The Internal Conical FIVE TiSmart is Leader Medica’s premier subcrestal bone-level dental implant, engineered in Italy specifically for subcrestal placement at a calibrated depth of 0.5–0.8 mm. Merging an authentic 22° internal conical connection, internal hex indexing, and constant platform switching, FIVE TiSmart delivers unmatched biological sealing, hard tissue preservation, and enduring pink esthetics in challenging clinical scenarios.

1. Biomechanical Principles & 22° Conical Connection

22° Internal Conical Connection: The calibrated 22° taper provides optimal friction locking, dispersing peak axial and lateral masticatory shear forces evenly along the implant body and eliminating dynamic bending fatigue on the retaining screw.
Internal Hex Indexing: Six-position hex index facilitates rapid, tactile abutment orientation and absolute rotational security for single-unit and multi-unit restorations.
Constant Platform Switching (0.3 mm to 1.1 mm): The internal connection dimensions remain uniform across all implant body diameters (Ø 3.3, 3.8, 4.25, 4.75, 5.5 mm). This yields an inherent platform shift ranging from 0.3 mm up to 1.1 mm, relocating the micro-gap away from the crestal bone margin and preserving the peri-implant biological width.

2. Coronal Morphology & Macro Geometry

0.5 mm Machined Coronal Collar: High-precision micro-machined collar resists plaque adhesion and biofilm formation while preventing inflammatory cell infiltration at the bone crest.
Cortical Microthreading: Constant-pitch micro-threads along the cervical section relieve peak shear stresses in dense cortical bone, eliminating the circumferential crestal bone saucerization common in straight implants.
Hybrid Cylindrical-Tapered Architecture: The coronal two-thirds maintain a cylindrical profile for maximum bone guidance and cortical engagement, transitioning into a tapered truncated cone apically to condense cancellous bone and guarantee high primary stability.
TiSmart Active Thread Dynamics: The TiSmart thread design features active, progressive cutting flutes that easily engage soft bone (D3/D4), achieving the optimal insertion torque necessary for immediate loading protocols.

3. Biomaterial & DAS® Bioactive Surface Technology

High-Purity Medical Grade 4 Titanium: Superior mechanical tensile strength combined with full European CE Class IIb certified biocompatibility.
Alumina-Free Dual Acid Etching (DAS®): Pure subtractive dual-acid treatment with hydrofluoric acid followed by hydrochloric/sulfuric acid ( = 1.35,mu ext{m}$), entirely free of residual sandblasting corundum debris.
Argon-Oxygen Cold Plasma Glow-Discharge: Decontaminated using cold glow-discharge plasma developed with Prof. Luigi Canullo, removing 100% of organic hydrocarbons and imparting superhydrophilic wettability for rapid osseointegration.

4. Step-by-Step Surgical Protocol & Drilling Sequence

Site Preparation: Initial cortical marking using a round bur, followed by a Ø 2.0 mm pilot drill at 800–1000 rpm with copious external chilled saline irrigation.
Sequential Osteotomy: Incremental drills corresponding to the selected diameter (600–800 rpm).
Dense Bone Protocol: In dense cortical bone (D1/D2), a crestal cortical bone tap should be utilized at 15–20 rpm to prevent excessive insertion friction.
Subcrestal Depth Positioning: The surgical protocol mandates subcrestal positioning at 0.5 to 0.8 mm below the bone crest to maximize biological width preservation.
Insertion Torque: 35 to 45 Ncm insertion torque at 15–25 rpm via surgical handpiece or manual torque ratchet, ensuring primary stability for immediate loading.

5. Prosthetic Portfolio & Restorative Workflows

Anatomic Healing Abutments: Heights of 2, 3, 4, and 5 mm in cylindrical and wide anatomical emergence profiles.
Straight & Angled (15°/25°) Abutments: Precision-milled Grade 5 titanium with variable scalloped gingival margins for custom esthetic adaptations.
Multi-Unit Abutment (MUA) System: Straight and 17°/30° angled MUAs for screw-retained bridges, hybrid prostheses, and full-arch immediate restorations.
Digital CAD/CAM Solutions: High-precision titanium/PEEK scan bodies compatible with Exocad and 3Shape, coupled with titanium bonding bases (Ti-Bases) in variable collar heights.

6. Primary Clinical Indications

High-esthetic maxillary anterior restorations with thin gingival biotypes and high smile lines.
Subcrestal protocols requiring long-term marginal bone crest preservation and zero collar exposure.
Immediate post-extraction placement (Type 1) coupled with immediate provisionalization.
Full-arch screw-retained restorations utilizing Multi-Unit Abutments.

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