April 2009, Volume 5, Issue 4
Published by AEGIS Communications
What Is it About NobelReplace that Makes it the Most Widely Used Implant System in the World?
Many prominent clinicians in the dental implant industry, including Jack Hahn, DDS, the inventor of NobelReplace (Nobel Biocare, Göteborg, Sweden), maintain that there are several key features that make this implant stand apart from its competitors. Not surprisingly, this implant system continues to be instrumental in transforming the face of implant dentistry around the globe.1
Perhaps the most important characteristic of the NobelReplace implant is the intuitive root-shaped design. This pioneering principle was the initial inspiration behind the invention. Dr. Hahn described the catalyst for his inspiration, which led to NobelReplace tapered implant system. “I came up with the concept of tapered implants one day in my office when I had four patients who needed single replacements in the maxillary anterior. I was using parallel-walled implants that had to be tilted at severe labial angles so as not to perforate the labial wall of the subnasal fossa. I thought to myself, the original teeth had tapered roots, so why am I trying to place a square peg in a tapered hole?”
This adaptable implant has become a favorite among clinicians for a variety of reasons. Its predictable outcome caters to all users and its practical features offer a host of advantages: versatility, tapered design, tri-channel internal connection, and intuitive color-coded system, which all work seamlessly in concert.
Many implant systems can be challenging to use because of the variety of tools one needs to perform surgery. NobelReplace addresses this issue with its completely color-coded system that provides increased simplicity both surgically and prosthetically. The modular kit includes everything a clinician needs to begin placing the NobelReplace implant, allowing complete flexibility between procedures and their ultimate solutions (Figure 1 and Figure 2).
Kiyoto Shiratori, DDS, PhD, director of a successful dental implant clinic in Japan believes that the NobelReplace tapered system is the most user-friendly system he has ever used. He says the surgical procedure is simpler because it has fewer steps, and it is easy to determine the length of the drills that are required. Dr. Shiratori favors the color-coded surgical kits, and is confident that he can manage all indications with the NobelReplace tapered implant system.
The tapered shape permits the placement of a wider cervical diameter implant in more favorable positions. The standardized step-by-step protocol produces predictable results in all indications. When Dr. Hahn was designing the implant, he wanted it to be able to be a universal system.
Russell Baer, DDS, a specialist from Chicago, IL, describes his experience with the NobelReplace implant: “As a user of Nobel Replace implants for more than 8 years, I have been able to broaden my implant services because of the versatility of the implant and its prosthetic options. The scientific evidence behind the implant that Nobel Biocare provides is extremely valuable. The Replace implant, being tapered, is ideal for immediate extraction and placement; and, with the prosthetic options available for tri-channel internal connection platform, I am able to transition the patient smoothly from tooth to implant/temporary to a beautiful, custom-made NobelProcera (Nobel Biocare) final restoration. This implant and the clinical solutions that go along with it have allowed me to expand my implant practice.” (Figure 3; Figure 4; Figure 5; Figure 6; Figure 7.)
The tri-channel internal connection of the NobelReplace implant is favored by new and experienced users alike. Certainly there may be times when external connections have their advantages, but Dr. Hahn relies on the internal. He maintains that once a clinician uses the internal connection, he or she will not go back to an external connection. The deep internal portion and the longer portion engaging the three lobes are designed to provide increased stability and to minimize the likelihood of screw loosening. Hahn points out that, unlike many other systems, the tri-channel internal connection provides three seating orientations to enable optimal prosthetic indexing. The tri-channel internal connection provides a tactile and direct feel when positioning the prosthetic components—the abutment literally drops into place.
With the internal connection, three broad categories of restorations are possible:
1.Cement-retained restorations: all-ceramic, porcelain-fused-to-metal, or cast gold; the abutment is screwed into the implant, but the restoration is cemented to the abutment.
2. Screw-retained restorations: an all-ceramic, porcelain-fused-to-metal, cast gold, or hybrid-type restoration is retained by screws to an abutment or directly to an implant.
3. Secure but removable denture solutions: attached to implants via ball or bar components.
The thread pattern of the NobelReplace tapered implants is designed with a variable pitch and sharp threads. Hahn states that he developed these factors “to help contribute to increased primary stability that is important for immediate temporization, as well as being user friendly in all qualities of bone.”
Another extraordinary feature about NobelReplace is the TiUnite® surface, a biomaterial that actively participates in its integration with the human bone (Figure 8). TiUnite, which is unique to Nobel Biocare, is a highly crystalline and phosphate-enriched titanium oxide surface that speeds up osseointegration compared with machined surface implants and encourages soft-tissue integration. Studies show that the structure of soft tissue around TiUnite implants resembles that around the natural teeth. TiUnite was developed to enhance osseointegration and increase the predictability of implant treatment. It has been proven to support the healing process and to preserve implant stability during healing better than machined surfaces in both experimental and clinical studies.2 Numerous studies have evaluated the use of TiUnite implants in various clinical and preclinical situations, using different types of protocols, and with various follow-up times.3-6 Five-year data have been published, demonstrating good long-term results for TiUnite implants.7
Dr. Hahn had the following to say regarding his experiences with TiUnite: “I have been using the NobelReplace tapered system with TiUnite for the past 5 years. We have noticed a more intimate bone contact at the top of implants compared with the ones with the machine-polished collar. In clinical observations, we see a firmer adaptation of the soft tissue, which is an extremely important factor for delivering enhanced esthetics and preserving bone. The TiUnite surface allows for quicker integration and helps to maintain stability, again offering the ability of immediate temporization and shorter treatment times.”
To increase the osseointegration of NobelReplace implants, a macroscopic groove (Groovy) – designed to work in conjunction with the TiUnite surface – was added to the implants’ threads. Research has shown that Groovy implants integrate faster than implants without the groove and are indicated whenever immediate or early loading is applied.8 Dr. Hahn is also an advocate of the grooved thread design. He says, “The addition of the small grooves to the NobelReplace tapered implant has also been helpful in bone maintenance. In our follow-up of 48 patients, 4 years in function, no bone loss has been noted below the first groove. It appears that the small grooves are beneficial. The grooves help to increase surface area and channel the blood to the collar contributing to quicker healing.”
Robert Tupac, DDS, a notable California clinician who places and restores implants and devotes much of his time to research, tested the osseoimplant stability quotient of thousands of NobelReplace implants. In a presentation of his research at the Pacific Coast Society for Prosthodontics (PCSP) in Kona, Hawaii, in June 2008, Dr. Tupac stated that, “After testing the osseoimplant stability quotient values of thousands of implants upon uncovering, results showed that NobelReplace implants consistently scored 15 to 20 points higher than any other implant I have tried, in every section of the mouth.” He added that, “NobelReplace implants offer easy, efficient, and common-sense restoration options—no matter what kind of prosthesis is ultimately delivered, from single crowns to full arches.”
The unique design of NobelReplace implants, with its predictable outcome and design features, has catered to and simplified treatment protocol for millions of doctors who place and restore implants around the globe. Perhaps Othman Shibley, DDS, a New York dentist who limits his practice to periodontology and implants and who is a clinical assistant professor at the State University of New York in Buffalo, NY, says it best: “NobelReplace tapered is a unique implant that is easy to use. Its design and associated surgical kit have given me the opportunity to place the implant in relatively shorter times than any other system without compromising the strength of its initial stability.”
Dr Hahn’s vision, talent, and insight has given our industry the world’s most widely used implant system and changed the way we look at and practice implant dentistry today.
About the Inventor
Jack Hahn, DDS, is a well-known pioneer in the field of implant dentistry. He brings more than 38 years of implant expertise to his patients and participants through courses of surgical placement and prosthetic restoration of dental implants. Dr. Hahn has developed implant devices and techniques that are used worldwide. He continues to participate in various clinical studies, as well as teaching structured programs in dental implants.
1. Statistics from the Millennium Research Group (MRG).
2. Glauser R, Portmann M, Ruhstaller P, et al. Stability measurements of immediately load-ed machined and oxidized implants in the posterior maxilla. A comparative clinical study using resonance frequency analysis. Appl Osseointegration Res. 2001; 2:27-29.
3. Balshi SF, Wolfinger GJ, Balshi TJ. Analysis of 164 titanium oxide-surface implants in completely edentulous arches for fixed prosthesis anchorage using the ptergomaxillary region. Int J Oral Maxillofac Implants. 2005;20:946-952.
4. Degidi M, Perrotti V, Piattelli A. Immediately loaded titanium implants with a porous anodized surface with at least 36 months of follow-up. Clin Implant Dent Relat Res. 2006;8:169-177.
5. Finne K, Rompen E, Toljanic J. Prospective multicenter study of marginal bone level and soft tissue health of a one-piece implant after two years. J Prosthet Dent. 2007;97(Suppl):79-S85.
6. Turkyilmaz I, Sennerby L, Tumer C, et al. Stability and marginal bone level measurements of unsplinted implants used for mandibular overdentures: a 1-year randomized prospective clinical study comparing early and conventional loading protocols. Clin Oral Implants Res. 2006;17:501-505.
7. Glauser R, Zembic A, Ruhstaller P, Windisch S. Five-year result of implants with an oxidized surface placed predominantly in soft quality bone and subjected to immediate occlusal loading. J Prosthet Dent. 2007; 97(Suppl):S59-S68.
8. Hall J, Miranda-Burgos P, Sennerby L. Stimulation of directed bone growth at oxidized titanium implants by macroscopic grooves: an in vivo study. Clin Implant Dent Relat Res. 2005;7(Suppl 1):76-82.
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The preceding material was provided by the manufacturer. The statements and opinions contained therein are solely those of the manufacturer and not of the editors, publisher, or the Editorial Board of Inside Dentistry. The preceding is not a warranty, endorsement, or approval for the aforementioned products or services or their effectiveness, quality, or safety on the part of Inside Dentistry or AEGIS Communications. The publisher disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the preceding material.
|Figure 1 NobelReplace Surgical Kit with the color-coded system for accurate and fast component identification and ease-of-use.||Figure 2 NobelReplace Tapered Implant with color-coding: step-by-step drilling protocol for predictable surgical procedures.|
|Figure 3 Preoperative presentation.||Figure 4 Preoperative x-ray.|
|Figure 5 Stable implant biologic width and veneer preparation.||Figure 6 Procera Zirconia crown and Procera Alumina veneer.|
|Figure 7 Postrestoration: 1-year follow-up X-ray.||Figure 8 Osteoblast in contact with TiUnite surface. Courtesy of P Miranda-Burgos, P Sch¸pbach, and J Hall.|