Inside Dentistry, June 2012Reprint from:

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

GERALD A. NIZNICK (GN): The successof a broad range of implant designs, surfaces,and materials is now well established in thedental literature. What has changed,especially in the last decade, is that implantcompanies have segmented into threecategories in order to find their USP (uniqueselling proposition). Premium Priced Playersdifferentiate their products based on claimsof research and the support of paid opinionleaders. This research is designed to createsound bites for marketing, comparing acompany’s new and improved products totheir old ones without providing any clinicalstudies to show a significant improvement insuccess. Each new version is accompaniedwith a price increase, now reaching anaverage of about $350 to $450 per implant.Discount Priced Players sell on price alone,offering a limited range of implant designsand dimensions. These companies vary theirimplant prices and volume discounts basedon the market and the negotiating skills ofthe dentists. With an average list price of $100 to $150 and substantial discounts forvolume purchases, the dentists purchasing these products are prepared to acceptpossible compromises in quality, precision,packaging, and limitations in implant orabutment options in order to get what theyperceive as a bargain. Value Priced Playersis a segment of the market that ImplantDirect created in 2006. Implant Direct

targets the established Premium-pricedproduct lines with systems that offersurgical and prosthetic compatibility for anon-negotiable list price of $150 to $200. We provide added value with All-in-1Packaging that typically includes a coverscrew, healing collar, transfer, and either finalor temporary abutment. Quality and abroad line of products are essential forImplant Direct’s “Value Strategy” to succeed.This is made possible, even at relatively lowprices, by operating the industry’s only“lights-out” 24/7 manufacturing facilitiesthat can be viewed on five online cameras on our website. This strategy has forcedmany of the premium-priced companies toaggressively discount to volume purchasersto maintain their best customers.

(ID): You have been widely recognized andhonored for your contributions to the dentalimplant market. Which of these contributionsdo you think made the biggest impact onhow implant dentistry is practiced today?

(GN): The original Core-Vent (1982) two-stage implant had a hex hole into which avariety of application-specific prostheticabutments could be cemented. This was incontrast to the Brånemark implant which didnot come on the US market until a year laterwith only one multi-unit abutment foredentulous screw-retained bridges. Thatconcept of versatile prosthetic applicationscontributed to making implant dentistry partof conventional fixed prosthetics withcemented crowns and bridges. The internalhex connection (Niznick US Pat. #4,960,381)and all the screw-retained abutments that Ideveloped thereafter accomplished the sameprosthetic versatility while offeringretrievability. When these types of two-pieceabutments were developed for the externalhex implants, it became apparent that theinternal connection offered greater stabilityand esthetics. The industry was slow tochange over because the internal connectionwas patent-protected, whereas any companycould make an external hex. In 1999, I solvedthe problem of achieving high initial stabilityin soft bone with the development of a soft-bone/hard-bone surgical protocol, insertingthe newly designed tapered Screw-Vent inundersized sockets prepared with straightstep drills. Inserting a tapered implant into an

undersized socket createdwith a straight step drill ledthe way for immediate loading of implants.When dense bone was encountered, the sizeof the socket would be enlarged, eliminatingthe need for bone taps and allowing self-tapping insertion in both soft and densebone. In addition, I am especially proud of the5-year clinical study conducted at 32 Veteran’sAffairs centers that included 900 patientsreceiving over 2,800 implants. This was thelargest dental implant study conductedworldwide and special issues of Journal ofPeriodontology and Journal of Oral andMaxillofacial Surgery were dedicated topublishing the results, which addedsignificantly to dental implant knowledge.

(ID): You’ve built Implant Direct into aninternational company with hundreds ofemployees and distributors in more than 30 countries. How would you define yourapproach to launching and successfullyrunning a business?

(GN): Building and running a successfulbusiness in a relatively short time takesproduction capacity, an innovative productline, the right “go-to-market” strategy and adedicated team of knowledgeable people.After selling Core-Vent/Paragon ImplantCompany to what is now Zimmer Dental in2001, I retired for a few years. In 2004,Zimmer chose not to renew the lease on my Los Angeles factory and moved theirmanufacturing closer to their corporateheadquarters near San Diego. This presentedan opportunity to re-occupy the factory I hadbuilt in 1994 for producing implants and re-hire 80 of Zimmer’s top machinists and QA specialists, many of whom had workedfor me for years before the sale to Zimmer. In the next 3 years, my team developed thelights-out manufacturing processes thatassured efficiency and quality. Together with my design engineering team, Ideveloped the Spectra-System® of six 1 and2-piece implants, all with the same body and,therefore, surgical protocol, but with differentplatforms and packaging for different clinicalapplications. This created the industry’s firstapplication-specific implant system witheach implant appropriately priced at$150— low enough that the premium-priced implant companies could not

An Interview with Implant Direct Gerald A. Niznick, DMD, MSD, President and CEO

priced implant companies could notroutinely discount to match that price. Thisformula of offering innovations, quality, andvalue was just what the industry was waitingfor and the 2008 economic recession madethe need for “appropriate” priced implantseven more compelling. To keep the sellingexpenses low, I focused on the internet foreducation and sales. Demand grew globallyfor the products and, today, Implant Directhas almost 150 people in North Americaproviding sales, customer service, andtechnical support. We opened an office inZurich to support our direct sales forces inGermany 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 ofprosthodontics for 14 years before startingmy implant business in 1982. Throughout the 1970s, I used the implants available atthat time to help my patients. The Core-Ventwas developed primarily to function free-standing to stabilize a lower overdenture. I published the first article showing theefficacy of this application, which has nowbecome the minimum standard of care bythe American College of Prosthodontists. Myinventions were needed to implement mytreatment philosophies of simplicity,versatility, and economy. I needed to becomean educator and entrepreneur to have thefinancial resources to see my inventions, nownumbering 35 US Patents, become clinicalrealities and to advance the field of implantdentistry. There is an invaluable symbiosisbetween these roles and I would not choose to separate them even if I could.

(ID): When you’re not inventing an implantproduct, you’re flying an airplane. Whatlessons 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 becommitted to education and you need to beextremely focused. I acquired a commercial,multi-engine, instrument rating with typeratings in two jets. Flying a plane is likeplaying the ultimate video game with all theavionics now available in the glass cockpits.You’re going at 500 miles an hour, monitoringall sorts of electronics on the control panel.You have to be aware of everything that’s

going on around you. It definitely sharpenedmy abilities to multitask and respond quickly.

(ID): Implant companies continue to facesome challenges with the economy. Haveyou done anything differently over the lastfew years to better position Implant Directfor growth? Did the recession alter yourbusiness model?

(GN): The recession has only further proventhe Implant Direct business model. Patientsneed and deserve affordable implant care.While other implant companies may becontracting, we are consistently expandingnot only with personnel but with newfacilities. We just underwent an expansion of our manufacturing capacity by adding18,000 square feet that provide room for 28machines in addition to the 40 we alreadyhad operating 24/7. We also have a newstate-of-the-art educational center in LasVegas with computers at each desk forimage-guided surgical training,models/mannequins for hands-ontraining, 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 Specialtieshas created many new and excitingopportunities. We merged Implant Directwith Attachments International, a SybronCompany, and absorbed the sales force and distribution responsibilities for SybronImplant Solutions primarily keeping theirbiologics products. Danaher owns such well-known brands as KaVo, Kerr, ImageSciences, Sybron, and Pelton & Crane, and we plan to integrate our efforts with ourDanaher and Sybron Dental Specialties sistercompanies to bring full digital solutions forimplant dentistry. I remain Implant Direct’spresident and CEO. I have been able tobroaden 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 implantsystem, the InterActive™. This system willprovide prosthetic compatibility withNobelActive™ and the NobelReplace™conical connection plus surgical compatibilitywith Legacy™, Zimmer Dental TaperedScrew-Vent®, and NobelReplace drills. Itoffers the first implant with both micro-grooves and micro-threads plus uniquepackaging that provides a patented coverscrew/healing collar assembly and a newtwo-piece (patent pending) fixture-mountthat can be modified for use as an abutmentand serves as a transfer that provides theaccuracy of an open-tray impression withthe 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 abutmentsby the end of this year. Our pricing for theseancillary services will be commensurate withour value-added philosophy, making ImplantDirect a full service company.

(ID): If you could look into the future, whatwould your prediction be for dentalimplantology in the next 10 years?

(GN): My predictions 30 years ago, thatimplants would become an integral part ofconventional dentistry, have come to pass.My gamble in 2004, with the start of ImplantDirect, that dentists would look beyond themarketing hype of the premium-pricedproducts and place a greater appreciation onvalue, has paid off for me as an entrepreneur.It will also continue to pay off for dentistswho take the time to learn what is importantfor implant success and trust in their owngood judgment. The day is fast approachingwhen patients, missing some or all theirteeth, or needing an extraction, will seekout dentists capable of replacing the missingteeth with implants. While implants havebecome a major part of every oral surgeryand periodontal practice, every generaldentist removing a tooth should have theknowledge and confidence to eitherimmediately place an implant into a resizedsocket or have the skills to perform the sitepreparation procedures needed to preservebone for future implant placement. Gooddentistry, as well as the patients, demandssuch services in ever-increasing number.Implant Direct’s goal has been, and continuesto be, to make that option accessible andaffordable to a greater number of patientswithout any compromise in the quality orlongevity of the treatment.