Xeal™ and TiUltra™: Innovation to improve patient outcomes

This interview originally appeared in the Science First Journal, Volume 6, Issue 1 (2023), page 18, as “Whenever an innovation can improve patient outcomes, I believe we should take it into consideration."

After graduating from the University of Lisbon in 2004, Ana Ferro joined the MALO CLINIC team. Since then, she has treated hundreds of patients with the All-on-4® treatment concept, and has conducted numerous clinical studies focused on the immediate function of implants, periodontology, oral surgery, and dental implant rehabilitation.

Q: You have years of experience with the All-on-4® treatment concept. Dr. Ferro, what makes it particularly unique?

In terms of medical approach, surgery, and prosthetics, All-on-4® is a straightforward procedure. Especially when it is compared to grafting, or placing many implants. One can learn it. However, the innovation of All-on-4® was the most important breakthrough in oral surgery, making it possible to give a fixed prosthesis to edentulous patients or patients with failing dentition in just one day. This makes it an amazing concept – with all the patient comfort, and the fact that they don't have to go through multiple surgeries, especially when they have systemic diseases, or when they are not the right fit for complex grafting procedures.

Q: You are conducting a clinical study with All-on-4® using NobelParallel™ CC implants and TiUltra and Xeal surfaces. What does this work investigate?

The aim of this study is to evaluate how the new implant and abutment surfaces behave in terms of the survival rate of the implant, the biological behavior, and hard and soft tissue responses. We started the study in 2019. But after a few patient enrollments, we were hit by the COVID pandemic and had to stop. That's why we could only finish the patient enrollment (n=40) at the end of 2021. So far, we have published the interim results, with a smaller group of patients (n=16), after 1 year of follow-up.¹

Q: What were your key results?

We achieved 100% implant survival rate for both implant and abutment with a mean marginal bone loss of just 0.46 mm after one year. Though some mechanical complications occurred with provisional-prosthesis screw fractures, there were no biological complications and a good and stable soft tissue response. In a nutshell, these are good results. And this is what we want for our patients – high success rate, good esthetics, predictability, safety.

Q: Did you use only NobelParallel™ CC implants in the study?

Yes. I usually use NobelParallel™ CC when I have minimal to medium resorption, and I can benefit from the TiUltra™ and Xeal™ new surfaces. However, depending on the quality and quantity of bone, and in an atrophic jaw, I may choose to work with other implant lines such as NobelZygoma™ or NobelSpeedy®.

Q: What are the main benefits of TiUltra™ and Xeal™ surfaces for the All-on-4® treatment concept?

The fact that not only the implant but also the abutment surface is modified is crucial from an All-on-4® treatment perspective. The area between the abutment and implant is the "sacred zone" of All-on-4® – and the success of treatment is heavily dependent on staying at the abutment level.

TiUltra promotes osseointegration, and with the Multi-unit Abutments featuring Xeal surface, I can achieve better soft tissue response.² I truly believe, whenever an innovation can improve patient outcomes, we should take it into consideration.

Q: You advocate the importance of teamwork. How do you orchestrate this within your dental team?

I believe All-on-4® is not only a surgical concept; it is a team concept, starting from the patient, when they trust and accept our offering. Then it comes to implant surgeons, prosthodontists, dental technicians, and dental hygienists.

We have strict protocols for all the steps to be done, and how to follow up. When the patient receives All-on-4®, it is only the start. If all goes well, they don't see me again and don't need me anymore.

However, the team continues to take care of the patient for all their life through regular hygiene visits and controls.

We make sure our team is calibrated and connected by diligently following our strict protocols for surgery, immediate prosthesis, final prosthesis, oral hygiene appointments, and what to do the day before surgery, after surgery, and later.

In this way, no matter who is the surgeon, prosthodontist, or oral hygienist, the results stay the same and predictable. This is what the patients deserve.

Dr. Ferro, you publish scientific articles, lecture on international stages, work full-time in the clinic, and more. Which activity makes you the happiest?

Being able to help others! My patients come first. But also, with my peers, love to contribute to knowledge sharing. I am a board member of two associations: the Professionals in Dentistry Esthetic Group (PiD-EG), which provides female dentists and dental students with tailored education programs and other networking opportunities to help them grow into more confident professionals. The second is the Foundation for Oral Rehabilitation (FOR), whose mission is to improve the quality of treatment available to oral healthcare providers. I am co-chair of the FOR Emerging Leader Program, which focuses on developing an international network of recognized professionals in the field.

However, the most rewarding time and what makes me the happiest is the time I can spend with my family.