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Root Implant Analog (RIA): Concepts, Benefits and Scientific Evidence

The Root Analog Implant (RIA) is an innovative approach in implant dentistry that aims to replicate the anatomy of the natural tooth root. Unlike conventional implants with a standardized shape, IARs are customized to fit precisely into the patient’s dental socket immediately after tooth extraction.

This technique seeks a replacement that is more biologically compatible with the original anatomy, while at the same time seeking efficient osseointegration and adequate aesthetics, providing a more natural solution for tooth replacement, says Dr. ROBERTO MARKARIAN, a specialist in implant dentistry.

Introduction: What is the Root Analog Implant (RAI)?

The Root Analog Implant (RAI) concept is well documented and refers to customized implants that mimic the shape of the natural tooth root. These implants are designed to be placed immediately after tooth extraction, using technologies such as cone-beam computed tomography (CBCT) and CAD/CAM to create accurate three-dimensional models of the root of the tooth to be replaced.[1-6] The concept of the Root Analog Implant (RIA) is well documented.

Principles and Fundamentals of Root Analog Implants (RAI)

The main feature of IARs is their ability to faithfully imitate the shape and size of the original tooth root. This customization is possible thanks to the use of advanced technologies such as cone beam computed tomography (CBCT) and CAD/CAM systems, which allow for the creation of tailor-made implants. The preferred material for manufacturing these implants is zirconia, due to its high biocompatibility and superior mechanical properties, however IAR implants can be manufactured using printing techniques for biocompatible metals such as titanium.

custom implant roor analog implant
Example of a custom implant manufactured by Metal Printing (Titanium)Source: Mangano et al 2012 [9]

Differentiating the Customized Implant Root Analog (IAR) from Conventional Implants

  • Shape: Conventional implants have a standardized shape, while IAR implants have a more anatomical design.
  • Load distribution: Root Analog Implants (RAI) seek to minimize the stress on the bone caused by the threads of common implants and better distribute the masticatory force along the alveolar bone.
  • Adaptation to existing bone: The use of IAR can reduce the need for bone grafts, as the implant adapts better to the local anatomy.

Advantages of Root Analog Implants (RAI)

Root-like implants aim to improve aesthetics and functionality while minimizing bone removal and trauma during implant placement. Studies indicate that these implants can offer acceptable clinical results, although the survival rate may vary depending on the material and manufacturing technique used.[1][4] In addition, the biomechanics of root analog implants show promising behavior in dissipating masticatory load, compared to conventional implants.[5]

IARs offer several advantages over conventional implants:

  • Perfect fit: Because they are customized, they fit exactly into the dental socket, eliminating the need for additional drilling or bone grafts.
  • Superior aesthetics: Zirconia has a color similar to that of the natural tooth, avoiding the gray discoloration that can occur with titanium implants.
  • Less Invasive Procedure: Immediate placement after extraction reduces the need for additional surgery and speeds up recovery time.
  • Lower risk of peri-implantitis: The absence of threads and the smooth surface of IARs reduce the accumulation of bacterial plaque, reducing the risk of peri-implant infections.
root analog implant
Example of clinical application of IAR. Above, the fractured tooth that was removed. Below, on the left, a comparison of the implant produced with a conventional implant. On the right, the IAR installed in the patient. Source: Pirker et al 2011 [8]

Materials and Technology in Root Analog Implants (RAI)

The Root Analog Implant (RAI) has benefited from advances in digital technologies, including:

  • CAD/CAM (Computer Aided Design and Manufacturing): Allows customized implants to be created based on the patient’s anatomy.
  • Cone Beam Computed Tomography: Ensures more precise planning, allowing the implant to be inserted in more favorable regions.
  • Advanced Materials: Zirconia has been explored as an alternative to titanium in the manufacture of these implants, due to its high biocompatibility.

Clinical Indications for a Root Analog Implant (RAI)

The Root Implant Analog (RIA) is recommended for:

  • Patients who need greater primary stability.
  • Cases where the preservation of cortical bone is essential.
  • Regions with limited bone where the use of conventional implants would require grafting.

IAR implants are particularly suitable for patients looking for less invasive treatments with shorter recovery times.

According to Dr. Roberto, the lower invasiveness is due to the fact that no additional drilling is required to place the anatomical implants. Common implants require drilling into the bone to place the implant, which is screwed in. However, IAR anatomical implants adapt perfectly to the hole that is left after tooth extraction (dental alveolus).

During this installation, the implant is placed under pressure inside this hole, without requiring any additional bone wear. In this way, it will adapt perfectly to the anatomical hole, closely resembling the shape of the old tooth.

IAR root analog implant
3D design of the root analogue implant. Sup L: Root shape extracted from CT scan. Sup R: Design of the IAR implant. Lower: Finalized design for production of the customized implant. Source: Al Moziek et al [7]

Scientific Evidence on Customized Implant Root Analogues (IAR)

Recent clinical studies show that IAR implants have a similar or higher success rate than conventional implants. A meta-analysis published in the Journal of Oral Implantology indicated that:

IAR implants are especially recommended for patients looking for less invasive treatments and shorter recovery times.

Our Clinical Director, Dr. Markarian, points out that the application of digital scanning techniques in the manufacture of prostheses on IAR implants can improve the precision of prosthetic adaptation and reduce biomechanical complications.

IAR root analog implant
This historical follow-up of the evolution of IAR root analogue implants was published in a scientific article by Pour et al 2019 [10]. We can see that experiments were carried out with a variety of formats, materials and manufacturing techniques.

Conclusion: The Future of Root Analog Implants (RAI)

Root Analog Implants (RAI) represent a promising and scientifically supported approach to modern implant dentistry. With the use of advanced technologies and a more anatomical design, this technique is proving to be a viable alternative for improving the distribution of masticatory forces, reducing peri-implant bone loss and increasing the long-term success rate.

It is important to note that, despite the potential advantages, the root-like implant technique still requires more long-term clinical studies to evaluate its effectiveness and success compared to traditional implants.[2][6] The technique is also used to evaluate the efficacy and success of root-like implants.

Therefore, these anatomical implants are not available for use in most countries, including Brazil. At our ImplArt Clinic we are always on the lookout for new developments and as soon as they are regulated in Brazil we will start using them. Stay tuned!

Written by: Dr. ROBERTO MARKARIAN. Master’s and Doctorate in Dentistry. Technical manager of the ImplArt Clinic.

References

1.Custom-Made Root Analog Immediate Dental Implants: A Prospective Clinical Study With 1-Year Follow-Up. Akkoyun EF, Demirbaş AE, Gümüş HÖ, Alkan BA, Alkan A. The International Journal of Oral & Maxillofacial Implants. 2022 Nov-Dec;37(6):1223-1231. doi:10.11607/jomi.7198.

2. Immediate Nonsubmerged Custom Root Analog Implants: A Prospective Pilot Clinical Study. Moin DA, Hassan B, Wismeijer D. The International Journal of Oral & Maxillofacial Implants. 2018 Mar/Apr;33(2):e37-e44. doi:10.11607/jomi.6048.

3. Innovative Single-Tooth Replacement With an Individual Root-Analog Hybrid Implant in the Esthetic Zone: Case Report. Saeidi Pour R, Randelzhofer P, Edelhoff D, et al. The International Journal of Oral & Maxillofacial Implants. 2017 May/Jun;32(3):e153-e160. doi:10.11607/jomi.5562.

4.Root-Analogue Implants Compared to Forced Orthodontic Extrusion: A Retrospective Analysis of Clinical, Radiological and Esthetic Outcomes After Restoration. Böse MWH, Beuer F, Naumann M, et al. Clinical Oral Investigations. 2023;27(10):5875-5886. doi:10.1007/s00784-023-05198-6.

5.Dental Biomechanics of Root-Analog Implants in Different Bone Types.Tribst JPM, Dal Piva AMO, Blom EJ, Kleverlaan CJ, Feilzer AJ.The Journal of Prosthetic Dentistry. 2024;131(5):905-915. doi:10.1016/j.prosdent.2022.10.005.

6.Accuracy of Preemptively Constructed, Cone Beam CT-, and CAD/CAM Technology-Based, Individual Root Analogue Implant Technique: An in Vitro Pilot Investigation. Moin DA, Hassan B, Parsa A, Mercelis P, Wismeijer D.Clinical Oral Implants Research. 2014;25(5):598-602. doi:10.1111/clr.12104.

7. Al Moziek et al Success and survival rates of immediate anatomic zirconia implants: a prospective clinical and radiographic evaluation. Braz J Oral Sci. 2023;22:e239183.

8. Pirker et al 2011 Immediate, single stage, truly anatomic zirconia implant in lower molar replacement: A case report with 2.5 years follow-up. IJOMI 2011 40(2) 212-216.

9. Mangano et al 2012. Custom-made, root-analogue direct laser metal forming implant:a case report. Lasers Med Sci.DOI 10.1007/s10103-012-1134-z.

10. Pour et at 2019. Historical development of root analogue implants: a review of published papers. British Journal of Oral and Maxillofacial Surgery. DOI: 10.1016/j.bjoms.2019.01.021

The title image was adapted from : https://en.wikipedia.org/wiki/Root_analogue_dental_implant

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