An Interview with Implant Direct

Gerald A. Niznick, DMD, MSD, President and CEO

INSIDE DENTISTRY (ID): How much has really changed about the implant industry since you started Core-Vent Corporation in 1982, Paragon in 1997, and Implant Direct in 2004?

Gerald A. Niznick (GN): The success of a broad range of implant designs, surfaces, and materials is now well established in the dental literature. What has changed, especially in the last decade, is that implant companies have segmented into three categories in order to find their USP (unique selling proposition). Premium Priced Players differentiate their products based on claims of research and the support of paid opinion leaders. This research is designed to create sound bites for marketing, comparing a company’s new and improved products to their old ones without providing any clinical studies to show a significant improvement in success. Each new version is accompanied with a price increase, now reaching an average of about $350 to $450 per implant. Discount Priced Players sell on price alone, offering a limited range of implant designs and dimensions. These companies vary their implant prices and volume discounts based on the market and the negotiating skills of the dentists. With an average list price of $100 to $150 and substantial discounts for volume purchases, the dentists purchasing these products are prepared to accept possible compromises in quality, precision, packaging, and limitations in implant or abutment options in order to get what they perceive as a bargain. Value Priced Players is a segment of the market that Implant Direct created in 2006. Implant Direct targets the established Premium-priced product lines with systems that offer surgical and prosthetic compatibility for a non-negotiable list price of $150 to $200. We provide added value with All-in-1 Packaging that typically includes a cover screw, healing collar, transfer, and either final or temporary abutment. Quality and a broad line of products are essential for Implant Direct’s “Value Strategy” to succeed. This is made possible, even at relatively low prices, by operating the industry’s only “lights-out” 24/7 manufacturing facilities that can be viewed on five online cameras on our website. This strategy has forced many of the premium-priced companies to aggressively discount to volume purchasers to maintain their best customers.

ID: You have been widely recognized and honored for your contributions to the dental implant market. Which of these contributions do you think made the biggest impact on how implant dentistry is practiced today?

GN: The original Core-Vent (1982) two-stage implant had a hex hole into which a variety of application-specific prosthetic abutments could be cemented. This was in contrast to the Brånemark implant which did not come on the US market until a year later with only one multi-unit abutment for edentulous screw-retained bridges. That concept of versatile prosthetic applications contributed to making implant dentistry part of conventional fixed prosthetics with cemented crowns and bridges. The internal hex connection (Niznick US Pat. #4,960,381) and all the screw-retained abutments that I developed thereafter accomplished the same prosthetic versatility while offering retrievability. When these types of two-piece abutments were developed for the external hex implants, it became apparent that the internal connection offered greater stability and esthetics. The industry was slow to change over because the internal connection was patent-protected, whereas any company could make an external hex. In 1999, I solved the problem of achieving high initial stability in soft bone with the development of a soft-bone/hard-bone surgical protocol, inserting the newly designed tapered Screw-Vent in undersized sockets prepared with straight step drills. Inserting a tapered implant into an undersized socket created with a straight step drill led the way for immediate loading of implants. When dense bone was encountered, the size of the socket would be enlarged, eliminating the need for bone taps and allowing self-tapping insertion in both soft and dense bone. In addition, I am especially proud of the 5-year clinical study conducted at 32 Veteran’s Affairs centers that included 900 patients receiving over 2,800 implants. This was the largest dental implant study conducted worldwide and special issues of Journal of Periodontology and Journal of Oral and Maxillofacial Surgery were dedicated to publishing the results, which added significantly to dental implant knowledge.

ID: You’ve built Implant Direct into an international company with hundreds of employees and distributors in more than 30 countries. How would you define your approach to launching and successfully running a business?

GN: Building and running a successful business in a relatively short time takes production capacity, an innovative product line, the right “go-to-market” strategy and a dedicated team of knowledgeable people. After selling Core-Vent/Paragon Implant Company to what is now Zimmer Dental in 2001, I retired for a few years. In 2004, Zimmer chose not to renew the lease on my Los Angeles factory and moved their manufacturing closer to their corporate headquarters near San Diego. This presented an opportunity to re-occupy the factory I had built in 1994 for producing implants and re-hire 80 of Zimmer’s top machinists and QA specialists, many of whom had worked for me for years before the sale to Zimmer. In the next 3 years, my team developed the lights-out manufacturing processes that assured efficiency and quality. Together with my design engineering team, I developed the Spectra-System^® of six 1 and 2-piece implants, all with the same body and, therefore, surgical protocol, but with different platforms and packaging for different clinical applications. This created the industry’s first application-specific implant system with each implant appropriately priced at $150—low enough that the premium-priced implant companies could not routinely discount to match that price. This formula of offering innovations, quality, and value was just what the industry was waiting for and the 2008 economic recession made the need for “appropriate” priced implants even more compelling. To keep the selling expenses low, I focused on the internet for education and sales. Demand grew globally for the products and, today, Implant Direct has almost 150 people in North America providing sales, customer service, and technical support. We opened an office in Zurich to support our direct sales forces in Germany and Italy, as well as shipping to our distributors throughout Europe.

ID: How do you separate—if you do at all—your roles as clinician, inventor, entrepreneur, educator, and researcher?

GN: I am first and foremost a clinician, having practiced the specialty of prosthodontics for 14 years before starting my implant business in 1982. Throughout the 1970s, I used the implants available at that time to help my patients. The Core-Vent was developed primarily to function free-standing to stabilize a lower overdenture. I published the first article showing the efficacy of this application, which has now become the minimum standard of care by the American College of Prosthodontists. My inventions were needed to implement my treatment philosophies of simplicity, versatility, and economy. I needed to become an educator and entrepreneur to have the financial resources to see my inventions, now numbering 35 US Patents, become clinical realities and to advance the field of implant dentistry. There is an invaluable symbiosis between these roles and I would not choose to separate them even if I could.

ID: When you’re not inventing an implant product, you’re flying an airplane. What lessons have you learned from being a pilot that you can correlate to your life’s work in dentistry?

GN: To fly an airplane you need to be committed to education and you need to be extremely focused. I acquired a commercial, multi-engine, instrument rating with type ratings in two jets. Flying a plane is like playing the ultimate video game with all the avionics now available in the glass cockpits. You’re going at 500 miles an hour, monitoring all sorts of electronics on the control panel. You have to be aware of everything that’s going on around you. It definitely sharpened my abilities to multitask and respond quickly.

ID: Implant companies continue to face some challenges with the economy. Have you done anything differently over the last few years to better position Implant Direct for growth? Did the recession alter your business model?

GN: The recession has only further proven the Implant Direct business model. Patients need and deserve affordable implant care. While other implant companies may be contracting, we are consistently expanding not only with personnel but with new facilities. We just underwent an expansion of our manufacturing capacity by adding 18,000 square feet that provide room for 28 machines in addition to the 40 we already had operating 24/7. We also have a new state-of-the-art educational center in Las Vegas with computers at each desk for image-guided surgical training, models/mannequins for hands-on training, and a four-chair dental office for live surgical demonstrations.

ID: It’s been over a year since Sybron Dental Specialties acquired a 75% interest in Implant Direct International. What impact has that had? What has changed in the scope and mission of Implant Direct since the acquisition?

GN: The new joint venture between Implant Direct and Sybron Dental Specialties has created many new and exciting opportunities. We merged Implant Direct with Attachments International, a Sybron Company, and absorbed the sales force and distribution responsibilities for Sybron Implant Solutions primarily keeping their biologics products. Danaher owns such well-known brands as KaVo, Kerr, Image Sciences, Sybron, and Pelton & Crane, and we plan to integrate our efforts with our Danaher and Sybron Dental Specialties sister companies to bring full digital solutions for implant dentistry. I remain Implant Direct’s president and CEO. I have been able to broaden the management team in sales and operations, leaving me even more time to focus on product development.

ID: Can you share anything with us that you might have in the pipeline right now?

GN: We will be launching a new implant system, the InterActive™. This system will provide prosthetic compatibility with NobelActive™ and the NobelReplace™ conical connection plus surgical compatibility with Legacy™, Zimmer Dental Tapered Screw-Vent^®, and NobelReplace drills. It offers the first implant with both micro-grooves and micro-threads plus unique packaging that provides a patented cover screw/healing collar assembly and a new two-piece (patent pending) fixture-mount that can be modified for use as an abutment and serves as a transfer that provides the accuracy of an open-tray impression with the simplicity of a closed-tray impression.

We also will be launching our own image-guided software, surgical guide, and CAD-milled titanium bars as well as custom-milled titanium and zirconia abutments by the end of this year. Our pricing for these ancillary services will be commensurate with our value-added philosophy, making Implant Direct a full service company.

ID: If you could look into the future, what would your prediction be for dental implantology in the next 10 years?

GN: My predictions 30 years ago, that implants would become an integral part of conventional dentistry, have come to pass. My gamble in 2004, with the start of Implant Direct, that dentists would look beyond the marketing hype of the premium-priced products and place a greater appreciation on value, has paid off for me as an entrepreneur. It will also continue to pay off for dentists who take the time to learn what is important for implant success and trust in their own good judgment. The day is fast approaching when patients, missing some or all their teeth, or needing an extraction, will seek out dentists capable of replacing the missing teeth with implants. While implants have become a major part of every oral surgery and periodontal practice, every general dentist removing a tooth should have the knowledge and confidence to either immediately place an implant into a resized socket or have the skills to perform the site preparation procedures needed to preserve bone for future implant placement. Good dentistry, as well as the patients, demands such services in ever-increasing number. Implant Direct’s goal has been, and continues to be, to make that option accessible and affordable to a greater number of patients without any compromise in the quality or longevity of the treatment.