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01 Jan 2010 | Australasian Dental Practice

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NobelActive provides excellent initial stability and perfect aesthetic results

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The Swiss company Nobel Biocare has recently introduced an innovative 3rd generation dental implant - NobelActive that was specifically developed to meet the needs of surgical and restorative clinicians.


Its innovative double lead thread design, expanding tapered body and built in platform shifting clearly sets NobelActive apart from conventional implant systems. So far, the market response one year after launch has been overwhelmingly positive, with over 200,000 implants sold worldwide.

With its novel, double lead thread design, NobelActive gradually condenses the bone during insertion with each rotation. The tapered implant body acts like a threaded osteotome, which enables atraumatic narrow ridge expansion. This was developed to attain high initial stability even in compromised bone situations.

The newly designed implant tip allows fine adjustments to implant orientation during insertion to optimise the final position of the implant in the bone. NobelActive also has two reverse-cutting flutes. Rotating the implant by half a turn anti-clockwise engages the cutting capability of these flutes. The coronal region of the regular platform NobelActive implant is back-tapered and designed to maximize alveolar bone volume around the implant collar for improved soft tissue support. These new attributes are very important advantages for optimal surgical and prosthetic management.

Grooves were also added to NobelActive. The arrangement of macroscopic surface grooves (Groovy) in conjunction with the special TiUnite surface, not only promotes but also accelerates new bone formation.1 TiUnite is a highly crystalline and phosphate-enriched titanium oxide surface, available exclusively from Nobel Biocare. TiUnite is a patented biocompatible material that has been scientifically proven both in the short and long term to enhance osseointegration and increase the predictability of implant treatment.2,3

Comprehensive solutions
NobelActive has an internal conical connection that offers the clinician the option of restoring the tooth with a wide range of standardised prosthetics as well as individualised options with NobelProcera. NobelProcera allows the implant to be restored with a comprehensive combination of individual aesthetics and prosthetic options e.g. with abutments made of zirconia or titanium. NobelProcera abutments can be designed to practically any angle, taper, finish line, height, width and cross-section to adapt the form, arch and axis of the prosthesis to the peri-implant structures. Each NobelProcera restoration is individually designed using state-of-the-art 3D computer-aided design software (CAD) and then milled from high-strength zirconia or titanium in a computer-assisted manufacturing (CAM) process.4,5,6

More than 2,000 dentists participated in pre-launch testing
Product development at Nobel Biocare is based upon the scientific principles established by the originator of dental implantology, Prof. Per-Ingvar Branemark. These principles clearly state that all innovation should be based on sound scientific research and adequate clinical trials during the pre-launch phase. It is for this reason that NobelActive was subjected to a rigorous clinical trial, eight months of clinical testing and extensive technical testing in the pre-launch phase. More than 2,000 dentists participated in the pre-launch test phase of NobelActive and over 30,000 implants were used. During this eight-month period, the practitioners first received extensive training with regard to the implant's capabilities.

Experience gained from clinical use and the subsequent feedback reports confirmed the effectiveness of the unique implant design. Their response also confirmed how important the previous training was in order to fully utilise the novel and innovative properties of the implant. Nobel Biocare therefore strongly recommends participating in the practical training course before using NobelActive. International and local experts who have undertaken a Nobel Biocare Train-The-Trainer Program lead the Training and Education courses. So far, 150 lecturers in 38 different countries have completed the programme with over 200,000 NobelActive implants sold worldwide.

Science foremost at Nobel Biocare
Nobel Biocare is currently conducting a number of multicentre clinical trials to assess the success of soft-tissue maintenance and bone remodelling of NobelActive implants over time. One is a five-year, randomised and controlled prospective study examining the NobelActive implant in the anterior and posterior regions of the maxilla and mandible for which an interim analysis was performed. All implants placed were provisionalised within 24 hours after insertion.7 A total of 177 patients were treated with 325 implants in 12 study centres and all patients were admitted consecutively into the study (the centres were not free to 'pick and choose' patients). Of the 325 total implants, 199 were NobelActive; the remainder were reference implants. All implants were inserted at least six months after extraction and no major bone augmentation was permitted at implant placement. Only minor augmentation to cover exposed threads and interproximal/buccal grafting were allowed in deficient sites. The one-year cumulative survival rate for NobelActive implants was 96.5% (taking all inserted implants into account) - average marginal bone resorption was 0.8 mm.8 The papilla index improved over time both for NobelActive and for the reference implants. Soft-tissue variables and peri-implant mucosa were stable over time for both types of implant. In addition, several other studies are ongoing to explore the unique design features of NobelActive.9,10

References
1. 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: S. 76-82.
2. 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): S. 59-68.
3. Glauser R, Portmann M, Ruhstaller P, Lundgren AK, Hammerle C, Gottlow J. Stability measurements of immediately loaded machined and oxidized implants in the posterior maxilla. A comparative clinical study using resonance frequency analysis. Appl Osseontegration Res 2001;2:27-29.
4. Lang LA, Sierraalta M, Hoffensperger M, Wang RF. Evaluation of the precision of fit between the Procera custom abutment and various implant systems. Int J Oral Maxillofac Implants 2003;18(5):652-8.
5. Oertorp A, Jemt T. Clinical experiences of computer numeric control milled titanium frameworks supported by implants in the edentulous jaw: a 5-year prospective study. Clin Impl Dent Relat Res 2004;6(4):199-209.
6. Halmoy A-M, Mustafa K, Berg E, Arvidson K. Two-year Prospective Follow-up Report on Nobel Biocare Ceramic Abutments. J Dent Res 2005; 84 (Spec Iss A): Abstract 3299.
7. Kielbassa AM, Arnhart C, Barlattani A, Jackowski J, Knauf M, Lorenzoni M, Maiorana C, Martinez-de Fuentes R, Mericske-Stern R, Rompen E, Sanz M, Goldstein M. Randomized Controlled Trial on a Novel Tapered, Variable Thread Implant Design Versus a Standard Tapered Implant Design in Immediate Function: 24th Annual Meeting of Academy of Osseointegration 23rd Annual Meeting, San Diego, CA, USA, February 26-28 2009; Abstract CO-5.
8. Kielbassa AM, Martinez- de Fuentes R, Goldstein M, Arnhart C,Barlattani A, Jackowski J, Knauf M, Lorenzoni M, Maiorana C, Mericske-Stern R, Rompen E, Sanz M. Randomized controlled trial comparing a variable-threat novel tapered and a standard tapered implant: interim one-year results. J Prosthet Dent 2009; 101:293-305.
9. Evaluation of NobelActive external implants in extraction sites. Ongoing prospective multi-center study in 7 centers. Clinical Research Department, Nobel Biocare Services AG.
10. Evaluation of NobelActive internal implants in extraction sites. Ongoing prospective multi-center study in 6 centers. Clinical Research Department, Nobel Biocare Services AG.

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