Part 4- A summary of the AQB implant system
Chapter 1 Concepts behind the AQB implant system
AQB Implant Team of Development and Clinical Research
I. Developmental history and its concepts (Fig. 4-1-1)
At the end of the 1980s when development of the AQB implant started, a significant number of dental
implants were being developed and the concept of dental implants was becoming well-known in oursociety. The implants that were then under development, as well as those already on the market, weretypically the two-piece type that required surgery twice (the two-stage method). The popularity of thistype was due to the belief, from past experience (failed examples), that the implant should be buried in
the gingiva until interaction with bone had been fully established.
The technical advances around this time must not be forgotten. Titanium metal that had been considered
impossible to sculpt had become manageable with the development of precision instruments. This allowed
small titanium implants to be cut with extreme precision, producing extremely precise screw fitting,thereby reducing episodes of loosening or breaking of screws.
Two-piece, two-stage implants were adopted into dental implant practice because manufacturers followed
the successful examples presented by past experience. However, from the patient's point of view, animplant treatment that is painless and feels like a natural tooth would be ideal. With two-piece, two-stageimplants, a second operation is required after implantation into the jaw bone, which can impose added
stress on the patient. A period of six months is required after the initial implantation before the second
operation can take place; therefore, rapid functional recovery cannot be expected. Considering the burdenof stress felt by the patient, the best treatment option would be one that reduces the treatment period.
Using two-piece, two-stage implants, this criterion could not be met. The aim of developing the AQP
implant therefore became a one-piece implant that only required one episode of surgery (a one-stagetype).
The idea of a one-piece, one-stage type was not viewed with enthusiasm at this time due to theentrenched negative perception built from the accumulation of failed examples in the past. The majorityof failed examples were one-piece (blade-type and cylinder-type) and the reason for disappointment was
the high risk of infection due to exposure of the abutment within the gingiva. Furthermore, this was theperiod where the use of a one-stage surgical approach, and HA coating of the implant were not accepted.
Therefore, research and development of the AQB implant can be said to have taken place against the flowof the general consensus.

A. Development of one-piece implant (Fig. 4-1-2)
The components of AQB implants were improved in several ways. In order to accelerate the speed ofadhesion to the jaw bone, the fixture part of the implant was coated with hydroxyapatite. The purity ofhydroxyapatite was improved with the development of a technique that allowed excellent
biocompatibility with the jaw bone (hydro-thermal treatment).
The fixture, the part of the implant that is inserted into the jaw, takes the form of a cylinder. In contrast
to the self-tapping screw-type that was the standard, the screw of the AQB implant lacks a blade that1

1981

Started basic research anddevelopmentNovember
1988

The first trial wasconducted

November
1990

The second trialwas conducted(Joint development by the Institute of
medical and dental engineering of theTokyo Medical and Dental University, andADVANCE CO., LTD)
Department of Dentistry, Oral and Maxillofacial
Surgery, Mitsui Memorial Hospital
Department of Dentistry, Oral and Maxillofacial
Surgery, Mitsui Memorial Hospital / Second Oral
Surgery, The Nippon Dental University Hospital

December
1992

Completed clinical trial. Submitted the application for
manufacturing approval.

June
1994

Obtained approval from the Ministry of Healthand Welfare (Current Ministry of Health, Labourand Welfare) and launched AQB one piece type

August1994

Started AQB implant system workshop

November
1998
April 2002

Launched AQB T type implant
Started Japanese society for Advanced
Implant Medicine (AIM)Dr. Yasunobu Uchida: firstpresident and professor emeritus
at Tokyo Medical University

Started IAIworkshop

Launched AQB two piece typeimplant

August2007
January2008

Dr. Hiroshige Chiba : President of AIM and head of oral andmaxillofacial surgery at Tokyo Medical and Dental UniversityFig. 4-1-1
The timeline of AQB Implant systemcuts into the bone. The purpose of the screw on the AQB fixture is to ease the insertion process by rotating
the implant to attain driving force. The AQB implant does not impose additional pressure on the bone,but instead, the concept is to merely to place it into the drilled hole, where a rapid and secure interaction
with the bone takes place due to the high adsorption ability of the re-crystallized hydroxyapatite coating.
The AQB implant was first placed on the market in 1994 after being approved by the Ministry of Health.
Clinical trials were completed in Mitsui Memorial Hospital and The Nippon Dental University Hospital.
Reduce the risk ofperiodontitis
Hydrothermal treatment(Treatment to improvebiocompatibility)
Excel in biocompatibility
with gingiva, has highsealing performance, andcontributes to the stable
convalescence
PatentEnhance stability
Spiral Cylinder form
Even though fixture is the screw
form, this does not cut bone.
Rotate implant to obtainpropulsion power

Shorten treatment
time by earlyosseointegration
Recrystallized HA coating
Excel in osteoconduction ,and
many cases have reported that
only one months was taken
until osseointegration

PatentExpand indication bysimple surgicalprocedure
Implantation itself is simple,
therefore this implant is able toapply effectively to difficult
cases which require difficult
techniquesFig. 4-1-2
Properties of AQB one-piece type implant2One piece type isenough (17%)

Fig. 4-1-3

Strongly desired(23%)

The chart illustrating the views of theusers for the necessity of two-piece typeimplants, 2001 survey.

Investigator :ADVANCE Co., ltd
Period of survey :2001
Research object : Dentist of AQB users
Target number:n = 228

Desired(60%)

B. Development of two piece implant
The properties that make the one-piece type superior are its simplicity and its mechanical strength,
however, with regards to aesthetic recovery, it cannot surpass the two-piece type. With a two-piece type,several options exist with an abutment that allows angling or the formation of a superstructure fromwithin the gingivae, providing a natural appearance. Unlike the two-stage type, the abutment of theone-piece type is exposed intra-orally after implantation, therefore its superstructure is fixed in thedirection of initial insertion.
The AQB implant team conducted a survey to investigate consumer demand for a two-piece type (Fig.
4-1-3). This showed that 83% of users felt the need for a two-piece type. A two-piece AQB implant wasdeveloped to meet this demand. The research and development of the two-piece AQB used the results ofanalysis of the advantages and disadvantages of previous two-piece types, to overcome problems that
included loosening of the screw and breaking, and resulted in manufacture of fixtures and abutmentswith improved contact (Fig. 4-1-4). The main problems encountered with the two-piece type included
loosening of the contact between the fixture and the abutment, and risk of breakage. Intending todistribute the applied stress, a new bolting mechanism, the SOL system, was developed (described in
more detail later on in this chapter). An octahedral shape without any edges was sculpted, in an attempt
to disperse grinding pressure and therefore reduce the risk of breakage. The tools used for implantation
were made to be the same as those used for the one-piece type, with some exceptions, to allow dental
practitioners to readily incorporate both one- and two-piece types into their practice. The two-piece typealso has a re-crystallized hydroxyapatite coating on the surface of the fixture, allowing the implant toadsorb more efficiently than those already on the market.

C. Development of a one-piece T type
In addition to the one-piece type, the AQB one-piece, one-stage T-type joined the lineup in 2007 (Fig.
4-1-4), with a tapered abutment design. The T-type was developed to protect the implant from subsidenceand aberration into the maxillary sinus after a sinus lift or socket lift procedure. Its diameter is larger
than the normal one-piece one-stage type by roughly 0.4 mm; it is thus possible to thicken the cervix ofthe superstructure, thereby improving the initial stability.
3

Fig. 4-1-4
The product line-up of AQB Implants

D. QOL improvement as the main objective, and implementing “Simple is best”
The development of the AQB has been founded upon the idea of QOL improvement not only for patients,
but also for dental surgeons. The AQB implant system started with the one-piece type, which was an
outcast at the start of its distribution, soon followed by the two-piece and T-type, in response to consumer
demand. The concept, “simple is best” has been sustained throughout the various series since the initialdevelopment stages. Methods that allow rapid recovery, such as immediate placement in which theimplant is placed immediately after tooth extraction, and immediate loading, are starting to be noticed. It
can be said that the AQB implant suits our age.

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