Tramonte is still the teacher

03 HYBRID IMPLANT
40% no surface treatment on the implant body
Sa 0.50 µm
Total average value on area measuring 30x30 µm. Decontamination with cold plasma.

60% surface treatment on the implant body
Sa 1.90 µm
Total average value on area measuring 30x30 µm. Sanding, double acid etching.  Decontamination with cold plasma.

Source of the image: Doctor Os, April, advertising page. See the text below

So, with no intention to start a polemic, but only with the pure intention to reaffirm merits and historical priorities, I take the opportunity of the casual observation of the advertising leaflet I show you, presenting a surface treatment limited to the apical part of the implant, as introduced by me for the first time to the world in 2010.  Here is a short summary of facts for the benefit of those who are too young, and have not been told the true story, leading them to think that Italian implantology is all to be discarded, because obsolete and produced by charlatans.  The delayed loading implantology of Swedish School was born to oppose and to be better than the Italian School implantology, that practiced immediate loading with success percentages greater than 95% already in the 60s.  The basic concepts and a lot of their principles where opposite.  However, in later years Swedish implantology was forced to acknowledge its mistakes and learn from the Italian School.  In spite of having opposed it fiercely for two decades, it came to methods that makes it indistinguishable from the Italian School, except for the fact that Swedish School implants have prosthetic connections, and implants of the Italian School do not have them.

1959 - Tramonte designed the first implant specifically adapted to immediate loading, featuring a very large pitch and very broad spires.  These will be defined too aggressive (?), fiercely criticized and opposed for decades, but will be later adopted by all the respective immediate loading implant lines.

1961 - Tramonte was the first to introduce the biological respect area.  It will take 20 years of "physiological bone resorption", true implantological iatrogenesis, before submerged implants decide to learn from Tramonte and adopt this basic design principle.

1963/64 - Tramonte introduces titanium in implantology, both in the clinical and commercial fields. Branemark follows experimentally in 1965 and commercially in 1978. Tramonte starts by using Ti2 and so does Branemark. However, Tramonte is a single piece implant, without prosthetic connections; so its emergence, having a diameter greater than 2 mm, hold fast.  The Branemark prosthetic connection does not, it is forced to use a higher titanium grade.  Then, when submerged implants must reduce the initial 5 mm diameter to be able to treat a greater number of cases, the use of Ti5 becomes compulsory for the prosthetic components, because it is the only one able to withstand work always applied to implants with very thin walls, with connecting screws as thin as 1.6 mm and even 1.4 mm, with thicknesses at the implant emergence that may be as thin as 0.3 mm!!

All on six – This is the typical configuration to rehabilitate a maxilla, as codified by Tramonte in his first Implantology text (The Rational Endosteal Implant, 1964) that will be abandoned later in favor of “Isotipia di Muratori” (advocating the placement of one implant for each prosthetic crown), capable of guaranteeing a greater percentage of success on the long-term.

Surgical guide - This is a Tramonte invention.  It also appears in the quoted text, written in 1964.  It was adopted massively by Swedish School implantology, but around 2005.

Flapless surgery - This technique was featured in the Italian School implantology from the beginning.  It was opposed and disqualified to an incredible degree by universities and scientific academies, but envied and sought after to the point of perfecting a computerized system to be able to realize it even without having the necessary surgical skills.

Transmucosal - Having acknowledged the qualities and advantages of a single piece transmucosal implant, the Swedish School implantology adopted the concept to transfer the prosthetic connection beyond the biological respect area.

Angled implants - This is a classic of Italian implantology.  This one too was opposed and ridiculed for decades, but imitated and revamped under the name "tilted implant" especially by Malò, who copied our all-on-six fan-shaped technique in the canine pyramid, eliminating the two central implants.

Post extractive - This is one more main principle of Italian implantology, used from the beginning.  This one too was copied by Swedish implantology.

Minimally invasive and atraumatic surgeries - Two very important principles of Italian implantology, born precisely with the intention of being minimally invasive and autraumatic, recently adopted by Swedish implantology that has discovered its ethical value, when it renounced the idea of compulsory flapping and reducing bone crests to adapt the bone to emergence diameters that are always too large.

Sinus bypass - This technique was used by Italian implantology from the beginning, to solve the problem of hyper pneumatized sinuses.  It uses a proximal implant angled along the mesial part of the sinus, and another implant angled in an opposing direction along the distal wall of the sinus.  This technique too was adopted by Swedish implantology in the past few years.

Mini implants - Born at the end of the 70s, copied almost immediately by the Swedish School, that in this case adopted the concept of a single piece implant, but changed the grade of its titanium.

Single piece implants - Italian implants where single piece from the beginning, and all their techniques where developed around this feature.  When Nobel attempted to copy this one too, it encountered a real disaster, that triggered even a parliament summon in Sweden.  The Nobel Direct implant featured success percentages lower than 50%!!!!

Disparallelism - Another concept vehemently supported by Swedish implantology was the parallelism of implant bodies.  Decades have been necessary in this case too in order to "realize" that Italian disparallelism was more effective and less iatrogenic, but, most importantly, more suitable to support the load and to better adapt to bone morphologies.  This one too was adopted.

Platform switching - This was an attempt to imitate the reduced emergence of Italian School implants.  To be precise, Tramonte implants were applying platform switching before the term was invented.

Intraoral welding - This was the second last theft of Italian instruments and techniques by Swedish School implantology.  The intraoral welder has belonged to the Italian School since 1978, and caused ridicule and scorn coming from those who belong to the Swedish School and today parade it as a great invention.  

Long implants - The Swedish School always criticized our habit of using implants as long as possible, claiming that the part beyond a certain length was useless.  However, when they were forced to do immediate loading on few implants (all on four) they suddenly discovered that long implants are useful indeed.  Also, that bycortical placements, another guiding principle of the Italian School, are very useful.

Surface treatment - This is the last gem.  In 2010, under pressure from continuous market requests and client disapproval, I decided to adopt surface treatment, that I had always opposed.  As I was absolutely aware of its dangers and disadvantages, I decided to treat only the lower part of my implants.  And once more we have been the teachers: shortly afterwards Simion publicly denounced the damaging load of surface treatments, and on his implant he copied the treatment configuration I had designed six years ago.  Now everyone notice: the image I publish comes from an April advertising page of Doctor Os, that reproduces a Swedish School implant proudly featuring its Italian style reduced treatment!