Evidence matters – Highlights from 2019 scientific literature
Implant dentistry is a continually evolving field and, in 2019, Nobel Biocare unveiled several major innovations – all backed by scientific evidence. At Nobel Biocare, we take pride in our investment in research and development, which is one of the largest in the industry. One recent study showed that, in the past 20 years, Nobel Biocare implants were evaluated in a greater number of randomized, controlled trials than products from most of its competitors.1
As we look back over another successful year, we wanted to share the recent outputs from several of our collaborations with expert dental clinicians. The six publications described here highlight our clinical trials, surface innovation, and the total system performance of our implant–abutment connections and restorative solutions. They also demonstrate the durability and wide applicability of our solutions for edentulous patients.
Randomized controlled trial demonstrating the efficacy of barrier membranes
Clinical trials are considered by many to be the “gold standard” for scientific evidence. One example of our investment in randomized, controlled, clinical trials is a study that compared bone formation and soft tissue healing with creos™ xenoprotect – a natural collagen membrane – with a reference membrane, Bio-Gide® (Geistlich Pharma AG).2 In this trial, patients received either the reference membrane (n = 25) or creos™ xenoprotect (n = 24) during simultaneous guided bone regeneration and placement of NobelReplace® Conical Connection implants at single dehisced sites.2
Surface innovation benefiting soft tissue health with novel, anodized abutments
In 2019, Nobel Biocare introduced the Xeal™ and TiUltra™ surfaces. With their chemistry and topography, these innovative surfaces were developed with the goal to optimize early tissue integration and long-term tissue stability.
Prior to its market release, Hall and colleagues conducted a randomized, controlled, clinical study to investigate if the anodized, nanostructured Xeal™ surface could improve healing and soft tissue health compared with machined titanium abutments.4
Total system performance: prospective demonstration of excellent clinical outcomes in the anterior maxilla
The choice of components that clinicians make undoubtedly influences how well patients’ restorations will function for years to come. When restoring anterior teeth, there is an additional prosthetic challenge of avoiding placement of the abutment screw hole too close to the incisal edge of the crown. Angulated screw channel (ASC) abutments provide one way to overcome this, offering flexibility and freedom also to place an implant in an optimal way given the available bone.
Friberg and colleagues initiated a prospective study in the Brånemark Clinic to evaluate NobelParallel™ Conical Connection implants in combination with authentic Nobel Biocare ASC abutments in single-tooth restorations in the anterior maxilla.5
The longest follow-up of the All-on-4® treatment concept
The All-on-4® treatment concept is a predictable treatment modality for full-arch rehabilitation with good results in the short, medium and long term.6
In this retrospective study, the very long-term clinical outcomes of 471 edentulous patients who received mandibular rehabilitations with the All-on-4® treatment concept, were investigated.6 An excellent cumulative prosthetic survival rate of 98.8% was observed after 10–18 years of follow-up.6 From a total of 1,884 implants, the cumulative implant survival and success rates were 93.0% and 91.7%, respectively. The average marginal bone level change for patients who attended a 10-year follow-up visit was −1.7 mm (95% confidence interval: −1.6, −1.9 mm).6 Fewer than 10% of patients (n = 27) exhibited >3 mm bone loss around their implants, with smoking (three-fold increased risk) and prior implant failure (almost four-fold increased risk) being the two most important risk indicators.6
Longevity of clinical success with maxillary full-arch restorations
Full‐arch rehabilitation of the edentulous maxilla according to the All‐on‐4® treatment concept is also a viable treatment option for the longer term.7
In this retrospective study, clinical outcomes after 5–13 years were evaluated among 1,072 patients who underwent a maxillary rehabilitation using the All-on-4® treatment concept.7
The prosthetic success rate was 99.2%; only 9 out of 1,072 patients lost their prostheses due to implant failures.7 The implant cumulative survival and success rates were 94.7% and 93.9%, respectively, from a total of 4,288 implants.7
Among patients who had periapical radiographs from the day of surgery and after 10 years (n=129), the average marginal bone loss was −1.67 mm (95% confidence interval: −1.58, −1.77 mm).7 Patients who were smokers exhibited the greatest risk of increased marginal bone loss (a 67% increased risk for bone loss >2.8 mm at 5 years).7
A large percentage of patients eligible for standardized treatment of the edentulous mandible
Nobel Biocare’s Trefoil™ system was developed with a time-efficient, template-guided clinical workflow and simplified laboratory protocol.8 But how well can an individualized fit be attained with a standardized, pre-fabricated restorative solution?