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NobelActive™ - Inventor's perspective on the new direction for implants

Seattle Study Club article. Vol 12, No 2. Winter 2007 Issue

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Nobel Biocare is currently in the pre-launch phase of a unique new implant with an advanced implant body design – NobelActive.

For the clinician, NobelActive is indicated for all positions, but is especially effective in regions of diminished bone quality or quantity, due to its bone-condensing capability, capacity for shorter drilling protocols, and ability to change direction or insertion.

On the patient side, NobelActive is a viable solution for difficult treatment situations, often providing quicker treatments, shorter healing times, and less invasive procedures.

The inventors of this radical design are Prof. Nitzan Bichacho and Drs. Ophir Fromovich, Benny Karmon, and Yuval Jacoby. For first-hand insight, Prof. Bichacho shares his experiences in developing and using NobelActive.

“Before being purchased by Nobel Biocare, this implant design has undergone more than three years of study and has been placed thousands of times, with equal – more often – better results than traditional implants,” claims Prof. Nitzan Bichacho, “There is not doubt the system will benefit even further from the enhancements introduced by Nobel Biocare.”

A retrospective multi-center clinical study, comprising 648 implants in 251 patients evaluated a predecessor to the NobelActive implant for up to four years. The cumulative survival rate was 98.3 percent.

Currently, three prospective multi-center studies are evaluating the currently available NobelActive implant. Interim results stability presented in October 2007 demonstrate good implant survival rate and bone support.

The enhancements Prof. Bichacho refers to are the well-proven TiUnite® surface and grooves – Groovy – on the implant threads. The TiUnite® biomaterial has been documented to improve osseointegration, promote soft tissue seal around the implant, and increase the esthetic result of implant rehabilitations.

Easier insertion by design

The NobelActive implant has a variable thread profile that becomes wider vertically and shorter horizontally, from bottom to top; the core of the implant forms condensing lines, unlike the linear profile as is the case with contemporary tapered implants.

In the apical region, the implant has pronounced tapered body with sharp threads, which facilitates its insertion into minimally prepared sites.

The apical region is followed by a sequence of variable thread units that allow easy insertion and gradual bone condensing, resulting in excellent initial implant stability especially in very low bone density.

The implant has a spiral tap extending along more than half of the implant length. This tap substantially increases the penetration of the implant.

The coronal region, adjacent to the threaded collar is tapered coronally, in all but the narrowest of implant diameters, allowing elastic relapse of the bone over the implant head.

Furthermore, a groove has been machined at the lower part of the thread flank and two circumferential grooves have been placed around the implant neck. Grooves enhance the stability of the implant, because bone forms faster to threads with grooves than without.

Finally, a spiral tap extends along the implant (length of tap depends implant length); if resistance is encountered during insertion (close to 70 Ncm), NobelActive can be turned counterclockwise (2-3 turns) thereby engaging its self-cutting capability. This function cuts the bone allowing for continued insertion.

All NobelActive implants feature TiUnite on the threads and collars, which promotes enhanced osseointegration and Immediate Function™ characteristics.

Fewer drilling steps

The complete NobelActive design produces a self-drilling, maneuverable, conical implant: a “double corkscrew” form, with a narrow core and sharp horizontal threads, which often requires less site preparation and minimizes bone and soft tissue trauma. This design also offers trained clinicians the ability to reorient a NobelActive implant during insertion, when necessary.

“These implants can be placed like any contemporary tapered implant,” says Prof. Bichacho, “The ability to redirect it on insertion is an added feature that makes it possible to place an implant and load it in sites with limited or diminished bone quantity.”

In areas of limited bone, the clinician is able to begin insertion of a NobelActive implant at an angle where more bone exists; during final torquing, of the implant is redirected to the desired final position.

The NobelActive system lineup consists of internal (2-piece) and external (1.5-piece) configurations, in 3.5, 4.3, 5.0 mm implant diameters and 10, 11.5, 13, 15 mm lengths, and are applicable in all indications. The prosthetic platform of all versions is uniformly narrow, ~ 3 mm.

Convenience and flexibility

NobelActive Internal is similar to conventional two-piece implants with screw-retained abutments. It features a new internal conical abutment connection to which a wide range of esthetic and healing abutments can be fitted.

In comparison, NobelActive External is a hybrid one-piece implant form, to which abutments are friction fit to the implants. This screw-less configuration allows for extra-oral cementation of single-unit crowns and eliminates the possibility of a micro-gap between the abutment and the implant.

“NobelActive External combines all the biologic and esthetic benefits of one-piece implants, with the esthetic results and flexibility of two-piece implants,” comments Prof. Bichacho, “NobelActive External is extremely useful in regions with limited or narrow ridges for delivering beautiful results.”

Training and pre-launch

NobelActive is a sophisticated implant and Nobel Biocare recommends that even experienced implant clinicians attend a NobelActive training course. Therefore, Nobel Biocare initiated a pre-launch of NobelActive and offered special training courses for clinicians interested in using this implant in 2007.

General release of NobelActive, including a full spectrum of training courses, is scheduled for Spring 2008.

Important information regarding Nobel Biocare solutions

Nobel Biocare strongly recommends caregivers always go through special training before undertaking a new treatment method.

Furthermore, clinicians should always work with an experienced colleague the first few times the employ a new treatment method. Nobel Biocare has a global network of mentors available for this purpose.

Read the manual carefully before starting any treatment. To be successful, the treatment must follow the manual precisely.

Nobel Biocare provides a wide range of courses for various levels of knowledge.

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 NobelActive internal and external implant systems

NobelActive™ Internal and External implant systems

Fig. 1

Fig. 1: Extraction of tooth and preparation of the fresh socket follows regular procedures

Fig. 2

Fig. 2: Penetration of the palatal wall in the apical third of the socket, with the Twist Drill w/Tip 0 2mm

Fig. 3

Fig. 3Drilling continues while gradually changing the direction to a more vertical direction

Fig. 4

Fig. 4Insertion begins at the same angle as initial drilling

Fig. 5 Fig. 6

Fig. 5 and 6: Insertion continues while gradually changing the angle until final optimal position is acheived