Guideline for the Speaker

Guideline for the Speaker
Instruction slide Guideline for the Speaker “NobelReplace® Innovation Evening Seminar for Platform Shift” Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Important instructions for the Speaker: How to prepare your course
Instruction slide Important instructions for the Speaker: How to prepare your course The following slide set has been created to support you in preparing for your course delivery. The structure of this guideline presentation is based on the relevant detailed course recipe that is available on the Speaker Portal. In order to achieve global consistency and the most effective delivery of our courses, we kindly ask you to always refer to this recipe when preparing your presentation. This guideline presentation contains a selection of slides you can choose from to enhance your own material. You are required to follow the course topics as stipulated in the recipe or the agenda from the guideline presentation as is, and may adjust the detailed content and timing as desired. Additional materials (including videos and animations) can be found in the respective course library on the Speaker Portal. To have a consistent start and finish of all Nobel Biocare courses, we have designed a generic set of intro and exit slides, which we kindly ask you to include in your presentation (especially the course objectives). The “key messages” are important points that should be repeated throughout the course for the participants to remember. Please ensure your presentation reflects these messages accordingly. In order to continuously improve the content and keep it up-to-date, Nobel Biocare very much appreciates your support. If you have any comments regarding the provided material, please provide your feedback to your local Nobel Biocare T&E contact.

Key Messages Instruction slide
Ease of use (easy drill protocol due to color-coding) Very effective implant for soft and hard tissue long-term stability (platform shifting) Large variety of pre-fabricated restoratives NobelProcera restorative solutions to achieve excellent esthetic results

Agenda Instruction slide Welcome and introduction
General introduction to the NobelReplace system Concepts of platform shifting Benefits of NobelReplace Platform Shift Review prosthetic components of the NobelReplace PS implant system Hands-on Scientific support Conclusion and wrap-up

Welcome and introduction
Instruction slide Welcome and introduction Introduce speaker and present short biography Introduce participating NB staff (focus on skill, education, i.e. dental assistant or technician, etc.) Provide ‘housekeeping’ information (restrooms, breaks, and related) Ask participants to introduce themselves and ask why they are here Why are we here? (Aim of this course) Present learning objectives Present agenda in brief

“NobelReplace® Innovation Evening Seminar for Platform Shift”
Location, date Presenter name Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

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Nobel Biocare on-site staff
Name, Title Certified dental technician or dental assistant or other Complete with additional point regarding knowledge in dental field

Course Objectives Provide an overview of the important features of the NobelReplace implant system Explore the concept of platform shifting and its benefits for tissue stability Illustrate the benefits of platform shifting in combination with tri-channel connection Examine the prosthetic components of the NobelReplace implant system Aim of this course: Enabling you to explore the newly launched concept and benefits of platform shifting in combination with the tri-channel connection of the NobelReplace implant system.

Agenda Part 1 Welcome and introduction
Part 2 General introduction to the NobelReplace system Part 3 Concepts of platform shifting Part 4 Benefits of NobelReplace Platform Shift Part 5 Review prosthetic components of the NobelReplace PS implant system Break Part 6 Hands-on Part 7 Conclusion and wrap-up

Agenda Welcome and introduction

General introduction to the NobelReplace® system
Instruction slide General introduction to the NobelReplace® system This chapter should cover the following topics: Explore history, track record, and product system

History of NobelReplace®
Evolution of Replace Select™/NobelReplace® implant family Replace Select Straight Replace Select TC Replace External Hex 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Replace Select Internal Connection Replace Select Tapered NobelReplace Tapered & Straight Groovy NobelReplace Conical Connection & Platform Shift Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

History of NobelReplace®
Speaker note! History of NobelReplace® Evolution of Replace Select™/NobelReplace® implant family Speaker note for previous slide : The Replace Implant System was developed by Jack Hahn. 1997 – The Replace External Hex implant was launched, with a “Brånemark style” hex but with the color-coding feature. All Replace implants were available in HA (hydroxyapatite) or TPS (Titanium plasma-sprayed) coating. 1999 – Replace Select implant system was introduced with the same color-coding as the external hex but with the addition of the predictable tri-channel connection that we know today. 2001 – TiUnite was added to the body of the implant. 2002 – The Replace tri-channel connection was added to an implant body that is similar to the Brånemark System allowing the benefits of a straight implant system (adjustable vertical placement not dependant on drill preparation) with the simplicity and predictability of the tri-channel connection. 2005 – The option of TiUnite on the collar and addition of Groovy were added. 2010 – Introduction of an additional length (11.5mm) to meet market requests and introduction to the Replace Select TC with 3mm machined collar as an implant to support overdenture solutions in edentulous cases 2011 – Introduction of NobelReplace Conical Connection and NobelReplace Platform Shift into the markets. Future – The world’s most used implant system will continue to evolve to support our clinicians. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Implant design Mimics the shape of a natural tooth root and allows placement in extraction sockets and healed sites by delivering optimal stability. Step-by-step drilling protocol Standardized step-by-step drilling protocol simplifies implant site preparation and ensures predictable surgical procedures. Simplicity and predictability of drill protocol, independent of bone type. Internal tri-channel connection Allows a tactile and direct feel when positioning the prosthetic connections, and accurate & secure placement of abutment. Color-coded system Color-coded components for accurate and fast component identification and easy logistics. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Color-coding Safety Color-coding ensures safety by guaranteeing accurate device/material selection throughout the surgical and restorative processes. Predictability Any NobelReplace implant in any patient can be very quickly identified by visual inspection eliminating need for a radiographic analysis or platform measurement etc. Organizational Benefits Universal color-coding ensures inventory organization and stocking efficiency. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

The preferred system to start with dental implants Color-coded system Easy identification during placement and restoration of all components due to color-coding (implants, drills, screw taps, implants driver, cover screw, abutments, surgical kits). Step-by-step drilling protocol Simplified standardized step-by-step drilling protocol to support surgical procedure. Prosthetic versatility Easy restoration due to only three positions in the tri-channel internal connection. Large prosthetic solutions range from conventional crown, bridge and denture work to implant-supported prostheses. Locator® is a registered trademark of Zest Anchors Inc. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

One universal implant system for all needs
General introduction to the NobelReplace® system Introduction: NobelReplace® Platform Shift & Conical Connection One universal implant system for all needs Same implant body, more restorative options Experience the strong and tight fit of the conical connection on our original tapered implant body Experience platform shifting on the original tapered implant body Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Instruction slide General introduction to the NobelReplace® system Content/material to be provided by lecturer Additional material can be found on the Speaker Portal

Concepts of platform shifting
Instruction slide Concepts of platform shifting This chapter should cover the following topics: Principles of platform shifting Material selection and tissue integration Advantages for soft and hard tissue management When to use and when not to use platform shifting: indications

Principles of platform shifting and soft tissue management Implant platform shifting, also frequently referred to as platform switching, is defined as: The inward horizontal repositioning of the implant-abutment interface. This connection shifts the perimeter of the implant-abutment junction inward toward to the central axis of the implant.1 1 Lazzara RJ, Porter SS. Platform switching: a new concept in implant dentistry for controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent 2006;26(1):9-17.* *The referenced study did not include Nobel Biocare implants. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Principles of platform shifting and soft tissue management This design feature can be created in an implant body by the manufacturer or achieved by the clinician using a compatible abutment of lesser diameter than the implant platform. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Principles of platform shifting and soft tissue management Platform switching helps to prevent crestal bone loss after implant placement and helps obtain satisfactory esthetic results.1 Regardless of the exact mechanism researchers are finding that implant systems utilizing a platform shift connection has less inflammation due to this design. Less inflammation leads to less bone loss. 1 López-Marí L, Calvo-Guirado JL, Martín-Castellote B, Gomez-Moreno G, López-Marí M. Implant platform switching concept: an updated review. Med Oral Patol Oral Cir Bucal 2009;14(9):e450-4.* *The referenced study did not include Nobel Biocare implants. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Principles of platform shifting and soft tissue management Vascularization Stability of crestal bone and mucosa / papillae is strongly dependent on their volume and respective vascularization and blood supply. Higher amount of tissue volume and vascularization will lead to more stable crestal bone and interdental papilla. By increasing volume and vascularization of hard and soft tissue, the platform shift design is contributing to tissue stability and esthetic outcome of the gingiva and interproximal papilla (“pink esthetics“).

Principles of platform shifting and soft tissue management The effect of platform shifting is to create a horizontal component for the total linear distance between abutment and bone crest required for biologic width. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Concepts of platform shifting Principles of platform shifting and soft tissue management Biologic width ≈ 3 mm Gingival sulcus Epithelial attachment Connective tissue attachment The biological width around the neck of a tooth or a dental implant constitutes a mucosal seal intended to offer protection to underlying bone. It is generally formed apical to the micro-gap and requires a minimum of about 1.5 mm of fibrous connective tissue between bone and epithelial attachment of the gingival sulcus of tooth or implant. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Principles of platform shifting and soft tissue management Biological effects / benefits of platform shifting Literature1,2,3 shows that a horizontal component (generally 0.5 mm) added to the total linear distance between abutment and bone crest created by platform shifting results in: Significantly less radiographically detectable crestal bone loss, in humans Better soft tissue support /maintenance in the esthetic zone 1 Atieh MA, Ibrahim HM, Atieh AH. Platform switching for marginal bone preservation around dental implants: a systematic review and meta-analysis. J Periodontol 2010;81(10): * 2 Canullo L, Rasperini G. Preservation of peri-implant soft and hard tissues using platform switching of implants placed in immediate extraction sockets: a proof-of-concept study with 12- to 36-month follow-up. Int J Oral Maxillofac Implants 2007;22(6): * 3 López-Marí L, Calvo-Guirado JL, Martín-Castellote B, Comez-Moreno G, López-Marí M. Implant platform switching concept: an updated review. Med Oral Patol Oral Cir Bucal 2009;14(9):e450-4* *The referenced studies did not include Nobel Biocare implants. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Instruction slide Concepts of platform shifting Content/material to be provided by lecturer Additional material can be found on the Speaker Portal

Benefits of NobelReplace® Platform Shift
Instruction slide Benefits of NobelReplace® Platform Shift This chapter should cover the following topics: Benefits of platform shifting in combination with tri-channel connection

Benefits of NobelReplace® Platform Shift NobelReplace® Platform Shift - overview Tri-channel connection with platform shifting Built-in platform shift, designed to improve soft tissue management, preserve crestal bone and increase esthetic result Clinically proven tapered implant body  designed for high initial stability Simple step-by-step drilling protocol (all indications) for treatment predictability Color-coding for simplicity and fast component identification Unique oxidized TiUnite surface with grooves (Groovy) increases implant stability in the early healing phase through faster bone formation1 Tri-channel connection provides tactile feed back and allows for easy and accurate abutment placement Same prosthetic components as NobelReplace tapered Access to big pool of trained referral doctors 1 Hall J, Miranda-Burgos P, Sennerby L. Stimulation of directed bone growth at oxidized titanium implants by macroscopic grooves: an in vivo study. Clin Implant Dent Relat Res 2005;7 Suppl 1:S76-82. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Features Built-in platform shift Benefits Designed to: Improve soft tissue management Increase hard and soft tissue volume Preserve crestal bone Optimize esthetic result Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Features Tri-channel connection Benefits Easy and accurate abutment placement Provides tactile feedback Three positions make it is easy to reposition abutments Use of all existing prosthetic components for tri-channel connection Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Features Color-coding system Benefits Easy and fast identification of surgery and prosthetic components Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Features Clinically proven tapered implant body Proven step-by-step drill protocol TiUnite surface and grooves (Groovy) Benefits Designed for high initial stability in all bone qualities Treatment predictability Increases implant stability in the early healing phase through faster bone formation Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

NobelReplace Platform Shift
Benefits of NobelReplace® Platform Shift Product description and design rationale Platform shifting can be technically implemented by: Providing a narrower diameter prosthetic component on a wider diameter implant platform, Creating an exposed ridge on the implant platform for soft-tissue to develop. NobelReplace Platform Shift RP 5.0 Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Implant without platform shift Implant with platform shift
Benefits of NobelReplace® Platform Shift Product description and design rationale Implant without platform shift Implant with platform shift NobelReplace Tapered Groovy RP 4.3 NobelReplace Platform Shift RP 5.0 Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. Platform Shifting: The abutments have a smaller diameter of the transmucosal part in relation to the implant platform diameter. 38

Product description and design rationale All existing NobelReplace tri-channel abutments fit NobelReplace Platform Shift as well. Implant platform guides prosthetic color choice. NobelReplace Tapered RP 4.3 NobelReplace Platform Shift RP 5.0 Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Instruction slide Benefits of NobelReplace® Platform Shift Content/material to be provided by lecturer Additional material can be found on the Speaker Portal

Review prosthetic components of the NobelReplace® PS implant system
Instruction slide Review prosthetic components of the NobelReplace® PS implant system This chapter should cover the following topics: Restorative options on Nobel Biocare implant platforms Abutment selection and design Abutments and their influence on restoration options Cement-retained or screw-retained restorations

Review prosthetic components of the NobelReplace® PS implant system Assortment overview - Implants RP 4.3 5.0 6.0 NP WP Connection: NP Implant diameter: 4.3 mm Implant length: 8, 10, 11.5, 13, 16 mm Connection: RP Implant diameter: 5.0 mm Implant length: 8, 10, 11.5, 13, 16 mm Connection: WP Implant diameter: 6.0 mm Implant length: 8, 10, 11.5, 13, 16 mm Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Manual torque wrench surgical For optimal placement of the abutments it is recommended to insert the implant into a final position, where one of the 3 tri-lobes is aligned towards the buccal side. A laser marking on the implant driver illustrates the alignment for each tri-channel apex and facilitates visualization of correct implant position. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Long implant drivers now in NobelReplace® surgical kit Clinician request NP, RP, WP driver added to NobelReplace surgical kit in spare positions Black markings to support correct implant positioning All implant drivers (short and long) with the black marking lines have new article numbers Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Bone mill and bone mill guide Bone mills Bone mills are intended to be used for removal of surrounding tissue remnants around an implant head/platform. NobelReplace Platform Shift NobelReplace Tapered Groovy Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Bone mill and bone mill guide The bone mill for NobelReplace is designed to fit in diameter to the flared healing abutments and impression copings. To guarantee a secure seating of these components the bone mill removes bone 0.2 mm below the implant platform. Even though the current design of the bone mills guarantees a secure seating of the prosthetic components it is in some cases judged to be too invasive as it removes bone around the implant below the implant platform. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Bone mill and bone mill guide Therefore a higher bone mill guide has been developed for the Platform Shift implants that secures that the bone mill stops 0.2 mm above the platform and thus does not damage the platform. For NobelReplace Platform Shift the NP bone mill is used for the mm implant, the RP for the 5.0 and the WP for the 6.0 mm implant. The new higher bone mill guides will be implemented also for the regular NobelReplace NP, RP and WP. 0.4 mm Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Review prosthetic components of the NobelReplace® PS implant system New abutment screw NobelReplace® NP With the new modified abutment screw the strength of a NobelReplace Platform Shift NP 4.3 Implant with a NP abutment achieves the strength of a NobelReplace RP 4.3 implant with RP abutment. The new abutment screw is color-coded for easier identification. Implant Fatigue strength NobelReplace RP Tri-Channel 320 N NobelReplace Platform Shift NP 4.3 342 N Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Review prosthetic components of the NobelReplace® PS implant system Abutment Platform Shift The Adapter Platform Shift RP-NP (34551) and WP-RP (34552) and its components will be discontinued. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Soft tissue management Biocompatible materials such as Titanium and Zirconia for both pre-fabricated and individualized solutions. NobelReplace Platform Shift – Platform shift design. Final abutments with option to temporize and unique temporary abutments. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. 51

Restorative options * Individualized restorations * Individualized abutments ** Pre-fabricated abutments Healing abutments and temporary components *** * Broad choice of materials, please refer to IFU for further information. ** Locator® is a registered trademark of Zest Anchors Inc. *** Temporary abutments plastic are indicated for max. 3 months intraoral use Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Platform Shift abutment selection guide Single tooth restoration Multiple unit restoration Overdenture: Fixed-removable / removable Screw-retained Cement-retained Screw-retained Cement-retained Bar-retained Abutment-retained NobelProcera Abutment Zirconia+ Titanium NobelProcera Abutment Zirconia NobelProcera Abutment Zirconia GoldAdapt Non-Engaging Locator* NobelProcera Abutment Titanium Multi-unit Abutment (straight , 17º or 30º angled) NobelProcera Abutment Titanium NobelProcera Implant Bar Overdenture Titanium Ball Abutment NobelProcera Abutment Zirconia+ Titanium for direct veneering (1 piece solution) Procera Esthetic Abutment Procera Esthetic Abutment GoldAdapt Non-Engaging Esthetic Abutment (straight or angled) Esthetic Abutment (straight or angled) NobelProcera Implant Bridge Zirconia + Titanium Snappy Abutment Snappy Abutment GoldAdapt Engaging Narrow Profile Abutment NobelProcera Implant Bar Overdenture Titanium GoldAdapt Engaging * Locator® is a registered trademark of Zest Anchors Inc. GoldAdapt Engaging Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Platform Shift temporary solutions Temporary solutions Temporization on final abutment Temporary abutments Screw-retained Cement-retained Screw-retained Cement-retained Multi-unit Abutment Esthetic Abutment (straight or angled) Immediate Temporary Abutment (Single-unit) Temporary Abutment Titanium & Plastic* Procera Esthetic Abutment QuickTemp Abutment (Multiple-unit) Snappy Abutment * Temporary abutments plastic are indicated for max. 3 months intraoral use Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Impression taking Clinical procedure Place the impression coping onto the implant and take a conventional implant level impression. Connect the temporary restoration or healing abutment and send the impression to the dental laboratory. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Impression taking Clinical procedure for implant level impression: Use a custom-made rigid impression tray with occlusal screw access holes following an open tray impression protocol. Syringe an elastomeric impression material around the impression copings intra-orally and take an impression. After complete setting of the impression material unscrew the impression coping screws and remove the impression tray. Make preliminary inter-occlusal records. Inspect the impression for discrepancies and send to the laboratory. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

NobelProcera™ product and material options Alumina Optimal esthetics with high translucency Zirconia (Shaded) For strength, and esthetics in four shades Titanium Long-term provisional or cost-efficient final solution Base Metal Alloy Cobalt Chromium Cost-efficient final solution Telio® CAD – Acrylic Temporary Full contour with optimal soft tissue support IPS e.max® CAD Full contour, esthetic and cost-efficient solution Telio® CAD and IPS e.max® CAD are registered trademarks of Ivoclar Vivadent AG. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. NobelProcera offers a wide range of materials including metal-based options such as Titanium and Base Metal Alloy Cobalt Chromium. Acrylic for temporary restorations are also available (Telio CAD)

NobelProcera™ Abutment Customized abutments Product Ideal support of peri-implant gingiva/soft tissue through individual emergence profile Anatomic design options provide proper support of the veneering material (for screw-retained solutions) Internal and external connections available for Nobel Biocare and third-party platforms Material Choice between Zirconia and Titanium depending on the location within the dental arch and preference of the clinician Maximizing esthetic results through application of shaded Zirconia Long-term clinical stability through biocompatible and homogenous materials Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

NobelProcera™: Restorative offering for Platform Shift PS Accessories New: New clinical screw design for NobelReplace tri-channel NP PS (Titanium Abutment) co-packed and shipped with NobelProcera Titanium Abutment NobelProcera Ti &Zr Abut NobelProcera Ti &Zr PIB NobelProcera Implant bar No change in portfolio No change in software Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

NobelProcera™ Implant Bridge Screw-retained implant restorations Product Screw-retained implant supra-structures allow access to the implant at any time Simple and efficient closure of screw access channel with conventional composite resin material (with NobelProcera Zirconia no esthetic impairment compared to cast metal structures) Anatomic design in CAD software ensures proper support of the veneering material Internal and external connections available for Nobel Biocare and third-party platforms Material Choice between Zirconia and Titanium depending on the location within the dental arch and preference of the clinician Maximizing esthetic results through application of shaded Zirconia Long-term clinical stability through biocompatible and homogenous materials Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

NobelProcera™ Implant Bar Overdenture solution Implant Bar Overdentures Product Beneficial rehabilitation in case of significant loss of hard- and soft tissue thereby eliminating the need for extensive vertical bone augmentation procedures Easy hygiene maintenance for the patient Various retention elements allow for adaptable retention and simple future reestablishing of retentive forces Combination of different implant systems and connections allows use of preferred implant system of choice Material Industrial milling from a homogenous monoblock of surgical grade Titanium guarantees excellent precision of fit No solder/laser welding joints that pose a potential site for fracture upon long-term functional loading Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Instruction slide Review prosthetic components of the NobelReplace® PS implant system Content/material to be provided by lecturer Additional material can be found on the Speaker Portal

Hands-on Instruction slide
This chapter should cover the following topics: NobelReplace surgery, NobelReplace prosthetic componentry including platform shift abutments, tri-channel connection Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Hands-on NobelReplace® Platform Shift – Finalization options
There are three options for finalizing the implant surgery. One-stage immediate loading* Provisionalize implant for immediate esthetics and function, using Nobel Biocare temporary or final abutments. One-stage delayed loading Use Screwdriver Unigrip to connect a healing abutment to implant. If applicable, suture back the soft tissue. Two-stage delayed loading Use Screwdriver Unigrip to connect a cover screw to the implant. Suture tissue flap using desired technique. * Provided that final torque of min. 35 Ncm can be achieved at implant placement and max. torque delivered as specified in manual should not be exceeded Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Hands-on NobelReplace® Platform Shift – One-stage - delayed loading
Hands-on NobelReplace® Platform Shift – One-stage - delayed loading Healing Abutment placement Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Hands-on Temporary solution - Immediate temporary solutions
Pre-fabricated plastic copings on abutments Temporary copings Quick temporary solution on abutments Ideal for immediate loading Available for Snappy Abutment Esthetic Abutment Immediate Temporary Abutment QuickTemp Abutment Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Immediate Temporary Abutment – for single-unit restorations Screw and abutment in one piece Narrow construction Plastic coping for easy temporization For single-units Cement-retained Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

QuickTemp Abutment Platform Shift – for multiple-unit restorations Screw and abutment in one piece Available for internal and external connection Plastic coping for easy temporization Snap-on function on plastic coping Cement-retained Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Temporary Abutment engaging & non-engaging – for single- and multiple-unit restorations Available in titanium & plastic* Available for internal and external connection For screw-retained temporary solutions * Temporary Abutments plastic are indicated for max. 3 months intraoral use Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Hands-on Final restoration
Procera Esthetic Abutment Zirconia – for single- and multiple-unit restorations Comprehensive selection of collar heights and angulations minimizes chair-side adjustments Biocompatible zirconia is certified for excellent strength and homogeneity Off-the-shelf abutment, based on the most individual abutment designs for excellent esthetic results in all indications Scalloped margin designed to profile natural soft tissue contours Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Hands-on Final restoration with temporary solution
Esthetic Abutment Titanium – for single and multiple unit restorations Comprehensive selection of collar heights and angulations minimizes chair-side adjustments Excellent esthetic results in all indications Scalloped margin designed to profile natural soft tissue contours Optional temporary coping for immediate temporization NP RP WP Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Hands-on Final restoration
GoldAdapt Abutment for all indications using the “lost wax” casting technique Indicated for both cement- and screw-retained restorations Burn-out cylinder for wax application For single-unit (engaging) and multiple-unit (non-engaging) restorations Gold alloy base Abutment screw included Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Hands-on Torque guide: prosthetic components By hand 74
Plastic Temporary Abutment Plastic Temporary Coping Healing Abutment Healing Cap Prosthetic Screws for final restorations Titanium Temporary Coping Ball Abutment 17° Multi-unit Abutment 30° Multi-unit Abutment All other abutment, Implant Bridge, and Implant Bar Overdenture for Nobel Biocare implant systems By hand Note: Other major implant systems may require different torque values. Always consult the respective instructions for use. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. 74

Hands-on Instruction slide Content/material to be provided by lecturer
Additional material can be found on the Speaker Portal

General introduction to the NobelReplace system Concepts of platform shifting Benefits of NobelReplace Platform Shift Review prosthetic components of the NobelReplace implant system Hands-on Scientific support Conclusion and wrap-up

Scientific support Scientific evidence supporting platform shifting
A. Clinical studies Randomized Clinical Trials (RCTs) : 4 reports found, all supporting the concept Uncontrolled Clinical Trials (UCTs): 18 reports found supporting the concept, 2 not supporting Main success parameter used: Marginal bone level 77

B. Biomechanical studies 10 reports found 7 supporting the concept (better stress distribution, lower stress in the crestal bone) 2 partly supporting ( > stress in the crown and screw) 1 not supporting Main methodology / parameters: FEM analysis/ Implant-bone stress distribution 78

Scientific support NobelReplace® – Key publications
den Hartog L, Raghoebar GM, Stellingsma K, Vissink A, Meijer HJA Immediate nonocclusal loading of single implants in the aesthetic zone: a randomized clinical trial. J Clin Periodontol 2011;38: Objective/Results: The aim of this randomized controlled study was to compare the outcome of immediate non-occlusal loading with conventional loading for single NobelReplace Tapered Groovy implants in the maxillary esthetic zone. Comparable results with high survival rates, stable bone levels, and high patient satisfaction were recorded for both loading protocols. Conclusion: NobelReplace Tapered Groovy is a predictable treatment solution for single crown restorations in the esthetic zone, both when applying immediate and delayed loading protocols. 79

Existing clinical literature seems to support a significantly less radiographically detectable crestal bone loss in humans when Platform Shifting concept is applied.1 Clinical studies also seem to support beneficial soft tissue maintenance.2 Biomechanical studies also seem to support the concept.3 1 Al-Nsour MM et al. Effect of the platform-switching technique on preservation of peri-implant marginal bone: a systematic review. Int J Oral Maxillofac Implants 2012;27(1): 2 Canullo L et al. Inward-Inclined Implant Platform for the Amplified Platform-Switching Concept: 18-Month Follow-up Report of a Prospective Randomized Matched-Pair Controlled Trial. Int J Oral Maxillofac Implants 2012;27(4): 3 Tabata LF et al. Platform switching: biomechanical evaluation using three-dimensional finite element analysis. Int J Oral Maxillofac Implants 2011;26(3): 80

Scientific support NobelReplace® Platform Shift - clinical testing and evaluation Case series with 26 clinicians have started in February 2011 5 year multi-center study has started in March 2011 Limited Market Entry (LME) from May 2011 to October 2011 Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. 81

Scientific support For scientific evidence we refer you to our Nobel Biocare web-page:

General introduction to the NobelReplace system Concepts of platform shifting Benefits of NobelReplace Platform Shift Review prosthetic components of the NobelReplace implant system Hands-on exercise Scientific support Conclusion and wrap-up

Wrap-up Provide an overview of the important features of the NobelReplace implant system Explore the concept of platform shifting and its benefits for tissue stability Illustrate the benefits of platform shifting in combination with tri-channel connection Examine the prosthetic components of the NobelReplace implant system Aim of this course: Enabling you to explore the newly launched concept and benefits of platform shifting in combination with the tri-channel connection of the NobelReplace implant system.

“NobelReplace® Innovation Evening Seminar for Platform Shift”
Thank you for your attention! Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

Conclusion and wrap-up
Round off lecture and show appreciation to lecture team Optional: Mentorship options: guidance through initial straightforward patient cases Optional: Advise participants of mentorship options to support them through their first straightforward patient cases Inform about upcoming courses and events Announce sales offer and distribute (handout, not in ppt) Distribute and collect course evaluation forms Distribute certificates

Nobel Biocare iTunes U online campus
Additional educational material can be found on iTunes

Mentorship This is an optional slide Insert information here if there is an established Mentorship Program in your country. … Questions? Please contact: Contact name Title Telephone address

Upcoming courses and events
List courses or events that will be of interest to audience “Next course in this series” Speaker: Speaker name and credentials listed here Date: Date listed here Location: Location listed here More information: Contact name or web address listed here

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