Module 1 | Session 2 Treatment planning and restoring the single posterior implant Please note: It is encouraged that the presentation at hand is adapted.

Module 1 | Session 2 Treatment planning and restoring the single posterior implant
Please note: It is encouraged that the presentation at hand is adapted and enhanced by clinical cases of the lecturer. Please feel free to adjust the slides according to your preferences. Welcome to session two of the first of four modules of our Esthetic Alliance Program My name is and I’m delighted to be your speaker today Disclaimer: Some products may not be regulatory cleared/released for sales in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability

Module 1: Course objectives
Treatment planning and restoring the single posterior dental implant Gain proficiency in diagnosis and treatment planning Master the restorative steps for a posterior dental implant Transform restorative decision-making and execution into a simple and easy process Learn how to avoid or manage complications Learn how to gain patient acceptance for dental implant treatment Note for lecturer: If course participants want to have additional training, Nobel Biocare can provide individual support and trainings on specific topics (e.g. how to restore on certain abutment)

Module 1: Session overview
Dental implants – the standard of care Indications and contraindications for dental implants Cement vs. screw-retained restorations Options for replacing a missing tooth Diagnosis and treatment planning Clinical examples How to find patients and gain treatment acceptance Time: 3 hours Session 2 Review of restorative options Surgical templates Biomechanics and occlusion in implant dentistry Case presentation from participants Treatment plan and case work-up with faculty Introduction for surgical preparation Time: 3 hours

Module 1: Session overview
Impression techniques Cement vs. screw-retained restorations Provisionalization NobelProcera Restorative workshop and hands-on Patient treatment status Basic patient communication concepts Time: 3 hours Session 4 Avoiding or managing complications Dental implant maintenance Final case presentations Time: 3 hours

Module 1 | Session 2 Agenda
Review restorative options Surgical templates Biomechanics and occlusion in implant dentistry Our goal for the lecture portion of today’s session is to cover 3 topics, namely Review restorative options Surgical templates Biomechanics and Occlusion in Implant dentistry 5

Restorative solutions for dental implants
Implant supported solutions from single tooth to full arch restorations Single posterior implant Single anterior implant Multiple implants Full arch implants In the last session, we described how this program is dedicated to addressing Implant supported restorative solutions for partially edentulous and edentulous arches, and is divided into 4 modules, the Single Posterior Implant, Single Anterior Implant, Multiple Implants and Implants in the Edentulous Arch.

Restorative solutions for dental implants
Implant supported solutions from single tooth to full arch restorations Single posterior implant We concentrated on Restoring the Single Posterior Dental Implant 7 7

Single missing tooth Restorative options for a single posterior implant: We discussed treatment planning, case presentations and informed consent. We discussed the restorative options for a single posterior implant in detail. Today, what we are going to do for the first few minutes is to review these restorative options. Clinical cases courtesy of Dr. Baldwin Marchack, Pasadena, USA 8 8

Single missing tooth Single posterior implant
We said that we had found the patient, performed the diagnosis and treatment plan, the surgeon had placed the implant, the implant has integrated and the case was ready to restore. Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany

Single missing tooth Restorative options for a single posterior implant: Pre-fabricated abutment, cement-retained crown Individualized abutment, cement-retained crown Screw-retained crown (one piece) And once again, if you have a single posterior implant, your abutment choices are to have a pre-fabricated abutment (Snappy or Esthetic), with a cemented crown, a custom abutment with a cemented crown, or no separate abutment, just a screw retained restoration.

Single missing tooth Screw-retained restoration
Single posterior implant You see, if you have a single posterior implant, you really only have two choices. You can have a screw retained restoration or you can have a cement retained restoration. Cement-retained restoration Photographs courtesy of MDT Claus-Peter Schulz, Baden-Baden, Germany

Single missing tooth Pre-fabricated abutment
Cement-retained restoration Individualized (CAD/CAM) abutment Now if you choose to make a cement retained restoration, once again, you have two choices. You can cement on a pre-fabricated abutment or you can cement on a custom abutment Photographs courtesy of Dr. Baldwin Marchack, Pasadena, USA Photographs courtesy of MDT Claus-Peter Schulz, Baden-Baden, Germany

Guidelines for abutment selection
Issues to be considered: Implant-abutment connection Distance from the implant platform to bone crest Interocclusal distance Depth of peri-implant soft tissues Biotype of the tissue Emergence profile Shape and contour of the tissue Screw-retained/cement-retained I wish it could be so easy that with every case you just take a pre-fabricated abutment, insert it in the implant, make a crown and cement it. Life would be very easy. But there are many things that need to be considered. Issues to be considered: Read list

For example If you have an Ideal gingival height – 1 to 3mm, Ideal interarch dimension – say 5 to 10mm And flat shape to the tissue Go right ahead and use a pre-fabricated abutment. In fact this would be an ideal situation for a Snappy abutment Ideal gingival height – 1 to 3mm, flat shape Ideal interarch dimension – 5 to 10mm

Too deep, not flat – use another solution.
Guidelines for abutment selection For example If you have an Ideal gingival height – 1 to 3mm, Ideal interarch dimension – say 5 to 10mm And flat shape to the tissue Go right ahead and use a pre-fabricated abutment. In fact this would be an ideal situation for a Snappy abutment Too deep, not flat – use another solution.

A case study: “Resistance to dislodgement of zirconia copings cemented onto titanium abutments of different heights.” Abbo B, Razzoog M, Vivas J, Sierraalta M. J Prosthet Dent 2008; 99: 25-29 Purpose: Authors measured the force it takes to dislodge a cemented crown on abutments of various heights Results: The taller the abutment height the greater the force required to dislodge a cemented crown. Study recommends that abutments should be no less than 4mm in height when using a cemented crown. Abutment height: 6.5mm 5.5mm Average dislodgement force: N N One other study I would like to share with you before we move on is this article by Razzoog and others. In this article the authors measured the force it takes to dislodge a crown cemented on abutments of various heights. They determined that the shortest height of an abutment should be no less than 4mm. Other wise the crown will fall off too easily regardless of what kind of cement you use

2-3mm gingival height 5mm interarch dimension Now remember that we developed a decision tree in the last session. In that decision tree we looked at 5 mm as the minimum interarch dimension for a cemented crown. Why? Well, if you have a single posterior implant, the first thing that needs to be evaluated is the interarch dimension. We know that if an abutment is too short and we cement a crown on it, the crown will keep falling off. The minimum abutment height as we saw earlier is 4mm. We also saw that the cement margin should be no deeper than 1mm below the crest of the tissue otherwise we may leave cement behind, and run the risk of peri-implantitis. That means we need 3 mm above the tissue for the rest of the abutment. We also know that we need 2mm of clearance above the abutment to make room for a crown. Therefore the minimum interarch dimension needed for a cemented crown is 3 + 2, =5 mm.

Posterior abutment decision tree – single implant crown
Interarch distance > 5mm Single posterior implant restoration Individualized one-piece restoration NobelProcera Screw-retained crown (Ti or Zr) With that in mind we discussed the decision tree which was created by Dr. Baldwin Marchack. The first part of this decision tree begins like this: If you have a single posterior implant, the first thing that needs to be evaluated is the interarch dimension. Is that dimension greater than or less than 5mm? If less, use a screw retained restoration, otherwise a cemented crown will keep falling off Make a non segmented, one piece, screw retained restoration Interarch distance < 5mm Screw-retained crown Posterior Abutment Decision Tree © Copyright 2010 Baldwin Marchack, DDS. Used by permission. 18 18

Limited interarch dimension Here is a case that illustrates that point. The interarch dimension is only 3 mm, there is no room for a cemented crown Photographs courtesy of Dr. Baldwin Marchack, Pasadena, USA

Use a screw-retained crown: Limited interarch dimension Patient is a bruxer Retrievability is desired Cement-free solution wanted Screw-retained crown: NobelProcera screw-retained crown GoldAdapt abutment You should consider using a screw-retained, non-segmented restoration when : Limited interarch dimension Patient is a bruxer Retrievability is desired Screw-retained, non-segmented restoration could be made from: NobelProcera custom abutment GoldAdapt abutment / UCLA abutment

Here is the NobelProcera Zirconia Angulated Screw Channel abutment, designed with anatomic support for the porcelain and with the porcelain veneered directly on to the abutment. Photographs courtesy of MDT Claus-Peter Schulz, Baden-Baden, Germany

And here it is, the completed, fully retrievable screw retained final restoration, with a composite filling to close the screw access hole Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany

Flat tissue < 3mm ID 5–10mm Pre-fabricated abutment Snappy Abutment Cement-retained crown Interarch distance > 5mm Single posterior implant restoration Retrievability is desired Individualized one-piece restoration NobelProcera Screw-retained crown (Ti or Zr) Now that does not mean that an implant with greater than 5 mm of interarch clearance cannot be screw retained. Of course it can, especially if retrievability is desired. But now, with 5mm or greater of interarch clearance you have the option of using a cement retained restoration. And if you choose a cement retained restoration, now you have to evaluate the depth and the shape of the tissue. If the tissue is flat, if the tissue is equal to or less than 3 mm deep, use a Snappy Abutment. Interarch distance < 5mm Screw-retained crown Posterior Abutment Decision Tree © Copyright 2010 Baldwin Marchack, DDS. Used by permission. 23 23

Ideal gingival height (1–3mm) Ideal interarch dimension (5-10mm) Flat tissue architecture Lets look at a case that illustrates this. We have Ideal gingival height (2–3mm) Ideal interarch dimension (6mm) Flat tissue architecture Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany

Snappy™ Abutment Ideal gingival height (1–3mm)
Ideal interarch dimension (5-10mm) Flat tissue architecture This is a perfect indication for a Snappy Abutment Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany

Snappy™ Abutment In this slide, the impression coping is placed on the Snappy abutment, (note the direction of the arrow) And, once the impression is made the coping is picked up in the impression material. In this example, and NobelProcera© Zirconia crown was used as the final restoration Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany

Flat tissue < 3mm ID 5–10mm Pre-fabricated abutment Snappy Abutment Cement-retained crown Interarch distance > 5mm Pre-fabricated abutment Esthetic Abutment (Ti) Procera Esthetic Abutment (Zr) Scalloped < 4mm ID 5–10mm Single posterior implant restoration Individualized one-piece restoration NobelProcera Screw-retained crown (Ti or Zr) Now, if the tissue is scalloped, or its up to 4 mm deep on the buccal, we can use another type of pre-fabricated abutment. We call these Esthetic Abutments. Interarch distance < 5mm Screw-retained crown Posterior Abutment Decision Tree © Copyright 2010 Baldwin Marchack, DDS. Used by permission. 27 27

Pre-fabricated Esthetic Abutment
Esthetic Abutment (Titanium) Pre-fabricated, customizable Titanium abutment: Comprehensive selection of different margin designs and angulations minimize chair-side adjustments Scalloped margin designed to profile natural soft tissue contours Optional temporary coping available for temporization Indications: Single- and multiple-unit implant restorations Cement-retained Esthetic Abutments for use in the posterior teeth come in titanium, in various collar heights, and 15% angled in titanium Depending on location, tissue biotype, etc we may elect to use one of these many choices.

Esthetic Abutment In this case with thick fibrous tissue biotype, there is no chance of metal show through, but by taking an implant level impression the lab has an opportunity to adjust the height and adjust the level of the margin to .5 to 1 mm below the crest of the tissue Clinical case courtesy of Dr. Christopher Marchack, Pasadena, USA

Esthetic Abutment Milled titanium Can be adjusted by the lab
Corrects minor angulation problems Fixture level impression Easy to cement Here are some advantages to the esthetic abutment Milled for proven accuracy of fit Can be prepped by the lab Corrects minor angulation problems Fixture level impression Easy to cement Clinical case courtesy of Dr. Christopher Marchack, Pasadena, USA 30 30

Flat tissue < 3mm ID 5–10mm Pre-fabricated abutment Snappy Abutment Cement-retained crown Interarch distance > 5mm Pre-fabricated abutment Esthetic Abutment (Ti) Procera Esthetic Abutment (Zr) Scalloped < 4mm ID 5–10mm Single posterior implant restoration Scalloped or flat tissue > 4mm ID > 5 mm Individualized abutment NobelProcera Abutment (Ti or Zr) Individualized one-piece restoration NobelProcera Screw-retained crown (Ti or Zr) Now, if the tissue is very scalloped, not flat, or simply very deep so no pre-fabricated abutments are manufactured with that tall of a collar height, then we have no choice we have to make a custom abutment Interarch distance < 5mm Screw-retained crown Depending on clinical situation and preference, the GoldAdapt Abutment can be a flexible solution for both cement- and screw-retained restorations and for various gingiva heights. Posterior Abutment Decision Tree © Copyright 2010 Baldwin Marchack, DDS. Used by permission. 31 31

Individualized abutment Scalloped tissue architecture Thick soft tissue Angled implant placement Excessive interarch dimension Excessive interproximal dimension Fabrication options: NobelProcera abutment in Titanium or Zirconia GoldAdapt abutment To summarize, we would utilize a custom abutment when we have: Scalloped tissue architecture Deep tissue Angled implant placement Excessive Interarch dimension Excessive interproximal dimension Screw access on buccal, working cusp And we have a choice of fabrication: NobelProcera custom abutment, titanium or zirconia GoldAdapt abutment UCLA abutment

NobelProcera® abutment
NobelProcera Angulated Screw Channel abutment Easy access due to tilted access hole This slide shows the NobelProcera angulated screw channel abutment Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany Photographs courtesy of MDT Claus-Peter Schulz, Baden-Baden, Germany

NobelProcera® abutment
And here we have the completed laboratory procedures with a NobelProcera custom abutment And a NobelProcera Zirconia crown Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany Photographs courtesy of MDT Claus-Peter Schulz, Baden-Baden, Germany

Posterior implant restoration
And the final photographs Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany

Flat tissue < 3mm ID 5–10mm Pre-fabricated abutment Snappy Abutment Cement-retained crown Interarch distance > 5mm Pre-fabricated abutment Esthetic Abutment (Ti) Procera Esthetic Abutment (Zr) Scalloped < 4mm ID 5–10mm Single posterior implant restoration Retrievability is desired Scalloped or flat tissue > 4mm ID > 5 mm Individualized abutment NobelProcera Abutment (Ti or Zr) Individualized one-piece restoration NobelProcera Screw-retained crown (Ti or Zr) So to conclude the abutment decision making process for the single posterior implant, this is how we can summarize it. Note: Not all abutments displayed in the decision tree on this slide are indicated for use in the posterior zone. Please always carefully read the instructions for use before using a Nobel Biocare product. Interarch distance < 5mm Screw-retained crown Depending on clinical situation and preference, the GoldAdapt Abutment can be a flexible solution for both cement- and screw-retained restorations and for various gingiva heights. Posterior Abutment Decision Tree © Copyright 2010 Baldwin Marchack, DDS. Used by permission. 36 36

Diagnosis and prosthetic treatment planning
Four important tools Diagnostic models Radiographs (CB)CT scans NobelClinician Software Now let’s discuss diagnostic and prosthetic treatment planning And, four important tools we need to utilize: 37

Diagnostic Models Evaluate: Centric relation position
Edentulous ridge relationship to adjacent teeth, opposing ridge, opposing dentition Inclination, rotation, extrusion, alignment of the remaining dentition Soft tissue, gingival heights, and other esthetic parameters Interarch space Determine: Options for occlusal schemes Ideal number and location of implants Direction of forces to which future implants would be subjected Diagnostic models allow us to evaluate: Centric relation position Edentulous ridge relationship to adjacent teeth, opposing ridge, opposing dentition Inclination, rotation, extrusion, alignment of the remaining dentition Soft tissue, gingival heights, and other esthetic parameters Interarch space They allow us to determine: Options for occlusal schemes Ideal number and location of implants Direction of forces to which future implants would be subjected 38 38

Radiographs Evaluate: Amount of bone available (2D only)
Angulation of adjacent teeth Location of anatomical structures Sinus, mandibular canal, mental foramen Please bear in mind that radiographs are not completely accurate Radiographs allow us to evaluate Amount of bone available Angulation of adjacent teeth Location of anatomical structures such as the sinus, mandibular canal, mental foramen However radiographs are limited, they are a 2-dimensional view only, and therefore not 100% accurate Clinical case courtesy of Dr. Richard Sullivan, Pasadena, USA 39

(CB)CT scans Since radiographs are not completely accurate, a (CB)CT scan can improve the diagnosis (CB)CT scans on the other hand are 100% accurate, but incur additional costs Clinical case courtesy of Dr. Christopher Marchack, Pasadena, USA 40

NobelClinician® Software
Visualize the patient’s (CB)CT data together with the intra-oral situation and the diagnostic setup thanks to NobelClinician’s SmartFusion™ technology SmartFusion technology allows the full automatic matching of (CB)CT data with surface scan of the dental cast Intra-oral situation of patient during (CB)CT scan and shown by dental cast – must be the same You can also scan the dental cast with the wax-up to allow for esthetic treatment planning. Use this opportunity to demonstrate the NobelClinician Software to the participants. For more information, please contact your local Nobel Biocare sales representative Clinical case courtesy of Dr. Christopher Marchack, Pasadena, USA

Surgical templates Models, radiographs and (CB)CT scans are essential in fabricating surgical templates for various types of surgery: Flapless Mini flap Flap All options are covered with the NobelClinician Software and NobelGuide Models, radiographs and CT scans are essential in fabricating surgical guides. Basically there are two types of surgical guides, guides for flapless surgery, often referred to as guided surgery, and guides for conventional open-flap surgery. 42

Surgical templates Benefits of surgical templates:
More precise placement of implants Preservation of anatomic structures Shorter treatment times, surgery times Less invasive, flapless surgery and therefore less chance of swelling Less post-operative strain on dentist and patient Read the bullets: Note: The list in this slide refers to the use of surgical templates with flapless surgery. The list does not rule out any advantages of free-hand surgery. Note to lecturer: Please feel free to adapt the slide according to your preferences. Manikandan R et al. Implant surgical guides: From the past to the present. J Pharm Bioallied Sci 2013;5(Suppl 1):S98-S102 43

One integrated treatment workflow, countless benefits
NobelConnect® Clinical diagnostics & treatment acceptance Capturing both the current & desired situation Treatment planning & patient communication Production of surgical template Implant placement Design of final restoration Production of prosthesis Restoration placement Clinical diagnostics and treatment acceptance Capturing both the current and desired situation Treatment planning and patient communication Production of surgical template Implant placement either freehand or using pilot drill template or fully guided template Prosthetic design Production of prosthesis Restoration placement Increasing treatment efficiency Save valuable time by linking several steps to form one integrated treatment workflow. From clinical diagnostics to implant placement, NobelConnect* seamlessly links the tools the clinician needs: NobelClinician supports efficient treatment planning by linking with the NobelProcera 2G System, allowing the capture of digitized prosthetic information for the current and desired situations, eliminating the need for a radiographic guide. NobelClinician Viewer or Communicator facilitates collaboration with all treatment partners and the iPad® app allows the clinician to present patient-specific treatment options in a way that is visual and easy to understand for increased patient acceptance. OsseoCare Pro records and documents final implant values or any surgical information the clinician needs. Information can be retrieved in NobelClinician automatically. Switch to guided surgery at any point during the planning process with no need for an additional patient visit.

~1.5mm on each side of implant, 2mm is better for soft tissue
Treatment planning What is the minimum space needed between teeth for a single-tooth implant? ø 3.5mm ø 4.3mm ø 5.0mm 1.5-2mm 1.5-2mm ~1.5mm on each side of implant, 2mm is better for soft tissue So if we look at the platform diameters of the three implants we will be concerned with, for a narrow platform, 3-1/2-millimeter diameter, if you allowed a minimum of 1.5 millimeters on each side, you’re looking for 6-1/2 millimeters of space. And accordingly, more for the regular platform and more for the wide platform. Speaker note: And when you’re on the wide platform, you can give them what your thoughts are on what space is too big for one wide platform implant. For example, if you think 12 millimeters is about the limit of what you would put in, one 5-millimeter or even 6-millimeter diameter implant, if you had room for it and you got the implant right in the middle, what is the effect of having a cantilever of 3 millimeters on each side or 4 millimeters on each side? But if the space gets to be 13-plus millimeters, should they be looking at two implants instead of one? That’s a good discussion point in treatment planning. 1.5-2mm Ø 4.3mm Illustrations refer to Nobel Biocare implants with Conical Connection 1 Gastaldo JF et al. Effect of the Vertical and Horizontal Distances Between Adjacent Implants and Between a Tooth and an Implant on the Incidence of Interproximal Papilla. J Periodontol 2004;75(9):

Occlusion and biomechanics
Forces acting during a condition of malocclusion The picture shows which force occurs during a situation of malocclusion The resulting force is perpendicular to the plane of contact If the resulting force is too strong for the crown, the restoration may break or may result in crestal bone loss The principles are the same for both natural teeth and implants → how can breakage and crestal bone loss be avoided? A failure of a dental implant is a rare condition that could happen if the structural integrity of the implant has deteriorated due to: Illustrations obtained through internet research: 46

Uneven loading Overloading may occur because of incorrect placement of the implant and critical restoration geometries This can result in uneven force distribution on the implant's surface Dental implants should ideally be placed so that the biting forces are directed straight downward onto the dental implant Now remember that we developed a decision tree in the last session. In that decision tree we looked at 5 mm as the minimum interarch dimension for a cemented crown. Why? Well, if you have a single posterior implant, the first thing that needs to be evaluated is the interarch dimension. We know that if an abutment is too short and we cement a crown on it, the crown will keep falling off. The minimum abutment height as we saw earlier is 4mm. We also saw that the cement margin should be no deeper than 1mm below the crest of the tissue otherwise we may leave cement behind, and run the risk of peri-implantitis. That means we need 3 mm above the tissue for the rest of the abutment. We also know that we need 2mm of clearance above the abutment to make room for a crown. Therefore the minimum interarch dimension needed for a cemented crown is 3 + 2, =5 mm.

FBite a1 FN1 FNx1 The steeper the line of contact, the stronger the resulting force The force necessary to equalize the vertical bite force is higher, when the line of contact is steeper In the dental environment, the occlusion should be shallow or flat in order to reduce the lateral forces impacting on the occlusion → it is recommended to create shallow or flat occlusion lines to reduce the overload risk FBite a2 FN2 FNx2 The angle of force to the implant body may be influenced by the cusp inclination. The natural dentition often has steep cuspal inclines. A greater cusp angles may incise food more easily and efficiently, yet the occlusal contact along an angled cusp results in an angled force to the crestal bone. The steeper the inclination of the occlusion the greater the lateral component of the resulting force. Which corresponds to a less favorable loading situation. The occlusal contact over an implant crown therefore should be ideally on a flat surface perpendicular to the implant body. 48

Possible consequences of overload Crestal bone loss Dislodged restorations Screw loosening Screw fracturing Restoration or ceramic fracture Peri-implantitis Implant failure We refer to excessive lateral forces on implants as overload, and some of the consequences of overload are: Crestal bone loss, Crowns falling off, Screw loosening, Screw fracturing, Prosthesis or porcelain fracture, Peri-implantitis, and Implant failure Here are two examples of severe bone loss leading to implant failure * This list makes not claim to be complete. Clinical case courtesy of Dr. Baldwin Marchack, Pasadena, USA 49 49

Possible consequences of overload And after extensive bone loss such as this, there is no option except to trephine out the implant and start all over Clinical case courtesy of Dr. Baldwin Marchack, Pasadena, USA 50

Summary Keep cusp inclines flat or shallow to minimize lateral forces No premature contacts Light occlusal contacts Avoid supra-occlusal axial and lateral loading Keep contacts in the same line as the long axis of the implant, i.e., as close to the center as possible Avoid cantilevers, whether mesial, distal, buccal, or lingual Occlusion has been an important variable in the success or failure of most prosthodontic reconstructions. With natural teeth, a certain degree of flexibility permits compensation for any occlusal irregularities. Implant dentistry is not as forgiving. The status of the occlusion must be properly diagnosed, corrected or compensated for, and properly integrated into the design of the definitive restoration. The occlusion must be more rigorously evaluated with implant-supported prosthodontics adjacent to natural dentition. Occlusal overload can be the main factor for an already osseointegrated implant to lose osseointegration. Hence careful consideration of the various components of implant protective occlusion is mandatory for the successful functioning of the implant supported prosthesis. Chia-Chun Yuan J, Sukotjo C. Occlusion for implant-supported fixed dental prostheses in partially edentulous patients: a literature review and current concepts. J Periodontal Implant Sci 2013;43:51-57 Rani G, Gambhir A. Occlusion In Implants - A Review. Indian J Dental Sci 2012;3(4):95-98 51 51

Your next steps for session 3
Treatment planning and restoring the single posterior dental implant Refer your patient to your surgical specialist for implant treatment Ensure a complete patient documentation for later case presentation You may invite your dental laboratory technician to participate in session 3 of the Esthetic Alliance Program Note for lecturer: Nobel Biocare offers to support participants along the Esthetic Alliance Program. E.g. additional individual training session, patient education material, training opportunities, preparation of case presentation etc. In case your restorative general practitioner, your dental staff or yourself need additional support on certain topics, we are glad to support you with small educational series on: Esthetic Abutment Multi-unit Abutment Snappy Abutment And other Nobel Biocare solutions The educational series can be executed by you or your Nobel Biocare representative

Thank you! Let’s get going and start a booming implant practice. Here are the tools you need to get started. It’s now up to you. Disclaimer: Some products may not be regulatory cleared/released for sales in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability © Nobel Biocare Services AG. All rights reserved.

Module 1 | Session 2 Treatment planning and restoring the single posterior implant Please note: It is encouraged that the presentation at hand is adapted.

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Module 1 | Session 2 Treatment planning and restoring the single posterior implant Please note: It is encouraged that the presentation at hand is adapted.

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