Analysis Of The Shortcomings Of The BioHorizon® Implants

The definition of a “Unique Selling Proposition” (USP) is a feature of a product that makes it different from other similar products and that can be emphasized in advertisements for the product. It is helpful if the differentiating feature also provides a real benefit. The BioHorizons’ USP implants is their Laser-Lok micro-channels on the neck of their implants and abutments. The claim is that these grooves help to form an epithelium attachment to isolate the endosteal portion of the implant from the oral environment. There are several histological studies showing gingival fibers orientated horizontally between the grooves of the laser lines. It has been proven, dating back to the 1970s that soft tissue adheres to an implant surface absent such micro-channels. There have been no controlled, prospective clinical studies proving any clinical advantage to Laser-Loc attachment vs that demonstrated to the blasted or smooth necks of other titanium implants. Since 2008, the Laser-Loc USP has been the cornerstone of BioHorizon’s marketing. About 20 years ago, BioHorizons acquired a license from Zimmer Dental on the Internal Conical Connection patent that the company had acquired when it bought Core-Vent/Paragon in 2001. In 2013 Henry Schein acquired both the German Camlog and American BioHorizons implant companies and in 2019 these two companies were merged. BioHorizons has introduced a wide selection of implant designs in response to the popularity of various features. The result is no clear statement about what features BioHorizons actually thinks are beneficial. The Camlog implants do not have Laser-lok micro-grooves, yet BioHorizons does not claim these implants are any less successful or have more bone loss.

Camlog and Conelog implants have different internal connections from the standard 45 degree lead-in bevel of the BioHorizon implants and have either a blasted or smooth surface on the neck of the implant. What this should say to dental professionals is that BioHorizons itself does not believe the Laser-Loc is essential for clinical success.

BioHorizons claims that studies show improved clinical results but this has never been proven in any side-by-side controlled clinical studies. The survival rates reported in some case series studies using BioHorizons’ Laser-Loc implants are similar to that reported with implants having micro-threads, blasted and even machined necks as evidenced by the published 10 year survival studies with ZimVie’s Tapered Screw-Vent (Niznick Gen3) and this 5 years study with Implant Direct’s Legacy (Niznick GEN4) implants that demonstrated an average of only 0.6mm of bone loss. Dental professionals placing implants are becoming increasingly concerned about the prevention and treatment of peri-implantitis around osseointegrated implants. The same ability of the Laser-Loc feature to attract soft tissue attachment is a concern with regard to the attachment of a biofilm that can contribute to peri-implantitis. There is a renewed interest in implants with a hybrid surface consisting of a smooth neck and textured body. This was the subject of 2022 articles in the Academy of Osseointegration News by

Gen5 cover


Applies to Straumann’s TLX implant and Paragon’s GEN5™ implant BUT not the BLX

Dr. Niznick Article: AO News Vol.33 No. 2, 2022: Dr. Buser cites a Swedish 10-year study comparing three implants: Astra, NobelBiocare and Straumann’s Tissue Level implant, claiming the latter exhibited significantly less peri-implantitis. Assuming part of the smooth neck of the Straumann TL implant was inserted in bone, this would give it a hybrid bone interface. It also adds the variable that the implant-abutment connection would be supra-crestal… [which] is at least as important a factor in minimizing peri-implantitis as a hybrid surface.” Dr. Michael Dard, Prof. NYU Interview: 
1. Explains peri-implantitis and 
2. Discusses results of the Derks et al study

peri-implantitis study
Dr. Daniel Buser tissue level

This case control study measured early crestal bone changes around sub-crestal placed platform-switched implants surrounded by thin soft tissue and compared them with regular, matching-platform implants placed in a supra-crestal position and surrounded by thick soft tissue. After 1 year, mean bone loss was 0.28mm (SD:0.36 mm; range: 0.1-1.63mm) in the control group and -0.6mm (SD:0.55 mm; range: 0.05-1.8 mm) in the test group. Platform-switched implants placed in a subcrestal position in vertically thin soft tissues showed statistically significantly more bone loss than non-platform-switched implants placed supra-crestal with vertically thick tissues.

crestal bone case

Paragon’s GEN5™ , GEN5+™ and NizPlant™ implants have the same implant body with a 2.5mm machined, anodized neck. Depth gauge lines at 1mm, 2mm and 2.5mm from the top (Pat. Pend.), along with 2 depths of drill stops, facilitate placement level with or 1mm above the crest of the ridge. The insertion depth control, in conjunction with the ability to varying the height of the prosthetic screw, minimizes the need and cost of maintaining an inventory of abutment heights. The GEN5+™ offers the additional flexibility of a 2mm friction-fit collar that can serve as the trans-mucosal collar of an abutment or be removed for abutment connection directly to the top of the implant for unprecedented vertical flexibility


Each Paragon implant is 1mm longer than the standard lengths of the respective Screw-Vent and Legacy implants. Paragon’s surgical system includes two options of drill stops. One is for placement 1mm supra-crestal, which moves the implant-abutment junction away from the bone and and creates a 1mm supra-crestal zone of titanium for undisturbed soft tissue attachment when prosthetic components are attached and removed from the implant. The other drill stop positions the implant level with the highest point on the the ridge, usually on the lingual, leaving the smooth neck exposed if there is bone recession on the labial/buccal. The diameters of the drill stops and the freedom of rotation of the drills within the drill stops allow there use through surgical guide without the need for keys.

paragon surgical system
gen5 friction-fit extender

Simulated case (right) shows 8 GEN5+™ implants replacing exposed implants (left). Little or no bone grafting needed because only smooth surfaces exposed. Attaching a Prosthetic Screw converts platform to standard MUA.

gen5 implant simulated case
patented features of nizplant
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