As an oral maxillofacial surgeon and president of Implants Northwest LIVE Learning Center, Dr. Daniel Cullum focuses on immediate and minimally invasive techniques in esthetic implant reconstruction. Here, he talks about his experiences using NobelActive and discusses the results of a clinical retrospective study he co-authored regarding this implant.
Dr. Cullum, when did you first become interested in dental implants?
When I was at the University of Alberta, the inventor of dental implants, Professor Brånemark, came to visit Toronto and Edmonton. I was in the oral surgery clinic rotation when they came to place the first implants in Edmonton, and this was my first exposure to implants. Meeting Professor Brånemark and seeing all they were doing was truly inspiring. I then began using the Brånemark System in the mid-1980s.
How did you first start using NobelActive?
I had already started immediate placement and provisional restoration in the early 1990s. The system I was using had a number of good components and aspects, but didn’t cover a lot of things. When I first saw the NobelActive design on the pre-release poster, I saw straight away that the new macro-geometry simply made sense. The severe taper and aggressive threads really meant that you could achieve primary stability for immediate placement, increasing the chances you’d be able to do a provisional restoration.
After doing some training with NobelActive prior to its release, I was pretty sold on what it could do – the design of the implant gave me a lot of confidence – and so I started using it in early 2008.
Did it take you very long to get comfortable using NobelActive?
I initially felt very confident using it – maybe even overconfident – because I could change the angle, change the position and achieve great primary stability. For clinicians who feel really confident to start using NobelActive, it is still really important to get the training first.
Once you’ve learnt the technique, NobelActive works excellently and lets the clinician do things you can’t do with other fixtures. There was no other implant design on the market that even let you approach the variety of positioning, while still maintaining primary stability, that NobelActive does. This primary stability is further enhanced by the thread design, which allows for a lot of flexibility in the osteotomy diameter. That’s what gives you confidence to use it for your patients.
You recently led a retrospective clinical study into the long-term treatment outcomes. What motivated you to look back on your 11 years of experience with NobelActive?
We all have things in life that we enjoy and think are great, but sometimes you think: Is my assessment accurate? Is this just a perception? Am I being objective?
For me, this retrospective study was a great chance to properly examine the data I have regarding NobelActive’s long-term survival, and to join this to data from other clinicians to really find out how well it really performed across different approaches, philosophies and skill sets.
*For implants with >1 year follow-up
Were you surprised at how good the results were?
Yes, somewhat. It’s important to remember that when NobelActive was introduced, it was a completely new and unique implant system and so it brought a real learning curve. You couldn’t manage it like a traditional implant system – even another immediate tapered system I had used relied on a mechanical drill for machined tightness, and it became a completely sensation when I switched to NobelActive and began using a hand driver for implant positioning in the esthetic zone. So I expected good results but was still pleasantly surprised, particularly by the stability that can be achieved in sites with poor bone quality.
In the study, 44% of the implants were placed in acceptable to poor oral hygiene conditions, and the survival rate for these implants was 96.8%. What do you make of these results?
In the real world, many patients aren’t excellent with their oral hygiene, and so it’s really important to see that in cases of suboptimal hygiene, this factor hasn’t seemed to affect the outcome of this minimally invasive and flapless approach to implant surgery.
I think NobelActive has delivered excellent function in a variety of situations. I’ve used it in soft bone, dense bone, and I haven’t seen any significant issues in terms of bone loss or pressure necrosis.
How does NobelActive help the relationship you build with patients?
I have been using NobelActive for over a decade. I have confidence in what’s achievable with this implant, reaffirmed by this study. Patients can recognize this – they can tell whether or not you’re confident a surgical procedure will be successful, and the number one thing I want from my patients is this trust.
When you break down the clinical results, the end outcome is that you, as a surgeon, can have the knowledge and confidence that you will be able to accomplish exactly what you want with a particular patient.
Over the past 10 years, there have been a lot of cheaper implants released trying to imitate NobelActive. Have you had any experience with these copycats?
I’ve placed some of the different brands before, and simply sent them back. To me, it’s clear you can fool yourself into thinking a knock-off can perform the same way, but in reality, you mustn’t expect a copycat of NobelActive will deliver the same results.”
Cullum D, Hermans M, Hugo O. Long-Term Survival Analysis of 361 Variable Thread Tapered Implants Placed Across a Wide Variety of Indications: Real World Data. Poster presented at: AO 2020 Annual Meeting in Seattle, WA – March 18-20 Read online