My eyes glaze over as I scan the peanut butter aisle - twelve options face me, all differentiated slightly by level of sodium, sugar, flavoring, price, size and brand. Five minutes pass and it is clear that I am struggling with the paradox of choice. This paradox suggests that when we are presented with too many options to choose from, it’s harder for us to make choices, and we often leave unsatisfied with what we have chosen.
I would imagine that dentists similarly experience this paradox when deciding what implants to use during dental implant procedures. There are a plethora of dental implants available on the market due to the fact that these devices suffer from high commoditization and low innovation; in fact, the last major innovative design to shake up the dental implant industry was the titanium implant, commercialized by the Swedish physician Dr. Per-Ingvar Brånemark, over thirty years ago. Since then, innovation in this space has been relatively stagnant, where changes to implant design materialize in the form of small tweaks.
For example, in the past couple of years, there has been a considerable amount of research and product launches involving new surface coatings for dental implants, such as using nanotechnology, acid washes, or adding hydrophilic properties, which all purport to promote bone growth around the implant. As an example, MIS Technologies most recently released their B+ implant, which features a hydrophilic surface coating. While some studies suggest that implant surfaces featuring micro and nanotechnology may have an edge in promoting osseointegration, nearly all implants of different surface types boast good clinical results, which makes the difficulty in choosing an implant that much harder for the dentist.
In addition to new surface coatings, another common area of focus for dental implant modification is in the shape of the implant. While the cylindrical threaded implant has been the standard of care for several decades, manufacturers have created short implants, narrow implants, tapered implants and hybrid implants that have a shape somewhere in between – just to name a few. As a recent example, Glidewell Laboratories just released the newest version of their 3.2 Inclusive Tapered Implant, which is now the narrowest of the four other implants in the Inclusive Tapered Implant series. While some implants have shown some better clinical success in terms of establishing better primary stability, many physicians agree that a single type of implant will be suitable for most patients’ needs.
In addition to minimizing the scale of innovation, the commoditization of dental implants has opened up the space for several value players to enter this market, which has put downward pressure on average selling prices. As a consequence, the dental implant competitive landscape is divided into premium players, who offer brand reputation and extensive clinical efficacy to support the use of their implants, and value players, who capitalize on selling aggressively priced implants. While one would assume that the clinical support behind premium implants would make these implants an obvious choice, some implantologists agree that the difference in quality between premium and value implants is actually little to non-existent.
Therefore, combining the cornucopia of implant options in terms of material, coating, shape and price, with somewhat conflicting views on the clinical superiority between these products, it would come as no surprise if dentists suffer from the paradox of choice. Perhaps manufacturers can cut through some of this indecision and uncertainty by focusing on providing dental device solutions for some of the longer-term implications of dental implants, such as peri-implant disease, which is becoming more prevalent as dental implant procedure volumes increase.
Now, back to my peanut butter…
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