Information for the Osseointegration Specialist Issue 2/2013

Nobel Biocare NewsIn this Issue

Lectures and hands-on sessions came alive as the audience followed each patient journey from initial planning and treatment, via potential complications (and how to avoid them), to follow-up and maintenance.

High-tech throughout, 3D presen-tations were featured, the symposium had its very own mobile app, and so-cial media sites such as Facebook and Twitter were alive with messaging be-tween attendees and lecturers from the very first day.

For many of the attendees, some of the most memorable exchanges of knowledge and experience took place between educational sessions.

Dr. Carlos Moglianesi of New Prov-idence, New Jersey, USA, made this point quite tellingly. “In many ways,” he said, “dentistry is a solitary enter-prise, but at this meeting, each of us has had the opportunity to network with leading authorities in our field.”

In an impromptu conversation with Professor George Zarb, who

chaired the event, Moglianesi said that he was reminded how important well-conceived and well-executed teamwork is for successful outcomes.

“No one but Nobel Biocare does meetings like this!” he exclaimed. “Here you have access to great minds in a city where you can’t help but have a great time.”

A dental technician day and a post-symposium day were also part of the meetings—as was a party, held at Pier 60, overlooking the Hudson River.

Nobel Biocare made two major an-nouncements during the meetings.

The first of these was the launch of the Foundation for Oral Rehabilita-tion (FOR), an independent, global body that unites professionals from various disciplines in order to im-prove oral health care and support humanitarian leadership. The second was the introduction of a new, fully integrated digital workflow. (Read more about both of these initiatives elsewhere in this issue.) <

More to explore:

Videos and summaries from each

day of the event are available at

nobelbiocare.com/newyork2013

sented implementable strategies de-signed to treat more patients with better results.

Richard Laube, CEO of Nobel Bio-care, explained the theme of the pro-ceedings the very first day.

“Many patients being treated today will have their implants not just for years,” he pointed out, “but for de-cades to come.” The point was well taken and reiterated repeatedly over the next four days by more than 100 internationally acclaimed speakers.

Organized like no other major symposium before it, the first two days covered four complete patient journeys: the loss of anterior and pos-terior single teeth; missing multiple anterior teeth; missing multiple pos-terior teeth; and how one best manag-es the transition to edentulism.

Minimally invasive treatment, graftless solutions, immediate re-placement and function, and soft tis-sue health and esthetics all had given places in this innovative program.

Participants at the Nobel Biocare Global Symposium 2013 explored the latest developments and clinical approaches in implant dentistry. When they went their separate ways after four days together in New York, they returned to patients and associates at home with updated knowledge about recent advances in their chosen field.

By Frederic Love

They came to the Waldorf Asto-ria from as far away as Asia, Africa and Australia—not to

mention Europe and the Americas. During four halcyon days of summer, some of the brightest minds in im-plant dentistry gathered in New York City to teach and to learn.

The theme of the sold-out event, which attracted more than 2,000 par-ticipants, was “Designing for Life: Today and in the Future.”

In virtually every aspect of the pro-gram, clinicians and academics pre-

From Every Corner of the EarthWorld-class discourse and hands-on training made the Nobel Biocare Global Symposium a New York hit.

2 Already a success The Foundation for Oral Rehabilitation (FOR) has become a hub for learning and collaboration.

3 Global Symposium 2013 Science in the city.

4 Veneering options for fixed implant-retained restorations, each of which can be adapted specifically to the needs of the patient.

7 Smarter standard OsseoCare Pro put through its paces by an early adopter.

8 Treating more patients better

A company built on a premise for growth.

11 Intelligent scanner The result of 30 years’ CAD/CAM heritage.

12 Sometimes complicated Dr. Enrico Agliardi offers answers from his files.

13 NobelProcera® Abutments Now for 3Shape®

users too!

“No one but Nobel Biocare does meetings like this!” — Dr. Carlos Moglianesi

87571_NB_NEWS_2-2013_b.indd 1 02.12.13 14:19

Nobel Biocare NewsPublished regularly by

Nobel Biocare Services AG

Vol. 15, No. 2, 2013

Editor-in-chief Frederic Love

Managing Editor Jim Mack

Editorial offices

Nobel Biocare News

Herdevägen 11

702 17 Örebro, Sweden

Telephone: +46 19-330680

Telefax: +46 19-330681

e-mail: news.editors@nobelbiocare.com

web: nobelbiocare.com/newsletter

The contents of contributor’s articles do

not necessarily express the opinions

of Nobel Biocare.

© Nobel Biocare Services AG, 2013.

All rights reserved.

Nobel Biocare News Issue 2/2013

Richard Laube, CEO

Nobel Biocare spends 10% of its sales revenue on Research and Develop-ment (R&D). That percentage is higher than anyone else’s in the in-dustry. Much of this investment goes to design, develop and produce new and innovative products and solu-tions that help you treat more pa-tients better every day.

An increasingly large portion of this R&D investment is also used to technically test and clinically vali-date Nobel Biocare’s implants and solutions, ensuring they are safe, predictable and perform as designed.

In addition, we have significantly increased investment in our manu-facturing quality management sys-tems. We do everything possible to ensure our products are produced to the most exacting standards every time.

Knowing all of the effort and in-vestment needed to develop and pro-duce a safe and predictable product according to high industry stan-dards, it is difficult to understand why any clinician would purchase an implant or restorative component that may remain in a patient’s mouth for decades from a company that does not provide similar evidence.

When it comes to patients, there is no compromising our standards. This is why we are so committed to evidence-based dentistry. <

From the CEO

2

The Birth of FORThe Foundation for Oral Rehabilitation celebrated at milestone event

Dr. Bertrand Piccard, the first FOR Humanity Award winner: “Freedom is when we manage to ... (get) out of the old patterns of thinking to invent a better future.”

the possibility of personal mentor-ship and an on- and offline network of peers around the world, the Foun-dation’s commitment to continuing professional education will enhance treatment outcomes, and, ultimately, patients’ quality of life.

The Foundation is comprised of four Councils—Science, Education, Governance and Emerging Leaders. The latter is chaired by Eric Rompen and Bernard Touati who appeared in New York to elaborate on the Foun-dation’s aim to identify, develop and build the next generation of leaders in the fields of Science, Education and Humanity. The event also saw the Foundation host its first session dedicated to young leaders of tomor-row—for an hour the stage was given to three impressive young speakers: Oscar Gonzalez Martin, Sunyoung Ma and France Lambert.

A hub for learning and collaboration: FOR.orgThe cornerstone of the Foundation is its online platform, which emphasiz-es a modern approach to learning and is a unique go-to place for com-plete patient case histories, covering planning through to follow-up and complication handling. The 30 cases made available at launch will be con-tinuously added to over time.

The website also offers a growing repository of video insights with key-note speeches from selected sympo-sia. All sessions in New York were filmed and are being uploaded to FOR.org, so those unable to attend the event can still catch up on the topics discussed.

Also to be found on FOR.org are a selection of pre- and post-surgery safety checklists. Developed by Dr. Franck Renouard and a team of lead-

ing experts, they are available for download and can also be viewed on mobile devices. Dr. Renouard was on hand in New York to demonstrate how easily and effectively the check-lists can be used in practice.

FOR HumanityFOR is partnering with Winds of Hope, an organization whose prima-ry objective is to eliminate Noma—an infection that develops from gin-givitis and, without treatment, causes permanent facial disfiguration. The organization’s President, Dr. Ber-trand Piccard, was presented with the first FOR Humanity Award for his work with Winds of Hope which personifies the key qualities we look for in the Foundation—compassion, generosity of spirit and leadership in humanitarian deeds.

In his acceptance speech, he evoked experiences from his circum-navigation of the world in a balloon, his professional role in psychothera-py and his humanitarian work to in-spire the audience: “Freedom is when

we manage to think in every possible direction … this is the spirit that we learn in ballooning, it is the spirit I try to teach in my profession of psy-chotherapy, it is the spirit of Winds of Hope, and I believe it should be the spirit of all the people who try to make the world a better place … get-ting out of the old patterns of think-ing to invent a better future.”

As the birthplace of FOR, the inau-guration in New York represented a milestone event. In less than four months the Foundation has already attracted more than 1,000 partici-pants interested in what FOR repre-sents and what it can offer them. The Symposium was an opportunity to explain the benefits of FOR and to demonstrate the tools that are already available for use in the dental prac-tice. The work of the Foundation, however, has only just begun. <

More to explore:

To learn more about the Foundation

for Oral Rehabilitation (FOR), please

visit: FOR.org

Online presence: All sessions in New York were filmed and are being uploaded to FOR.org, so those unable to attend the event can still catch up on the topics discussed.

On June 20, 2013, the Waldorf Astoria Hotel in New York provided the prestigious setting for the launch of the Foundation for Oral Rehabili-tation (FOR). A new initiative, endowed by Nobel Biocare, FOR aims to take the lead in professional education and build a cross-disciplinary, global community where insights and experience can be shared. The executive director of FOR reports.

By Dr. Sreenivas Koka

In an address to an audience of over 2,000, Nobel Biocare CEO Richard Laube introduced FOR,

reaffirming Nobel Biocare’s commit-ment to professional education be-fore calling on Professor George Zarb, Chairman of FOR, to explain the mission of the Foundation: achieving effective worldwide pa-tient care through scholarship and humanitarian engagement.

Committed to better patient care for generations to comeFOR is committed to staying at the forefront of innovation. It will moni-tor and encourage scientific break-throughs based on clinical evidence. This builds on the heritage of osseo-integration that began in the pio-neering days of the 1960s. It was therefore apt that the Foundation be-stowed its very first Honorary Fel-lowship on Per-Ingvar Brånemark in New York.

The Foundation for Oral Rehabili-tation promotes the exchange of ideas on an international level. Through emerging leader programs,

87571_NB_NEWS_2-2013_b.indd 2 02.12.13 14:19

Nobel Biocare NewsIssue 2/2013 3

Science and Society in the CityAn amazing assembly of over 100 world-class speakers took the stage at the Nobel Biocare Global Symposium.

For four days in June, New York City became the world capital of osseointegration. The Nobel Biocare Global Symposium was a star- studded scientific event that also included practical hands-on training and a wide variety of opportunities for participating implant profes-sionals to network as well.

By Frederic Love

All the right people were there, the pioneers of science-based

implant dentistry, such as George Zarb and (by the way of video) Per-Ingvar Brånemark himself; but also the up-and-coming names one reads in the best journals and sees lecturing at the annual professional association conferences.

Bring more than two thousand implant professionals together in a venue like the Waldorf Astoria and serendipity is bound to happen.

Meaningful exchanges of knowl-edge and frequent “Aha!” experienc-es took place during those four days in June, both in the course of the for-mal presentations and during the re-laxed receptions, dinners and soirees Nobel Biocare had arranged.

Staying at the forefrontProfessionals of many different disci-plines met in New York not only to improve their skills, but also to learn from people with complementary expertise and experiences.

Surface physicists, biomechanical engineers, statisticians and econo-mists rubbed shoulders with den-tists, surgeons, prosthodontists, peri-odontists, laboratory technicians, nurses, office staff and even writers like me. The outcome? There were no boring conversations at the Glob-al Symposium!

In the mosaic of good memories to the right, we at Nobel Biocare News have chosen to depict a small frac-tion of the people who came to New York to be a part of this great event.

Many of them have already written for you on these pages. Many more will be joining their ranks in the fu-ture. Keep your eyes open for the sto-ries they have to tell and the knowl-edge they have to share. <

More to explore:

Videos and summaries from the

Nobel Biocare Global Symposium:

nobelbiocare.com/newyork2013

87571_NB_NEWS_2-2013_b.indd 3 02.12.13 14:19

Nobel Biocare News Issue 2/20134

Veneering Options for Fixed Implant-Retained Restorations – Part 2

A follow-up presentation on state-of-the-art techniques and materials

In this issue of Nobel Biocare News, Professor Stefan Holst continues to present restor-ative options for manufactur- ing definitive restorations with NobelProcera, each of which can be adapted specif-ically to the needs of the patient and the preferences of the treatment team.

Compiled by Professor Stefan Holst

The following case reports from some of our skilled partner clinicians underline the versa-

tility and display the functional and esthetic outcomes that can be achieved with the NobelProcera Software. To view the complete treat-ment sequences online, please see the “More to explore” section at the end of this article.

Case 1Dr. Ferdinando D’Avenia and Master Dental Technician Cesare Ferri of Parma, Italy, utilized a NobelProcera Implant Bridge Titanium veneered with acrylics to accommodate for the clinical situation and the expecta-tions of the patient:

A 55-year-old man, suffering from bi-maxillary severe bone atro-phy, presented with discomfort and chewing deficiencies. He was wear-ing two severely worn, 20-year-old complete dentures and requested implant-supported fixed restora-tions. Following diagnostic and ra-diographic examinations, the defin-itive treatment plan compensated for the extensive resorption of alve-olar ridges (hard- and soft-tissue architecture) via prosthetic means.

In addition to functional and es-thetic rehabilitation, the patient needed a cost-efficient solution that would not require high maintenance costs. To meet his needs and expec-tations, the treatment team decided to go for the following solution:

Four NobelActive implants were placed in both the maxilla and the mandible according to the All-on-4® concept. Treatment planning and execution were carried out with NobelClinician/NobelGuide tech-nology, and an immediate provi-sional restoration was provided. To reduce additional costs for the pa-tient, the existing dentures were

transformed into an immediate, screw-retained provisional (re-adapted to a correct VDO). Follow-ing a four-month healing period to allow for osseointegration of the fixtures, the provisional was subse-quently replaced with definitive res-torations, i.e. NobelProcera Implant Bridge Titanium veneered with conventional denture teeth and cold-cure acrylics. (See figures 1 through 7 on this page.)

Why this approach?The team’s rationale for selecting this approach has to do with a number of clinical and technical advantages.

First of all, the titanium frame-work represents an economical so-lution, which also demonstrates beneficial biomechanical properties in combination with Nobel Biocare’s Multi-unit Abutments (MUA).

Not only does this solution pro-vide excellent peri-implant, soft tis-sue biocompatibility, it is also asso-ciated with a straightforward handling protocol for both the clini-cian and the dental technician.

MUAs provide ease of use through accessibility. At the same time, their use supports biologic sta-bility of the peri-implant tissues, as this critical interface remains undis-turbed during the change from a provisional to final restoration (e.g. abutment-level impression and fixa-tion of the definitive framework).

From a technical and longevity perspective, the performance of the chemical bond between titanium and acrylic has ample scientific background, can be easily achieved, and is stronger than a zirconia-ce-ramic bonding.

What’s more, costs for the patient can be significantly reduced through material selection and the choice of prefabricated standard acrylic den-ture teeth. In fact, there are any

number of time- and cost-saving production steps in the dental labo-ratory when this option is chosen.

Reduced maintenance costs in case of late prosthetic reintervention can be expected and most repairs can be performed intra-orally.

Finally, this restorative approach produces highly esthetic results thanks to an optional outer layer of composite resin that can be added after a cut-back of the denture teeth (depending on the esthetic needs and expectations of the patient).

Case 2 – with photographs on the facing pageDrs. Mario Imburgia and Giovanni Cricchio, and Ceramicists Angelo Canale and Angela Giordano of Italy chose a NobelProcera Implant Bridge Zirconia, manually veneered with feldspathic ceramics as a solu-tion in their daily routine:

The patient presented was a 64-year-old woman who was affect-ed by generalized severe periodontal disease. She had been wearing an upper partial removable denture for approximately 10 years prior to her first consultation for implant-sup-ported restorative treatment.

Her chief complaint was discom-fort and lack of masticatory efficien-cy and esthetics. Migration and in-creased mobility of her teeth had resulted in altered speech and con-tributed significantly to her sense of insecurity.

She made it clear that esthetics were as important as the functional outcome. She wanted to regain a natural and esthetically pleasing ap-pearance without the “Hollywood smile” effect.

The treatment team had to com-ply with two conditions: 1) The pa-tient did not want to be subjected to invasive surgical procedures, and 2) she was unwilling to wear remov-

able dentures during the provisional phase.

To accommodate both needs and stipulations, the treatment team de-cided to go for the following solu-tion: Implant treatment planning in both the maxilla and mandible was

carried out using NobelClinician Software. Post-extraction, immedi-ate flapless implant placement was done with a two-piece radiographic guide, after which an immediate pro-visional restoration was provided.

Fixed implant-supported zirconia

Figure 2: Milled NobelProcera Implant Bridge Titanium, custom designed to accommodate for material support and retention after veneering.

Figures 1a & b: The initial intra-oral situation: The photograph to the left shows a 20+ year old prosthesis with which the patient presented at the first consultation visit, and the picture to the right depicts the same situation without the dentures, clearly showing the loss of hard and soft tissue architecture. (Images courtesy of Dr. D’Avenia et al.)

Figure 5: Proper size, shape and color of the latest generation composite denture teeth were selected, and minor manual super-ficial adaptations were performed without impairing the mechanical properties.

Figure 3: Screenshot of Nobel-Procera Software displaying the custom design options applicable in this case.

Figure 4: Following an intraoral assessment of the anticipated tooth set-up, which respected the functional and esthetic require-ments, a silicon rim was used to maintain acrylic denture teeth in position prior to injecting pink acrylic material.

Figure 7a: Intraoral view of maxillary and mandibular restora-tions retained by four NobelActive implants each (see radiograph below).

Figure 6: Finalized maxillary resto-ration. Gingival tissues were manu-ally layered in an “onion-like” mode, with a thicker inner layer of cold cure acrylic resin and a thinner outer layer of pink composite material.

Figure 7b: Radiographic view of maxillary and mandibular restorations, each of which are retained by four NobelActive implants.

87571_NB_NEWS_2-2013_b.indd 4 02.12.13 14:19

Nobel Biocare NewsIssue 2/2013 5

Figure 8: Preoperative clinical view. Following clinical and radiographic examination, the teeth of the upper arch were evaluated as hopeless. The primary request of the patient was to optimize function and esthetics through minimally invasive techniques.

Figure 11: The preoperative planning allowed for the mainte-nance of sufficient thicknesses of the framework and veneering ceramic as well as adequate material surrounding the occlusal screw access channels. This gives greater resistance and reduces the risk of mechanical failures.

Figure 9: Intraoral occlusal view of the zirconia implant bridge. Based on an accurate surgical plan, it was possible to manufacture a framework directly screwed onto the implants. The morphology of the frameworks ensures uniform thicknesses of the veneering ceramic, reducing the risk of chipping.

Figure 12: Clinical control of the definitive implant-prosthetic restoration.

Figure 10: The zirconia framework together with a careful layering technique ensures an optimal esthetic outcome.

Images courtesy of Drs. Imburgia and Cricchio.

Figure 13: Radiographic control of the definitive implant-prosthetic restoration.

bridges (NobelProcera Implant Bridge Zirconia) were produced for the definitive restoration in order to ensure high comfort, stability and good esthetics. In the mandible, five implants were placed and restored with screw-retained, single tooth restorations and a screw-retained implant bridge (zirconia).

Rationale behind the choiceThe team chose this combination of zirconia frameworks and veneering ceramic for a number of reasons. From extensive earlier experience, they knew that this option would allow them to obtain an optimal es-thetic result, achieving natural-looking color and translucency in the individual dental restorations while elsewhere preserving soft tis-sue volume and architecture.

With this combination of materi-als and techniques, they also knew that they would be using a highly biocompatible material to make a prosthetic restoration that would provide excellent integration and stability of the peri-implant tissues.

The team also chose this combi-nation in order to obtain an optimal esthetic result in a fully customiz-able prosthetic solution; one that would be, at the same time, both simple and retrievable.

From a technical point of view, the team points out, “This choice has allowed us to maintain an excel-lent fit of the framework due to

Recent Findings

Immediate placement, immediate function with immediate success Bone gain accompanies high survival rates of implant and prosthesis with immediate placement and immediate provi-sionalization. (Hartlev et al. Clin Oral Implants Res. 2013.)

The CSR was 98% and 100% for implants and final prostheses, respec-

tively, at 33 months mean follow-up (range 11–89) with Replace Select

Tapered TiUnite implants immediately placed in extraction sockets in

the esthetic zone. All 55 implants followed were immediately provision-

alized with a Procera Abutment and a provisional crown. Patients were

instructed to avoid chewing and biting with the provisional for 10 weeks

and definitive crowns were placed after a mean period of 7 months

(range 2–37).

Immediate provisionalization with the definitive abutment avoids

later abutment change, which may improve the preservation of the peri-

implant tissues. Healthy peri-implant tissues were observed, as

assessed by bleeding on probing and probing depth parameters. A sig-

nificant 0.5 mm gain in mean marginal bone levels was shown around

implants (P = 0.022).

www.ncbi.nlm.nih.gov/pubmed/22409733

NobelActive® 3-year follow-upContinued high survival, stable bone levels and significant improvements in soft tissue with NobelActive implants placed in extraction sites with Immediate Function. (Kolinski et al. J Periodontol. 2013. [Epub] )

Results showed 98.3% cumulative survival of NobelActive implants at 3

years of follow-up. Marginal bone remodeling showed a non-significant

mean gain of 0.30 ± 1.62 mm in implants evaluated both at implant

insertion and 3-year follow-up. Jemt papilla score increased significantly

(P < 0.001).

Patients experienced significant increases in function, esthetics,

sense, speech and self-esteem from baseline to 3 year follow-up. The

authors conclude that NobelActive is a safe and effective implant for

use under demanding conditions—like immediate loading in extraction

sockets—and provides a high degree of patient satisfaction.

www.joponline.org/doi/abs/10.1902/jop.2013.120638

Implants are not genericEarly failures doubled when switching to a new chemically altered surface implant. (Hujoel et al. Clin Oral Implants Res. 2013.)

In a single-center quality-control study, the failure rates of 860 porous

oxidized surface (POS) and 759 chemically altered surface (CAS)

implants were assessed. The POS implant failure rates (4%) were signifi-

cantly lower than the CAS implants at 8% (P=0.0146). Failures were not

associated with any other analyzed variable including: implant length

and diameter, type of surgery, location, bone quantity and quality. As a

result of this quality study, the clinic abandoned the use of CAS

implants and returned to POS implants. Although not statistically signifi-

cant, the change showed a 64% reduction in failures within less than 1

year.

www.ncbi.nlm.nih.gov/pubmed/22540393

continued on page 10

CAD/CAM technology and the high stability of zirconia during the firing of the veneering ceramic.”

Finally—and not least of all—they chose this combination of zirconia and veneering ceramics because of the NobelProcera Software features,

which allow for fully customized frameworks, designed to support the veneering materials for stable, long-term results.

87571_NB_NEWS_2-2013_b.indd 5 02.12.13 14:20

Nobel Biocare News Issue 2/20136

Shame, Guilt and ToothlessnessOn treating the edentulous patient with respect as well as good oral care

The mouth, teeth and tooth-lessness collectively comprise an emotionally charged subject to say the least. Poor oral health is generally associated with shame and guilt. While the individual tries to hide such a predicament as much as possible, the opinion of the rest of the world is usually unmistakable: “It is your own fault! Poor oral health is self-inflicted, so you have no one but yourself to blame!” It’s not that simple, of course.

By Dr. Björn Klinge

The Swedish author Per Olov Enquist writes in the begin-ning of his book Ett annat liv

(A Different Life) of a mother who is associated, because of her edentu-lism, with “a teacup holding a pros-thesis; she lost her teeth already at the age of seventeen. She never talks about this, doesn’t want to acknowl-edge the shame of it all, but when she laughs, her laughter is oddly re-strained and unnerving, as if she still felt the shame.”

In my daily work I often meet this shame and self-reproach among des-perate people who are about to lose their teeth because of disease, and among patients with ill-fitting, loose dentures that display the disgrace they’re trying to hide.

I want to share with you some of the experiences that are especially etched into my memory.

The first story is about a grand-son and his grandmother. The

grandson, Christer, has heard that missing teeth can be replaced with implants and talks to us about his beloved grandmother and her toothlessness. He wonders if we can help her with new, bone-anchored teeth.

Grandmother loves to treat her ex-tended family to dinner, and pre-pares quite a feast on Sundays. Over the years, Christer has noticed that his grandmother rarely sits with her family to enjoy the good food and fellowship around the table.

There always seems to be some-thing that needs to be done in the kitchen, keeping her away from her plate. A bowl needs to be refilled with gravy, more potatoes need to be served, or there is simply too little meat left on the serving plate.

When she serves herself, she al-ways dishes up a miniscule portion and never spends more than a few moments at her seat. She moves the food around a bit to make it look like she is eating, but in fact she never takes a single bite.

When he gets a chance to be alone with his grandmother, Christer con-fronts her with his observations. At first she hesitates to reply, but then she admits to the desperation she feels about her edentulism and ill-fit-ting dentures, and how anxious she is about being exposed as toothless. She is not prepared to bear this dis-grace, not even in front of her close-knit family.

For years, she has struggled to conceal her situation. She never eats a meal with other people, even though she loves the social interac-tion around a table and has actually learned to enjoy mashed and finely cut food.

Like being rebornThis story has a happy ending. We operate and prepare a prosthesis, providing the grandmother with tita-nium implants in place of her lost natural tooth roots, and on top of them, we screw on a dental bridge.

Christer’s grandmother describes the experience as being reborn. At one annual visit after the other, she tells me of some new aspect of the life she can now enjoy because of her bone-anchored teeth.

Another story is about homeless-ness and edentulism, personified by a man named Pontus.

Our research group at Karolinska Institutet in Stockholm was involved in a project concerning the health of the homeless. It soon became clear that one of the main problems of this group—in addition to homeless-ness—is oral disease.

Previously, Pontus led a fairly nor-mal life including work, home and a family. As a result of substance abuse, he lost everything and ended up among the homeless. To put it mild-ly, he neglected his oral health as a result of his addiction. Eventually, all that Pontus had left of his teeth were a few rotten root fragments.

After countless meetings with so-cial workers and health care profes-sionals, Pontus described how dis-gusted they all were by his rotten mouth, and how they were even re-luctant to look him in the face.

Eventually, Pontus came under the care of Dr. Patricia de Palma, a den-tist in our group. She cleaned up his mouth and provided Pontus with a new denture.

As he makes his way back from the fringes of society, Pontus says that the people he now encounters at So-cial Services seem happy to see him. He is no longer invisible. They see him, meet his gaze and smile at him; and Pontus smiles back.

He now has a place to live, a job, new friends, and he is back in touch with his daughter. This is not all due to his new teeth, of course, but Pon-tus claims that, for him, new teeth have meant the difference between life and death.

Like in the moviesWhen I had listened to a number of stories in which patients described the significance of their teeth and mouth to their lives in general, I felt at times uncertain. Could the mouth and its contents really mean so much?

I needed some first-hand experi-ence, and knew exactly what to do. I turned to one of our skilled dental technicians, Jan Ringvall, who often makes special effects teeth for the movies and the theater, and asked him to make something out of the ordinary for me.

The appliance he designed could be worn over my natural teeth and made it look as if I were missing some front teeth and was suffering from advanced periodontal disease, gingivitis, loose teeth, tartar and

plaque. I wore this “prosthesis” in a variety of social contexts, always with the same result: As soon as I re-vealed these teeth with even the hint of a smile, people recoiled with dis-gusted looks on their faces and turned away.

Their relief was palpable when I removed the teeth. I was met with smiles, nervous laughter and often a hug. I found the strong reactions that my practical joke evoked disturbing, yet the experience did help me to better understand how important good teeth and a healthy mouth are to one’s quality of life.

At one point, I was scheduled to participate in a debate in an early morning TV show. The Minister of Social Affairs at the time and I were going to discuss the importance of good teeth as a social class identifier.

As I was waiting in the green room for our turn in the TV studio, I drank a cup of coffee, browsed through a magazine and slipped my theatrical appliance into my mouth to see what

kind of reaction I’d get. The two hosts, a man and a woman, came in to welcome us.

The woman approached diagonal-ly from the front, while her male col-league stood behind me. There were a few of us sitting around a coffee table when she asked for the profes-sor in dentistry. I rose, stretching out my hand, and smiled.

She backed off, apparently terri-fied, right into the wall, murmuring something about a misunderstand-ing. I took out the false teeth and she looked at me with wide-eyed relief.

Her co-host, commenting on the incident, said it was a shame that there were no TV cameras to capture her reaction of disgust, which he would have loved to show their view-ers. Interestingly, the woman re-fused to acknowledge her response,

Dr. Björn Klinge is Dean of the Faculty of Odontology at Malmö University in southern Sweden. The author is also a Professor at Karolinska Institutet in Stockholm and President Elect of the European Association of Osseointegration, EAO.

M&RMyths and Realities

Poor oral status can put even a professor on the fringes of society.

continued on page 16

87571_NB_NEWS_2-2013_b.indd 6 02.12.13 14:20

Nobel Biocare NewsIssue 2/2013 7

By Barbara Neuhold

Teeth are important in so many different ways. I work full-time

as a tax consultant. I have two teen-age sons, who are terrific, and often spend my spare time in the recording studio doing narrations and other voice recordings. My hobby is acting.

I have been interested in speech and acting for many years, and the most important tool for speaking is, of course, the mouth.

Ever since I was a little girl, one particular tooth had always given me problems. I frequently had toothaches and received my first filling at an early age. Ultimately, the tooth had to be removed—and I was really unhappy about that.

It was just a single tooth, but its loss affected me profoundly. I loved to laugh but was hesitant to do so. I

“My instrument is my voice!”

couldn’t eat properly either. The gums in the gap between my re-maining teeth would go sore every time I bit into something hard.

As time went by, the bone that had once supported my missing

tooth atrophied. I realized that something had to be done but was terrified of dentists, which is why it took me so long to decide to do something about it in the first place.

Then I met Professor Werner

OsseoCare™ Pro at WorkAn early adopter shares some of his first impressions.

Dr. Roland Glauser was one of the first dentists in the world to put the OsseoCare Pro through its paces. In the following article, he explains how the first dental drill motor ever to be operated by an iPad® enhances produc-tivity and security for the benefit of both his patients and himself.

By Frederic Love

Ever since the final hardware and the first software versions were

available a year ago, Dr. Roland Glauser of Zurich, Switzerland, has been routinely using the OsseoCare Pro on a daily basis.

“It’s that good an instrument,” he says, “reliable and remarkably easy to use.”

From a layman’s point-of-view, the stylish industrial design is the first thing one notices.

“Well, certainly,” Glauser con-cedes, “the equipment configuration is an obvious eye-catcher for the staff and the patient. With its clean, clinical design, and the integrated iPad®, it represents a new technolo-gy for medical and surgical use.”

Dr. Glauser recently provided the editors of Nobel Biocare News with a

photograph of the handpiece, taken during one of his first surgeries using the OsseoCare Pro.

“The small size of the handpiece and the integrated, very strong LED illumination have enhanced access and overview in the surgical field.”

Aside from the distinctive visual improvements pioneered by the OsseoCare Pro, many clinicians say the handpiece simply feels better in their hands.

“I couldn’t agree more,” says Glauser. “The small handpiece weighs less than any other hand-piece I’ve ever used, and it is very easy to handle. You should also con-sider this: The lighter the weight, the better the tactility, which trans-mits important information on bone quality and resistance via sense-of-touch feedback when you’re drilling.”

Both compact and durableAlthough lightweight in many of its parts, the OsseoCare Pro is as robust in every detail as it is diminutive in its design.

“I think of it as strong engineer-ing,” says Glauser. “The mechanical

power of the handpiece allows not only for high insertion torque val-ues—much higher than other ma-chines—but also provides the good traction necessary to generate the torques. Very impressive! Drilling, even in dense bone conditions, is very fast and straightforward, which means, of course, that the overall surgical trauma can be reduced.”

For the sake of increased safety and efficacy, the OsseoCare Pro fea-tures stable torque and rotation speed. Smart Logic technology con-stantly adapts power according to the desired speed, and even at a very low speed, the torque and rotation are perfectly controlled.

“The iPad® app that controls the drill motor lives up to this plat-form’s reputation for a great graph-ical user interface. It’s all very user friendly. The steps to go through for setting up a surgical protocol are more or less self-explanatory.”

He also says that his patients are in-evitably impressed when they see their names appear on the iPad® in conjunc-tion with the surgical workflow.

“This clearly indicates that we are well prepared for the upcoming pro-

cedures and provides peace of mind for our patients. It shows that we have personalized the plan for each of them, which further strengthens the relationship of trust between the patient and the doctor.”

How about using the OsseoCare Pro to store, check, print and export data?

“It’s a big plus that clinical docu-mentation of the implant installa-tion can be monitored for immedi-ate reference and stored if one wants to add it to the patient’s file for fu-ture reference.”

The OsseoCare Pro has been get-ting good marks for set-up and user friendliness. Dr. Roland Glauser ob-viously agrees: ”My assistant has found the equipment very easy to install and assemble. What’s more, it’s proven itself over and over again to be very easy to clean and prepare for the next surgery.

“All in all, this is the best drill con-troller I’ve ever used.”

... and more iPad® app newsNobelClinician and the NobelClini-cian Communicator iPad® app al-ready provide convenient platforms to present NobelClinician treatment plans to patients. Now NobelClini-cian users can transfer their treatment plans with ease to OsseoCare Pro.

This new connection—ready to use today—is the first part of the up-coming digital treatment workflow, and makes it possible to transfer the digital planning treatment file from NobelClinician directly to the intelli-gent OsseoCare Pro drill unit for ei-ther free-hand or guided surgeries.

After the surgery, patient-specific data is exported back to Nobel- Clinician and stored in the fully- encrypted NobelClinician file for later reference and traceability. <

More to explore

Learn more about OsseoCare Pro

today by visiting us online at:

nobelbiocare.com/osseocare

A satisfied user confirms: The OsseoCare Pro can help you to improve treatment efficiency, increase patient security and shape a more orderly digital treatment flow.

Zechner, who understood the dif-ferent issues I was facing, suggested implant treatment and offered friendly support.

Although the treatment in my case included bone grafting, which I might have avoided if I had met Pro-fessor Zechner earlier, I decided on the implant-based solution to my problem because I did not want to damage my healthy, adjacent teeth.

In addition to eating better and laughing openheartedly again, I now feel much more sure of myself at the microphone. I have a new tooth today, indistinguishable from the others.

I am very, very happy. <

More to explore

Learn more about single tooth

solutions from the patient’s point-

of-view by visiting us at:

nobelbiocare.com/patientstories

S&Esafety and efficacy

Mrs. Barbara Neuhold says that after receiving a single dental implant, she has returned to the recording studio more self-assured than ever.

The OsseoCare Pro handpiece

being used during a guided

surgery with a NobelGuide surgical

template. Note the good access

and excellent overview provided by

the small-sized handpiece.

87571_NB_NEWS_2-2013_b.indd 7 02.12.13 14:20

Nobel Biocare News Issue 2/20138

Nobel Biocare is dedicated to helping you treat more pa-tients better. This philosophy is built on over 60 years of experience stemming from Per-Ingvar Brånemark’s ground-breaking work with osseointegration in 1952.

By Jim Mack

As the pioneer of implant sci-ence, we have a unique role contributing both to the his-

toric and future innovations of the dental implant industry. We have in-troduced, and been connected to, many solutions that have become standards in the industry. From pio-neering the industrial production of both dental implants and individual-ized CAD/CAM restorations to the first comprehensive concept for 3D diagnostics, 3D treatment planning, and guided surgery.

We will continue offering you su-perior products and solutions for all indications, comprehensive training and education programs, and initia-tives to help increase your patient flow and treatment acceptance. To accomplish this, we build on three patient-focused pillars.

Designing for LifeTo give your patients fully functional and natural-looking restorations that aspire to last a lifetime, we continu-ously design and improve our prod-ucts to make a lasting change in pa-tient quality of life.

Learning for LifeOur comprehensive training pro-gram touches every step of the treat-ment workflow and every stage of your professional development. We believe in peer-to-peer training through renowned expert profes-sionals—worldwide.

Partnering for LifeWe support you in increasing your patient flow and developing your practice through initiatives that de-liver efficient workflows and more referrals. We also show you how to use networking platforms and study clubs to your advantage.

We have stood the test of time and our pioneering, innovative spirit will continue helping you treat more patients better. <

More to explore

Our website: nobelbiocare.com

Treating More Patients Better Superior products and solutions from a time-honored partner you can trust

321Diagnose and plan efficiently

Help your patient understand

Rely on safe and proven treatment options

Know your patients before you treat them and avoid surprises during surgery—by enhancing your diagnostics. Work with your colleagues and team over our digital network and save time.

Use the latest technology to gain treatment acceptance. With our iPad® app for NobelClinician, you can visualize and present the treatment options to your patients. With a better understanding, more patients will choose the treatments you recommend.

You can treat all indications with our proven and innovative products and solutions. Rely on a comprehensive portfolio, backed by the most extensive scientific evidence. Make your treatments safe, effective and predictable. A custom-made device service helps you tackle even the most demanding cases.

Professor Per-Ingvar Brånemark first observes osseointegration.

Professor Brånemark treats first patient with titanium dental implants.

Launch of the Brånemark System®, the world’s first successful system of dental implants.

Dr. Matts Andersson pioneers industrially

machined dental prosthetic production.

First titanium Procera®

Abutment.

Dr. Paulo Maló treats first patient using the All-on-4® Treatment

Concept. New proprietary cold-worked Grade 4 Titanium surpasses

yield strength standards.

An implant like no other, NobelActive® is released following an extensive

prelaunch period.NobelProcera® System revolutionizes dental CAD/CAM with new products

like implant bars.Replace Select™ TC featuring a 3 mm machined

tissue-level collar.

NobelReplace® implant system receives two new additions: Conical

Connection and Platform Shift.

NobelClinician™ Software is the first diagnostics and

treatment planning software available on both Mac OS® X

and Windows® platforms.

NobelActive® 3.0 provides solutions for areas with

limited space. NobelClinician™ Communicator

app helps patients better

understand their treatments.

Nobel Biocare endows the

Foundation for Oral Rehabilitation

(FOR).

New NobelProcera® 2G System launched. Open access

available for NobelProcera®

Abutments.

OsseoCare™ Pro – the

first drill unit operated by

an iPad®.

Launch of Brånemark System® Zygoma

(machined)

87571_NB_NEWS_2-2013_b.indd 8 02.12.13 14:20

Nobel Biocare NewsIssue 2/2013 9

54

FoR eVeRy PATIeNT Need

RelIAble clINIcAl eVIdeNce

HIGH quAlITy ANd SAFeTy STANdARdS

Achieve successful treatment outcomes

Maintain your patient’s new smile

Nobel Biocare focuses on treatment concepts that enhance diagnostics and treatment planning, primary implant stability, improving hard and soft tissue interaction, guided implant insertion for less invasive surgical protocols and highly precise prosthetic solutions that provide unmatched restorative flexibility.

Built on a long heritage of scientific leadership. Our products and solutions have proven themselves in all types of clinical studies—many of them following the more demanding one-stage protocol with immediate loading.

All Nobel Biocare implants and final Nobel Biocare restorative components are covered by a lifetime warranty. As a leading medical-device company, we strive to manufacture and distribute all products with maximum efficiency while meeting the highest standards of quality.

Give your patients the new smile they dream of, with our full range of prefabricated and individualized CAD/CAM restorations. We support dental laboratories worldwide in delivering the ideal prosthetics: for natural-looking results, improved function, and a new quality of life for your patients.

After the treatment, you benefit from an extended warranty, our replacement part offering, and local support network. Our dedicated sales force and customer service teams are at hand to make your patients’ new smiles last a lifetime.

NobelClinician Software Accurate diagnostics and treatment planning is the key to success.

The moderately rough implant surface TiUnite has been documented in more than 220 publications with up to 11 years’ follow-up.

All-on-4® treatment concept—giving patients their quality of life back.

Toronto conference hosted by Professor George Zarb validates dental implants & osseointegration.

CerAdapt™ densely sintered alumina

abutment is introduced.

Replace® launched, goes on to be the world’s most

used implant system.

TiUnite® implant surface launched to increase the predictability and speed of osseointegration.

Launch of 3.3 Brånemark System® MK III adds to narrow implant development expertise.

Zirconia abutments

now available.

Procera® Forte

Scanner capable of single units to full-arch

bridges.

Procera® Bridge Zirconia.

“Immediate Function”

receives FDA clearance,

unique only to Nobel Biocare.

Introduction of cost-effective overdenture

solution on two implants.

NobelGuide® is the first comprehensive system for 3D diagnostics, treatment

planning and guided surgery.

Groovy® implants further enhance

osseointegration with added grooves.

Snappy™ Abutment offers an efficient and predictable prosthetic solution.

Time-efficient NobelSpeedy® launches,

offering bicortical anchorage and high initial stability also in soft bone.

Regenerative product line beginning with

creos™ xeno.protect announced.

Fully integrated digital treatment

workflow steered by the

NobelConnect™ online network

announced.

Procera® Implant Bridge Zirconia available in full-arch. Procera®

Implant Bridge Zirconia.

Procera® Bridge Alumina.

Procera® launched with fully-

automated industrial manufacturing.

Prototype workshop established.

(Predecessor to the Custom-made

device service.)

First sterile implant

packaging in the

industry.

Brånemark introduces

machined zygomatic implants designed to rehabilitate the

upper maxilla.

First ceramic CeraOne® Coping.

First angled abutment simplifies prosthetic access for diverging

implant angles.

The first Mod 10 Procera®

Scanner.First Procera® Implant

Bridge provides enhanced esthetic

solutions for multiple missing teeth.

Launch of Brånemark System® Zygoma TiUnite®.

Launch of All-on-4®

Treatment Concept for efficient and

effective edentulous treatment.

Launch of Brånemark System® Zygoma

(machined)

Imag

e ©

Sch

üpba

ch L

td.

87571_NB_NEWS_2-2013_b.indd 9 02.12.13 14:20

Nobel Biocare News Issue 2/201310

Case 3Professor Alessandro Pozzi and Master Dental Technicians Paolo Paglia and Alberto Bonaca of Rome, Italy, were presented with the following case.

The patient, a 62-year-old lady, had been wearing a porcelain-fused-to-metal restoration in the upper jaw since the late 1980s. She presented with a failing dentition in both the maxilla and mandible and a moderate bone re-sorption pattern.

After some discussion, it became clear that she was looking for full mouth rehabilitation and requested a minimally invasive approach that would provide natural-looking, life-like prosthetic emergence from the gingival tissue. No artifical gingiva was acceptable for the patient.

Because of the daily administration of oral anticoagulant medications, a minimally invasive surgical approach, avoiding any major bone grafting pro-cedures, was medically essential.

continued from page 5

Veneering Options

Figure 1: The high smile line of the

patient doesn’t hide the porcelain-

fused-to-metal (PFM) restoration

with vertical and horizontal over-

contouring, as well as the grayness

and deformity of the soft tissue

architecture that follows with the

disappearance of the papilla.

Figure 2: The NobelProcera

frameworks try-in. This shape

design has been milled in order to

ensure biomechanical strength and

enhance the cementation of the

single lithium disilicate crowns.

The soft tissue/restorative interface

has been modeled with a scallop

pontic design in the anterior zone

and with a modified slope design

in the posterior in order to allow for

hygienic maintenance.

Figure 3: The lithium disilicate

crowns, fabricated by the accurate

and precise NobelProcera CAD/CAM

workflow, are tried into the mouth

at the presintering Blue stage in

order to assess the fit and check

for proper occlusion.

Figure 7: The RX orthopantomograph at just under three-year follow-up. The bone level around the six NobelActive

implants and the four NobelReplace Conical Connection implants in the upper and lower jaw, respectively, demon-

strate the success of the implant-supported restorations.

Please note: All the treatment concepts presented in this article have been evaluated in extensive clinical trials.

These concepts meet patient needs and expectations, as well as advanced functional and esthetic criteria. Together,

they represent only a few of the many alternatives available when using products from Nobel Biocare.

Figure 4: For the upper jaw, the

lithium disilicate single crowns are

cemented onto the zirconia

framework in the lab (with the

exception of the units with the

screw access holes, which are

cemented directly in the mouth

after screwing the restoration to

the implants).

Figure 5: In the lower jaw the

screw access holes didn’t impact

the esthetic area of the restoration

and thus all the crowns have been

cemented in the lab. Furthermore

the biomechanical strength of the

CAD/CAM lithium disilicate allowed

the perforation of the units in order

to deliver a screw-retained, easy-to-

retrieve restoration.

Figure 6: The post-operative smile

of the patient combines a pleasant

prosthetic design with a natural

soft tissue framework.

Images courtesy of Professor

Alessandro Pozzi.

Treatment choicesA novel fixed restorative option, com-prising single CAD/CAM lithium disili-cate crowns cemented onto a precision zirconia framework, was used to reha-bilitate the upper and lower jaws.

NobelClinician Software was used to prepare the digital treatment plan—and to communicate that plan with the patient. NobelGuide was employed to allow for ideal implant position and angulation based on available bone in order to reduce the surgical invasive-ness and post-operative morbidity, and still ensure ideal framework design. <

More to explore

To view the complete treatment

sequences online and to read short

biographies of the dentists and

technicians whose work is

represented on these pages,

please go to: nobelbiocare.com/

newsletter

In brief

cerAdapt™, 17 years laterIn 1996, at the encouragement of his colleague, Bioengineer Bo Rangert,

PhD, Dr. Rick Sullivan positioned the collar of the implant depicted below

supra-osseous in the healed site. This was an opportunity to act on

June 1996 June 2013

Rangert’s observation that the design flexibility of a Brånemark System

implant allowed its use as a so-called “one-piece implant” if the counter-

sink was not used and the machined collar was planned for supra-osse-

ous placement. The restoration in this case was done by Dr. Patrick Gan-

non of Palos Heights, Illinois, USA, in collaboration with the North Shore

Dental Laboratories of Lynn, Massachusetts. A CerAdapt abutment was

the foundation for a one-piece porcelain-to-alumina crown/abutment

complex, which was screwed directly to the implant. Still looking good

and working well after all these years of follow-up!

The contributors wish to acknowledge Dr. Vincent Prestopino and the late Dr. Abe Ingber

for their contribution of this restorative format so widely used today.

87571_NB_NEWS_2-2013_b.indd 10 02.12.13 14:20

Nobel Biocare NewsIssue 2/2013 11

Visit Nobel Biocare at events around the world. They provide a great opportunity for observing the latest innovations and scientific research.

2013

ABAOMS Annual Conference

November 13–15

York, United Kingdom

Competence in Esthetics Symposium

November 15–16

Vienna, Austria

Quintessence Baltic Conference

November 14–16

Kaunas, Lithuania

OMD Annual Congress

November 21–23

Lisbon, Portugal

DGI Congress

November 28–30

Frankfurt, Germany

GNYDM Annual Congress

November 29 – December 4

New York City, New York, USA

AAOMS Congress

December 5–8

Chicago, Illinois, USA

2014

AEEDC Congress

February 4–6

Dubai, UAE

SIO Congress

February 7–8

Milan, Italy

JSOI Kanto Koushinetsu Meeting

February 8–9

Tokyo, Japan

CDS Midwinter Meeting

February 20–22

Chicago, Illinois, USA

LMT Lab Day

February 21–22

Chicago, Illinois, USA

Pacific Dental Conference

March 6–8

Vancouver, Canada

AO Annual Meeting

March 6–8

Seattle, Washington, USA

EXPODENTAL

March 13–15

Madrid, Spain

SIdP Congress

March 13–15

Rimini, Italy

IDEM Congress

April 4–6

Singapore, Singapore

JADD Annual Meeting

April 19–20

Osaka, Japan

More to explore |

For the most recent updates,

visit: nobelbiocare.com/events

upcoming events

Behind all NobelProcera products sits 30 years’ experience in developing leading cad/cam dental solutions. It is this extensive expertise that Nobel Biocare has utilized to develop the new NobelProcera 2G System.

By Michael Stuart

For busy dental laboratories look-ing to expand their business, the

NobelProcera 2G System will be a valuable tool. The new 2G System includes updated software and an exciting new scanner which provides direct access to high-quality pros-thetic solutions through the Nobel-Procera global production network.

Expert engineering provides this next-generation scanner with effi-ciency and flexibility at a level that will significantly increase a lab’s pro-ductivity without compromising on precision. The NobelProcera 2G Scanner offers accuracy that sur-passes even the high standard set by its predecessor.

With the NobelProcera 2G Sys-tem, users benefit from direct access to prosthetic solutions that deliver a great functional and esthetic out-come, whether it be for a single cop-ing or an advanced full-arch implant case. Plus, with direct local product support providing training for both dental laboratories and their restor-ative dentist customers, the Nobel-Procera 2G System helps facilitate stronger relationships between pro-fessionals, enabling them to grow their business by providing more pa-tients with better treatment than ever before.

Ease-of-use was a key priority during the creation of the 2G System with the development process taking into account valuable feedback from first-generation NobelProcera Scan-ner users.

While the new System does re-semble the original in appearance, this second generation product has more than earned its 2G designation. Current NobelProcera Scanner users will be impressed by the new scan-ner’s improved ease of operation and pleased by the fact that Nobel Bio-care is running an exchange pro-gram, which makes it easy to up-grade to the 2G System.

Key to increasing productivity is the introduction of the Smart Mo-torized Holder. Scan objects are easi-

Superb Engineering and Intelligence Characterize NobelProcera® 2G SystemEasy upgrade program proving popular among current users

ly secured to the new holder using magnets. Moving independently, the holder then automatically positions each object on the model at the ideal height, tilt and rotation.

Predictably precise resultsEfficiency is increased by reducing the need for user interaction while, at the same time, improving the scanning range. Additional new workflow options such as articulated model scanning have therefore also been introduced. The result is opti-mal scan data that enables consisten-cy with less manual operation. This is the case even for difficult scanning situations such as undercuts, freeing up technicians to focus on tasks where they can deliver the most value with their skills and expertise.

The NobelProcera 2G System makes it easier for dental profession-als to process larger and more com-plex cases with confidence. The user is also offered the flexibility to con-trol their scanning—and to add ad-ditional scan data—at any stage of the process. This means predictably high-quality prosthetics for each and every customer.

A next-generation scanner for the workflow of the futureThe NobelProcera 2G System will play a crucial role as Nobel Biocare introduces its new digital treatment workflow in early 2014. This seam-lessly integrated workflow brings to-gether the latest innovations at each stage of the treatment process over the secure, online NobelConnect network. Naturally, it is supported by NobelClinician diagnostics and treatment planning software.

Current standard procedure is for a clinician to take an initial impres-sion which is sent to a lab for the cre-ation of a radiographic guide. With the NobelProcera 2G System the ra-

diographic guide is no longer need-ed, lowering the cost for the clinician and increasing flexibility.

Instead, the laboratory can add further value as a treatment partner by providing intraoral model surface information that assists with the cli-nician’s diagnostic treatment plan.

Thanks to its solid model scanning capability, the 2G Scanner delivers a model scan with intraoral surface in-formation such as soft tissue and di-agnostic tooth set-up that is com-bined with a patient’s (CB)CT scan by Smart Fusion Technology within the NobelClinician Software.

The result is an accurate diagnos-tic picture displaying both soft and hard tissue information for the clini-cian without a radiographic guide, saving precious time for both dental professional and patient.

With vital diagnostic information coming directly from the lab, dental technicians gain the opportunity to discuss their restorative consider-ations with the clinician at an early stage. Such a collaborative approach improves implant diagnostics and therefore the overall treatment out-

come, reducing the likelihood of prosthetic challenges arising.

At the next step, based on a post-surgical scan, individualized CAD/CAM prosthetics are easily designed in the NobelProcera Software and then ordered digitally from Nobel-Procera’s integrated global produc-tion network. The end product is a precisely manufactured restoration that comes with a certificate of au-thenticity and an extensive warranty.

In summary, the NobelProcera 2G System offers an evolutionary scan-ner that provides next-generation re-sults. For professionals looking to take their restorations to a new level, it offers increased productivity, pre-cision and collaboration with the cli-nician, which enables them to build their business.

Simply put, it’s a wise investment in the future of dentistry. <

More to explore

For detailed information, including

technical specifications, please go to

nobelbiocare.com/2G

Figure 3: The new table with Smart Motorized Holder positions each object on the model at the ideal height, tilt and rotation for optimal scan data.

Figure 2: The NobelProcera 2G Scanner offers easy placement of all scan objects thanks to new holders which are secured on the Smart Motorized Holder with magnets.

Figure 1: The new second-generation NobelProcera 2G Scanner is expertly engineered in every detail to provide greater efficiency, flexibility and precision.

Figure 4: The NobelProcera 2G System will play a crucial role in the transition to the new Nobel Biocare digital treatment workflow in early 2014, which will bring together the latest innovations at each stage of the treatment process—from diagnostics to follow-up—over the secure online NobelConnect network.

LOW RES

87571_NB_NEWS_2-2013_b.indd 11 02.12.13 14:20

Nobel Biocare News Issue 2/201312

Solutions for the Out of the Ordinary

As with any other profession, the practice of dentistry occasionally presents unusual challenges that call for professional counsel and collaboration. Words of wisdom, tips and advice, are available from colleagues, of course, but also here in our continuing Q&A column.

With extensive experience in oral and orthognathic sur-

gery, and intraoral and extraoral im-plant surgery, Dr. Enrico Agliardi has become well-known as a lucid voice of authority in his native Italy, as well as in the international arena.

A respected author as well as an experienced clinician, Dr. Agliardi shares some of his insights concern-ing implant-based treatment in the following Questions and Answers.

In a situation of limited bone volume in the posterior maxilla due to sinus pneumatization, how would you replace a failing bridge/dentition or restore an edentulous area with a fixed restoration?dr. enrico Agliardi: In our practice we often see situations like the one de-picted in Figure 1 and I think we may find this situation appearing more frequently in the near future.

A three unit bridge is present in the right maxilla, replacing both pre-molars and the first molar, and both abutments have been compromised by periodontal disease. A conven-tional approach might include a sinus augmentation with a lateral ap-proach and delayed implant place-

ment and loading, which would re-sult in 12 to 18 months of treatment at high biological and economic costs to the patient.

Furthermore, the use of a partial removable prosthesis to restore es-thetics and function during the vari-ous phases of treatment may risk sig-nificant discomfort for the patient. Fortunately, there is another solution available.

I have concentrated the last 7 years of my practice on treating atrophic arches or segments with the use of axial and tilted implants to support fixed immediate restorations, avoid-ing pre-prosthetic surgery and ex-tensive ridge reconstruction.

One of the advantages in implant inclination is that we can place lon-ger fixtures, engaging cortical areas in the mouth, thus increasing the primary stability of the implants.

In this case, after the reflection of the anterior part of the sinus mem-brane, the osteotomy is prepared with a 40 degree inclination from distal to mesial and an 18 mm im-plant secures coronal anchorage in the residual ridge and apical anchor-age in the anterior sinus wall. (Fig-ures 2a and b.)

One implant was placed axially in the extraction socket of the first pre-molar. Both implants reached 50 Newton of final torque, and a screw-retained bridge was delivered three hours afterwards.

This technique, called Trans-Sinus Tilted Implants (TSTI), allows the immediate rehabilitation of posterior segments of the maxilla with a fixed bridge supported by a posterior tilted fixture with an intra-sinus insertion and a conventional axial fixture.

Preliminary results from a cohort of subjects treated in my private practice are very encouraging after as much as three years of follow-up (Figures 2b and 3).

When do you propose using the All-on-4® treatment concept as the first choice of treatment ?dr. enrico Agliardi: In cases similar to this one: the patient here was re-ferred to my practice because she wanted a fixed solution for the reha-bilitation of the lower jaw (Figure 4) avoiding 2-stage augmentation pro-cedures and a long treatment time.

The use of an improper remov-able prosthesis has created a severe bone resorption, resulting in a su-perficial path of the alveolar canal over the years. Since the patient de-clined any kind of vertical bone

Q&AQuestions and Answers

Figure 1 shows a three-unit bridge in the right maxilla, supported by abutments that have been compromised by periodontal disease, and the resolution of the case with the final prostheses.

Figures 2a and b: Positioning of the two implants (2b taken at three years of follow-up).

Dr. Enrico Agliardi of Milan, Italy, is both a gifted clinician and a much-sought-after lecturer in international osseointegration circles.

Figure 3: The restoration in the patient’s mouth at three years of follow-up.

augmentation, the only available bone remained in the interforami-nal region.

The conebeam-scan verified a narrow interforaminal alveolar process with an hourglass shape. A thorough treatment plan with NobelClinician showed once more that the placement of regular plat-form implants would be challeng-ing (Figure 5).

A consistent surgical bone reduc-tion was necessary until the mini-mum 5 mm width was obtained. Four implants were placed in the basal bone according to the All-on-4® treatment concept protocol (Figure 6) and an immediate pros-

Figure 4: The situation before treatment.

Figure 5: The conebeam-scan verified a narrow alveolar process inter-foraminal with an hourglass shape. A thorough treatment plan with NobelClinician followed. (Images courtesy of Dr. Agliardi.)

Figure 6: The four implants in place.

Figure 7: Immediate prosthesis delivered three hours later.

Figure 8: The post-op OPG confirmed implant distribution very similar to the surgical simulation.

More to explore!

For more case studies by

Dr. Agliardi, please see:

nobelbiocare.com/newsletter

thesis was delivered after 3 hours (Figure 7).

The post-op OPG indicated im-plant distribution very similar to the surgical simulation (Figure 8). <

87571_NB_NEWS_2-2013_b.indd 12 02.12.13 14:20

Nobel Biocare NewsIssue 2/2013 13

NobelProcera® Abutments Now Available for 3Shape® UsersOpen access to high quality products from Nobel Biocare

Recent Findings

Recent study with All-on-4® treatment concept Equally good outcomes in the mandible as in the maxilla with TiUnite implants using the All-on-4® treatment concept protocol. (Balshi et al. J Prosthodont. 2013. [Epub])

A recently published retrospective study evaluated the All-on-4® treatment

concept in 152 patients with Brånemark System MkIII and MkIV implants

placed from May 2005 until December 2011. CSR was 96.3% and 97.8% at

one and at five years in the maxilla (300 implants) and the mandible (500

implants), respectively. Sub-analyses by tilted vs. axial placement and by

gender showed no difference or no significant difference. Implant failures

were higher in smokers than non-smokers (6.1% vs. 2.1%); however, likely

due to low failure rates overall, statistical significance was not reported.

The authors discussed the improvements in CSR witnessed in the pub-

lished literature over time with the All-on-4® treatment concept and attrib-

uted these successes to the introduction of TiUnite surface implants.

www.ncbi.nlm.nih.gov/pubmed/23890014

excellent results with Replace Select™ Tapered implantsHigh survival rate and steady bone levels of Replace Select Tapered in everyday clinical practice. (Pettersson et al. Clin Implant Dent Relat Res. 2013. [Epub] )

Excellent CSR of 99.6% of Replace Select Tapered implants at 5-years

follow-up is reported in this retrospective study aimed to investigate

outcomes in routine clinical practice. Eighty-eight consecutive patients

received 271 implants for a variety of indications, in mostly healed sites,

using a two-stage surgery with loading after 3 months in almost all

cases. A paired analysis of radiographs available at baseline and 5-year

follow-up (n=115) revealed minimal bone remodeling, mean of –0.07

(SD 2.41) mm from implant insertion. Frequency distribution of crestal

bone showed a gain around more than 30% of implants from baseline

to 1 and 5 years. This study confirms that the high survival rate and

steady crestal bone levels seen in clinical research with Replace Select

Tapered dental implants are achievable in everyday practice.

www.ncbi.nlm.nih.gov/pubmed/23815482

Science matters!A few reflections on the value of peer review from an American writer and educator, William Harris.

Think of peer review as a quality-control system. When a team of

reviewers gives a green light to a particular paper, they are saying the

science described in the paper is valid and trustworthy. This is similar to

what quality-control inspectors do at a manufacturing plant. They check

products by sight, sound, feel, smell or even taste to locate imperfec-

tions that might cause harm or dissatisfaction among end-users.

Inspectors adhere to strict quality standards, discarding any product

that doesn’t meet the standard. Peer review does the same thing by

setting a scientific standard.

Validating scientific results benefits everyone, from the scientists

doing the work to professionals like you who eventually read about the

research or hear news of it from colleagues and friends.

Open access to high-quality NobelProcera® Abutments is now available for 3Shape® users.

By Michael Stuart

Nobel Biocare was the first to produce industrially-milled

CAD/CAM abutments and to this day, NobelProcera leads the field in high-quality, ready-to-use restorations. In a new partnership, this leading pro-duction expertise is now also accessi-ble for users of the 3Shape Dental System.™

Through this open access arrange-ment, 3Shape® users can easily inte-grate their systems with the Nobel-Procera production network. They thereby gain access to top quality NobelProcera Abutments in zirconia and titanium—for both Nobel Bio-care and other major implant sys-tems—at no additional cost.

Once integrated with NobelProcera, 3Shape® users simply maintain their current workflow of scanning and de-signing in their dental laboratory using the 3Shape Dental System™.

Users of 3Shape® now have the option, however, to produce indus-try-leading NobelProcera Abut-ments via the global network of NobelProcera production facilities. In doing so, 3Shape® users tap into more than 30 years of CAD/CAM ex-perience, which has seen the pro-duction of over 11 million units.

This heritage and know-how make NobelProcera a clear leader in the precision-engineering and manufac-turing of medical device restorations. All NobelProcera Abutments are me-ticulously developed, verified and validated to ensure they meet the pa-tient’s needs. The result is an excep-tionally high-quality product with a predictable fit, and, what’s more, one that is designed to last a lifetime.

Designing for LifeThe design process in the 3Shape® software is integrated with the NobelProcera production approach in order to assure design-constraint adherence for each and every Nobel-Procera Abutment. This in turn en-sures that the patient receives a prod-uct which meets Nobel Biocare’s

strict quality standards. Each abut-ment is created using a specialized milling strategy and tooling that de-liver ready-to-use abutments with outstanding surface quality.

The test of timeOver the years, scientific evaluation has consistently demonstrated the excellent multi-criteria reproducibil-ity of NobelProcera Abutments, with recent tests also establishing that the first-rate reproduction characteris-tics also apply to NobelProcera Abut-ments on non-Nobel Biocare im-plants, providing excellent abutment seating. Moreover, fast and reliable delivery means that the clinician re-ceives the solution the patient needs on time.

The latest additions to the assort-ment of third-party NobelProcera Abutments provide affordable and high-quality options that pair patient needs with individual products.

In addition to the existing selec-tion, which includes Straumann® and Astra Tech®, a whole new range of im-plant-based restorative options, in-cluding Biomet 3i®, Camlog® and Zimmer®, are also available. Nobel-Procera offers unrivaled third-party CAD/CAM abutments with an indi-vidual finish line (margin) and emer-gence profile for unparalleled tissue support and esthetics.

Extensive testing and imaging has proven that the precise fit of the NobelProcera Abutment over the critical interface area of the implant is comparable, or in some cases even better, than that of the prefabricated product from the original manufac-turer.

The NobelProcera Abutment inter-face is designed for both a precise fit and to create a barrier to prevent the penetration of bacteria.

No compromise on qualityNobelProcera and 3Shape® users alike can be sure that Nobel Biocare complies with all relevant quality and safety standards for consistent precision of fit, every time. Rotation-al play for the NobelProcera Abut-ment is minimized through industri-al quality-controlled production processes. All Nobel Biocare abut-ments and clinical screws are fatigue tested according to ISO standards, and every NobelProcera Abutment is CE-marked and FDA cleared. The production processes are quality-as-sured under ISO 13485 and are mon-itored on a 24-hour basis.

For further peace of mind, authen-ticity labels are delivered with each restoration, providing product trace-ability and documentation specific to the individual case. In addition, an extensive warranty covers both the restoration and the implants—even including cases in which the implants are not Nobel Biocare products.

With direct local product support providing training for both dental laboratories and their restorative den-tist customers, Nobel Biocare can fa-cilitate stronger relationships between professionals, helping them to grow their businesses by providing more patients with better treatment. <

More to explore!

Learn more about NobelProcera

Abutments by visiting:

nobelbiocare.com/nobelprocera-

abutments

While browsing, you can also

request an appointment with your

local sales representative to design

a test sample of a NobelProcera

Abutment. The sample you design

will then be delivered to you in

short order.

New open access partnership:

3Shape® Dental System™ users can

now produce superior-quality

titanium and zirconia abutments

using the global production net-

work of NobelProcera—and at no

extra cost. Manufacturing pro-

cesses and tooling are optimized

for each product, using high quality

materials in accordance with

medical device standards.

87571_NB_NEWS_2-2013_b.indd 13 02.12.13 14:20

Nobel Biocare News Issue 2/201314

Professor Alessandro Pozzi reports from his state-of-the-art private practice in Rome, where he has accumulated several years of experience using NobelReplace Conical Connection implants.

By Professor Alessandro Pozzi

One might begin by saying, “Peri-implant tissues are not an issue with the Nobel-

Replace Conical Connection (CC),” but that indeed is just the beginning of all that ought to be said!

I have been working with Nobel-Replace CC since late 2010, yet at the start I was a bit hesitant to intro-duce a new implant system into my implant practice.

“Why,” I asked myself, “should I disturb my team’s well-established

implant workflow by using a new fixture so far from the traditional and well-proven Brånemark de-sign?”

Fortunately, a desire to constantly improve patient care—along with my innate “researcher mentality”—helped me to overcome this initial ambivalence and provided me with the impetus to move forward.

Today, the NobelReplace CC has become my implant of choice. I think it provides the perfect implant body and neck configuration to imi-tate the natural tooth and establish a natural connection at the peri-im-plant interface. It certainly contrib-utes to the long-lasting success of my restorations.

Great natural outcomes are the result of biological synergy between the TiUnite surface, the tight pros-thetic connection—which incorpo-rates built-in platform shifting—

and a minimally invasive operating approach that considers the implant surgery, to quote Per-Ingvar Bråne-mark, “a gentle handling of Mother Nature’s gifts.”

The NobelReplace CC is a new implant concept that merges the biomechanical and prosthetic fea-tures of a meticulously engineered third-generation internal connec-tion within a strong implant body with the biological advantages of the platform shifting concept.

From all the experience I have gathered to date, the NobelReplace CC is a versatile, easy-to-use im-plant, which performs well in soft

and hard bone alike, in both partial and totally edentulous clinical sce-narios, and with axial and tilted in-sertion.

Widely used new restorative de-signs for the treatment of total eden-tulism (based as they are on a re-duced number of implants and by immediate loading protocols) re-quire stronger implant-prosthetic connections in order to withstand the higher insertion torque and the lateral loading stress, as well as to minimize forces on the retaining screw and prosthetic components.

Without compromiseUp until now, internal connections (as a consequence of the designs themselves) have exacerbated this stress, due to the weakness of im-plant walls and deficient load distri-bution to the bone. The wall thick-ness of the implant in the critical stress zones has to be able to resist material fatigue and breakage under prolonged use, while neither sacri-ficing “osseointegratable” threads at the neck nor reducing the diameter of the connecting screw.

In the design of the NobelReplace CC implant, the depth of the con-nection has been optimized to ob-tain all the biomechanical and clini-cal benefits associated with an internal connection without sub-stantially weakening the implant body by reducing the thickness of its walls.

The anti-rotational design of the conical connection minimizes tor-sion forces and allows the applica-tion of high insertion torque on the implant without incurring distor-tion.

In my practice, I have personally determined that the mean bone loss (MBL) and soft-tissue parameters—from implant insertion to nearly three years of function—have evi-denced an overall stability of the peri-implant hard and soft tissues. This applies in both post-extraction and healed sites, regardless of the loading protocol.

Platform shiftingIn my experience, NobelReplace CC is effective in preserving the peri-implant bone and maximizing the soft tissue volume.

Although the mechanisms have yet to be definitively established, it has been suggested that the biologi-cal process resulting in the loss of marginal bone may be limited when the outer edge of the implant–abut-

For the Benefit of the PatientAn assessment of three years of extensive clinical experience with the NobelReplace® Conical Connection

ment interface is horizontally repo-sitioned inwardly, away from the outer edge of the implant platform.

This prosthetic concept is gener-ally defined as “platform shifting” (i.e. the use of a smaller diameter abutment on a wider diameter im-plant platform) and it has been inte-grated into the NobelReplace CC design. The reduction of marginal bone loss that I have observed may be the result of how platform shift-ing encourages soft tissue healing away from the crestal bone.

The concept is as simple as it is in-genious: Platform shifting moves the initial inflammatory area that exists at the implant-abutment in-terface away from the crestal bone, resulting in less bone resorption and highly satisfactory esthetics.

This approach minimizes micro-bial colonization of the prosthetic interface and internal cavity, as well as the spread of bacterial endotoxins into the surrounding tissue, which might otherwise result in peri-im-plant inflammation and marginal bone loss.

Preserving marginal boneWhenever a microgap exists at the implant-abutment interface, there is a concomitant risk of bacterial colo-nization of the implant sulcus, con-sequently leading to peri-implant inflammatory reactions and bone resorption.

The unwelcome presence of a mi-crogap also results in micromove-ments occurring at the implant-abutment interface, which can affect the stress distribution in the sur-rounding bone, thus increasing crestal bone resorption.

The conical connection—as engi-neered by Nobel Biocare—decreases the micromovements at the im-plant-abutment prosthetic interface,

Strong and tight seal with the internal conical connection.

Natural-looking esthetics with built-in platform shifting.

High initial stability with the proven tapered implant body.

Proven stability, high esthetics.

« NobelReplace Conical Connection merges the well-proven implant body of NobelReplace Tapered with a tight internal conical connection. It is a versatile, easy-to-use implant which performs well in soft and hard bone.

Prof. Alessandro Pozzi (Rome, Italy)»

Option with 0.75 mm machined collarN

EW

Visit nobelbiocare.com/nobelreplace

The NobelReplace Conical

Connection combines the original

tapered implant body with a sealed

conical connection, offering you

and your patients a stable, esthetic

solution for all indications.

S&Esafety and efficacy

87571_NB_NEWS_2-2013_b.indd 14 02.12.13 14:20

Nobel Biocare NewsIssue 2/2013 15

Professor Alessandro Pozzi: “From all the experience I have gathered to date, the NobelReplace CC is a versatile, easy-to-use implant, which per- forms well in soft and hard bone alike, in both partial and totally edentulous clinical scenarios, and with axial and tilted insertion.”

reducing the stress and strain on the alveolar crest.

The tight, precision-manufac-tured conical connection preserves the marginal bone not only by mini-mizing micromovements, but also by preventing microleakage and the subsequent bacterial contamination of the implant–abutment complex.

As an advantageous consequence, these CC stability features also lead to enhanced pink esthetics.

Versatility in useIn addition to all these outstanding features, I would also like to high-light the surgical flexibility of the NobelReplace CC. Its use ensures the safe placement of the implant platform up to 3 mm below the bone crest, for example, and without un-usual bone resorption.

The tight conical connection with built-in platform shifting makes the deep placement of the implant pos-sible as a rescue solution in clinical scenarios where we need to increase the running room in order to meet the biomechanical demands for a long-lasting restoration.

Meeting needs and demandsThe NobelReplace CC makes the kind of implant dentistry that I want to practice possible.

It facilitates the minimally inva-sive surgical approach I prefer. It serves as the benchmark for highly biocompatible prosthetic accuracy. And perhaps most important of all, working with NobelReplace CC makes it possible for me and my team to concentrate on my patients’ needs and comfort, every single step of the way.

I’ve written this before, but it de-serves to be repeated: NobelReplace CC is an implant system that meets the demands and requirements of both clinician and patient alike.

I recommend it confidently to col-leagues, not only because it is a plea-sure to work with, but also because it is the product of an evidence-based R&D culture that I admire.

I have never been as productive as I am today, and NobelReplace CC can take at least part of the credit. This well-conceived, well-engi-neered design is an implant I can hardly imagine working without! <

Two collar options. Choose between TiUnite on collar and a 0.75 mm

partially machined collar (PMC) to meet different clinical needs and

treatment preferences.

Figure 1: Preoperative clinical view:

Failing dentitions and root fractures of the 1.1, 1.2

and 2.2 (US notation: 8, 7 and 10). Periodontal

deformity and inflammation observed.

A Case in PointAn anterior restoration with NobelReplace® Conical Connection

Courtesy of Prof. Alessandro Pozzi; Lab Technicians Paolo Paglia and Alberto Bonaca.

Figure 2: NobelClinician 3D treatment plan with

postextractive immediate placement of two

NobelReplace CC implants.

Figure 3: CAD/CAM lithium disilicate crowns

cemented onto the NobelProcera shaded zirconia

abutments emerge from the soft tissue with a life-like

appearance, imitating the restoration cemented on

natural teeth on the controlateral side.

Figure 4: Biologic synergy

comprising the tight internal

conical connection and

platform shifting ensures

long lasting bone and soft

tissue integration.

Figure 5: Periapical radiograph

at nearly 3-year timepoint

shows the bone level well-

maintained, both around and

between the implant platforms.

Figures 6 & 7: The Cone Beam examination at

recent follow-up demonstrated the preservation

of the buccal wall at the central and lateral

implant sites.

87571_NB_NEWS_2-2013_b.indd 15 02.12.13 14:20

Nobel Biocare News Issue 2/201316

Nobel Biocare NewsPrinted on non-chlorine bleached

FSC-certified paper.

Printing: www.linkgroup.ch

Prefer e-mail delivery? Then visit:

www.nobelbiocare.com/enews

Europe and Russia

AustriaNobel Biocare AustriaPhone: +43 1 892 89 90

BelgiumNobel Biocare BelgiumPhone: +32 2 467 41 70

DenmarkNobel Biocare DenmarkPhone: +45 39 40 48 46

FinlandNobel Biocare FinlandPhone: +358 9 343 69 70

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GermanyNobel Biocare GermanyPhone: +49 221 500 85 590

HungaryNobel Biocare HungaryPhone: +36 1 279 33 79

IrelandNobel Biocare IrelandPhone: toll free 1 800 677 306

ItalyNobel Biocare ItalyPhone: +39 039 683 61Cust. support: toll free 800 53 93 28

LithuaniaNobel Biocare LithuaniaPhone: +370 5 268 3448

NetherlandsNobel Biocare NetherlandsPhone: +31 30 635 4949

NorwayNobel Biocare NorwayPhone: +47 64 95 75 55

PolandNobel Biocare PolandPhone: +48 22 549 93 50Cust. support: +48 22 549 93 52

PortugalNobel Biocare PortugalPhone: +351 22 374 73 50Cust. support: toll free 800 300 100

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United KingdomNobel Biocare UKPhone: +44 208 756 3300

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CanadaNobel Biocare CanadaPhone: +1 905 762 3500Cust. support: +1 800 939 9394

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AustraliaNobel Biocare AustraliaPhone: +61 2 8064 5100Cust. support: toll free 1800 804 597

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South AfricaNobel Biocare South AfricaPhone: +27 11 802 0112

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Distributor Markets

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Phone: +48 22 549 93 56Cust. support: +48 22 549 93 55

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Nobel Biocare Services AG P.O. Box 8058 Zürich-Flughafen, Switzerland

Offices: Balsberg, Balz-Zimmermann-Strasse 7 8302 Kloten, Switzerland Phone +41 43 211 42 00 Fax +41 43 211 42 42

Web contact: www.nobelbiocare.com/contact

Shame, Guilt and Toothlessness

claiming to have been totally unaf-fected, much less disgusted, by a guest on the show. As she did her best trying to save face, I found my-self also wishing that the scene had been captured in pictures—not to humiliate her, but to demonstrate that the mouth is indeed a very sen-sitive subject, and that we treat peo-ple very differently depending on how we assess their teeth and gums.

Just how strong an impact oral status has on social interaction can be seen very clearly in how oral healthcare is managed in nursing homes and other, similar facilities.

Several studies show that oral healthcare is strongly neglected there. Sometimes the staff has train-ing in oral healthcare and under-stands how essential it is, yet neglect the patients’ oral hygiene neverthe-less. It is not that they lack knowl-edge; it’s just that they perceive their patients’ mouths as repulsive.

Change is imperativeWe must change this attitude. As the population grows older, after all, we will find ourselves increasingly de-pendent on professional care at the end of our lives. Many of us want to die with teeth in our mouths—but certainly not in mismanaged, filthy mouths—and preferably not with a set of dentures in a glass of water on our bedside table.

Several studies have shown the im-portance of the mouth and teeth for the quality of life. Many people find the prospect of losing one or more teeth demoralizing.

The importance of appearance, function and self-esteem Edentulism is often named when people are asked what they most hope to avoid in life. “To lose all my teeth” is as frightening a prospect, at least for women, as the possibility of breast cancer or the complete loss of one’s hair.

The loss of teeth may prove pain-ful in a number of different ways, as one is deprived of appearance, func-tion and self-esteem. Edentulism sometimes leads to poor self-confi-dence and an altered self-image. An individual who loses teeth is likely to become less satisfied with his or her appearance, and it’s not a subject that is easy to discuss with others.

Most people, in fact, are unwilling to fully disclose their dental prob-lems to others—often not even to close relatives and friends. People who have lost teeth sometimes alter their patterns of social interaction, and the manner in which they ap-proach intimacy. Missing teeth are kept secret.

Not too long ago, someone stole my trick dentures. It doesn’t matter much; I still have my real teeth, after

all; and in the long run, I wouldn’t want anyone to think that I’m mak-ing fun of the disabled.

They served their purpose, giving me a better understanding of the in-dignities that many other people are forced to suffer.

For people with poor oral health, it’s not a question of fun and games in a TV studio. They have to live every day with the humiliating con-sequences of their situation, the de-moralizing reactions of people around them, and their own deep feelings of disgrace.

We who practice implant dentistry have an opportunity to change their world for the better, but with that op-portunity comes a responsibility to respect the inevitable vulnerability of each edentulous patient we meet. <

More to explore

Originally published in Swedish as

a chapter in Munnen, Tänder, kropp

och själ (The Mouth, Teeth body and

soul), the abridged text above has

been translated from the Swedish

original by Frederic Love.

For readers of Swedish, the book

is available from Karolinska

Institutet University Press, ISBN

978-91-85565-29-0 and can be

ordered via: www.kiup.se

continued from page 6

NobelActive® celebrates five-year anniversary highlighted by outstanding three-year clinical results

By Jim Mack

Since its introduction in 2008, NobelActive has become the im-

plant of choice for an ever-increasing number of clinicians. For these early adopters, its unique design has ex-panded treatment options and of-fered maximum flexibility both in placement and restorability.

To date, more than 3,000 Nobel Active implants have been clinically documented in over 1,300 patients including published studies with three-year follow-up data.

The results have been remarkable, not least because NobelActive’s unique design has been recognized as supporting implant placement even in compromised situations. Its variable thread design “cuts” soft bone as it is placed, enabling implant placement with a narrower osteotomy.

NobelActive has demonstrated limited bone loss during the initial remodeling period and stable or even improving bone levels within the first two years.

With its conical connection feature, NobelActive has been shown to offer statistically better radiological mar-

ginal bone crestal levels and less mar-ginal bone loss in comparison with a control implant, both from implant placement to loading and from base-line to one year of function.

Studies of NobelActive have prov-en that the same clinical and esthetic results can be achieved with Imme-diate Function as with delayed load-ing, even in demanding conditions such as extraction sites.

Recent studies have also shown high implant survival rates with Im-mediate Function and statistically significant papilla improvement over three years of follow-up.

Patients pleasedWhen surveyed, patients reported statistically significant increases in function, esthetics, sense, speech and self-esteem over three years of follow-up after having NobelActive implants placed with Immediate Function in the extraction sites of failing teeth.

NobelActive is also safe and effec-tive in edentulous cases; performing as well in the maxilla as it does in the mandible, and effective even in se-verely atrophic jaws. NobelActive has even demonstrated its efficacy in patients with osteoporosis. <

More to explore!

To read references supporting the

claims in this article, see

nobelbiocare.com/newsletter

87571_NB_NEWS_2-2013_b.indd 16 02.12.13 14:20