can then eat anything they want to.

The more screws or holes you put in the bone, the more failure points you add to the case, the more opportunities you add for infection. Not a good idea. We try to avoid screws for these types of implants.

Single tooth implants can be done with a screw post.

The cobalt is not a problem?
Nor the Molybdenum?
What’s wrong with Titanium?

The CoCrMo Alloy is far stronger than Titanium and that means you don't have to use as much metal to get the same strength as a much larger amount of Titanium. The CoCrMo can be 1/2 the thickness of the Ti part for equal strength. Like Ti, CoCrMo is medically inert... and the body will accept it as part of itself if it is properly prepared and super-cleaned. We used to use a device called a "picotron" which bathed the implant in electrons and cleaned it of any contaminants. It was then coated with HA... and then a drop of the patient's own blood was touched to it. It was fascinating to watch. Touch a drop of blood anywhere on the implant and it instantly covered the implant! The implant was immediately placed... and granular HA packed around it, blood added, gums carefully and tightly closed. The patients existing modified or a temporary denture made to fit the implant... and the patient sent home. Total time of surgery, an hour to two hours.

Now, we find we no longer need the picotron... the same results can be gotten with super clean distilled water very high temperature steam. Lots of research went into finding out that water could do what an expensive piece of equipment could do. ;^)>

Then there’s the noise about implants loosening from lateral pressures.

That's why the implants healed in scar tissue fail... they aren't supported well. But if they are healed in BONE... the bone surrounds them and they are well supported. Bone is hard, scar tissue is, well, soft. and movement causes irritation, and eventually space develops, and inflammation and infection.

While the COIIs heal, we have our patients avoid lateral pressure to make sure no scar tissue develops. Once healed, there's no possibility of that happening. We do have some problems develop, but with proper engineering design, it may only require the removal of one infected post out of several... and the implant survives, still functional. Placing up/down minor thrust is not too bad, but the lateral can leverage the partially healed bone and prevent proper healing. We usually recommend removing the dentures at night for people who might be "thrusters" until the healing is done.

Before, when the implants were made out of massive titanium metal, and were mounted on scar tissue, the whole thing had to be removed because the struts were connected below the gum line for support (not necessary with the vitalium) and the infection followed the connected metal, the scar tissue, being soft, infectable meat, rapidly deteriorated, and the entire implant could be lost in a matter of days.

With the COII implant, when made out of strong CoCrMO, each strut is independent, not connected below the gum line so no connection to the next and therefore no pathway for infection to follow to the next strut, revision surgery is simple and straight forward, leaving the implant structure in place and functional when only one infected strut has to be removed. Safer, easier, and less healing time. No money to even fantasize really but would sure like to be able to have 4 posts for my lower dentures.

Strange that you should mention that. The Arthur A. Dugoni School of Dentistry at the University of the Pacific (a Stockton educational institution) at their San Francisco campus is offering to place four mini-implant screws to secure a lower denture for $7000. They claim they have a 92% survival rate of their mini-implants at ten years which is pretty good. Our office has been running a special for the last four months. Two full size screw implants to secure your lower denture, 2 year guarantee or free replacement, with our doctor's 100% at 10 year track record and his world renowned reputation, for only $1600. You don't need four... two full size screw implants with O ring attachments to your denture is more than enough to secure your lowers. I'm not trying to sell dentistry here on FR, I've carefully avoided even saying my office name or the dentist's name... but it's a great bargain. If you are close to Stockton, you might want to check us out. We don't really like taking patients from more than an hour away. It's too much of a problem if something happens to the implant and revision surgery becomes necessary. If you are interested in implants, tell me where you are and perhaps we can refer you to a good implant dentist in your area... one who knows more than just a screw.