WIXLIB

NobelReplace TaperedNobelReplace Tapered –for all indications and users.TMNobelReplace Tapered is an implantsystem that covers a broad range of applications and user skill levels – from softto dense bone, and starting to experienced/advanced users.Optimal initial stabilityTapered implants are shaped following theform of natural teeth. This design providespredictable osseointegration results anddelivers optimal initial stability. The originaltapered implant design (Replace) wasintroduced in 1997. Many substantialimprovements have been made since thattime, leading to the currently availableNobelReplace Tapered Groovy implant, whichwas introduced to the market in 2005.Step-by-step drilling protocolThe standardized drilling protocol developedfor NobelReplace Tapered provides dentalprofessionals with a step-by-step approachfor preparing the implant insertion site.The protocol works in all bone types andsupports all surgical modalities: one- andtwo-stage, flapless and flapped, and immediate and delayed loading.Flexibility in restorative optionsDue to the broad prosthetic assortmentand ease-of-use of the tri-channel internalconnection, NobelReplace Tapered isincredibly flexible with regard to restorativeoptions. Both standard and individualized(NobelProcera) prosthetic options areavailable for use with NobelReplace Tapered,including temporary solutions for singleand multiple unit restorations (see pages12 –15).In practical terms, the system grows tomeet the restorative needs of both clinicians and their patients: from basic implantrestorations, such as two mandibularimplants with an overdenture and four implants with fixed prosthetic, to advancedsingle-tooth anterior mandible restorations.11

12NobelReplace TaperedComplete prostheticflexibility.Individualizedcrowns and bridgesNobelProcera CrownAlumina and ZirconiaNobelProcera BridgeAlumina and ZirconiaIndividualized abutmentsStandard abutmentsLOCATOR Healing and temporarycomponentsBallAbutmentGoldAbutment BarGoldAdapt

NobelReplace TaperedNobelProcera Implant Bridge Zirconia13NobelProcera Implant Bridge TitaniumNobelProcera Abutment ZirconiaNobelProcera Abutment Titanium0 / 17 / 30 Multi-unit Abutments SnappyAbutment Narrow ProfileAbutmentEstheticAbutment NobelProcera Esthetic AbutmentCoverScrewHealing Abutment(single and bridge)QuickTemp Abutment ConicalImmediate TemporaryAbutmentTemporary Abutment(non-engaging)

14NobelReplace TaperedNobelProcera CrownAlumina and ZirconiaNobelProcera BridgeAlumina and ZirconiaFlexibility in individualizedrestorative options.For individualized restorative options, acomprehensive prosthetic range is availablefor NobelReplace Tapered – designed towork in harmony with the versatility of thisimplant system and its tri-channel internalconnection.Individualized abutmentsAs a perfect complement to its estheticstandard components, NobelProcera offers individualized prosthetics, such asNobelProcera Abutment Zirconia andTitanium.NobelProcera Abutment ZirconiaNobelProcera abutments can be designedto practically any angle, taper, finish line,height, width, and cross-sectional form,thereby creating a natural tooth form andemergence profile.NobelProcera Esthetic Abutment SelectionKits are also available. Abutments in thesekits come in a range of predetermined sizesand shapes, based on thousands of existingrestoration designs. These kits make selecting the appropriate abutment convenientand easy.NobelProcera Abutment TitaniumIndividualized crowns and bridgesNobelProcera produces individualizedcrowns and bridges, and NobelProceraImplant Bridge Zirconia and Titanium.Single crowns, multi-unit bridges, evenfull-ceramic restorations – all forms of finalesthetics can be used with NobelReplaceTapered. For high esthetics, all-ceramicNobelProcera crowns 5, bridges and overdentures are optimal.NobelProcera metal-free materials – alumina and zirconia – provide natural-lookingrestorations and remove the possibility ofunsightly darkening at the gum line.Simultaneously, their high biocompatibilityeliminates potential allergic reactions andpromotes long-term soft tissue stability.6 –11Each NobelProcera Abutment and ImplantBridge is individually designed using thelatest 3D computer-aided design software(CAD), and then milled from high-strengthzirconia or titanium in a computer-assistedmanufacturing (CAM) process.12 – 14

NobelReplace TaperedFlexibility in standardizedrestorative options.Snappy Abutment The standardized prosthetic assortment forNobelReplace Tapered provides restorativeclinicians a comprehensive selection ofabutments and components, which facilitate all surgical and restorative situations.Abutment and component screwsAll abutment and component screwsfeature a Unigrip internal fitting, whichtolerates high torque capacity and offersa screw carrying action for ease-of-use.Standard abutmentsIn situations where standard crown andbridge techniques are desired – fromsingle-tooth replacements to full-arch restorations – standard abutments can be used.Included in this assortment is the SnappyAbutment, which is ideal for posterior,partially edentulous, and simple implantrestorations. Its short profile also meansthere is little or no need to make any heightmodifications.Additionally, screws have been coatedwith a friction-reducing surface – TorqTite –to ensure a long-term stable screw jointand help remove the incidence of screwloosening.Healing and temporary componentsWhen a particular clinical situation doesnot warrant immediate temporization,clinicians can use healing abutments inone-stage surgical procedures, and coverscrews in two-stage surgical procedures.Healing abutments are available for use insingle and multiple (bridge) restorations.When the definitive abutment is notchosen at time of surgery, but a quick andconvenient chair-side temporization isdesired, there exist a number of temporarysolutions. Included here are the ImmediateTemporary Abutment and QuickTempAbutment – both come with a pre-madeplastic coping for use in fabricating a temporary crown or bridge.Immediate TemporaryAbutmentHealing Abutment RPTorqTite15

16NobelReplace TaperedNPProsthetic Kit *Surgery Kit ** For simpler viewing, components have been removed from the kits.RPWP6.0

NobelReplace TaperedProsthetic and SurgeryKits – simplicity and clinicalefficiency.Color-coded surgery kitThe surgical kits for NobelReplace Taperedhave been designed for simplicity andclinical efficiency. Kit layout is completelycolor-coded, and the drilling sequenceis numbered for easy-to-follow protocols.Kits include one set of diamond-coatedreusable drills for placing all diameters ofNobelReplace Tapered. For implant placement, the NobelReplace Implant Driverimproves visibility and versatility duringimplant insertion by eliminating the needfor insertion mounts and several otherinstruments.– Color-coded for easier componentidentification– Each instrument has a clearly markedstorage position– Autoclave compatible– Manufactured of anti-slip material forease of handlingOne common prosthetic systemfor maximum versatilityNobelReplace Tapered implants sharea common versatile, yet simplified, lineof color-coded prosthetic components forevery function and esthetic need. Colorcoding makes matching componentseasier, which facilitates communicationwithin the dental team and simplifiesordering processes. Options are availablefor cement- and screw-retained restorations, and ball-, bar- or Locator-retainedoverdentures.The ultimate esthetic solutionToday’s patients expect excellent estheticresults from all types of restorations, including implants. Nobel Biocare offers two linesof restorative solutions for recreating missing dentition using implants: Standardizedand Individualized abutments.Standardized Esthetic Abutment SelectionKits are based on thousands of existingrestoration designs. They come in a rangeof prefabricated sizes and shapes, therebymaking the abutment selection processextremely convenient and easy. The abutments in these kits are also color-codedto match the particular NobelReplaceTapered platform used in the restoration.Individualized NobelProcera Abutmentsoffer the ultimate esthetic solutions.All NobelProcera abutments, available inzirconia or titanium, are custom-designedin virtually any shape in order to create themost natural form and emergence profile.For more information on NobelReplaceTapered Prosthetic Flexibility, see pages12 –15.17

18NobelReplace TaperedNobelReplace Tapered –excellent results.TMSingle tooth restorationYoung female in good overall health, non-smoker, with no parafunctional habits,with a persistent deciduous lateral incisor.DiagnosisMissing lateral central incisor, limited spaceto adjacent teeth after extraction of thepersistent deciduous lateral incisor andfinalized Orthodontic treatment.Intraoperative x-ray shows the narrowspace conditions.Control x-ray after two years, no boneloss and stable gingival conditions resulting in good esthetics.Case courtesy of Dr Oliver Hugo(Germany).TreatmentInsertion of a NobelReplace Tapered NPimplant, intraoperative x-ray showsthe narrow space conditions, immediateloading with a temporary resin crown.Products used1 NobelReplace Tapered NP.1 NobelProcera Abutment Zirconia.1 NobelProcera Crown Alumina.ResultsExcellent esthetics and soft tissueresponse shortly after final prostheticinstalled.

NobelReplace Tapered19Multiple teeth restorationYoung female, came to clinic because of trauma to central incisors.DiagnosisCentral incisors tooth / root fractures.11 and 21 tooth/root fractures.Atraumatic tooth extraction #11and #21Flapless immediate implant placement2 NobelReplace Tapered, WP.Products used2 NobelProcera Abutment Zirconia.2 NobelReplace Tapered WP.2 NobelProcera Crown Alumina.Results2 NobelProcera Crown Alumina (Graft forsoft tissue thickness).Case courtesy of IñakiGamborena (Spain).

20NobelReplace TaperedDr Jack Hahn, DDSPrivate practice limited to placementand restoration of dental implants,Cosmetic and Implant Dental Centerof Cincinnati, Cincinnati, Ohio.NobelReplace Tapered –clinicians confirm efficacy.TMDr Oliver Hugo, DDS, DMDJoint general practice in Schweinfurt,Germany, and lecturer in implantologyand ceramics.Dr Bernard Touati, DDS, MSPrivate practice in Paris and VisitingProfessor with Hadassah Facultyof Dental Medicine, Jerusalem, Israel.Dr Othman Shibly, DDSPrivate practice limited to periodontology and implants, Clinical AssistantProfessor at State University ofNew York, Buffalo, NY.“I’ve placed over 5000 Replace implants with a success rate ofapproximately 97 %. I especially like the tri-channel internalconnection. To me, it makes the restoration process simple; youknow the exact position because it can be only in one of threepositions.”Dr Jack Hahn“Besides increased primary stability, NobelReplace Tapered offersadvantages in narrow spaces, due to its very slender tip. Thisdesign helps eliminate the danger of damaging the neighboringteeth or the buccal perforation.”Dr Oliver Hugo“NobelReplace Tapered offers me numerous prosthetic optionsto fulfill my esthetic and biological expectations. Moreover,positioning of prosthetic components is unequivocal: no radiographic control is required and screw loosening almost neveroccurs.”Dr Bernard Touati“NobelReplace Tapered is a unique implant that is easy to use. Itsdesign and associated surgical kit have given me the opportunityto place the implant in relatively shorter times than any othersystem without compromising the strength of its initial stability.”Dr Othman Shibly

NobelReplace TaperedNobelGuide – digitalprecision for all indications.TMPowerful indication-based diagnosisand treatment-planning platform.NobelGuide is a complete treatmentconcept for planning and placing dentalimplants, developed to work in harmonywith the requirements of the future prosthetic restoration. NobelGuide is the perfectpartner – assisting the entire team in making the appropriate treatment decisionsand executing the planned result with highpredictability. The digital integration of aconventional diagnostic tooth setup and full3D view of the patient’s anatomy in thesoftware offer a profound basis for evaluating and defining implant positions forlong-term success. 40–42For all indicationsNobelGuide is intended for all indications –from patients missing a single tooth tototally edentulous cases. Functional, esthetic and biomechanical prosthetic considerations are optimized during the implanttreatment planning phase. In fact, dentalprofessionals can decide all elementsof the treatment path, including the stageof implant loading (immediate or delayedloading), far in advance of the surgicalprocedure. 43Prosthetic-driven planningThe NobelGuide workflow benefits from aprosthetic-driven, backwards-planning approach. Based on the proposed final restoration, and a clinically evaluated tooth setup,a radiographic guide is generated. This radiographic guide serves as a template forattaining the expected function and esthetics of the final restoration.Integrated complete supply chainBased on the planning, a surgical templateis automatically designed and orderedvia the Internet from a NobelProcera production facility. The surgical template isproduced with consistent quality andshipped back to the dental professionalwithin a few working days. In the same order, implants, anchor pins to secure thetemplate, drills and prosthetic componentscan be included.Minimally invasiveThe surgical template guides all implanttreatment steps from drilling to implant insertion, and allows for safe flapless surgicalprotocols, which help minimize patientdiscomfort as well as pain and swelling.NobelReplace is fully compatible with thesurgical template – all specific NobelReplacedrills (including Twist drill 2 mm) aredesigned to provide internal irrigationduring surgery.Safe and predictable treatmentCareful diagnostics, optimized assessmentof bone and prosthetic considerations,allow for alignment of the entire treatmentteam, including the dental lab, and clearcommunication with the patient – all ofwhich lead to a treatment that is optimizedfor safety and meeting the high estheticdemands of the patient.The NobelGuide process.21

22NobelReplace TaperedScientific research.Marginal bone remodeling0.50.25Remodeling (mm)0.0– 0.25– 0.5– 0.75– 1.0– 1.25– 1.5– 1.75– 2.0Error bars: standard error036Follow-up (months)9NobelReplace (n 85)12Science firstNobel Biocare builds upon the scientificprinciples of Professor P-I Brånemarkand bases all of its innovations on solidscientific research and evidence, which isbacked by sound clinical experience.NobelReplace Tapered GroovyNobelReplace Tapered Groovy, introducedin June 2005, shares the same implantbody as Replace Select Tapered, butfeatures TiUnite on the entire surface of theimplant, and Groovy on the threads andcollar. A number of clinical studies onNobelReplace Tapered Groovy are ongoingand manuscripts are being prepared forsubmission.15 –18Ongoing researchNobel Biocare is using NobelReplaceTapered as the control in a multi-centerclinical study to validate the success, softtissue maintenance and bone remodelingover time of a novel tapered implantdesign.18The five-year randomized controlledprospective study is examining implants inboth anterior and posterior regions of themaxilla and mandible. All implants placedwere subjected to immediate temporization(i.e., patients received a tooth-like restoration within 24 hours after implant placement). Twelve centers, 177 patients, and325 implants are included in the study.Patients were consecutively included (i.e.,centers were not able to “pick and choose”patients). Of the 325 total implants, 126were NobelReplace Tapered.All implants were placed in healed sites(at least six months after extraction).No major bone augmentation at implantplacement was permitted; only minoraugmentation to cover exposed threads orinterproximal/buccal grafting in deficientsites. The one-year cumulative survival ratefor NobelReplace Tapered, placed in allsites and subjected to immediate temporization, was 97.6 %; marginal bone remodeling, averaged – 0.6 mm (see figure toleft).The papilla index improved over time inNobelReplace Tapered and novel implantsites. Soft tissue variables, plaque andperi-implant mucosa, were stable over timefor both implant types.Replace Replace External Hex is the original NobelBiocare tapered implant design that wasintroduced in 1997.19 – 27 TiUnite was addedto the threaded portion in 2002 (the collarsurface retained its machined surface).In published studies, in which one-stagesurgery and immediate temporizationwere applied, Replace implants were oftenplaced directly into extraction sockets.Results from such studies demonstratehigh cumulative survival rates, between97 and 100 %, up to 3 years followingprosthetic loading.28 – 39

NobelReplace TaperedStrength and safety.Strength and safetyIn general, two mechanical parametersmust be satisfied in an implant design:fatigue strength and torque strength.Of the two, fatigue strength is the moreimportant for guaranteeing the lifetimesafety and success of a given restoration.Fatigue strengthFatigue strength is the maximum force animplant/abutment combination can survivefor a minimum of five million cycles. NobelBiocare developed its protocol for testingfatigue strength in 1992. Today, the ISO14801 international standard for single-postendosseous dental implants fatigue testingis used, which is very similar to the originalNobel Biocare protocol.The ISO 14801 protocol includes:– implant/abutment combinations mountedin 30 off-axis orientation– cyclic force applied (frequency 14 Hz)– 5 million cycle durationBased on Nobel Biocare internal fatiguetesting, the fatigue strengths forNobelReplace Tapered Groovy NP and RPimplants are 197 N and 283 N, respectively.Torque strengthTorque strength was an important designconsideration in the development of thetri-channel internal connection. The goalwas to have the largest margin of safety aspossible for each of the implant diameters,above the 45 Ncm prescribed insertiontorque for immediate temporization protocols. Based on torque testing results, thefracture strengths of the NobelReplaceTapered Groovy NP and RP implants weredetermined at 150 Ncm and 300 Ncm,respectively.Material selectionThe TiUnite surface on the im

2 NobelReplace Tapered At a glance. NobelReplace Tapered NP 3.5 mm x 8, 10, 13 and 16 mm 3.5 3.5 NobelReplace Tapered RP 4.3 mm x 8, 10, 13 and 16 mm 4.3 4.3 NobelReplace Tapered WP 5.0 mm x 8, 10, 13 and 16 mm NobelReplace Tapered 6.0 . Groovy - Macroscopic grooves on implant threads and collar .