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Special Issues
July/August 2021
Volume 42, Issue 1

Treatment of a Maxillary Arch Featuring NobelProcera Zirconia Implant Bridge

Dennis Nagata, DDS ; and James Michino, DMD

A 60-year-old male patient presented to Dr. Nagata's practice with a chief complaint of wanting to replace his maxillary teeth and remove existing failed implants and an implant bridge previously placed by a different practitioner. After a discussion of the protocols and benefits of implant treatment, the patient accepted the All-on-4® treatment concept. Dr. Nagata referred the patient to Dr. Michino. An implant bridge in the mandible had put the patient into severe malocclusion, as well as functional and esthetic imbalance. The patient intends to restore the mandibular arch. The NobelProcera® Zirconia Implant Bridge (Nobel Biocare, nobelbiocare.com) in the maxillary arch will serve as a framework to rehabilitate the mandibular implant bridge, creating balance and occlusion. Following the surgical procedure and placement of TiUltra™ implants, Xeal™ Multi-unit Abutments were placed. The case was immediately loaded with a provisional screw-retained denture fabricated by Hiro Kobayashi, RDT (Hiro's Dental Studio, Honolulu, Hawaii). After 2 months of healing, the provisional denture was removed by Dr. Nagata. Tissue around the abutments looked completely healed with no inflammation. Multi-unit abutment-level open-tray impressions were taken along with vertical dimension of occlusion and occlusal records to proceed toward fabrication of the NobelProcera Zirconia Implant Bridge. Mr. Kobayashi designed a bridge spanning from Nos. 3 to 14 using DTX Studio™ Lab software.

Key Takeaways

TiUltra implants feature a gradual change in topography, becoming moderately rough and porous toward the implant apex, promoting early osseointegration and supporting bone stability. The surface chemistry and ultra-hydrophilicity of the implants are designed to speed up the natural healing process.

Xeal, available on multi-unit abutments, is designed to promote soft-tissue attachment through its smooth, non-porous surface and enhanced surface chemistry. Both TiUltra and Xeal from Nobel Biocare are built on decades of anodization experience.

Made for esthetics, NobelProcera Zirconia Implant Bridge is a premium restoration that is cement-free and provides extensive flexibility. This simplifies the partnership between clinicians and technicians, offering restorative freedom.

About the Authors

Dennis Nagata, DDS
Restorative Dentist,
Private Practice,
Honolulu, Hawaii

James Michino, DMD
Oral and Maxillofacial Surgeon,
Private Practice,
Honolulu, Hawaii

Fig 1. Postoperative panoramic radiograph. Note fractured implant in the apical region.

Fig 1

Fig 2. Surgical photograph. Nobel Biocare TiUltra NobelActive implants were placed using All-on-4 treatment concept. Xeal Multi-unit Abutments, which help foster soft-tissue health, were placed as well.

Fig 2

Fig 3. Verification jig.

Fig 3

Fig 4. Verification jig and impression tray.

Fig 4

Fig 5. Surrounding soft tissue.

Fig 5

Fig 6. Verification jig placed.

Fig 6

Fig 7. Attached jig with flowable composite.

Fig 7

Fig 8. Impression material being injected.

Fig 8

Fig 9. Open tray impression.

Fig 9

Fig 10. Unfinished NobleProcera Zirconia Implant Bridge.

Fig 10

Fig 11. Finished NobleProcera Zirconia Implant Bridge.

Fig 11

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