NobelDirect 3.0

The NobelDirect 3.0 implant encompasses the osseous component and restorative component in one piece. This design is based on the One-Stage Placement concept and offers a number of possible advantages :

• New indications : NobelDirect 3.0 is the first FDA-cleared implant on the market with a diameter of 3.0 mm. For the first time the mandibular central and lateral incisors or maxillary lateral incisors can be restored with an excellent esthetic outcome.
• Ease-of-use : The NobelDirect 3.0 implant is a threaded one-piece implant with an integrated abutment designed for one-stage surgical procedures and cemented restorations.
• Tissue friendliness : The surgery is performed only once, allowing the soft tissue to adapt to the implant / abutment interface without further manipulation.
• Esthetics : The abutment can be prepared to an optimized adaptation to the gingival margin
• The TiUnite surface on NobelDirect 3.0 : Due to a more rapid formation and greater amount of bone to implant contact during healing, Nobel Biocare's Ti-Unite® surfaced implants result in faster and stronger osseointegration and better maintenance of the initial implant stability than machined titanium implants.

Treatment Planning

Indication for use

The diameter of two-piece implants is limited due to the lesser strength of the hollow implant body and the screwjoint. The one-piece design overcomes this limitation and allows us to offer a special small diameter implant – NobelDirect 3.0. This implant is intended for use in the tight space challenges in the region of the mandibular central and lateral incisors and maxillary lateral incisors with a delayed loading protocol.

When the implant is placed it should be restored with a Healing Cap or temporary crown without occlusal loading during the healing time.

Inclusion / Exclusion criteria

The following criteria are recommended for the use of NobelDirect 3.0

• Good gingival / periodontal / periapical status of adjacent teeth
• Favorable and stable occlusal relationship
• No apical disorder / inflammation at the area of the implant site or adjacent teeth
• Good bone volume and density
• No cantilevered restorations
• Angulation requirements of the restoration not exceeding 10⁰
• High initial implant stability
• Controlled loads
  The treatment plan should identify and reduce potential load factors such as lateral occlusal contacts, unstable dental occlusion and severe bruxism or other pronounced parafunctions.

Pretreatment Considerations

• The crestal gingiva must be of adequate width if the tissue punch is to be used. In addition, the facial gingiva must also be of an adequate thickness and width to enable sufficient vestibular depth.
• In the presence of an inadequate quantity of gingiva, shallow vestibular depth, and/or frenula pulling, a free gingival graft must be placed at least 3 months before placing the NobelDirect 3.0 implants.
• In the presence of a severely resorbed alveolar ridge, bone augmentation may be required.

Radiographic Examinations

Implant templates that are actual size or magnified 130% or 170% are supplied for NobelDirect 3.0 and used in conjunction with radiographic imaging as a guide to selecting the proper implant to be used. These overlays are to be used as guides only. When more accurate measurements are required, radiographic techniques such as tomograms and computerized tomographic (CT) scans should be utilized.

Additional diagnostic radiographic imaging may be indicated to determine the quality and quantity of alveolar bone or to identify anatomical landmarks.

Implant placement with Flap Reflection

A flap approach is recommended if adequate bone has not been confirmed, if direct vision of anatomic landmarks is necessary or if the facial gingival surface needs connective tissue augmentation.

Implant placement immediately after extraction

The healing capacity of an extraction site is excellent and, as long as the initial stability is reached, implant therapy is well suited to extraction sites. In addition to the above criteria, careful removal of any soft tissue and / or infected tissue is required. If periodontitis is the cause of the extraction, healing before implant treatment is often the procedure of choice.

The following steps are recommended for placement at time of extraction :

• Carry out gentle extraction, where possible keeping the labial bone plate intact
• Carefully remove remnants of any soft tissue from the socket
• Select the length of the implant so its apical end extends beyond the extraction socket
• Using the drills and drill guide, align the preparation as it should ideally be, independent of the direction of the tooth root/extraction socket
• Make optimal use of the interproximal walls for stability
• For immediate placement after an extraction, ensure that the gap between the implant and the bone wall is as small as possible
• Ensure that soft tissue closure around the implant is complete, as this is essential. Vestibular incisons may be required

Flapless Implant Placement

Flapless surgery is indicated in situations where adequate bone and attached gingiva are present, as well as sufficient vestibular depth.

Note: Available bone and significant anatomical landmarks such as blood vessels, nerves and concavities have to be confirmed with conventional diagnostic tools such as radiographic imaging, probing and palpation.