Digital precision for all indications NobelGuide

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Emory Stone
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1 Guided pilot drilling also for edentulous patients Digital precision for all indications NobelGuide

For accurate implant placement NobelGuide is a complete treatment concept for diagnostics, treatment planning and guided

In the 10 years since its launch, more than 40 publications have assessed the clinical application of NobelGuide, reporting on

Key findings of the clinical studies are: Higher accuracy and predictability of implant positions, in comparison with freehand

8% weighted mean in 38 studies with guided surgery technique in up to seven years of follow-up.

2 regarding masticatory function and 98.1 for esthetics.

process through careful diagnosis and treatment planning with the user-friendly NobelClinician Software.

Visualizing prosthetics from the start minimizes restorative challenges.

2 For accurate implant placement NobelGuide is a complete treatment concept for diagnostics, treatment planning and guided implant surgery from a single missing tooth to an edentulous jaw. In the 10 years since its launch, more than 40 publications have assessed the clinical application of NobelGuide, reporting on its use with over 5900 Nobel Biocare implants in more than 950 patients. Key findings of the clinical studies are: Higher accuracy and predictability of implant positions, in comparison with freehand surgery.1 Excellent cumulative implant survival rates (CSR) of 96.8% weighted mean in 38 studies with guided surgery technique in up to seven years of follow-up.2 Significantly lower swelling, edema and pain3,4 as well as use of analgesics5,3,4 with guided flapless surgery compared with freehand surgery. Very high subjective patient satisfaction3,6,7 and high average VAS: Visual Analogue Scale (1 100) scores of 99.2 regarding masticatory function and 98.1 for esthetics.8 years NobelGuide consistent precision Powerful diagnostics and treatment planning Avoid surprises during the treatment process through careful diagnosis and treatment planning with the user-friendly NobelClinician Software. Safety margins and a warning system help to plan the safe placement of implants. Visualizing prosthetics from the start minimizes restorative challenges. High accuracy and predictability of implant positions9, 10, 11, 12 Using the custom-manufactured surgical templates turns your treatment plan into clinical reality. Choose between guided pilot drilling with the first drill or fully guided implant insertion. The latter leads to smaller deviations in entry point, orientation and depth compared with freehand placement.1 It is also proven to support precise implant placement in the planned position.9, 10, 11, 12 Implant positioning in NobelClinician software takes prosthetic requirements of the patient into account. Periapical radiograph after one year of function. Case courtesy of Dr. Alessandro Pozzi

Rely on high quality templates that fit Ensure the perfect fit.

Our processes are regularly audited by the notified body BSI and inspected by the FDA.

All this provides you with an exceptional product.

It s strongly recommended for the radiographic-guide-based workflow.

Our restorations demonstrate high precision of fit13, mechanical stability14 and biocompatibility to provide years of safe and reliable

15, 16 Enhanced patient satisfaction17 Involve patients in the treatment planning with the NobelClinician Software and improve their

3 Rely on high quality templates that fit Ensure the perfect fit. We develop and produce templates according to Medical Devices Quality Management ISO and ISO Our processes are regularly audited by the notified body BSI and inspected by the FDA. Plus, every template you design is manually checked before production and verified for quality afterwards. All this provides you with an exceptional product. Further enhance the fit before designing a surgical template with our unique (CB)CT calibration procedure. It s strongly recommended for the radiographic-guide-based workflow. Optimize your restorative outcome Offer your patients optimized esthetics and function with a comprehensive range of prosthetic solutions. Our restorations demonstrate high precision of fit13, mechanical stability14 and biocompatibility to provide years of safe and reliable function.15, 16 Enhanced patient satisfaction17 Involve patients in the treatment planning with the NobelClinician Software and improve their understanding of the treatment plan. Interactive visual communication significantly increases patient satisfaction.17 Optimized visualization and treatment planning with 3D software may reduce the need for bone augmentation procedures5,18 and treating the patient with flapless surgery cause less pain and discomfort.5 100% P< % 80% 5% 5% 9% No 60% 40% 90% 75% 20% 0% Do not know Yes Before After Patients are more satisfied with the outcome of their treatment after a discussion using visual tools to review the pre- and postoperative clinical pictures, summarize the clinical steps and highlight the details of the restored region.

A seamless workflow for every case Every case you have is different.

Edentulous patients 1 Clinical diagnostics Partially edentulous patients 1 Clinical diagnostics and

Take a definitive impression. Obtain treatment acceptance before making further investments.

2 Examine the patient. Take an impression for study models and, later, the master cast.

Fabricate and clinically validate the diagnostic tooth setup.

3 Digitization with (CB)CT scan Make a (CB)CT scan of the patient and the radiographic guide following

Collaborate with your lab technician and capture the soft tissue using the NobelProcera 2G System s

3 3D diagnostics, treatment planning and communication 4 3D diagnostics, treatment planning and patient

combining tooth setup with patient anatomy.

the diagnostic setup, when you use NobelClinician s SmartFusion technology.

4 A seamless workflow for every case Every case you have is different. That s why NobelGuide offers you a choice of treatment workflows. Edentulous patients 1 Clinical diagnostics Partially edentulous patients 1 Clinical diagnostics and treatment acceptance Diagnose critical anatomical structures with the NobelClinician Software. Take a definitive impression. Obtain treatment acceptance before making further investments. A (CB)CT scan can be taken at the first visit with no need to use a radiographic guide. 2 Examine the patient. Take an impression for study models and, later, the master cast. Digitizing prosthetic information 2 Diagnostic tooth setup and fabrication of radiographic guide Fabricate and clinically validate the diagnostic tooth setup. Transform the tooth setup into a radiographic guide your prosthetic reference during planning. 3 Digitization with (CB)CT scan Make a (CB)CT scan of the patient and the radiographic guide following the doublescan protocol. Collaborate with your lab technician and capture the soft tissue using the NobelProcera 2G System s precise model scan. Choose whether to include the diagnostic tooth setup. 3 3D diagnostics, treatment planning and communication 4 3D diagnostics, treatment planning and patient communication Define implant positions from a clinical, anatomical and prosthetic perspective by combining tooth setup with patient anatomy. Visualize the patient s (CB)CT data together with the intra-oral situation, includ ing soft tissue and the diagnostic setup, when you use NobelClinician s SmartFusion technology. Effectively communicate the treatment plan to your patients using the Communicator ipad app. 4 5 Guided surgery Guided surgery Go for guided pilot drilling or fully guided drilling and guided implant insertion using a custom-manufactured NobelGuide surgical template based upon the treatment plan. Choose either guided pilot drilling or fully guided drilling and guided implant insertion using a custom-manufactured NobelGuide surgical template based on the treatment plan. 5 Restoration 6 Restoration

Right from the start with guided pilot drilling Design a surgical template for partially edentulous patients in just one click

The result is a precise guide for predictable freehand implant placement.

When there s no room for error Guided pilot drilling assists you in achieving the correct angulation, direction and depth of the first

Your starting point for edentulous treatment Confidently make use of all available bone and overcome challenges such as bone

5 Right from the start with guided pilot drilling Design a surgical template for partially edentulous patients in just one click following a plan prepared with NobelClinician s SmartFusion function. The result is a precise guide for predictable freehand implant placement. The ready-to-use template safely guides your initial drill according to your NobelClinician plan. When there s no room for error Guided pilot drilling assists you in achieving the correct angulation, direction and depth of the first drill when placing implants in narrow spaces or close to the inferior alveolar nerve. Your starting point for edentulous treatment Confidently make use of all available bone and overcome challenges such as bone resorption. Avoid critical anatomical structures and place implants deeper using the sleeve-offset function. It supports bone reduction, allowing for the initial treatment plan to remain unchanged. NobelActive NobelParallel Conical Connection NobelReplace Conical Connection Replace Select NobelSpeedy Brånemark System, exclusive Mk III TiUnite and Mk IV TiUnite

Patients today are more esthetically demanding. Placement of implants using guided surgery is crucial to routinely achieve the necessary precision, resulting in treatment predictability.

Patient presented with request for dental implant treatment subsequent to orthodontic therapy. Periapical and (CB)CT radiograph revealed loss of most of the root structure.

Virtual placement of NobelActive NP for the lateral incisors and NobelActive RP for the central incisors. The surgical template was seated immediately after atraumatic tooth extraction.

Two-year post-insertion periapical radiographs demonstrate precise implant placement and stable bone levels. Two-year post insertion clinical view demonstrates excellent soft tissue contours.

com/nobelguide Learn from the pioneers To develop the knowledge and skills needed to achieve the best possible results with the NobelGuide treatment concept, you need to learn from the best.

Contact Nobel Biocare customer service to start with NobelGuide nobelbiocare.com/contact References 1 Tahmaseb A, Wismeijer D, Coucke W, Derksen W.

2 Integrated treatment workflow: Diagnostics, treatment planning and guided surgery with NobelClinician and NobelGuide. Nobel Biocare Services AG GMT79393. Science First 2015;(3)2.

Computer-guided versus free-hand placement of immediately loaded dental implants: 1-year post-loading results of a multicentre randomised controlled trial. Eur J Oral Implantol 2014;7(3):229-42.

Patientcentred outcomes comparing transmucosal implant placement with an open approach in the maxilla: a prospective, non-randomized pilot study. Clin Oral Implants Res 2007;18(2):197-203.

6 Patients today are more esthetically demanding. Placement of implants using guided surgery is crucial to routinely achieve the necessary precision, resulting in treatment predictability. And for me: Predictability equals patient satisfaction. Dr. Peter Wöhrle, USA Clinical case Twenty-year-old patient. Non-smoker, with no parafunctional habits. Patient presented with request for dental implant treatment subsequent to orthodontic therapy. Periapical and (CB)CT radiograph revealed loss of most of the root structure. The four maxillary incisors were considered hopeless. Visualization of patient s anatomic structures and diagnostic wax-up using the SmartFusion. Virtual placement of NobelActive NP for the lateral incisors and NobelActive RP for the central incisors. The surgical template was seated immediately after atraumatic tooth extraction. Implants were placed using a fully guided surgical template. Implants in situ after removal of the insertion assembly. Two-year post-insertion periapical radiographs demonstrate precise implant placement and stable bone levels. Two-year post insertion clinical view demonstrates excellent soft tissue contours. Case courtesy of Dr. Peter Wöhrle, USA Discover more NobelGuide clinical cases and videos at nobelbiocare.com/nobelguide Learn from the pioneers To develop the knowledge and skills needed to achieve the best possible results with the NobelGuide treatment concept, you need to learn from the best. Whether you re an experienced clinician or at the beginning of your implant career, we will find an implant course tailored to your experience level. Contact Nobel Biocare customer service to start with NobelGuide nobelbiocare.com/contact References 1 Tahmaseb A, Wismeijer D, Coucke W, Derksen W. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants 2014;29 Suppl: Integrated treatment workflow: Diagnostics, treatment planning and guided surgery with NobelClinician and NobelGuide. Nobel Biocare Services AG GMT Science First 2015;(3)2. 3 Pozzi A, Tallarico M, Marchetti M, Scarfo B, Esposito M. Computer-guided versus free-hand placement of immediately loaded dental implants: 1-year post-loading results of a multicentre randomised controlled trial. Eur J Oral Implantol 2014;7(3): Nkenke E, Eitner S, Radespiel-Troger M, Vairaktaris E, Neukam FW, Fenner M. Patientcentred outcomes comparing transmucosal implant placement with an open approach in the maxilla: a prospective, non-randomized pilot study. Clin Oral Implants Res 2007;18(2): Bertossi D, Gerosa R, Schembri E, Zanotti G, Rossini N, Colletti G, et al. NobelGuide influence in the perception of postoperative pain. Minerva Stomatol Puig CP. A retrospective study of edentulous patients rehabilitated according to the all-on-four or the all-on-six immediate function concept using flapless computer-guided implant surgery. Eur J Oral Implantol 2010;3(2): Meloni SM, De Riu G, Pisano M, Cattina G, Tullio A. Implant treatment software planning and guided flapless surgery with immediate provisional prosthesis delivery in the fully edentulous maxilla. A retrospective analysis of 15 consecutively treated patients. Eur J Oral Implantol 2010;3(3): Pozzi A, Holst S, Fabbri G, Tallarico M. Clinical Reliability of CAD/CAM Cross-Arch Zirconia Bridges on Immediately Loaded Implants Placed with Computer-Assisted/Template-Guided Surgery: A Retrospective Study with a FollowUp between 3 and 5 Years. Clin Implant Dent Relat Res 2015;17(S1):e86-e96. 9 Vasak C, Watzak G, Gahleitner A, Strbac G, Schemper M, Zechner W. Computed tomo graphy-based evaluation of template (NobelGuide() )-guided implant positions: a prospective radiological study. Clin Oral Implants Res 2011;22(10): Van Assche N, van Steenberghe D, Quirynen M, Jacobs R. Accuracy assessment of computer-assisted flapless implant placement in partial edentulism. J Clin Periodontol 2010;37(4): Furhauser R, Mailath-Pokorny G, Haas R, Busenlechner D, Watzek G, Pommer B. Esthetics of Flapless Single-Tooth Implants in the Anterior Maxilla Using Guided Surgery: Association of Three-Dimensional Accuracy and Pink Esthetic Score. Clin Implant Dent Relat Res epub ahead Pettersson A, Komiyama A, Hultin M, Nasstrom K, Klinge B. Accuracy of virtually planned and template guided implant surgery on edentate patients. Clin Implant Dent Relat Res Aug;14(4): Katsoulis J, Mericske-Stern R, Rotkina L, Zbären C, Enkling N, Blatz MB. Precision of fit of implant-supported screw-retained 10-unit computer-aided-designed and computer-aided-manufactured frameworks made from zirconium dioxide and titanium: an in vitro study. Clin Oral Implants Res Feb;25(2): Truninger TC, Stawarczyk B, Leutert CR, et al. Bending moments of zirconia and titanium abutments with internal and external implant-abutment connections after aging and chewing simulation. Clin Oral Implants Res 2012;23(1): Zembic A, Bosch A, Jung RE, Hammerle CH, Sailer I. Five-year results of a randomized controlled clinical trial comparing zirconia and titanium abutments supporting single-implant crowns in canine and posterior regions. Clin Oral Implants Res 2013;24(4): Ozer F, Mante FK, Chiche G, et al. A retrospective survey on long-term survival of posterior zirconia and porcelain-fused-to-metal crowns in private practice. Quintessence Int 2014;45(1): Imburgia M, Coachman C. Using digital devices to improve communications between clinicians and patients during implantprosthetic treatment: a clinical study [#519]. 23rd Annual Scientific Meeting of the European Association for Osseointegration. Rome, Italy: Wiley; p Scotti R, Pellegrino G, Marchetti C, Corinaldesi G, Ciocca L. Diagnostic value of NobelGuide to minimize the need for reconstructive surgery of jaws before implant placement: a review. Quintessence Int 2010;41(10): nobelbiocare.com/nobelguide A Lot US 1509 Printed in USA Nobel Biocare USA, LLC, All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. NobelGuide for predictable outcomes

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