Comparison of Two/Three Piece & Single Piece Dental Implants

Considerations

Single Piece [BASAL] Implants

Two – Three Piece Implants

Basic design

The implant and the abutment are fused – they are manufactured as one piece

The implant and the abutment are separate. The abutment is either cemented or cold welded. If the abutment is secured with a screw onto the implant, then it can be considered to be three piece.


Implant Placement Procedures

Single sitting surgical procedure and very often flapless (no open surgical procedures are necessary). Implant procedures are less time consuming than that required for bridgework.

Very often more complex surgical procedures are necessary, spread over 2 or 3 sittings in a period of 3-6 months (Implant placement, Healing Screw placement & Abutment Placement)


Loading

Immediate Loading – ie patient can be given the crown(s) / bridge(s) the very next day

Delayed Loading – very often a waiting period of minimum of 3 months is necessary before loading the implants with prosthesis.


Prosthodontic Procedures

Conventional impressions of the implants can be made just as is the case with conventional bridgework. Less time consuming.

Requires more complex procedures and is more time consuming.


Sizes & Designs

A wide range of sizes and designs are available suiting various bone types and measurements. The designs even help avoid bone augmentation and sinus lifts.

Limited sizes and designs are available thereby limiting their application


Cost

These work out a lot more cost effective in comparison with two/three piece implants

Expensive – with respect to the costs of the implants as well as the time taken for multiple procedures


From the patient’s point of view

Less complex placement procedure, less number of sittings and crown(s) & bridges can be cemented in a day or two… more or less like that of a conventional bridgework & costs are comparable with that of conventional bridgework

More complex placement procedure involving two or more surgical phases. Crowns / bridges are cemented only after 3 months after the healing phase. Much more expensive than the conventional bridgework.


Long term maintenance

Being a single piece, the strength provided by the implant is excellent and there is no separate root portion and abutment portion. Maintenance is very simple… maintenance is just the same as that of conventional bridgework

Being two piece, the relation between the root portion and the abutment portion can present problems. Studies have proved that two piece implants experience higher mechanical stress under oblique loading. Maintenance of these implants are more complex… very often screws (when used) are to be tightened at periodic intervals as there will be micro-movement between the implant and the abutment.


Healing time - clinically

bone healing time clinically not Significant

Prolonged healing significant


Masticatory Forces

Transferred to the basal plate deep into the cortical bone areas which are able to accept large loads and have great capacity of regeneration.

Act in the vertical direction along the sides of the screw structure.


Bone Grafting Procedures

Not required

Essential in cases of deficiency in bone height. Grafting procedures give Unpredictable results.


Smoking Patients

Best option for smokers.

Failure rate for smokers is nearly 100%


Controlled Diabetic Patients

Blood Sugar variation does not affect the survival of implant at all.

Crestal implants always run risk of failure where there are good blood sugar variation.