Three names dominate any serious conversation about dental implants in Europe: Straumann, the Swiss incumbent; Nobel Biocare, the Swedish pioneer of full-arch protocols; and MIS, the Israeli manufacturer that has captured a large slice of the mid-market. Most clinics use at least one of these three. Some use all three, and choose per case.
The question patients ask us most often is not “which brand is best” (the honest answer is that all three work), but “which one fits my case, and what does the price difference actually buy me?” This guide answers both, using published clinical data and twelve years of clinical observation at our clinic.
The three systems at a glance
| Feature | Straumann | Nobel Biocare | MIS |
|---|---|---|---|
| Country of origin | Switzerland | Sweden / Switzerland | Israel |
| Founded | 1954 | 1981 (Brånemark) | 1995 |
| 10-year survival (published) | 98.2% (1,692-implant study) | 98.8% prosthetic (Malo 471-patient cohort, All-on-4) | ~96.8% (Israeli registry cohort) |
| Typical strength | Single implants, premium cases, bone-grafted sites | Full-arch immediate load (All-on-4, All-on-6) | Straightforward single and multi-implant cases |
| Price tier | Premium | Premium | Mid-market |
| Signature technology | SLActive / SLA surface | All-on-4 protocol, TiUnite surface | V3 / SEVEN body designs |
Straumann: the clinical standard-setter
Straumann is the implant system with the deepest independent clinical data. The most-cited long-term study followed 1,692 Straumann tissue-level implants placed in general practice and reported a 10-year survival rate of 98.2 percent (published in Clinical Implant Dentistry and Related Research, 2018). A separate randomised controlled trial published in 2023 reported a 100 percent survival rate for Straumann implants at 10 years, though in a smaller cohort.
The technical innovation Straumann is best known for is the SLA (sandblasted, large-grit, acid-etched) surface and its successor SLActive. These surface treatments increase the area of bone-to-implant contact during the first weeks of healing, which shortens integration time and improves outcomes in patients with compromised bone quality. In practice this means a patient with osteoporosis or borderline bone density has a noticeably better prognosis with a Straumann SLActive implant than with an older untreated surface.
Where we choose Straumann at Empire: single-implant cases in the aesthetic zone, patients with osteoporosis or type 2 diabetes, any case that involves a simultaneous bone graft, and patients who explicitly want the longest-documented implant track record.
Nobel Biocare: the All-on-4 pioneer
Nobel Biocare traces its history to Professor Per-Ingvar Brånemark, the Swedish orthopaedic surgeon who discovered osseointegration in 1952 and placed the first modern dental implant in a patient in 1965. Nobel Biocare as a company was founded in 1981 to commercialise Brånemark’s work, and the brand has remained at the clinical frontier ever since.
The system’s most important contribution to modern dentistry is the All-on-4 protocol, developed by Dr. Paulo Malo in Lisbon starting in the early 1990s and commercially launched by Nobel Biocare in 2004. The insight was that a full edentulous arch could be rehabilitated on just four implants (two vertical in the front, two tilted posteriorly) rather than six or more, often without bone grafting. Dr. Malo’s own prospective study on 471 patients reported a cumulative prosthetic survival rate of 98.8 percent. More than 250,000 patients worldwide have now been treated with the protocol, according to Nobel Biocare’s clinical documentation.
Where we choose Nobel Biocare at Empire: any full-arch case (All-on-4, All-on-6, All-on-8), any patient who would otherwise need extensive bone grafting before implant placement, and same-day immediate-load cases where the surgical guide is critical.
MIS: the mid-market option with real data
MIS (Medical Implant System) was founded in Shlomi, Israel in 1995 and is now one of the most-placed implant brands in Israel and a meaningful share of the German, UK, and southern European markets. The brand’s positioning is practical: high-quality manufacturing at a price point well below Straumann or Nobel Biocare, targeted at straightforward cases where the premium-brand surface treatments are not critical.
Independent clinical data on MIS is less extensive than the two premium brands, but a 2024 registry study of 158,824 implants placed at Maccabi Dent clinics in Israel between 2014 and 2022 (the majority of which were MIS) reported an overall failure rate of 2.21 percent, with an early-failure rate of 1.56 percent during the osseointegration phase. These numbers are in the same ballpark as top-tier brands, though the follow-up period is shorter than the 10-year Straumann cohorts.
Where we choose MIS at Empire: straightforward single-implant cases with good bone quality, patients on a constrained budget who want a branded, traceable system rather than a no-name import, and multi-implant cases in healthy younger patients where a mid-market system is clinically appropriate.
How to choose the right system for your case
A good dentist does not pick a brand before seeing the case. These are the five factors that determine which system fits which patient.
Bone quality and quantity
A CBCT scan shows how much healthy bone surrounds the planned implant site. When the bone is dense and plentiful, any of the three systems performs well. When the bone is compromised (osteoporosis, grafted sites, post-extraction sockets without adequate healing), a Straumann SLActive surface or a Nobel Biocare TiUnite surface outperforms untreated systems in the first critical weeks of integration.
Case complexity and load
Single implants in good bone are well-served by any of the three brands. Full-arch immediate-load cases (teeth fitted the same day) favour Nobel Biocare because the All-on-4 protocol was developed for exactly this scenario and has the deepest clinical documentation for it. Implants placed into grafted sinus-lift sites favour Straumann because of the surface biology.
Aesthetic zone considerations
Front teeth demand both clinical success and invisible-to-the-eye emergence profiles. Straumann and Nobel Biocare both produce soft-tissue-friendly abutments with proven aesthetic outcomes. MIS produces good aesthetic abutments but with less documented long-term soft-tissue stability.
Medical conditions and medications
Patients on bisphosphonates, patients with uncontrolled diabetes, patients with autoimmune conditions, and heavy smokers all have modified implant risk profiles. In these cases, the surface chemistry of a top-tier system can be the difference between integration and failure.
Budget, honestly
A Straumann or Nobel Biocare single-implant restoration will cost roughly 20 to 30 percent more than the equivalent case with a mid-market brand like MIS. For a single tooth this is a small premium relative to the total cost of dentistry. For a full-mouth rehabilitation involving twelve implants, the cumulative difference can be meaningful, and a mix (Straumann where it matters, MIS where it is clinically appropriate) can be a sensible middle path. A serious dentist will discuss this tradeoff openly rather than defaulting to the most expensive option.
What we use at Empire, and how we decide
We stock all three systems and use them routinely. For any new case the decision happens after the CBCT scan, not before. The factors above drive it: bone quality first, case complexity second, aesthetic zone third, medical history fourth, budget last.
The dentist who sees your case (Dr. Gersi Vercani for most implant work at Empire) recommends a specific brand and line with a written explanation of why. You have the final say. If you want a premium brand for peace of mind even where a mid-market one would do clinically, we accommodate that. If you want the most cost-effective option your case allows, we accommodate that too. What we do not do is quietly substitute a cheaper brand for a premium one after you have paid for the premium.
Every implant we place ships with a serial number, which we hand you on paper at the end of treatment. You can verify authenticity directly with the manufacturer. Ask any clinic you are considering whether they can do the same.
Want our honest recommendation for your case?
Send us a photo of your smile and, if you have one, a panoramic X-ray from your home dentist. Dr. Gersi will review it and reply within 24 hours with a written recommendation including the specific implant brand and line we would use, with reasons. No obligation, no pressure.
Frequently asked questions
Are premium implants actually worth the extra cost?+
For most patients, yes. The difference between a top-tier implant (Straumann, Nobel Biocare) and a budget implant is roughly 20 to 30 percent of the total treatment cost, but the difference in documented 10-year survival data is meaningful. Top-tier brands publish survival rates of 98 percent or higher across cohorts of thousands of patients. Budget brands often rely on surface modifications of older systems with limited independent data. For a single implant, the extra cost is small relative to the cost of redoing failed work.
What is the difference between Straumann and Nobel Biocare?+
Both are top-tier Swiss/Swedish implant systems with excellent clinical data. The differences are mostly technical. Straumann pioneered the SLA (sandblasted, large-grit, acid-etched) surface treatment that accelerates bone integration and is used in roughly 70 percent of Straumann implants placed today. Nobel Biocare invented the All-on-4 protocol for full-arch restoration on tilted implants and has the deepest clinical documentation for that specific approach. In single-implant cases both perform similarly. In full-arch immediate-load cases Nobel Biocare tends to be the default choice.
Are MIS implants a good choice?+
MIS (Medical Implant System) is an Israeli manufacturer that produces implants at a lower price point than Straumann or Nobel Biocare. Published clinical data is more limited than the two premium brands, but a Maccabi Dent registry study covering 158,824 implants (mostly MIS) in Israel between 2014 and 2022 showed a 2.21 percent failure rate across all procedures. MIS is a reasonable option for straightforward cases where the patient's budget is a constraint, and it is used routinely in Israel, the UK, and Germany.
Can the dentist use the brand my insurance requires?+
Sometimes. If you need documentation for Italian, German, or UK insurance reimbursement, ask the clinic to confirm the brand and specific implant line before treatment. At Empire we can work with Straumann, Nobel Biocare, Nobel Replace, or MIS depending on what your insurance requires. We hand you the serial number of every implant placed so you can verify authenticity and file claims correctly.
How do I verify my implant is genuine?+
Every Straumann, Nobel Biocare, and MIS implant ships with a unique serial or batch number. At the end of your treatment we give you a document listing the brand, the product line, the serial number of each implant, and the date of placement. You can verify authenticity directly with the manufacturer if you ever need to. A clinic that cannot produce a serial number is using either a counterfeit or an unbranded implant marketed as a premium one.