Innovative Atraumatic Implant Protocol Decreases Healing Time
Nobel Biocare’s N1™ system and Cytoplast™ MicroDerm improve tissue health around implants for optimal long-term results
By carefully curating the service offerings at his two-location practice in South Ogden and Kaysville, Utah, Kim Cassity, DMD, MS, has ensured that he gets to practice the dentistry that he loves the most every day. In his case, that is implant dentistry. "When I first became interested in dentistry, I didn't actually know a lot about the profession," he says. "I knew I was interested in the dental aspect of medicine when I was younger-I even did a science fair project about teeth in the eighth grade-and I liked the entrepreneurial component of it, but I had never even heard of an implant before starting dental school."
Nonetheless, Cassity soon discovered that he loved the surgical aspect of dentistry and decided to specialize in implants and periodontics. "I felt strongly that implants were the future of dentistry," he says, "so when I finished my periodontal residency in 2001, I bought out a periodontal practice and renamed it Cassity Implants and Periodontics-putting implants first to emphasize what my focus and true love was."
Cassity notes that back in the mid-90s, implant treatments were not performed as often or to the same level that they are now. The periodontist who had owned the practice prior to Cassity had only placed about 12 implants during the year before Cassity took over. "I also started out as a periodontist doing a lot more soft-tissue grafting and treating periodontal disease," he says. "However, during the last 20 years, we have been able to increase the number of implant cases that we do such that at one point I had placed approximately 1,800 implants in a single year."
Cassity's increased focus on implant dentistry became possible largely because he was able to bring on a partner and an associate periodontist. In 2008, Cassity expanded the practice to a second location, and in 2014, each of the three periodontists began to subspecialize. "My partner limited his practice to performing soft-tissue grafts, and our associate periodontist began treating all of the periodontal disease in the practice," he says. "This allowed me to limit my own practice to just the surgical aspects of implant dentistry, including extractions, bone grafts, ridge augmentations, sinus lifts, implant placement, and any soft-tissue grafting necessary for those procedures."
Cassity's current implant system of choice is the Nobel Biocare N1™ system, which offers atraumatic site preparation, enhanced osteogenesis, and remarkable soft-tissue maintenance. As a next-generation implant system, the N1 system provides healing/temporary components, impression components, and final abutments for implant-level, base-level, or multi-unit abutment-level restorations along with a predictable protocol that reduces heat generation during osteotomy preparation, preserves vital tissues, and is minimally invasive when compared with many conventional implant protocols. Cassity had early access to the N1 system, so he has been using it for a little more than 2 years. One of the main reasons that he continues to use the system is that it has decreased the healing time for his patients. It has also decreased the total number of appointments required to complete treatment. "With these implants, the base components get modified to interact more favorably with the soft tissue," he says. "This creates a soft-tissue attachment to the base, which provides a better seal to protect the underlying bone from any inflammatory responses from the oral cavity and creates a more stable environment for long-term success and preservation of the bone."
According to Cassity, the N1 system's three-step implant placement protocol improves efficiency while also preventing damage to the bone cells that might occur with traditional osteotomy drilling protocols. "Basically, you have two preparation steps that use specialized tools, and then the third step is implant placement," he explains. "So, first, you do an initial preparation with the OsseoDirector™, which is used to establish the implant's position. Then, the second preparation step is done with the OsseoShaper™, which expands the preparation and cuts the bone as needed to create the osteotomy. What is unique about the OsseoShaper is that it operates at a low speed and without irrigation in such a way that it minimizes heat generation and vibration to prevent damage to the bone cells. Therefore, after implant placement, you end up with more living bone cells at the periphery of the implant that are ready to start healing immediately, which improves osseointegration."
In addition to the improved healing times and other efficiencies of the N1 system, Cassity also appreciates the flexibility that it offers to address a wide variety of implant situations. "When we do things like bridge work, we can use the N1 system's multi-unit abutments instead of the base components," he says. "And the system also offers a screw taper into the multi-unit abutments. You can also use it for full-arch rehabilitation to deliver an All-on-X type restoration as well. Furthermore, we really like that it enables restorations with angulated screw channels, so we can screw-retain anterior restorations very easily, which eliminates the need for cements and provides better long-term health in the anterior region."
In implant situations that require soft-tissue grafting, Cassity utilizes Nobel Biocare's Cytoplast™ MicroDerm material. "I like this material because of its friendly handling characteristics and its thickness," he says. "Moreover, I've used other allograft products in the past and have had patients complain of a bad smell and taste, but Cytoplast MicroDerm does not have that issue. I've also noticed that it results in minimal swelling and inflammation when compared with some of the other products that I've previously used."
Cytoplast MicroDerm is a microtextured acellular dermal matrix that is intended to provide support during coverage procedures of localized gingival recession defects and for local soft-tissue augmentation indications around teeth or implants. Cassity notes that he uses this allograft material when implant patients present with thinner tissue phenotypes. "In these cases, I can easily put Cytoplast MicroDerm around an implant to increase the tissue quality and thickness, which provides better long-term stability, improves implant survival, and makes it easier to maintain the tissue health around the implant," he says. "Using an allograft is also a much better option than using a patient's own tissue because it is more conservative. Eliminating the need for a donor site can make for a significantly easier recovery for patients."
When it comes to implant dentistry, Cassity believes that Nobel Biocare is on the cutting-edge regarding providing the most innovative solutions. "Our Nobel Biocare client representative is very knowledgeable and makes sure that we get the support that we need with these innovative new systems," he says. "And the reduction in overall treatment time is such an advantage. We strive to tailor our treatment plans to each patient's desires and current oral condition and to offer the best, most long-lasting dentistry possible, and the N1 implant system along with Cytoplast MicroDerm allows us to do that and more by improving healing and the overall patient experience."
Key Points
• Confidently place implants with just two surgical steps in more than 93% of cases.
• Reduce hard-tissue traumawith the revolutionary OsseoShaper protocol.
• Protect the biology of the surgical site with slow speed drilling that requires no irrigation.
• Provide soft-tissue augmentation with reduced inflammation with Cytoplast MicroDerm.
