With a private practice in San Sebastián dedicated to esthetics, restorative dentistry and implants, Dr. Iñaki Gamborena knows exactly what to look for when selecting an esthetic implant solution. Here, Dr. Gamborena explains:

  • What features of an implant impact the esthetic outcome
  • How self-tapping, bone condensing implant solutions allow for stability, flexibility and esthetic performance
  • Why a precision-fit implant–abutment interface is crucial for implant success

Dr. Iñaki Gamborena will be speaking on esthetic treatments and providing hands-on training in immediate implant placement protocols in extraction sockets at Nobel Biocare Global Symposium 2019.

Nobel Biocare: Dr. Gamborena, could you share your perspective of how an implant can impact the esthetic outcome?

Dr. Gamborena: “Esthetic outcomes depend on more than just restorations. When clinicians think about the dental implant, sometimes things like stability and osseointegration come to mind before esthetics. Though these are of course important elements to consider, an implant’s design and versatility also greatly affect the overall esthetic outcome. If an implant is self-tapping and bone condensing, for example, you can place it in narrow spaces where a conventional implant would not function.”

With highly limited space conditions, two NobelActive 3.0 implants were placed for two central incisors in the mandible. NobelActive clinical case courtesy of Dr Iñaki Gamborena.

Nobel Biocare: What are the key features of NobelActive that benefit the esthetic outcome?

Dr. Gamborena: “For one, NobelActive has a very high capability for primary stability which provides me with great security and confidence when working in difficult or compromised situations. These include immediate implant placement, narrow spaces, and when I’m working on placing an implant in crestal bone or when the bone is really soft.

“The self-tapping nature of it allows for more precise positioning of my implants than any other. For example – when immediately placing an implant, I find that even when using a surgical guide, there is often a degree of deviation when using a conical implant. With NobelActive, its bone condensing properties and ability to be adjusted when necessary allow me to correct any deviations without reducing the high level of primary stability.

 “With NobelActive, its bone condensing properties and ability to be adjusted when necessary allows me to correct any deviations without reducing the high level of initial stability.”

In addition, NobelActive’s platform-shifting capability, especially in the anterior region, allows you to merge it with a narrower prosthetic part and create a great interaction with the soft tissue with natural esthetic outcomes. It is also advantageous in small bridges, minimizing the amount of bone grafting needed and eliminating it altogether in some cases.”

Nobel Biocare: What features are unique to NobelActive and which have enabled you to achieve the ideal esthetic outcome?

Dr. Gamborena: “I think a big difference from what I have seen is the precision of Nobel Biocare’s manufacturing and the quality of the implant’s threads, as well as the overall design on both the macro and micro level. Where I think there is the biggest difference is in the prosthetic connection, as it is highly flexible and can be customized for the desired esthetic outcomes.

“I also think it’s important to consider the fact that NobelActive has more than 10 years of clinical experience at this point – far more than any imitator. This long-term success means that I can be comfortable knowing that it will provide an esthetic implant with an excellent survival rate and proven positive outcomes for hard and soft tissue.

“I’m also extremely excited to be able to experience the new TiUltra surface* with NobelActive.”

Dr. Gamborena using NobelActive in one of his training courses on achieving optimal esthetic outcomes.

Nobel Biocare: What effect has it had on your dental practice?

Dr. Gamborena: “NobelActive has had a massive impact on my practice. Today, I can do unbelievable things I had never thought I’d be able to achieve. For example, in certain cases I can extract a tooth, place the implant, transfer the zirconia final abutment, do a screw-retained segment, and cement the restoration – all on the same day and exactly following how I had planned it.

“For me, this is because of the ability to place the implant exactly where you’ve planned. It’s important to know which cases you can do this for, and which ones you can’t. But in ideal situations, we can do amazing things with an implant that we never thought possible.”

“We can do amazing things with an implant that we never thought possible.”

Nobel Biocare: Is precision-fit implant-abutment interface important in order to achieve esthetic implant outcomes?

Dr. Gamborena: “Yes, absolutely, otherwise this interface could be damaged. For me, the NobelProcera ASC Abutment is fantastic and changed my practice, because the angulated screw channel allowed for screw-retained restorations that couldn’t happen previously.

In my experience, it has few overall complications, decreases technique sensitivity, and enables a great fit.

“If you have a prosthetic that is not well-fitted, it can lead to inflammation and then bone destruction, which is clearly a problem. The more precise a fit we can achieve, the better results we will have.”

“The more precise a fit we can achieve, the better results we will have.”

It is also true that the fit of the prosthetic component is much better when working with components from the same brand. To reduce costs, dentists will sometimes use components from other brands, but it is never the same. I think the components should be the original ones, and this is what I want to stress – the original is the way to go.”

*Please note: TiUltra is under regulatory review and might not be currently available in your region. Contact your local Sales Representative for more information.


Posted by Chris Kendall