Nobel Biocare News Information for the Osseointegration Specialist
Issue 1/2014
In this Issue 2 New talent steps forward: The Foundation for Oral Rehabilitation (FOR) commits resources and energy to young leaders.
3 Recent findings:
Science matters!
4 Implants and
first-class esthetics go hand in hand: Insight into anterior soft tissue management techniques and procedures.
6 One streamlined flow:
The Remedy for Lost Front Teeth
Integrated and efficient treatment workflow gives clinicians and labs a connection pathway.
Want to make patients without front teeth happy and confident again? Then give them beautiful new teeth! NobelConnect®
Nobel Biocare offers the products—and equally important, the experience— to help you diagnose, plan, carry out and follow up multiple-unit anterior cases more effectively than ever before. By Frederic Love
O
ften the result of traumatic injury, the loss of multiple anterior teeth is as likely to strike young patients as the elderly. In both situations, challenging anatomical conditions must be faced in the vital undertaking of replacing the lost teeth and repairing the broken smile convincingly. In the anterior zone, soft tissue considerations are often as important as hard tissue osseointegration, although it must be recognized that the appropriate placement of the implants quite literally represents the foundation upon which prosthetic success is built in cases like these. Nobel Biocare offers the products
and experience to help you accomplish each of the demanding tasks that make up the step-by-step workflow for multiple-unit partial cases like the one above (as well as for single-tooth and edentulous situations).
fusing detail into clear focus for the patient. This can lead to enthusiastic “Aha!” responses and more frequent acceptance of the treatment being proposed.
“The goal remains the same for our surgical and our restorative interventions: We try to mimic nature as closely as possible.” — Prof. Markus B. Blatz Especially useful in high-visibility anterior cases, innovative “smart fusion” technology from Nobel Biocare merges and aligns medical imaging from (CB)CT scans with tissue information received from the NobelProcera 2G Scanner. Following all or even part of the new workflow featured on pages 6–7 in this issue of Nobel Biocare News can lead to more predictable and efficient treatment—which is also easier to explain to patients during the planning and proposal stages. The visual nature of the digitized treatment plan provided by NobelClinician brings even the most con-
Working with Nobel Biocare, you will be able to reduce the number of visits for each patient while enhancing predictability at the same time. The workflow now being introduced saves time and effort for everyone involved in delivering treatment, thus reducing costs, as well. In short, the workflow presented in this edition’s centerfold encourages teamwork across professional frontiers, offers efficiencies at each treatment step, and promotes the cooperative interaction that can help all the dental professionals involved to further build their businesses.
Regaining confidence People who have lost teeth in the front of their mouth find themselves in an especially vulnerable situation. As much as they miss the function of the teeth they’ve lost, most of all they want to regain their smiles, which are invariably an essential part of their social connection to friends, family and the world around them. The smile you can reproduce with the help of Nobel Biocare products today is made up of natural-looking teeth and healthy soft tissue. Equally important to the patient, regaining his or her smile with an implantbased solution does not require grinding down adjacent healthy teeth. At the Nobel Biocare Global Symposium in New York last June, Professor Markus Blatz of the University of Pennsylvania gave voice to a sound strategy: “The goal remains the same for our surgical and our restorative interventions: We try to mimic nature as closely as possible.” Never before has the pathway to this admirable objective been as straightforward to travel as now. <
9 Esthetics from a
new angle: NobelProcera® Angulated Screw Channel (ASC) abutment and Omnigrip™ tooling
10 Introducing creos™
regenerative solutions: Providing bone regeneration options for a wide variety of indications.
2 From the CEO
Nobel Biocare News
Issue 1/2014
FOR Instills Podium Power The Foundation for Oral Rehabilitation commits resources and energy to young leaders.
Richard Laube, CEO Nobel Biocare continues to invest significantly in our R&D efforts and in 2013, we invested a larger amount than that of our closest competitor. These investments are being made with several simple objectives in mind, each for the benefit of you and your patients. First of all, our investments enable you to treat patients with a superior treatment outcome, providing functionality, esthetics and longevity. They also make it possible for you to treat even the most challenging patients. (Consider the ease with which you can deliver a NobelActive 3.0 implant in a very narrow space thanks to treatment planning with NobelClinician.) Finally, our investments give you the means to treat patients more efficiently—from single-tooth to fullarch restorations—with our immediate loading treatment protocols. When all is said and done, we believe our innovation efforts—which we pursue in order to help you treat more patients for all indications with fewer surgical interventions, fewer patient visits, higher predictability and less rework—are far more beneficial to you than buying less expensive implants. We invest and innovate to provide you with a competitive advantage. Let us show you what we can do together. <
Fifteen dental clinicians participated in FOR’s Emerging Leaders Presentation Skills Workshop in Feusisberg, Switzerland, on February 3–5, 2014. Drs. Eric Rompen and Bernard Touati created and led this workshop, the first in a series of FOR activities that will be scheduled throughout the year. By Carolyn Moncel
T
his first FOR workshop for emerging leaders introduced participants to state-of-the-art PowerPoint® and Keynote® techniques, as well as in-depth analysis of presentation format, content, speaking style and the integration of scientific content. Additionally, participants benefited from expert counsel on such topics as digital photography with FOR expert Dr. Egon Euwe from Italy, as well as the hidden mysteries of body language with celebrated presentation expert Tom Mucciolo from the United States.
Maximizing impact “Teaching successfully has many facets, and an often overlooked one is the art of presenting and lecturing,” said Dr. Sreenivas Koka, FOR’s Executive Director. “This workshop takes a group of talented clinicians who
FOR’s young clinicians and mentors assemble for a quick photo during day one of the Presentation Skills Workshop in Feusisberg, Switzerland.
have great content to share, and positions them to have the maximum possible impact with their audiences.” Members of the group in Feusisberg represented such diverse places as Spain, Portugal, Italy, France, Denmark and Germany. The participants earned entry into the workshop by submitting their presentations to a six-person panel of experts via FOR’s website back in December 2013. The panel, comprised of experts representing Sweden, Spain, Italy,
Singapore and the United States, evaluated each submitted presentation based on the following criteria: title and design of the presentation; appropriate use of content, images and iconography; clinical treatment quality, oral presentation content, skill and mastery of the English language; and finally enthusiasm for the subject matter presented. The top 15 were selected to give their seven-minute presentation in person and received customized
Nobel Biocare News Published regularly by Nobel Biocare Services AG Vol. 16, No. 1, 2014 Editor-in-chief Frederic Love Managing Editor Jim Mack Assistant Editor Michael Stuart Editorial offices Nobel Biocare News Herdevägen 11 702 17 Örebro, Sweden Telephone: +46 19-330680 Telefax: +46 19-330681 e-mail:
[email protected] web: nobelbiocare.com/newsletter
More to explore: To learn more please visit:
The contents of contributor’s articles do not necessarily express the opinions of Nobel Biocare. © Nobel Biocare Services AG, 2014. All rights reserved.
feedback for refining skills. “Let’s not forget that these presentation skills workshops not only bring a new generation of lecturers to the podium, but they also serve as a means for knowledge transfer and mentorship,” said Dr. Touati, who also co-chairs FOR’s Emerging Leaders Global Council along with Dr. Rompen. “The interactions between the clinicians and mentors facilitate learning, and in the end it is the patient who benefits most from these activities.” Overall feedback from participants was excellent. As Dr. Arturo Llobell, a presentation participant from Spain noted, “I already had very high expectations for this workshop beforehand due to the people involved. The workshop fulfilled those expectations, and I feel very fortunate to have taken part.” The outstanding success of this workshop means that FOR is making plans to sponsor future workshops around the world for aspiring young presenters. The next Presentation Skills Workshop for Emerging Leaders will be held in North America in July 2014. Submission details will be posted soon on FOR’s website. <
FOR.org/leaders. To receive
regular updates on upcoming events and learning activities, “like” Dr. Arturo Llobell converses with Emerging Leaders Council member and event judge, Dr. Jose Navarro, at FOR’s Presentation Skills Workshop.
FOR on Facebook: facebook.com/for.organisation.
Recent Findings Evidence supporting TiUnite® Two recent studies demonstrate the superiority of TiUnite over machined implants at up to 9 years follow-up. (Polizzi G, Gualini F, Friberg B. Int J Prosthodont. 2013 Jul–Aug;26(4):350–8. / Rocci A, Rocci M, Rocci C, Scoccia A, Gargari M, Martignoni M, Gottlow J, Sennerby L. Int J Oral Maxillofac Implants. 2013 May–Jun;28(3):891–5.) TiUnite outperforms machined implants in terms of survival and marginal bone remodeling in two recent long-term studies. Polizzi et al. (2013) retrospectively shows a CSR 96.6% for TiUnite compared to 90.3% for machined implants at 6–9 years and Rocci et al. (2013) demonstrates a CSR of 95.5% for TiUnite versus 85.5% for machined implants at 9 years. Both were statistically significant. TiUnite also demonstrated an advantage in terms of mean marginal bone remodeling in both studies, although statistically significant only in the study by Polizzi. After 9 years, TiUnite continues to outperform machined implants. www.ncbi.nlm.nih.gov/pubmed/23837166
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Issue 1/2014
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Report on new membrane In a comparative study, creos xeno.protect monolayer non-cross-linked collagen membrane shows higher tensile strength in vitro and greater vascularization in vivo. (Bozkurt A, Apel C, Sellhaus B, van Neerven S, Wessing B, Hilgers RD, Pallua N. COIR 2013 [epub 28 October] DOI: 10.1111/clr.12284.) In vitro, the creos xeno.protect (Nobel Biocare / Remaix, Matricel) showed significantly greater tensile strength in terms of both force at break (N) and stress at break (N/mm²) and in terms of suture retention when compared to a bi-layer non-cross-linked collagen membrane (Bio-Gide, Geistlich). An accompanying animal study confirmed slower biodegradation of creos xeno.protect. Degradation was similar between the two membranes during the first nine weeks, but a marked difference at 20 weeks showed only a slight decrease in thickness of the creos xeno.protect membrane compared to 51% loss of thickness of the comparison membrane. Histomorphometric analyses at 20 weeks showed higher vascularization of the creos xeno.protect membrane with approximately twofold increase in the number of blood vessels at week 20. onlinelibrary.wiley.com/doi/10.1111/clr.12284/abstract
Zirconia strength testing results
“The day after my procedure, I played golf!” By James Kim
I
am a Korean-American, who was born in Korea and moved to the United States when I was two years old. When I was quite young, I broke my front two teeth and got crowns to replace them. Then I started playing basketball—which can be a full-contact support at times—and I got my teeth knocked out more than once. Most recently, I lost them five or six years ago, when somebody smashed his elbow into my mouth. That time, the crown on one of my upper central incisors was actually shattered, and my dentist had to extract the tooth entirely, leaving me with one crown. To replace the lost tooth, they put in a new crown and a half-bridge with a half-wing attached to the back of one of my adjacent teeth. After just a few years, it grew quite unsteady and was unsightly, too. I had a black post, and the gums weren’t covering it, so when I went to see clients or spend time with my friends, I found myself not smiling fully or covering my smile with my hand. The mobility of the bridge led to the loss of my other broken incisor, so an implant-based solution was suggested, and I agreed.
All the difference in the world With two new front teeth, I can really enjoy local cuisine wherever I am. I enjoy a lot of things that were difficult to eat before, like chili crab in Singapore, for example. Now with implants, it is a lot easier to bite
Mr. James Kim had a traumatic injury of his upper central incisors at a young age and faced further injury playing basketball as a young man.
down and eat properly. The worries are gone and I don’t even think about it very much any more. For patients who are looking to get an implant, I think the biggest thing to remember is: “Don’t be scared of going through with it!” Accept the minor discomfort, and you’ll discover that the whole process is really not that bad. Recovering, the afternoon of my
procedure, I was actually quite okay! I didn’t need to take any pain medication, and the next day I went out to play golf. < More to explore Learn more about implant-based solutions from the patient’s pointof-view by visiting us at: nobelbiocare.com/patientstories
In vitro performance of Nobel Biocare Replace and Brånemark zirconia abutments show strength testing results equal or superior to other zirconia abutments after aging. (Mühlemann S, Truninger TC, Stawarczyk B, Hämmerle CH, Sailer I. Clin Oral Implants Res. 2014 Jan;25(1):74–81.) In vitro testing shows good performance of Procera zirconia abutments in terms of fracture load compared to other zirconia abutments. Bending moments of both Replace Select two-piece internal tri-channel connection and Brånemark System Mk III external connection were similar to Bone Level one-piece (Straumann) and StandardPlus two-piece internal connections (Straumann), and furthermore they significantly outperformed Osseospeed (AstraTech) one-piece internal connection (P