1. Clinical solutions with NobelActive™ implant design
Location, date
Presenter name
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383 Library_NobelActive Design_March 2012

2. NobelActive with color-coded implant platforms will be introduced during 2012-13
NobelActive™ design
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The NobelActive™ implant is a conical 2-piece implant with a unique combination of design features that enables easy insertion and high initial stability even in compromised bone situations.
There is a new internal connection using conical seating and hexagon interlocking that serves as a dual-function prosthetic connection which enables prosthetic flexibility including Procera ® Implant Bridges.

3. NobelActive™ design General Features
Expanding tapered body with double variable thread design and apical drilling blades.
Manual insertion protocol
Benefits
Gradual bone condensing and high initial stability
Enables ”active” directional changes for optimal restorative position
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The unique design of the NobelActive™ implant facilitates placement in clinically demanding situations. The ability to gain high initial stability, even in compromised bone situations is desirable in most clinical situations such as placement in extraction sites. The ability to redirect the implant during placement could facilitate optimal placement.
The design also enables minimal osteotomy with minor trauma to bone and surrounding tissue.

4. NobelActive™ design General Features TiUnite Benefits
Documented to enhance osseointegration and increase the predictability of implant treatment1
Groovy
Bone forms faster within the grooves, compared to implant without grooves2
Glauser R, Zembic A, Ruhstaller P, Windisch S. Five-year results 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.
2) 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):S76-82.
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The NobelActive™ implant also has the benefit of the TiUnite™ surface, which is well documented with published research documenting 5 year success. TiUnite™ has been shown to be osseoconductive, which is advantageous when considering Immediate Function™. This enlarges the bone-to-implant contact area, greatly enhancing osseointegration and increasing the predictability of the implant treatment in both the short- and long term.
The NobelActive™ also has grooves on its threads. We know from previous research that bone forms more rapidly within the grooves compared to implants without grooves.

5. NobelActive™ design Features Back-tapered coronal region Benefits
Allows for maximum alveolar bone volume around implant for improved soft tissue support
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The coronal design allows for bypassing the cortical bone and elastic relapse of bone around the collar, which enables maximum alveolar bone volume around implant for improved soft tissue support.

6. NobelActive™ design Implant body Features
Expanding tapered body that acts like a threaded osteotome
Reverse cutting flutes
Benefits
Enables narrow ridge expansion and is designed to reach high stability in compromised bone situations
Enables gradual widening of the osteotomy
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The implant has an expanding tapered body. This feature results in excellent stabilization in soft cancellous bone, as the implant expands the bone as an osteotome.
The thread design gives the implant self drilling, self cutting and self condensing abilities. This results in advantages in most types of bone and compromised situations.
Reverse cutting flutes enable gradual widening of the osteotomy.

7. NobelActive™ design Apical Features Drilling blades on apex
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The drilling blades on apex enable for minimized osteotomy.

8. NobelActive™ design Prosthetic connection / dual-function Features
NobelActive with color-coded implant platforms will be introduced during
NobelActive™ design
Prosthetic connection / dual-function
Features
Conical connection
Built-in platform shifting
Benefits
Sealed connection
Increased mechanical strength
Designed to enhance soft tissue integration
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NobelActive offers a unique prosthetic connection. The mechanical connection is conical which gives a sealed connection with increased mechanical strength. Platform Shifting is also built into this prosthetic connection enabling better soft tissue integration.

9. NobelActive™ design Prosthetic connection / dual-function* Features
NobelActive with color-coded implant platforms will be introduced during
NobelActive™ design
Prosthetic connection / dual-function*
Features
Hexagonal interlocking
Dual-function prosthetic connection
Benefits
Secure reposition of prosthetic components
Prosthetic flexibility for abutments and screw-retained restorations
*NobelProcera Zirconia  abutments and implant level bridges are not indicated for NobelActive 3.0
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Another feature of NobelActive is the hexagonal interlocking that secures reposition of the prosthetic components. In addition to this, the connection is dual-functional and allows for prosthetic flexibility as well as implant level bridges.

10. Internal conical connection and NobelProcera™ Implant Bridge platform.
NobelActive™ design
Dual-function prosthetic connection
Individual abutments
The internal conical connection was designed to provide a secure and sealed connection for a wide range of single abutments. The specified tolerances for the implant / abutment combination are such that a very tight fit is achieved at the top of the connection. For all three diameters of NobelActive, the size of the internal prosthetic connection was designed to accept a NobelProcera Abutment Zirconia, while maintaining an implant wall thickness capable of withstanding the fatigue stresses placed upon it. The hexagonal interlocking at the base of the connection provides for secure positioning of individual abutments, and helps to deliver the most desirable esthetic outcome.
Implant-level bridges*
The second function of the prosthetic connection is delivered by the horizontal surface at the top. This platform provides a surface upon which an implant-level bridge can be placed. When a NobelProcera Implant Bridge Titanium or Zirconia is used, this exceptionally strong restoration also eliminates the need for additional single abutments and provides a cost saving for the patient.1
Internal conical connection and NobelProcera™ Implant Bridge platform.
1 Sierraalta M, Razzoog ME. Load to Fracture of Procera® Zirconia Bridges. J Dent Res 2006;85 (Spec Iss A):abstract 1871.
*NobelProcera Zirconia  abutments and implant level bridges are not indicated for NobelActive 3.0
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When the prosthetic connection for NobelActive was being developed, satisfying the demands of restorative clinicians was the top priority. To be successful, NobelActive needed to accommodate a variety of prosthetic options such as titanium and zirconia standard and custom abutments to screw-retained restorations on implants, or abutment-level restorations using single-unit, short span, or full-arch bridges in titanium and zirconia.

11. Technical data of NobelActive™
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12. NobelActive™ macro design features
NobelActive with color-coded implant platforms will be introduced during
NobelActive™ macro design features 1
1. Coronal portion back taper (except 3.0 and NP)
Maximizes the volume of alveolar bone around the implant
2. Constantly expanding central core
Acts like a threaded osteotomy
Compacts the bone outward
Provides excellent primary stability
3. Sharp blades, deep widely spaced 35º double lead threads
Allows implant to condense through bone
Actively changes direction 2 3
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When the initial design and clinical data was presented to Nobel Biocare by the inventors, the decision was made to jointly develop a new implant incorporating the concepts of this implant design with Nobel Biocare technology. The basic design parameters for this implant are shown in this picture.

13. System development 1. Design
NobelActive with color-coded implant platforms will be introduced during
System development
1. Design
Coronal back taper on implant (except 3.0 and NP)
Connection for Titanium and Zirconia* fixed abutments
Platform for NobelProcera Implant Bridges
2. Design solution
12º conical connection with internal hex
0.25 mm wide flat shoulder
Dual-function
*NobelProcera Zirconia abutments and implant level bridges are not indicated for NobelActive 3.0
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Looking at this implant design from the top down, the first challenge is to combine the implant back taper with the clinical need for Titanium and Zirconia fixed abutments and implant level Procera® Implant Bridges. To achieve this with the NobelActive™ implant system a conical connection was chosen. This connection combines compact size, high strength and a very tight fit. The flat surface surrounding the conical connection yields a 0.25 mm wide platform shift around the abutments. The flat surface serves an additional function as a platform for implant level Titanium and Zirconia Procera® Implant Bridges. This eliminates the use of abutments for these restorations providing a cost savings to the patient.

14. Built-in platform shifting
NobelActive with color-coded implant platforms will be introduced during
Built-in platform shifting
1. Emergence profile abutment
0.25 mm
0.25 mm
2. Horizontal shoulder of 0.25 mm
3. Back tapered neck
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15. Design balance 1
The size of the conical connection must be large enough for Zirconia abutments
The internal hex must have enough strength for insertion torque, serve as indexing feature
The flat platform must be wide enough to support a NobelProcera Implant Bridge
The wall of the implant must be thick enough to withstand fatigue stresses
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For each implant diameter the size of the conical connection must be large enough for Zirconia abutments. Titanium abutments can be quite thin, whereas Zirconia abutments rely on material bulk for strength.

16. Design balance 2
The size of the conical connection must be large enough for Zirconia abutments
The internal hex must have enough strength for insertion torque, serve as indexing feature
The flat platform must be wide enough to support a NobelProcera Implant Bridge
The wall of the implant must be thick enough to withstand fatigue stresses
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The internal hex serves as the wrenching surface for inserting the implant into the osteotomy as well as the indexing feature for the abutment. This configuration must be strong enough to transmit the insertion torque without any distortion, which would lead to a less accurate index of the abutment. Again, the hex must be large enough to provide enough bulk thickness for the hex on the Zirconia abutment.

17. Design balance 3
The size of the conical connection must be large enough for Zirconia abutments
The internal hex must have enough strength for insertion torque, serve as indexing feature
The flat platform must be wide enough to support a NobelProcera Implant Bridge
The wall of the implant must be thick enough to withstand fatigue stresses
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The top surface of the implant must have enough surface area to withstand the loads placed upon it by an implant level bridge. The NobelActive™ implants are designed to have the same surface area as Branemark® System implants, which have a long successful history with Procera® Implant Bridges.

18. Design balance
The size of the conical connection must be large enough for Zirconia abutments
The internal hex must have enough strength for insertion torque, serve as indexing feature
The flat platform must be wide enough to support a NobelProcera Implant Bridge
The wall of the implant must be thick enough to withstand fatigue stresses 4
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Fatigue strength is one of the most important engineering aspects of the implant design. The size of the internal connection and external threads must be balanced to ensure enough wall thickness for high fatigue strength.

19. Implants placed with Ø3.8/4.2 step drill preparation
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According to the drilling protocol, incrementally larger drills are to be used as the bone density increases. When the larger drills are utilized in dense bone a gap exists between the osteotomy and the minor diameter of the implants. This series of radiographs demonstrate how the bone fills in between the threads of the implants with no adverse effects. These Ø4.3 implants were placed with a final step drill size Ø and were tightened to an insertion torque of 50 Ncm. No correlation between final drill size and implant complications was seen in the study.

20. Conclusion
When developing a new implant system, every aspect of the system must be verified and validated. The information shown demonstrates just some of the steps in the process to ensure long term clinical success and safety for the patient.
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When developing a new implant system every aspect of the system must be verified and validated. The information shown above demonstrate just some of the steps in the process to ensure long term clinical success and safety for the patient. This process has been successfully completed for the NobelActive™ system.
This concludes the lecture session on NobelActive design.