NobelProcera® Angulated Screw-Channel Abutment for Conical Connection

Current industry trends for abutments Individualized CAD/CAM Abutments CAD/CAM is the quick and cost-effective route to customized abutment Allows you to easily create and digitally visualize both the ideal emergence profile and support for the veneering material Provides the convenience and safety with built-in parameters for material and production ensuring longevity Industrial CAD/CAM Abutments Access to esthetic, biocompatible, and homogenous materials like Zirconia Increased consistent precision of fit thanks to advanced production methods Extensive warranty New concepts Cement-free screw retained crown

CAD/CAM Zirconia abutment concepts New Cement-retained (abutment + coping) Screw-retained (abutment for direct veneering) Straight screw access channel One piece With titanium adapter Angulated screw access channel Each solution has indication specific advantages Various concepts can be combined Labial view of abutments

CAD/CAM Zirconia abutment concepts Cement- vs. screw-retained solution Cement-retained (abutment + coping) Esthetic (cement-retained crown covers abutment screw access hole) Independent of implant orientation / angulation Ideal occlusal morphology Challenges: Ensuring removal of all cement remnants (especially with a submucosal cement line) Can be difficult to remove Unknown retention of crown Screw-retained crown (abutment for direct veneering) No risk of leaving residual cement Easy to remove for maintenance Predictable retention Cost-effective Challenges: Esthetics: Depends on implant orientation / angulation Occlusal morphology may be hindered due to position of screw access hole Required interocclusal (vertical) space is needed for tooling solve Labial view of abutments

CAD/CAM Zirconia abutment concepts Straight vs CAD/CAM Zirconia abutment concepts Straight vs. angulated screw-channel solution Screw-retained crown (abutment for direct veneering) No risk of leaving residual cement Easy to remove for maintenance Predictable retention Cost-effective Challenges: Esthetics: Depends on implant orientation / angulation Occlusal morphology may be hindered due to position of screw access hole Required interocclusal (vertical) space is needed for tooling Angled screw access channel New For easy access to screw, hole can be placed in an angulation up to 25° in a 360° of rotation Ideal solution when interocclusal space is limited - ability to easily position screw access hole in easily accessible position solve Labial view of abutments

CAD/CAM Zirconia abutment concepts Angulated screw-channel solution Components of the angulated screw-channel abutment 1. 2. Zirconia abutment with screw access hole on the palatal aspect of the abutment Metal adapter with Conical connection implant interface Friction type connection between adapter and abutment Clinical screw with blue color-coded head to indicate ASC and Omnigrip tooling Warning: Because of the small size of the components, care must be taken that they are not swallowed or aspirated by the patient.

NobelProcera® angulated screw-channel abutment Zirconia Abutment Restorative flexibility Anterior: ability to place the screw access hole in a position to achieve optimal esthetics (0 - 25°) Posterior: ability to place the screw access hole in a more favorable position Benefit: Esthetics Clinician now has an esthetic screw-retained solution to offer patients – for both anterior & posterior regions Restorative ease with a cement-free restoration and screw access ideally positioned for easy approach

NobelProcera® angulated screw-channel abutment ASC Metal adapter Precision of fit: seal created between abutment (ASC adapter) and implant connection due to NobelProcera precision engineering & manufacturing 1. Zirconia abutment ASC adapter Precision of fit between ASC adapter and implant Clinical screw Implant

NobelProcera® angulated screw-channel abutment ASC Metal adapter Conical Connection restorative connection Metal adapter interface now enables Conical Connection Zirconia abutments to be used in posterior region Benefit Esthetic posterior solution Clinicians now have an esthetic screw retained solution for Nobel Biocare Conical Connection implants placed in the posterior region 1.

NobelProcera® angulated screw-channel abutment ASC Metal adapter Precision of fit: Predictable retention between adapter & Zirconia Mechanically retained: Easy to use: removal & re-insertion during veneering in lab No need for cement Benefit: Predictable retention and resistance Time efficient handling in the dental lab or clinic No irritation of mucosa due to cement between adapter and abutment body 2.

NobelProcera® – peace of mind Clinical issues caused by excess cement: Implant cement can act like a foreign body in the mouth. Residual cement in the mucosal margin effects the patient’s soft tissue, causing e.g. soft-tissue hyperplasia or recession and may even lead to bone loss. Even the most diligent of clinicians may sometimes miss residual sub-mucosal cement in implant cases. Sometimes, it may not immediately be apparent that there is residual cement - and the effects can be delayed for years after cementation. Due to known issues related to cementation clinicians tend to prescribe screw- retained implant restorations over cement-retained.

Screw-retained vs. cement-retained restorations Screw-retained restorations show lower failure rates, but overall, the difference in survival between cement- retained vs. all types of screw-retained is very small to none1,2. Screw-retained restorations exhibit fewer technical and biological complications2: Screw-retained: 7.50 (95% confidence interval: 5.37 to 10.47) per 100 life years Cement-retained: 9.81 (95% confidence interval: 6.6 to 14.6) per 100 life years Additionally, two-piece screw-retained restorations were lower in failure than one-piece screw-retained restorations2. 1 Cicciu M, Beretta M, Risitano G, Maiorana C. Cemented-retained vs screw-retained implant restorations: an investigation on 1939 dental implants. Minerva Stomatol. 2008;57(4):167-79. 2 Wittneben J-G, Millen C, Brägger U. Clinical performance of screw vs cement-retained fixed implant-supported reconstructions – A systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:84-98. doi: 10.11607/jomi.2014suppl.g2.1

Screw-retained vs. cement-retained restorations Figure 1: Time to peri-implant disease Time Implants with peri-implant disease Adaptation of Wilson et al. Lower risk of peri-implantitis Excess cement was a factor in 81% of cases 3/4 of cases resolved upon cement- removal peri-implant disease occurred as little as 4 months to 9 years after placement Wilson TG, Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009;80(9):1388-92.

NobelProcera® angulated screw-channel abutment - screw NEW Omnigrip Screw The Omnigrip Tooling – unique and patented connection concept Benefit: Confidence: exceptional pick-up function Ease of use: flexibility and handling (plus blue color coding for easy identification) An updated version of the Prosthetic Kit including Omnigrip is available.

NobelProcera® angulated screw-channel abutment - screw NEW Omnigrip Screw Important - where does the screw actually sit ? Screw sits in Zirconia body – so it holds the abutment to implant when torqued Benefit: Predictable retention and resistance – screw seating in Zirconia abutment body and mechanically retained ASC adapter Zirconia abutment Clinical screw Metal adapter Torque value is 35Ncm

Increased restorative flexibility without cement: NobelProcera® ASC Abutment – anterior case video The video clip of NobelProcera ASC abutment in an anterior case can be downloaded from the Speaker Portal

NobelProcera® ASC Abutment Efficient screw-retained design with cut-back function ? This anterior restoration shows multiple challenges: Position of screw access hole, projecting from labial aspect of the crown Current design shows no support for the veneering material Optimal screw-retained crown design

NobelProcera® ASC Abutment Efficient screw-retained design with cut-back function Select "cutback from crown" - this brilliantly triggers a pre-defined diagnostic cutback from anatomic virtual crown Make sure to increase the number of handles and rows Select the desired shoulder type and ceramic thickness (veneering support can be altered to your ideal preference) Drag and drop the handles to further adjust the anatomic design

Abutments on Conical Connection WP will be available Q1 2015 NobelProcera® ASC Abutment Restorative flexibility with angulated screw option Angulated screw channel abutments are available for Conical Connection NP and RP abutments in Zirconia. Select in the scan module one of the 3 production type options for conical connection: ASC Angulated (description) ASC Straight Straight In case you would like to design the case first and decide on a later stage, you can select ASC through Rx Menu or simply activate the screw channel design icon later during the design.

NobelProcera® ASC Abutment Restorative flexibility with angulated screw option Activate screw channel design icon Easily move the screw access hole to the ideal position - this can be done by dragging the blue screw axis white handle to any angle of up 25 degrees at a rotation of 360 degrees Green cylinder represents screw channel diameter and direction. When displayed green - this illustrates an acceptable angle If an unacceptable angle is designed, the channel changes to a red color

NobelProcera® ASC Abutment Restorative flexibility with angulated screw option NobelProcera software is fully integrated into NobelProcera production securing that the required material thickness is always met. In cases where manual refinements have been made, it is necessary to eliminate all red areas (warning areas - illustrating minimal material thickness violation): use abutment design tools as for any other abutment type

NobelProcera® ASC Abutment Posterior CAD case The video clip of NobelProcera ASC abutment in a posterior case can be downloaded from the Speaker Portal

NobelProcera® ASC Abutment Addressing daily challenges Anterior challenge: For many anterior cases the screw access hole of the abutment has to be covered by a cement-retained crown if an esthetic outcome is to be achieved. Your benefits with ASC: Restorative flexibility to place the screw access hole in a position that creates optimal esthetics. Cement-free: Intelligently designed mechanically retained adapter.

NobelProcera® ASC Abutment Addressing daily challenges Posterior challenges: Secure handling and access with tooling in the posterior region can be challenging in situations with limited interocclusal distance (vertical space). Occlusal function may be hindered due to position of screw access hole on screw-retained crowns. Risk of leaving residual cement. Your benefits with ASC: Easy access to restoration with the option to position screw access hole mesially. Work easily with the pick-up function and securely hold the screw using the Omnigrip Screwdriver. Optimum occlusal function (screw access hole can be positioned in ideal place for optimal occlusal function). Cement-free: Intelligently designed mechanically retained adapter.

Case presentation Placeholder slide for case presentation - anterior case presentation - posterior case presentation

NobelProcera® ASC Abutment Tried and tested Medical device directive ISO standards Tried and tested for you Nobel Biocare was the first to produce industrially milled CAD/CAM abutments. This experience, engineering and production know-how results in precision of fit and unrivaled product quality for reliable product performance. Each NobelProcera Abutment meets medical device standards and offers you the highest possible safety, predictability and efficacy as confirmed by neutral authorities. All products have documented evidence, meaning you benefit directly from product quality assurance and traceability. Quality system Micro gap analysis Inspected by notified bodies Strength test

Your benefits with the ASC Abutment and Omnigrip tooling: Confidently use an esthetic, easy to use, cement-free solution to restore your single-implant cases in both anterior and posterior regions: Benefit from the advantages of screw-retained crowns in more cases: Avoid the risks of leaving residual cement under the mucosal tissues causing potential irritations Easy to remove / re-tighten if maintenance is required Offer a cost-efficient alternative to your patients Secure predictable retention Gain full restorative flexibility: Work with the ideal solution when interocclusal (vertical) space is limited Confidently use esthetic Zirconia abutments in the molar region, thanks to the new metal adapter

Your benefits with the ASC Abutment and Omnigrip tooling: Confidently use an esthetic, easy to use, cement-free solution to restore your single-implant cases in both anterior and posterior regions: Ideal esthetics and function: Position the screw access hole in the most esthetically pleasing way Achieve ideal occlusal or incisal function by positioning the screw access hole in the optimum place Work quicker and easier with the never-before-experienced grip of the Omnigrip Screwdriver Gain peace of mind with a thoroughly tested solution

NobelProcera® ASC Abutment Get started now Omnigrip Screws can only be tightened with the Omnigrip Screwdriver: Omnigrip Clinical screw Conical connection NP Omnigrip Clinical screw Conical connection RP Omnigrip Lab screw Conical connection NP Omnigrip Lab screw Conical connection RP Omnigrip Screwdriver machine Unigrip Screwdriver machine û Torque value is 35Ncm

Maintenance It is recommended to use Abutment Retrieval instrument Zirconia CC for easy removal if the ASC adapter is stuck in the implant connection due to the tight conical seal. For abutment removal and abutment screw removal instrumentation please see additional presentations: Retrieval instrumentation – Abutment screw removal options Retrieval instrumentation – Abutment retrieval

Finalizing procedures for NobelProcera® ASC Abutments Zirconia If necessary, make minor adjustments with a diamond bur or flex disc with fine grit size under low pressure and with copious irrigation Proper surface finishing is mandatory if minor adjustments on the sintered frameworks are made Sandblast using max. 1 bar of pressure utilizing 110µm aluminum oxide, at an approximate distance of 10mm Clean in an ultrasonic unit

Cleaning and sterilization instructions This device is delivered non-sterile and must be cleaned and sterilized prior to use. Full set of recommended parameters are provided in “Cleaning & Sterilization Guidelines including MRI information of Nobel Biocare Products” available at www.nobelbiocare.com/sterilization or request latest printed version from a Nobel Biocare sales representative.