Nobel Biocare NEWS Information for the Osseointegration Specialist Issue 3/2017

In this Issue

3 A patient’s perspective The All-on-4® treatment concept made a world of difference for Silviana Ribeiro: “Both a reason and the means to smile once more.”

5-7 Trefoil is here! The next full-arch revolution has arrived, backed by science and delivered by a name you can trust. Bringing Joy to the People We Serve Nobel Biocare does it again, addressing an unmet need with a life-changing innovation.

According to Brånemark, all the and of itself. Because this titanium bar tanium bar with 1) a simplified restor- 8 Question & Answers First came Brånemark System things that we talked about in that facilitates the production of a defini- ative workflow, 2) a fixed and defini- Speaking with Nobel full-arch prostheses. Then conversation—smiling, speaking and tive acrylic prosthesis, it saves time for tive acrylic prosthesis and 3) fewer Biocare News, Dr. Glen came implant supported eating with confidence—are all social both the clinician and the technician. restorative components. Liddelow addresses one overdentures and zygomatic activities at their core. Today the den- Depending on individual clinical of the key breakthroughs solutions for the maxilla. The patient’s point-of-view of the Trefoil treatment: Procera prosthetic bridges When patients discover that the Tre- efficiency. revolutionized the esthetics of “When you provide a toothless person with a new, foil system may resolve the social this burgeoning field, and the bone-anchored dentition, you are ... first and fore- and physiological issues they have All-on-4® treatment concept most ... restoring the patient’s dignity.” been facing as denture wearers—and was soon to follow, ushering — Professor Per-Ingvar Brånemark can provide a fixed and definitive implant-based therapy into prosthesis in short order—they are the twenty-first century. Each often profoundly impressed.* of these was a groundbreak- tal community agrees. You may be preferences—and contingent upon Nancy Rojo, a patient who was one ing advance in the struggle to able to survive without teeth, but you close collaboration with the lab—Tre- of the first to be treated with Trefoil in tame edentulism. Nobel are not going to be able to live well. foil is such an efficient solution that it Chile—as part of a five-year multi-cen- Biocare is now taking the next can make Immediate Function rou- ter study—puts it this way: “With my step forward. Trefoil redefines efficiency tine, as it makes fixed and definitive old prosthesis I never had peace of A new system for treating the eden- teeth on the day of implant surgery an mind because it moved. With Trefoil, I By Frederic Love tulous mandible is presented on option for more patients. can laugh with my mouth open again!” pages five through eight in this issue For a formerly edentulous woman, n a conversation I had with Pro- of Nobel Biocare News. From the clinician’s perspective being able to laugh whole-heartedly fessor Per-Ingvar Brånemark for It’s called the Trefoil system. Think The Trefoil system manifests innova- again is not a trivial accomplish- ISwedish Television back in 1983, of it not as a replacement for other tion aimed towards greater efficiency ment—and it is certainly what Per- we discussed edentulism as a disabil- solutions from Nobel Biocare, but as at every step, from the design and Ingvar Brånemark meant when he ity. “When you provide a toothless yet another scientifically well-docu- production of components to the de- spoke about restoring dignity. < 9 Professor Jill A. Helms person with a new, bone-anchored mented option for bringing the ben- finitive restoration. Compared to tra- concludes her three-part dentition, you are not just restoring efits of implant-based dentistry to ditional modes of treatment with pro- More to explore! series on how and why his or her smile, or even the ability to new groups of potential patients. visional prosthetics, the Trefoil system * Please turn to pages 5-8 for immediately placed chew and speak without inhibition,” At its most basic level, Trefoil con- requires less chair time and provides more information about the Trefoil implants routinely he said. “No, first and foremost you sists of the first pre-manufactured bar shorter time-to-teeth by combining a system, the science behind it, and succeed. are restoring the patient’s dignity.” with a passive fit. That’s big news in pre-manufactured—yet versatile—ti- how it works in detail. 2 Nobel Biocare NEWS Issue 3/2017

From the President Scan, Plan, and Deliver! New collaborative workflow offers a fully digital provisional restoration on the day of surgery.

Hans Geiselhöringer, President The next generation of Nobel Biocare’s integrated treatment As the forerunner in edentulous solu- workflow has been developed tions, Nobel Biocare is continuously to improve collaboration advancing existing proven innovations between treatment partners to further increase predictability and while increasing both efficiency for patients and clinicians. treatment efficiency and A perfect example is the evolution of acceptance. the original All-on-4® treatment con- By Lilibeth Brogna Salas cept. New componentry significantly TempShell wings ensure correct positioning of the TempShell at try-in and are subsequently removed chairside reduces chair time, while the introduc- before placement. tion of updated zygomatic implants evised for partially edentu- and an extended line of NobelSpeedy lous patients, the new collab- tion. The clinician can subsequently implants enable even more patients to Dorative workflow from Nobel diagnose and plan the implant treat- benefit from this life-changing solu- Biocare offers a time-efficient proto- ment based on the underlying anato- tion. Now, the Nobel Biocare portfolio col for providing screw-retained, in- my (hard tissue), the intraoral tissue, can cater even for patients that were dividualized provisionals on the day and the prosthethic information. previously deemed untreatable. of surgery through the fully digital The final treatment plan can then Addressing an unmet patient need design and in-house production of be used to order a surgical template is the driving force behind the launch TempShell temporary restorations. for pilot-drilling or fully guided im- of the Trefoil system—a ground- plant placement. breaking new option for the edentu- Step-by-step In the new collaborative workflow, lous lower jaw. Its IP-protected frame- As with the current integrated work- the clinician is able to share the work with a unique fixation flow, the clinician takes a (CB)CT scan NobelClinician treatment plan via mechanism enables the fixed, defini- in line with his or her usual diagnostic NobelConnect with a partner labora- tive, full-arch restoration of the man- procedures. Additionally, a dental tory that is using the DTX Studio de- dible on the day of surgery. scan of the intraoral situation is ac- sign software.* The lab uses the infor- Using the market as a testing ground quired from an intraoral or desktop mation from the treatment plan to for innovations is not the Nobel Bio- scanner. The STL or PLY(color scan) finalize the TempShell (provisional) care way. Prior to launch, one-year file is then imported into Nobel- design and fabricate it in-house. After- A TempShell is a single or partial provisional, which is fully digitally preliminary results of a global multi- Clinician. wards, it is sent directly to the clinician. designed from a treatment plan and fabricated in-house either by 3D printing center already showed outstanding re- This hard and soft tissue data can Because the TempShell is produced or milling. At the heart of the concept for single unit restorations, a sults for Trefoil patients. then be combined effortlessly using according to the digital treatment Temporary Snap Abutment can be used. Just as our dedication to restoring the SmartFusion function in the plan, the technician can be confident quality of life for edentulous patients software to provide a detailed visual- that it meets the needs of both the cli- ting, screw-retained provisional. leave the dental office with a person- endures, so too does our dedication to ization of the anatomical situation. nician and the patient. This updated workflow is designed alized, screw-retained provisional res- scientific rigor and providing evi- The planning process is made even On the day of surgery, the clinician not only to engender more time-effi- toration on the day of surgery. < dence-based solutions. < more efficient by the introduction of places the implants and the tempo- cient work and closer collaboration * DTX Studio is a digital platform for the SmartSetup feature. This auto- rary abutments, and then makes any between the clinician and the lab, but dental diagnostics and treatment matically creates virtual teeth by ana- needed modifications to the Temp- also to reduce time-to-teeth for pa- consisting of modules connecting the lyzing the patient’s remaining denti- Shell chairside to form a passive-fit- tients, making it possible for them to patient’s treatment workflow from beginning to end.

Nobel Biocare NEWS More to explore! For information about Nobel Published regularly by Nobel Biocare Services AG Biocare’s collaborative treatment workflow, please visit: Volume 19, Number 3, 2017 nobelbiocare.com/tempshell.

Editor-in-chief Frederic Love Managing Editor Jim Mack Associate Editor Michael Stuart Important notice: The new Nobel Biocare collab- Editorial offices Nobel Biocare News orative workflow was launched Herdevägen 11 in October at the European 702 17 Örebro, Sweden Academy of Osseointegration (EAO) Congress in Madrid, and Telephone: +46 19-330680 is under 510k review by the Telefax: +46 19-330681 e-mail: [email protected] FDA. It is not currently avail- web: nobelbiocare.com/news able in the USA and some other markets around the The contents of contributors’ articles do world. Please also note that not necessarily express the ­opinions immediate loading protocols of Nobel Biocare. should only be followed when © Nobel Biocare Services AG, 2017. The new SmartSetup feature automatically generates the diagnostic tooth setup in the NobelClinician Software the relevant clinical require- All rights reserved. (left). It can then be transferred via NobelConnect to the DTX Studio design software (right) where the setup can be ments are met. used to create the provisional design for the TempShell restoration (middle). Issue 3/2017 Nobel Biocare NEWS 3 Moving Forward “Both a reason and the means to smile once more” Report of expert consensus All-on-4® treatment concept makes life worth living again.

As a young woman, Silviana Ribeiro faced the all-too- common consequences of a failing dentition in her upper jaw. She received a removable maxillary acrylic denture, The FOR consensus conference held at the University of Pennsylvania which did not meet her School of Dental Medicine on November 30 to December 1, 2016 gath- esthetic or chewing needs, ered a panel of international experts to discuss the topic of prosthetic due to lack of retention and protocols in implant-based rehabilitation. stability. At the age of 37, she The methods by which single crowns and prostheses are designed received a fixed prosthesis and fabricated for implant-based treatments have changed over the supported by 4 implants (in years. Recently, new materials and innovative techniques have been accordance with the All-on-4® introduced, and relevant scientific evidence has been compiled. Ten treatment concept) in the international experts each conducted a systematic review of the litera- upper jaw using NobelSpeedy ture on a specific topic in the field of prosthodontics, yielding the fol- Groovy implants. On the same lowing results. day, an all-acrylic fixed Both fixed and removable complete arch implant prosthesis were provisional prosthesis was associated with high implant survival rates (on average >90% after 10 adapted, re-establishing the years). Implant overdentures were associated with more maintenance occlusal vertical dimension, needs / complications esthetics and function. than fixed prostheses as well as with By Silviana Ribeiro Smiling once more, Silviana Ribeiro says, “I didn’t just gain a winning greater postplace- smile and the ability to eat unabashedly again, I won back my self-confidence.” ment residual ridge y teeth began to give me prob- resorption. The level Mlems during my first pregnan- Seen and heard on TV “It changed my life!” of patient satisfaction cy. At that point, they started to grow I first learned that there was a very For me the results were transforma- was high, however, very weak and began to fracture. promising potential solution to my tional. My outlook on life—if not my with both types of One after the other, they had to be situation when I saw Dr. Paulo Malo personality itself—changed dramati- prostheses. extracted, and before my recent re- being interviewed on a television cally once I could smile uninhibited- Monolithic zirconia with gingival coloring (“gingival staining”), or zir- habilitation, I only had three teeth program that I was watching here in ly again. conia with veneered porcelain limited to the gingival area, offers prom- remaining in the upper jaw. Portugal. I was reluctant at first to Where I was once hesitant and so- ising results for fixed complete dentures. I had been using a removable den- seek care, but my son signed me up cially insecure, I now greet the peo- The choice of prosthetic material seemed to have no influence on ture since the age of 20, but it both- without telling me. He is very ple around me with a sincere smile implant or prosthetic survival rates in fixed restorations. ered me a lot, and I found it difficult young—but apparently not too and an upbeat attitude. A systematic review on the clinical outcome of monolithic ceramic to cope with its drawbacks. young to worry about me. He under- These days, people tell me I’m very implant-supported, single- and multi-unit prostheses determined that It was difficult for me to eat, and I stood that I was suffering and want- pretty, something I hadn’t heard very the risk of fracture and chipping was significantly reduced in monolithic found no pleasure around the dining ed to help me. often when I was wearing dentures. I restorations. Another systematic review determined that CAD/CAM abut- table anymore. In fact, I actually stopped At malo clinic, I saw cases reha- didn’t just gain a winning smile and ments have good survival and success rates and provide comparable, if eating many foods, such as bread and bilitated via the All-on-4® treatment the ability to eat unabashedly again, I not better, clinical outcomes than conventional abutments. Ti-inserts for apples, for example. Because I could not concept and it seemed like a dream won back my self-confidence. CAD/CAM monolithic implant-supported ceramic restorations improve the chew properly, my overall health was to me. People were completely trans- Whenever I meet someone who is overall fracture strength of ceramic abutments and crowns, protect the adversely affected, of course. What’s formed. They looked so beautiful. experiencing problems with a den- implant connection from wear, and offer a better marginal fit when more, eating difficulties were only part Only those who have the kind of ture and is considering implant compared with all-ceramic abutments. However, independent clinical of the problem. I stopped smiling. I felt problems I’ve faced can understand treatment, I tell them my story and trials that document long-term performance need to be carried out. ashamed of myself. that removable dentures are simply recommend the treatment whole- Zygomatic implants offer an alternative treatment option for patients not a viable solution. heartedly. I never had any pain dur- with severely resorbed maxillae, thus avoiding invasive bone graft proce- Wide-ranging impact To say the least, I was motivated at ing my treatment and recovery was dures. The survival rate of prostheses is related to the number and posi- In my day-to-day life, I became a this stage to solve my problem per- very fast. In short, I have only seen tion of the zygomatic implants. It reached 96 –100 % with one to six years more closed person. I was embar- manently. They scheduled me for the advantages. This treatment is one survival. Prosthetic complications included loosening and the fracture of rassed by my dentures and simply treatment and soon it was underway. of the best things that ever happened prosthetic screws with the attendant fracture of abutment screws. did not smile—not even on my wed- After the surgery I was able to to me. It has given me both a reason Intraoral scanning is more challenging than in-vitro scanning of a ding day! leave the clinic with new teeth in and the means to smile broadly once model, and more in vivo studies are needed to define clinical indications I was afraid that someone would place.* What a change it made! A again. < for different types of IOS. Such is also the case for the impact of the notice that I was wearing a prosthe- loose denture user no more, I was re- misfit at the prosthesis-implant interface on clinical outcomes of screw- sis. When I didn’t wear my dentures gaining well-anchored teeth, which More to explore! retained implant prostheses, where the available literature does not pro- for one reason or another, I shut my- was very important. My quality-of- To see how the All-on-4® treatment vide sufficient evidence. self in. Although I never hid my pre- life suddenly improved tremendous- concept can revolutionize your practice, please visit: The Foundation for Oral Rehabilitation would like to express their appre- dicament from my husband or my ly. This treatment is not just about nobelbiocare.com/all-on-4. ciation to the organizers and all the presenters. (See Nobel Biocare News son, nobody knew my secret outside having beautiful teeth, however. It’s 2/2017.) To join the FOR community, please go to the website below. a small circle of family and friends. about being able to lead a normal * Loading with a fixed provisional restora- In short, the dentures were discom- life. When I looked in the mirror for tion on the day of surgery is possible provid- for.org/en/user/sign-up fiting and diminished both my phys- the first time, I felt happy, truly ed patient criteria are met and adequate ical and psychological well-being. happy. I still feel that way today. implant stability is achieved. 4 Nobel Biocare NEWS Issue 3/2017 Science matters Regenerative Solutions For Clinical Success Extraction and osseointegration Opening a world of exciting treatment options Contribution of the periodontal ligament to osteotomy repair and implant osseointegration. (Pei et al., J Dent Res. 2017) dictable clinical success. In a meta- The immediate placement of implants following extraction is increas- Professor Werner Zechner, analytic study that we performed, ingly commonplace. Yet, few studies have investigated how the heal- a specialist in bone grafting, comparing creos xenoprotect with ing of extraction sockets differs from that of osteotomies, and how implant surfaces and guided other collagen membranes, we have any differences might influence implant osseointegration. implant placement protocols, observed a reduced rate in dehis- Pei and coworkers used mouse models to investigate these sce- summarizes his experiences cences with creos xenoprotect. In narios at the cellular level. In extraction sockets, the authors observed with creos regenerative general, we have seen fewer compli- that remnants of a healthy periodontal ligament could mineralize and solutions. cations in healing, especially versus contribute to new bone formation. Healing of extraction sockets, other stiffer and cross-linked mem- where remnants of a healthy periodontal ligament were present, was By Prof. Werner Zechner branes. We have also demonstrated also observed to be faster than the healing of osteotomies, where the the efficacy of the membrane in a periodontal ligament had been stripped out. These observations suggest that surgical approaches to minimize rom the very beginning, my expe- multi-center study. trauma and maximize retention of formerly healthy tissue may benefit Friences with the creos xenopro- In addition, the creos xenogain healing and, in turn, implant osseointegration. tect membrane have been very posi- bone substitute is available in a use- tive. It is simple to trim, even after ful variety of packaging options. De- Professor Werner Zechner is ncbi.nlm.nih.gov/pubmed/28481696 soaking with autogenous blood. It’s pending on the indication and clini- Co-head of the Department for Oral easy to handle during surgery and of- cal situation, a vial, a syringe, or a Surgery and Implantology at the fers excellent stability. bowl is offered. The latter avoids the University Dental Clinic of the A reliable angle My choice of membrane depends use of an additional sterile dappen Medical University in Vienna, on the indication. I find creos xeno- dish for mixing the particulate with Austria. He has published over 40 Mechanical complications associated with angled screw protect is particularly well-suited to autogenous blood, which I prefer in articles in peer-reviewed, interna- tional scientific journals and books. channel restorations (Greer et al., Int J Prosthodont. 2017) bone augmentation techniques, es- most of my surgeries. Angulated screw channel (ASC) solutions overcome the esthetic challenges pecially in situations with reduced In my overall experience, the creos of screw-retained restorations in the anterior, improve occlusal access in the soft tissue. In many clinical situa- xenogain bone matrix is a reliable More to explore! tions, it offers the balance I need be- choice. It has been in clinical use for posterior, and eliminate the risks associated with excess cement. In this clini- See “In brief” on page 10 of this cal study, Greer and coworkers examined the clinical performance of Nobel tween space-maintaining stability many years and examined in various issue, and for the full references to Biocare ASC abutments and crowns at a British dental hospital. and a slow resorption rate. research and clinical publications, this story, please visit: nobelbiocare. Sixty patients received a total of 84 single-implant restorations between Most importantly, what I expect which is a very important consider- com/news. 2014 and 2016. NobelProcera ASC crowns were used in 90% of restorations from a membrane when using guid- ation for me when selecting a bone and NobelProcera Full Contour Zirconia crowns in the remainder. The clinic ed bone regeneration (GBR) is pre- substitute to treat my patients. < successfully used ASC restorations to replace single crowns in a broad range of applications. In 96% of patients, no prosthodontic complications were seen. When issues did arise, these were similar to those that affect conventional implant-retained solutions: one loose screw attributed to under-torquing, one ceramic failure due to poor occlusal management, and one implant failure. TM The conclusion was reached that Nobel Biocare ASC abutments and NobelZygoma Dramatically Shortens Time-to-teeth crowns, when used with Nobel Biocare Conical Connection implants, offer a reliable alternative to traditional cement or screw-retained restorations. An excellent alternative to extensive grafting procedures

ncbi.nlm.nih.gov/pubmed/28453001

Promoting new bone formation Prof. Paulo Malo successfully treated the first patient with Tissue dynamics and regenerative outcome in two the All-on-4® treatment resorbable non-chemically cross-linked collagen membranes concept decades ago. Here he for guided bone regeneration: A preclinical molecular and comments on using the new histological study in vivo (Omar et al., Clin Oral Implants NobelZygoma implant series. Res. 2017; doi: 10.1111/clr.13032) By Professor Paulo Malo The potential for some membranes used in guided bone regeneration (GBR) to behave as bioactive modulators of bone healing is increas- he design features of the new ingly being recognized. This study used a rodent model to investigate NobelZygoma implant allow me how two non-cross-linked collagen membranes, creos xenoprotect T to offer even better treatment solu- and Bio-Gide®, promoted cellular and molecular activity during bone NobelZygoma, the implant system of choice for immediate loading in healing in GBR. After the introduction of defects in the femoral epi- tions to my patients in a more effec- cases of severe maxillary resorption. It also offers a broad choice of temporary prosthetic options, dramatically decreasing time-to-teeth. physis (trabecular bone) of anaesthetized rats, investigational sites tive way: The new apex shape gives were filled with deproteinized bovine bone and covered with either me enhanced bicortical anchorage in creos xenoprotect or Bio-Gide®. Both membranes promoted a compa- zygomatic bone without spinning, tics: 1) the apex, which is tapered for deeper, and therefore reach a more rable amount of bone formation overall. However, only creos xeno- and the non-threaded coronal part high primary stability and very im- buccal position. This is a great im- protect encouraged significant new bone formation in the central allows me to use the extra-maxilla portant for immediate load; 2) the provement in terms of prosthetic region of the defects. These results suggest that creos xenoprotect, technique, thus optimizing the pros- body of the implant, which is very flexibility and has completely rather than being a mere passive barrier, may play an active role in thetic outcome. kind to soft tissue; and 3) the head of changed the way we now do prosthe- regulating bone healing dynamics as well. We’ve been having nothing but the implant, which now comes both ses in the zygoma. < great experiences with these new im- in 45 degree and zero-degree ver- ncbi.nlm.nih.gov/pubmed/28703398 plants. The NobelZygoma implant sions—the latter of which makes it More to explore! basically has three major characteris- possible for us to place the implant nobelbiocare.com/nobelzygoma Issue 3/2017 Nobel Biocare NEWS 5

Trefoil™ – Preliminary Results Upcoming Now Available for Your Review Events Report on an adaptive prefabricated full-arch framework on three implants in the mandible Meet Nobel Biocare at events around the world. month results for most patients and case. Both patients were subse- These professional gather- At a series of professional one-year outcomes for early re- quently treated with a custom pros- ings provide a great oppor- meetings this fall, Dr. Kenji cruits, have now been presented. thesis. tunity for catching up with Higuchi and his colleagues Within the constraints of these the latest innovations and have reported on early The results you expect preliminary findings, the Trefoil scientific research. clinical outcomes of Trefoil, from Nobel Biocare system demonstrates good early • 2017 • an innovative edentulous When recruitment closed in Febru- outcomes in terms of prosthetic and ADF Annual Meeting solution combining straight- ary 2017, the study encompassed 110 implant survival rates, as well as pa- November 28–December 2 Paris, France forward guided surgery with patients (330 implants). tient and clinician satisfaction.* a simplified restorative At the time of the Trefoil system This innovative, adaptive, prefab- AAOMS Dental Implant Conference November 30–December 2 protocol that allows for launch, 94 patients had completed ricated framework supported on Chicago, IL delivery of the definitive the six-month follow-up visit and 40 three implants allows for immediate DGI Congress prosthesis on the day of patients attended the one-year as- loading of a final fixed solution for November 30–December 2 surgery. sessment. Implant survival rate was the edentulous mandible. As the Dusseldorf, Germany 98.2% (n=282) at six months and study continues, outcomes for ex- By Chris Kendall With the support of Nobel • 2018 • Vision 21 – National Association of Biocare, clinicians in Australia, 97.6% (n=120) at one year. A total of tended periods of time will be re- < Dental Laboratories Chile, Italy, Spain and the United eight implant failures were reported ported on a regular basis. January 18–20 he Trefoil system—featured in States are carrying out a five-year, in six patients. Las Vegas, NV detail on the following four international, multicenter, In four of these patients, a single More to explore! 25th Malaysian Dental Association SCATE prospective study evaluating the Tpages—uses a standardized implant failed, and their prostheses Turn the page for more information January 26–28 prefabricated framework fitted with implant and prosthetic survival of remained in function until the im- about Trefoil, how it works, and Kuala Lumpur, Malaysia the Trefoil system in the mandible. what it can do for your practice. specialized adaptive mechanisms that This study includes 110 patients plants were replaced. These patients AEEDC Conference ensure passive fit of the prosthesis by were advised to switch to a soft diet, nobelbiocare.com/trefoil. February 6–8 and 330 Trefoil implants. For details, Dubai, UAE compensating for horizontal, vertical such as inclusion criteria, declared and following a healing period, their and angular deviations from the purpose, etc. please visit the U.S. third implants were replaced with ei- * Higuchi K, Davó R, Liddelow G, et CDS – Chicago Dental Society Library of Medicine’s website: Midwinter Meeting planned placement of the three sup- ther a new Trefoil implant (n=3) or al. “An adaptive prefabricated full- February 22–24 bit.ly/TrefoilMCS. porting implants. NobelActive implant (n=1). arch framework on three implants in Chicago, IL

The first data are now being pre- The prosthetic survival rate was the mandible: preliminary results.” LMT Lab Day sented from a 5-year international implant and prosthetic survival of 98.2% at one year, as two prostheses Clin Oral Implants Res 2017;28(Suppl). February 23–24 multicenter clinical investigation the Trefoil system in the mandible.* were removed due to two implants Chicago, IL that is being carried out to evaluate Preliminary data, including six- failing to osseointegrate in each AO – Academy of Osseointegration Annual Meeting 28 February–3 March Los Angeles, CA

Pacific Dental Conference March 8–10 Nobel Biocare 2017 Symposia – Voices in the Crowd Vancouver, Canada

Expodental Eleven symposia, eleven memorable events March 15–17 Madrid, Spain

AADR Annual Meeting “The scientific program in Dubai March 12–14 Fort Lauderdale, FL The last of this year’s Nobel was outstanding,” said Professor Nabil Biocare symposia—held in Barakat of Lebanon. “The renowned SIDP National Congress March 15–17 London, on November 10-11, clinicians who lectured succeeded in Rimini, Italy 2017—has proven as relating how Nobel Biocare has al- IDEM Scientific Conference successful as all the others ways joined science and innovative April 13–15 held earlier this year. Most technologies in the constant evolution Singapore impressive: The science of their products to better serve den- American Academy of Cosmetic behind the products. tists and their patients.” Dentistry • Annual Scientific Session April 18–21 Chicago, IL By Frederic Love Something for everybody Dr. Beatriz Aranguena of Spain, who Centennial Meeting of the Academy of Prosthodontics attended the symposium in Santiago May 9–12 rom locations as widespread as de Compostela, agreed. “We enjoyed Chicago, IL FPortugal, the United Arab Emir- a top-level scientific program. For me, SEPES Primavera ates, Spain, Mexico, Russia, China, the highlights were the interdisciplin- May 19 Nobel Biocare Symposia stand for global learning opportunities in a local Madrid, Spain the US, Japan, the Netherlands, Croa- ary approach, the live surgeries, and setting. New products and innovative techniques have been presented in tia, and the UK, upbeat reports from also an excellent program for the lab- multiple forums at each of this year’s eleven symposia, such as this one in European Academy of Esthetic Dentistry North America. Spring Meeting organizers and participants alike have oratory technicians, who play a very May 24–26 been overwhelming. They all seem to important role in treatment—all of Sorrento, Italy want to do it again. which is crucial for the benefit of pa- zhou was well-organized with fantas- More to explore! Among the thousands of dental tients.” tic academic topics. It provided den- To stay on top of upcoming events More to explore | professionals who attended Nobel On the other side of the globe, Pro- tists with a good chance to be exposed in the world of osseointegration For the most recent updates, visit: nobelbiocare.com/events Biocare symposia this year, here are a fessor Ye Lin of China said, “The to the latest ideas and technologies of visit: nobelbiocare.com/events few of the voices we’ve heard: Nobel Biocare symposium in Huang- the dental implant industry.” < 6 Nobel Biocare NEWS Issue 3/2017 Trefoil™– The Next Full-arch Revolution A cutting-edge, fixed solution—designed and implemented to treat more patients better—has just arrived.

Nobel Biocare has led innova- Leading in immediate solutions tion in full-arch solutions for over 50 years. The latest addi- By continually challenging existing treatment methods we aim to drive tion to the company’s already efficiency and make high-quality implant treatment a viable choice for extensive assortment of inno- more patients. vations for full-arch rehabilita- tion is the perfect example of this approach in action. THE FIRST PRE-MANUFACTURED By Mike Stuart BAR WITH PASSIVE FIT The ingenious fixation mechanism is a breakthrough in treating the edentulous mandible. he Trefoil system is a break- PATENT through in efficiency for Anatomically designed for the natural arch of the lower jaw, the standardized bar contains adaptive joints that adjust to PENDING Ttreating the mandible. Previ- compensate for horizontal, vertical and angular deviations for fixation ously, manufactured bars might from the ideal implant position. have been cost-efficient, but passive mechanism fit always posed a challenge. Now, Trefoil has overcome this drawback with a unique fixation mechanism, which can adjust to compensate for inherent deviations from the ideal implant position. This feat of engi- neering lies at the heart of a new fixed solution that makes it possible for clinicians to offer patients fixed and definitive teeth in a single day.*

More patients can now benefit from a fixed solution For a very large number of patients, conventional dentures do not pro- Angular deviation Horizontal deviation Vertical deviation vide an adequate solution to their masticatory, esthetic or even social ±4.0° ±0.4 mm ±0.5 mm needs. Consequently, the benefits of fixed solutions often outweigh the perceived lower cost of dentures— or even a fixed-removable—for many patients. For patients consid- PATENT PENDING FOR FIXATION MECHANISM ering implant-supported solutions, Each mechanism has five self-adjusting joints that the Trefoil system offers a fast, af- help correct the position of the prefabricated bar, enabling the passive fit of the definitive prosthesis. fordable, state-of-the-art fixed treat- ment solution. Developed with the needs of the many in mind, the efficiency of the Trefoil system empowers clinicians to provide many patients who are held back by time or by finances with the premium-quality, fixed so- lution they deserve.** PROVEN STRENGTH WHEN Even before launch, the patient PUSHED TO THE LIMIT benefits of the Trefoil system are The Trefoil system maintains its strength when pushed to the clear. A global, five-year multi-cen- extreme of its compensation capability. In fact, tests prove almost ter study using the solution began in no difference in fatigue limit between the maximum compensation configuration and the configuration without compensation. 2015 and has already yielded very telling results. With the Trefoil sys- tem now widely available, many more patients around the world will No soon be able to experience the quali- compensation ty of life improvements that Trefoil (n=6) was designed to deliver. < p = 0.292 Maximum *Depending on clinician preference and compensation (n=6) close cooperation with the laboratory. FIND OUT MORE

** Loading with a fixed provisional restora- 0 50 100 150 200 250 300 350 tion on the day of surgery is possible provid- Discover the detail behind this ed patient criteria are met and adequate revolutionary full-arch solution: implant stability is achieved. Median Fatigue Limit nobelbiocare.com/trefoil Issue 3/2017 Nobel Biocare NEWS 7

DEFINITIVE TEETH Trefoil IN ONE DAY* Dental implant patients are increasingly demanding immediate restorations. 1 DAY The Trefoil system is a cost- efficient solution that allows Implant placement and fixed Immediate Function and makes definitive restoration in one visit.* fixed and definitive teeth on the day of implant surgery* an option for more patients. Conventional treatment

1 DAY

Implant placement: 3-6 MONTHS Implant and provisional Fixed and definitive denture are placed. restoration is placed. *Depending on clinician preference and close cooperation with the laboratory.

STRAIGHTFORWARD PROSTHETIC WORKFLOW Substantial time savings for the restorative clinician and the lab.

The restorative workflow is simplified thanks to the use of the pre-manufactured bar. An experienced clinician and lab will require approximately six hours of active working time to create the definitive acrylic prosthesis.**

PROSTHODONTIST 1 hour

LAB TECHNICIAN 3 hours 6 HOURS

SURGEON 2 hours

**The comparison above demonstrates possible treatment methods with approximate treatment times.

ALREADY BACKED BY CLINICAL RESEARCH Trefoil is the focus of an ongoing five-year, multi-center study across four continents that began in 2015. Positive 5 results are already being reported for implant and YEARS prosthetic survival rates.

Prof. Dr. Massimo Albanese, Italy 4 CONTINENTS

110 Dr. Kenji Higuchi, PATIENTS United States

Dr. Glen Liddelow, Australia

Dr. Rubén Rosenberg, Chile Dr. Rubén Davó, Spain 8 Nobel Biocare NEWS Issue 3/2017 Breakthrough in Efficiency with Trefoil™ Speaking with Nobel Biocare News, Dr. Glen Liddelow addresses one of the key breakthroughs of the treatment – efficiency.

Dr. Glen Liddelow, from Western Australia Surgery and Prosthetics in Perth, has been treating patients with mandibular edentulism or failing mandibular dentition Prosthodontist Surgeon Lab Technician 1 hour 2 hours 3 hours using the Trefoil system since 2016. He has performed over Trefoil treatment time: Active working time estimate based on median time 40 Trefoil treatments and is a observed in clinical use.* principal investigator in an jaw relations take about five min- the pre-manufactured bar there is no ongoing, 5-year Trefoil utes. Then the insertion of the need to design the bridge framework. multi-center study. bridge typically takes about 15 min- The fit is determined in the lab utiliz- utes; but do I allocate about 30 min- ing the fixation mechanism, so a sur- Verifying the fit of the Trefoil bar. utes to have a chat with the patient prise is less likely than when receiving and go through such things as oral a custom framework from a third hygiene instructions. party, where there can be scanning or How do you expect the These gains are consolidated by the ccording to Dr. Glen Lid- milling errors. The biggest factor is introduction of the Trefoil efficiency of pre-manufactured, pre- delow, the Trefoil system is the time-saving in waiting for the system to affect your dental assembled components. The Trefoil Aan efficient way to get a framework—the technician can get practice? system forms a great alternative to high-quality immediate prosthesis. on with the production of the bridge Liddelow: The most significant im- fixed-removable options and gives Ever since the first loaded bridges Q&A and not have to wait while tracking pact comes from the time- and cost- more people than ever before access were introduced 18 years ago, reduc- Questions and Answers framework delivery. efficiency of the Trefoil system. With to something that feels like a third tions in time and cost have improved pre-manufactured components, no dentition. < treatment acceptance dramatically, In total, how much time do How would you describe the multiple customization and no pro- and he sees the Trefoil system as yet you spend on treatment with prosthetic workflow of the visional phase, it allows me to treat More to explore! another step in the right direction. a case using the Trefoil Trefoil system? more patients with a fixed, full-arch Discover the detail behind this system? Liddelow: The flexibility of the Trefoil solution. That provides a big growth revolutionary full-arch solution: At what key stages do you Liddelow: In total, an experienced system allows for variations in pros- potential for the practice and—more nobelbiocare.com/trefoil. save time with the Trefoil clinician and lab will require around thetic workflow to suit the clinicians importantly—an opportunity to bet- system in comparison with six hours of working time. involved and their respective practic- ter serve the community. conventional fixed full-arch I spend around 2.5 clinical hours es. It can be managed a number of Case images courtesy of Dr. Glen Liddelow treatments? on treatment at the practice, includ- ways. (Editor’s note: Please see the How would you describe the and Michael Standish Dental Laboratories. Dr. Glen Liddelow: The real time-saver ing both surgical and restorative pro- Trefoil Procedures Manual for more main patient benefits of the is the fact that there is no temporary cedures. Compared with conven- information.) Trefoil system? * Data on file from use by experienced bridge in the Trefoil system work- tional full-arch treatments, I can save Because I do both the surgery and Liddelow: Getting a definitive pros- clinicians and lab technicians. flow, and that there are fewer steps around 4.5 clinical hours. If the sur- prosthetics, I combine the impres- thesis is fast: there is no provisional required than for a conventional cus- gical and restorative steps are carried sion and jaw relation at the time of phase, a simplified workflow and less tom bridge. out separately, and if you do a wax surgery, then provide the bridge at a active working time for both practice With the Trefoil system you cut rim and a try-in before bridge inser- separate appointment. If the treat- and lab. out all of the appointments required tion, treatment takes around 3.5 clin- ment is divided between specialists Not only does time-efficiency to produce a definitive bridge, such ical hours. on the other hand, there could be make the treatment convenient for as impressions, jaw relations, tooth A clinician that does both surgical more prosthetic appointments for the patient, it also has the potential try-in, framework try-in and defini- and restorative work will immedi- jaw relations and try-in, for example. to translate into greater affordability. tive bridge insertion. This is signifi- ately save a lot of time with the Tre- The impression or verification cant for the clinician as well as the foil system. I spend a similar amount part of the treatment is very efficient. patient. of time on the surgery as with con- A surgeon with little experience in We treat many patients that live ventional treatments. As usual with implant impressions could provide considerable distances from our any new surgical technique, times this at the time of surgery, save sig- practice, and the ability to almost have gradually improved along the nificant time, and improve patient immediately provide a definitive learning curve. It’s important to note comfort by lessening the need for Articulation of the bar to the opposing arch. bridge can save them airfares, travel in this context that comprehensive manipulation of tissues immediately costs and time off work. The im- training is recommended before after the operation. Fixation of the mechanism using either laser welding or resin. pression procedure is much quicker starting with the Trefoil system. The bar shown here is laser than other treatments—it takes me Both time-savings and cost-savings welded. around ten minutes. I don’t do a can be realized at the laboratory. With wax-rim type of jaw relation, so my

Delivery of the final bridge on The Transfer Abutments and a the day of surgery. Occlusion is non-engaging temporary abutment checked for even contact and are placed to construct the verifi- anterior guidance. Accessibility for cation index. The Transfer Conventional wax-up and cleaning is verified and screws are The central implant is inserted Abutments are luted with light- processing for a wrap-around tightened to 35 Ncm. Access holes Pre-treatment view of the mandi- into place using the positioning cured resin to fix the verification hybrid acrylic / titanium fixed are sealed with Teflon and bular residual ridge. template. index. prosthesis. composite. Issue 3/2017 Nobel Biocare NEWS 9 Overcoming Obstacles Ground-breaking work is underway to accelerate implant osseointegration at extraction sites.

Working with researchers Fig. 1 Fig. 2 Fig. 3 Fig. 4 Xing Yin, Jingtao Li, and Xibo Pei at the Stanford University Department of Surgery, Pro- fessor Jill A. Helms has been studying the biology and mechanics of immediately loaded implants. In this, the third of a three-part series on the topic, Dr. Helms discuss- es the molecular mechanisms Figures 1-4 (left to right). Histology sections of rodent osteotomy site: Dying osteocytes (Fig. 1) trigger bone resorption by osteoclasts (Fig. 2) and the void of bone formation, implica- left behind needs to be filled with new bone (Fig. 3). It is this new bone that is ultimately responsible for the long-term osseointegration of an implant. (Fig. 4) tions for immediate implants and interesting directions for These types of damage are essentially further long-term research. “erased” from the bone because this Fig. 6a Fig. 6b Fig. 6c tissue is in a constant state of turn- By Professor Jill A. Helms over: dead osteocytes (Fig. 1) trigger bone resorption by osteoclasts (Fig. 2) n the previous two issues of Nobel and the void left behind needs to be Biocare News we discussed the ex- filled with new bone (Fig. 3). It is this Itraction socket and what hap- new bone that is ultimately responsi- pens—from both biological and bio- Wnt responding mechanical perspectives—around +Wnt day 7 +Wnt day 14 osseo-progenitors. implants that are placed in extraction sockets. In this third and final article, Response to Wnt stimulus over time. (Fibroblasts around saline-treated implants showed no such response.) we focus on overcoming obstacles to R&D accelerate implant osseointegration at Research and Development mass diseases have too much Wnt with the Wnt therapeutic (delivered by agent must be safe after all. Some extraction sites. signaling, while patients with osteo- injection into the fibrous tissue cap- might remember issues surrounding Of all the dental specialties, the ble for the long-term osseointegration porosis have too little. In my lab, we sule) and the other half received an in- use of Bone Morphogenetic Protein 2 field of implantology stands apart as a of an implant (Fig 4). see Wnts as a potential therapeutic jection of saline. Then we waited. (BMP2) in dental and orthopedic pa- leader in design innovation. New ma- My colleagues and I started with a agent to accelerate implant osseoin- The first sign we looked for was ev- tients; these reported complications terials, modifications in surface tex- simple enough question: Where does tegration. idence that the Wnt therapeutic “acti- are unacceptable for non-life-threaten- tures and implant shapes—as well as this new osseointegrating bone come vated” cells in the fibrous tissue enve- ing indications such as dental im- advances in osteotomy site prepara- from? The answer is that the new Serious team science lope. Within 24 hours of injection, we plants. The protein also must be man- tion—have all contributed signifi- bone arises from a population of The cells responsible for osseointe- saw the first signs that fibroblasts re- ufactured to meet regulatory specifica- cantly to the success of dental im- bone-forming progenitor cells lining gration are Wnt-responding cells, sponded to the Wnt stimulus and tions. Finally, any new biologic must plants. And yet there remains still the socket, and are especially con- that is, they respond to the body’s began to multiply (Fig. 6a). Fibro- fill an important gap in clinical care. more design space for improvements. centrated in the remnants of the own Wnt signal. We wanted to test blasts around the saline-treated im- Our research, and the biologics that In my laboratory at Stanford, our goal periodontal ligament left behind whether or not delivering Wnt pro- plants showed no such response. are the fruit of that research, specifi- is to tweak the body’s natural bone- after tooth removal (Fig. 5a). These tein itself to the tissues around an A few more days passed and the cally address challenges to the osseo- making capacity to accelerate bone osteo-progenitors are Wnt respon- implant could accelerate the forma- Wnt responsive osteoprogenitors con- integration of immediate implants in formation around implants. sive (Fig. 5b). tion of new bone. Proving this was a tinued to multiply (Fig. 6b and 6c). A routine clinical practice. The work Some people wonder if new bone is challenge. Even in rodent models, few more days and the once-loose im- continues. actually necessary. After all, when you Potent proteins miniaturized dental implants rou- plants that had been treated with the We’ll have more to report soon. < place an implant, and it’s stable, it’s Some people may have heard of Wnt tinely osseointegrate! Therefore, we Wnt therapeutic were encased in bone, reasonable to wonder why you might proteins acting as intercellular sig- had to recreate a condition where whereas those treated with saline re- More to explore! need new bone. The answer has to do nals in other contexts, but for many implants would reliably fail, and then mained in a fibrous tissue envelope The two previous installments of with the fact that even the most care- readers this may be an unfamiliar potentially rescue that failure with (Fig. 7b and 7a respectively). We suc- Professor Helm’s series, “Under- ful implant site preparation still dam- word in the context of dentistry. the Wnt therapeutic. We created this ceeded in rescuing the failing implants! standing the Biology and Mechan- ages bone, and this damage can be ex- Here’s the reason they are so interest- scenario in an animal model by in- We still have challenges ahead be- ics of Immediate Placement,” are acerbated if an implant is placed with ing: Wnts are potent bone-inducing tentionally placing implants into fore a Wnt therapeutic is available for available online at: excessively high insertion torque. proteins. Patients with high bone oversized osteotomies. implant specialists. A bone anabolic nobelbiocare.com/news What came next required some se- Fig. 5a Fig. 5b rious team science: biochemists had Fig. 7a Fig. 7b to purify the Wnt therapeutic and make it ready for in vivo use, bioengi- neers had to characterize the mechan- ical environment, and an internation- al group of talented surgeons had to devise methods to place the implants in sleeping mice. As anticipated from human data, the loose-fitting implants in the ro- dents were surrounded by a persistent fibrous envelope. Using these unstable Wnt-responsive osseoprogenitor cells in an extraction socket. implant cases, one-half were treated Loose-fitting implants treated with saline (7a) and the Wnt therapeutic (7b). 10 Nobel Biocare NEWS Issue 3/2017 Ribbon-cutting Ceremony In Brief At Yorba Linda Institute Fulfilling a commitment to post-graduate and continuing education Thumbs up for creos® xenoprotect

The full results of a study highlighting the efficacy of the creos xenoprotect membrane are now available via open access.

A randomized controlled clinical trial confirmed that creos xenoprotect, a resorbable, non-cross-linked collagen dental membrane, facilitates bone gain to support implant placement in dehiscence defects. These findings, pub- lished in the peer-reviewed Clinical Oral Implants Research, are relevant for dental clinicians as they support creos xenoprotect as a scientific-evidence- based choice to meet all their guided bone regeneration (GBR) needs. In a double-blind, multicenter, prospective study, Dr. Bastian Wessing and his colleagues placed implants to support single restorations in 49 patients, with bone augmentation material placed at dehisced implant sites. This material was immobilized with either creos xenoprotect (Nobel Biocare) or the reference membrane, Bio-Gide® (a registered trademark of Geistlich Pharma AG). The results show the efficacy of creos xenoprotect in facilitating bone augmentation and non-inferiority to Bio-Gide®. For more details about the study and a direct link to the online report in Clinical Oral Implants Research, please use the following URL: Surrounded by Nobel Biocare associates and civic leaders, Tom Olsen, President and General Manager, Nobel Biocare North America, cut the red ribbon on July 12 to re-open the Nobel Biocare Training Institute in Yorba Linda, bit.ly/creosxenoprotectstudy California, after a comprehensive facility upgrade.

obel Biocare has called Yorba The renovated space provides All-on-4® webinar wildly popular Nobel Biocare supports its NLinda, California, home for training and education venues for a customers through every the past 18 years. This summer, the wide variety of health care profes- An All-on-4® treatment concept online course was launched just a phase of professional devel- company opened its doors to the sionals, and a modern workplace for year ago. In the first five months alone, more than 10,000 trainees opment, offering world-class Yorba Linda community in order to everyone working at Nobel Biocare. from over 100 countries had already registered to participate. Pro- training and education along share in the completion of a state-of- Guests toured the 100-seat auditori- fessionals from across the dentistry spectrum are taking part. The with practice support and the-art remodeling of its highly-re- um, its fully outfitted surgical suite, course has proven especially 3CE patient information materials. garded training institute. the Interactive Health Care Profes- Nobel Biocare popular with general practitioners certificate The company recently In partnership with the Yorba sional Lounge, an imaging center who place and restore implants and re-opened and re-dedicated Linda Chamber of Commerce, Nobel with the latest in 3D technology, the want to learn more about the oppor- the Nobel Biocare Training Biocare employees welcomed mem- Digital Dental Technology Training tunities offered by the All-on-4® Institute at Yorba Linda in bers of the local community, partner Lab, multi-purpose hands-on train- treatment concept. order to remain a leader in the customers and close friends for the ing rooms, and collaborative meeting field of post-graduate and ribbon cutting ceremony and subse- spaces for everyone involved in the The training was developed with Drs. Saj Jivraj and Hooman Zarrinkelk, continuing education. quent open house. teaching and learning experience. < and was recently ranked the most creative webinar of the year by the On24 Platform. Of the trainees who responded, 100% rated the speakers good or excellent, and over three-quarters shared the course with col- leagues or partners. On completion of the course, participants earn three Optimizing the Prosthetic Outcome CE credits and a certificate from Nobel Biocare. Register for free and expand your knowledge by visiting: Place with confidence, restore with ease! nobelbiocare.com/all-on-4course

complication that may can use the On1 concept On1™ e-book now available online The On1 restorative concept arise at this interface will with three different coni- makes it possible to maintain be at the soft tissue level cal connection implant The On1 concept is unique. It’s the first concept to preserve the the soft tissue healing process rather than in proximity systems—NobelActive, soft tissue attachment and maintain full restorative and surgical without interruption. Read to the bone, enhancing — NobelParallel and Nobel- flexibility. The concept also radically simplifies the restorative pro- here what an experienced as I see it—the reliability Replace. cedure, as the On1 Base moves the restorative platform of Nobel clinician has to say! of the prosthetic outcome. Working with Nobel Biocare conical connection implants from bone level to tissue Compare the On1 con- Biocare’s conical connec- By Dr. Giacomo Fabbri level. It remains in position from implant placement to finalization, cept to traditional trans- tion with platform switch- which leaves the soft tissue undisturbed for optimized healing. mucosal implants, and Dr. Giacomo Fabbri: ing means that we can y first reaction to the On1 re- you’ll find multiple ad- “Why hasn’t anyone work flexibly in terms of thought of this Want to learn more? Now there’s a book: The Importance of the Soft storative concept was, “Why vantages. First of all, the the vertical position of the M before?” Tissue Barrier: An introduction to the On1 concept. This e-book brings hasn’t anyone thought of this be- On1 concept implements implant, which can be lo- together work from leading implantology experts. They explore the signif- fore?” This innovative prosthetic platform-switching at the bone crest cated either at the bone crest level or icance of unimpaired soft tissue healing for the success of dental implant component helps us to optimize the level, thus facilitating bone mainte- below the bone crest. We can select treatment. And they will introduce you to the On1 concept, which is spe- prosthetic outcome while providing nance around the implants. Addi- the appropriate On1 Base height and cifically designed to preserve soft-tissue adhesion. Many different a more comfortable treatment plan tionally, the two base-height op- choose the vertical position of the im- resources are available in this e-book, including clinical studies, articles, for the patient. tions—1.75 mm, and 2.5 mm— plant to adapt to the specific soft tis- videos and quizzes. The Importance of the Soft Tissue Barrier is available On1 gives us the opportunity to provide versatility. This means that sue thickness. free of charge at the web address below. move the prosthetic interface of the we can select the ideal height in rela- Thanks to the On1 concept, we can restoration from the bone level to a tion to soft tissue thickness. virtually manage any kind of clinical nobelbiocare.com/on1-ebook more coronal position. This means The On1 concept also entails sur- situation in reference to soft tissue that any biological or biomechanical gical flexibility, in as much as you thickness. < Issue 3/2017 Nobel Biocare NEWS 11 Taking the All-on-4® Treatment Concept to the Next Level This minimally invasive solution – with a fixed full-arch restoration for high patient satisfaction – just keeps getting better.

For patients, the All-on-4 treatment concept stands for a rapid improvement in their quality-of-life. For clinicians, providing a fixed full-arch prosthesis on the day of surgery can quickly lead to improved patient satisfaction in terms of function, esthet- ics, sense, speech and self-esteem. Now, some new Efficiency through versatility— components make it more this tool enables the identification effective than ever before. of three angulations and six rotational positions using one By Chris Kendall instrument.

revolution when it was first both the lab technician and clinician, introduced almost two de- and the caps are conveniently deliv- Acades ago, the many benefits ered ready to use in packs of two. of the All-on-4® treatment concept are It’s important to note that the caps now well proven. are for single use only. There are a va- A key enabler of the concept today riety of reasons for avoiding reuse. is the Multi-unit Abutment, a catalyst The Multi-unit Aligning Instrument reduces the time required to place the implant in the proper position for an For example, research has shown that of the trend for restoring multiple easy restorative workflow. It also facilitates selection of the most suitable Multi-unit Abutment. 99% of healing abutments may show teeth using tilted implant placement. protein contamination at one or more Abutment eliminates the need for ment rotational position and angula- choice of Multi-unit Abutment and sites following cleaning and steriliza- screw fixation during try-in and ad- tion, Nobel Biocare has designed the rotational position of the implant. tion. What’s more, whichever steril- justment of the provisional prosthesis. Multi-unit Aligning Instrument. This ization method is used, the pristine Now, for ease, speed and efficiency, latest innovation has been designed to Multi-unit healing caps: an surface of the original abutment will PinD the Multi-unit Aligning Instrument reduce chair time by indicating three individualized approach to never be restored. Products in Development and Titanium Multi-unit Healing Cap different angulations using one tool. soft tissue healing represent the latest step forward in the The instrument makes it easy to The Titanium Multi-unit Healing Next generation of the First developed by Nobel Biocare in All-on-4® treatment concept. identify the angulation of the most- Cap assortment is a new facilitator All-on-4® treatment concept 2000—and a first in the industry at suitable Multi-unit Abutment and the for the placement of the provisional The All-on-4® treatment concept is the time—the technology continues Three angulations in one rotational position of the implant, prosthesis. Designed to help individ- now accepted as an industry standard. to evolve. Selecting a less-than-optimal im- helping to optimize the final abut- ualized treatment, this newly ex- Nobel Biocare’s ongoing development The introduction of the Multi-unit plant position for the seating of the ment position and prosthetic design. panded portfolio of healing caps pro- of the concept and associated technol- Abutment Plus in 2016 supported a Multi-unit Abutment, or the wrong This is further helped by easy-to-see vides clinicians with a choice of ogies doesn’t just help experienced significant reduction in chair time for Multi-unit Abutment, can cause sig- laser-etched markings. Clinicians can dimensions and designs to suit the surgeons in offering their expertise the All-on-4® treatment concept. This nificant inconvenience for both cli- easily identify the screw-hole trajecto- thickness of the soft tissue, in order faster, but supports the next genera- evolution of the original Multi-unit nician and patient during subse- ry to avoid facially protruding screws to gain improved access to the Multi- tion of All-on-4® treatment concept quent steps of the restorative and to optimize prosthesis design. unit Abutment. practitioners. < workflow. When this happens, the Compatible with existing implant The new healing caps have been restorative technician must poten- drivers and the manual torque developed with ease of use in mind, More to explore! tially remove and then re-seat four or wrench, the new and reusable align- helped by a new internal design. The Find out more about the Multi-unit more abutments, costing time and ing instrument complements the inside of the cap is only partially Abutment and other new compo- money that could have been avoided. Nobel Biocare product range in facili- threaded, with 0.3 mm of smooth sur- nents at: nobelbiocare.com/mua. For ease, speed and efficiency in tating straightforward placement of face at the tip. This makes it easy to For a full list of references to this choosing the correct Multi-unit Abut- the abutment. slip into position and place onto the article, please see: nobelbiocare. The instrument is particularly ben- abutment. For strength and ease of com/news. eficial for the All-on-4® treatment placement, the new caps are one- concept procedure, both for improv- piece components made of titanium. ing the speed and efficiency of experi- The external design features special enced clinicians, and in supporting markings to facilitate the visual iden- new clinicians in making the correct tification of healing cap heights for

The Titanium Multi-unit Healing Cap is a temporary The new healing caps are component designed to facilitate partially threaded for easy the placement of the provisional positioning and screwing into the prosthesis. abutment. The Titanium Multi-unit Healing Cap range has been expanded for individualized treatment for different anatomies. 12 Nobel Biocare NEWS Issue 3/2017 Bringing Science to the Surface An interview with Professor Matthias Karl of Saarland University about a major meta-analysis of TiUnite

32,519 How did you decide which What did you set out to publications prevalence of peri-implantitis is ex- A recently published meta- studies to include in the discover within all this data? screened tremely low. There were no major bi- analysis evaluating Nobel analysis? Karl: We did not have any predeter- 106 ological complications and the mar- prospective studies Biocare’s TiUnite implant Karl: We had strict inclusion crite- mined expectations—this is another analysed ginal bone level changes are well surface is believed to be the ria. We looked only at prospective strong point of this review in my within the accepted thresholds for a largest such evaluation of a clinical studies with at least 20 pa- opinion. It was really, “let’s look and successful implant. single implant brand ever tients receiving TiUnite implants see what we find.” Our aim was not No cherry picking! The conducted. from the beginning of the study. A to cherry-pick data, but to conduct How can the findings of your Karl-Albrektsson study includes all minimum of one-year post-loading an unbiased review of the literature. patients with a TiUnite implant analysis be used to optimize follow-up was also required. In terms Another unique feature of the prospectively evaluated in a clinical clinical practice? n the interview below, the lead of reporting we had to be able to ei- study is that we used implant place- study with a minimum of 20 patients Karl: Clinicians can use the values author of “Clinical performance ther derive the accumulative survival ment as a base line. Bone remodeling and 12 months of post-loading. presented in the paper as a reference. Iof dental implants with a moder- rate from the paper or calculate the takes place predominantly between This is the real benefit of such an ex- ately rough (TiUnite) surface,”* survival rate based on the data given implant placement and abutment not to over- or underestimate peri- tensive review. In our own practices Professor Matthias Karl of Saarland in the paper. connection. In many studies, it’s only implantitis. If the primary author we can only see a limited number of University in Germany, discusses at the time of prosthetic restoration referenced peri-implantitis or if patients. What we have here is an the relevance of the study for clini- Despite the strict inclusion that the clock starts to run. But by there was peri-implant inflammation analysis of over 12,000 implants cians and patients. criteria, the study is thought then a certain amount of remodeling or peri-implant pathology, we count- spanning a 15-year period. I would to be the largest analysis of has already taken place; it’s more ed this as peri-implantitis no matter say, look at these values and compare What was your rationale for this kind on a single brand of honest to go back and report the im- what. We are well aware that these them with what you see in your prac- conducting a meta-analysis implants. What was the scale plant surgery as the base line and as- authors were acting on different tice. Then you can ask yourself, correlating clinical perfor- of the data examined? sess the bone levels from then on. scales, but if they used the term “Where am I in relation to the data mance of implants with the Karl: It’s certainly the largest such We were able to really look at mar- “peri-implantitis,” or something sim- and why might that be?” If you are TiUnite surface? study I’ve seen. Of 32,519 studies ginal bone level changes from the ilar, we did not question it. not seeing the same success, why is Professor Matthias Karl: The screened, we reviewed 106 well-doc- beginning—from the surgery, for this? The findings are a helpful TiUnite surface was launched over 15 umented prospective clinical studies. many, many studies—and also What were the key findings of benchmark for modern practice.< years ago and in that time certainly To have such a high number of looked into biological complications your analysis? has set the standard in implant primary studies in a single review is if they had been reported. Of course, Karl: For me, the key finding was More to explore! dentistry. rather unique, to say the least. In we were also looking at peri-implan- that TiUnite is a highly reliable im- For more information about the It’s one of the major implant sur- total, over 12,000 TiUnite implants titis and peri-implant pathology. plant surface even in very challeng- TiUnite surface, visit faces on the market. We felt that it were part of the evaluation. This rep- ing situations. Nobel Biocare has a nobelbiocare.com/TiUnite. was time to evaluate TiUnite im- resents a huge database and should The definition of peri-implan- full range of implant designs with the plants in a comprehensive meta- be perceived as a real strength for titis is presently a much- TiUnite surface and we could not * Karl, M., and Albrektsson, T.: analysis of prospective clinical stud- Nobel Biocare, the clinicians using debated topic. How did you differentiate implant performance “Clinical performance of dental implants ies—not with pre-clinical data, not Nobel Biocare implants and their pa- define it for the purposes of between different implant geome- with a moderately rough (TiUnite) sur- with retrospective data, not with case tients. I think it’s really the highest this paper? tries. In the end you can absolutely face: A meta-analysis of prospective clini- reports, but a real focus on the high- level of evidence we have right now Karl: The definition of peri-implan- say it’s a really great surface. It keeps cal studies,” Int J Oral Maxillofac Im- est possible quality of evidence. documenting the clinical success of a titis is indeed a hot topic right now. the implant in place, the longevity is plants. 2017 Jul/Aug;32(4):717-734. doi: single implant surface. What we have done in the paper is definitely there—it’s proven. The 10.11607/jomi.5699.

Americas Asia Pacific Europe, Middle East and Africa

Brazil Australia Austria Lithuania Switzerland Nobel Biocare Brazil Nobel Biocare Australia Nobel Biocare Austria Nobel Biocare Lithuania Nobel Biocare Switzerland Phone: 0800 16 999 6 Phone: 1800 804 597 Phone: +43 1 892 89 90 Phone: +370 5 268 3448 Phone: 0800 211 424 Belgium Netherlands United Kingdom Nobel Biocare NEWS Canada China Nobel Biocare Belgium Nobel Biocare Netherlands Nobel Biocare UK Nobel Biocare Canada Nobel Biocare China Phone: +32 2 467 41 70 Phone: +31 30 635 49 49 Phone: +44 208 756 3300 Printed on non-chlorine bleached Phone: +1 800 939 9394 Phone: +86 400 081 7707 FSC-certified paper. Denmark Norway Nobel Biocare Denmark Nobel Biocare Norway Chile Hong Kong Phone: +45 39 40 48 46 Phone: +47 64 95 75 55 Distributor Markets Dental Biocare Nobel Biocare Hong Kong Read us online at: Phone: +56 220 19282 Phone: +852 2845 1266 Finland Poland Algeria, Bulgaria, Croatia, nobelbiocare.com/news Nobel Biocare Finland Nobel Biocare Poland Cyprus, Czech Republic, Greece, Jordan, Kuwait, Lebanon, Malta, Colombia India Phone: +358 20 740 61 00 Phone: +48 22 395 73 60 Qatar, Romania, Saudi Arabia, Hospimedics S.A. Nobel Biocare India France Portugal Headquarters Serbia, Slovenia, Tunisia, Turkey, Phone: +57 1 640 0608 Phone: 1800 266 0308 Nobel Biocare France Nobel Biocare Portugal United Arab Emirates Phone: +33 1 49 20 00 30 Phone: +351 800 300 100 Nobel Biocare Services AG Phone: +34 933 560 562 Mexico Japan P.O. Box Germany Russia Nobel Biocare Mexico Nobel Biocare Japan 8058 Zürich-Flughafen, Switzerland Nobel Biocare Germany Nobel Biocare Russia Southeast Asia Distributor Markets: Phone: +52 55 524 974 60 Phone: +81 3 6408 4182 Offices: Phone: +49 221 500 850 Phone: +7 495 974 77 55 Indonesia, Malaysia, Myanmar, Balsberg, Balz-Zimmermann-Strasse 7 Philippines, Singapore, Thailand, USA New Zealand Hungary South Africa 8302 Kloten, Switzerland Vietnam, South Korea Nobel Biocare USA Nobel Biocare New Zealand Nobel Biocare Hungary Nobel Biocare South Africa Phone +41 43 211 42 00 Phone: +852 28238926 Phone: +1 800 322 5001 Phone: 0800 441 657 Phone: +36 1 279 33 79 Phone: +27 11 802 0112 Fax +41 43 211 42 42 Ireland Spain South Asia Distributor Markets: Taiwan Nobel Biocare Ireland Nobel Biocare Spain Bangladesh, Nepal, Pakistan and Nobel Biocare Taiwan Phone: +44 208 756 3300 Phone: +34 900 850 008 Phone: +886 080 00 779 Srilanka Italy Sweden Phone: +91 22 67519999 Nobel Biocare Italy Nobel Biocare Sweden Phone: +39 800 53 93 28 Phone: +46 31 335 49 00

Web contact: nobelbiocare.com/contact v 17.3 All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. in a certain case, trademarks of Nobel Biocare. from the context Nobel Biocare, the Biocare logotype and all other trademarks are, if nothing else is stated or evident 2017. All rights reserved. Services AG, GMT 54125 GB 1711, Printed in the EU © Nobel Biocare Please contact the local Nobel Biocare sales office for current product not be regulatory cleared/released for sale in all markets. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily scale. Disclaimer: Some products may and precautions. to sale by or on the order of a licensed dentist. See Instructions for Use full prescribing information, including indications, contraindications, warnings restricts this device (United States) law Caution: Federal prescription use only. For assortment and availability.