NobelActive Internal and External Hex Implants Nobel Marketing Claims this is the “Implant of the Future”

NobelActive is a Conglomeration of Common Features that work individually but not necessarily in combination Screw-Vent Internal Hex/bevel Niznick Patent 1986 Astra 11Deg. Bevel NobelActive hex too deep to allow for 8mm implant length 45 Deg. Bevel Bevel with proven 20 year history of stability Osstem’s double Threads over entire length. NobelActive transition of sharp to flat threads not conducive for self-tapping insertion in dense bone Oraltronics’ Pitt-Easy Implant with Deep Apical Threads Alpha Bio Clone with Conical Connection

1.5mm High External Hex 3.5mm Morse Taper Post NobelActive External -With External Locking Taper Connection Nobel Marketing Claims this is the “Implant of the Future” 1.5mm High External Hex 3.5mm Morse Taper Post

NobelActive External - 5mm high tapered post requires parallelism Miter Implant with External Post – Evolved quickly to Internal Socket (Bicon) “Those who cannot remember the past are condemned to repeat it” QUOTATION: George Santayana (1863–1952), U.S. philosopher, Driskell Patent 1985: Tapered Post on Implant “Locking taper concept – impacting the female taper of the implant head with the male counterpart on the root structure.” Driskell Patent 1988: Tapered Socket in Implant Locking Taper Concept “The head member has … a tapered rod or socket for connection to the root”

NobelActive (TiUnite) and Alpha Bio’s SFB (SLA) Implants BUT Nobel claims 98.3% Alpha Bio study applies to its new implant ABOVE: Nobel Claims NobelActive success of “98.3% for up to 4 years” BELOW: Alpha Bio’s Catalog Claims same 98.3% success “after more than 5 years” but the surface is SLA (sand blasted with large grit followed by acid etching) like Straumann’s Surface

Nobel Claims NobelActive Functions like “Corkscrew” Close Evaluation indicates they should have left it in the bottle

Nobel Biocare’s NobelActive Marketing Claims Questionable Validity of Marketing Claims Higher than What – Replace? Increased stability achieved by spreading bone whereas deep threads cut bone Self-threading – like any screw in soft bone. Path of implant insertion should be established during surgery, not during implant insertion. That is what guide pins and end-cutting drills are for. Nothing unique about press-fit connection. Miter Implant (1980) had external tapered post – evolved to internal press-fit connection of Bicon If cement is a risk, why does NobelActive Internal have a screw-retained connection? Why does NobelActive have spiral cutting grooves if not to “cut through bone like conventional (self-tapping) implants”? “bone-condensing – expands indication range and gives even higher initial stability.” “self-drilling” “ability to change direction during surgery” “unique press-fit connection of abutment – -removes risk of excess cement” NobelActive Internal and External implants don’t cut through bone like conventional implants, they press through it like a corkscrew

NobelActive External Claims Claims are not Valid “One piece implant design with 2-piece flexibility” locking tapered interface .. Eliminates bone level micro gap, micro-movement and the use of abutment screws.” It is not a “one-piece implant – requires an abutment. Does not have 2-piece flexibility – Can not use angled heads greater than 12 degrees, ball, screw-receiving or ceramic abutments. Require parallel placement of implants for bridges. A one-piece implant eliminates “micro gap” but a precise-fitting internal connections maintain marginal integrity anyway. Nobel still sells external hex implants – less stable

Dense Bone Drill is 4. 6mmD but Platform is 3 Dense Bone Drill is 4.6mmD but Platform is 3.9mmD NobelActive Leaves Gap around neck of Implant in Dense Bone

4. 3mmD Replace Implant is better choice than 4 4.3mmD Replace Implant is better choice than 4.2mmD NobelActive for insertion into Immediate Extraction Sockets Narrow Neck of NobelActive Requires Bone and Soft tissue Grafting to fill defect left at crest of ridge 5.0 5.0 3.9 5.0

ScrewDirect $150 incl. Snap Transfer & Cap Compare NobelActive External Hex with ScrewDirect One-Piece Implant The Prosthetic Advantages are Obvious & Cost Savings Significant ScrewDirect $150 incl. Snap Transfer & Cap NobelActive External Requires Attachment of one of these four abutments

Attach & Remove Long Friction Fit Head to NobelActive Heads of Implant exposed above bone Straight Friction-fit abutment too long Try in straight abutment.. Too long but locks in Tried to remove abutment with Forceps

Attach Two Short Friction Fit Heads to NobelActive using Mallet Jack off abutment using Removal Screw Shorter Abutment attached to Implants Shorter Abutment attached to Distal Implant Tap on Taper Lock Abutments with Mallet

Preferred placement is angled between buccal and lingual plates Straight Post of NobelActive External requires vertical placement

Why Change Drills and Platforms, just to change threads? RePlus Nobel Active ReActive RePlus and ReActive have compatible Tri-Lobe Connection Both have Platform switching interface – of questionable value Both have even taper to allow insertion into an undersized socket for bone expansion, Nobel Active has straight outer threads with very tapered inside thread dimension RePlus and ReActive have Mini-threads whereas NobelActive has horizontal grooves. RePlus and ReActive seal opening at crest of ridge whereas NobelActive 4.3 & 5.0 implants are narrower at top, leaving gap RePlus and ReActive have double lead threads on body for faster insertion.

Very deep threads apically cuts rather than compresses soft bone - any screw implant will self-tap in soft bone. NobelActive No Taper to OD of Threads ScrewPlant Gradual Taper for Bone Expansion NobelActive™ Claim The product is easy to use and provides high initial stability and good outcomes. The Apical Threads are too aggressive for self-tapping insertion in Dense bone and are designed to cut threads in soft bone rather than expand and compress the bone for increased initial stability. Any Implant will self-tap in soft bone. Deep apical threads will not expand narrow ridge or compress soft bone Soft Bone (Balsa) = 3.91 in/lbs Insertion Torque Hard Bone (Oak) = 6.35 in/lbs Insertion Torque

ReActive with Tri-Lobe Connection and Platform Switching Projected Launch Date – January 2008 Same taper to body as RePlus Implants allow insertion in undersized socket for expansion Flat-based deeper threads provide increased surface area for greater stability in soft bone 1.5Deg. 3.0Deg.