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ZURICH, Switzerland: In a recent interview, Dr Tomas Albrektsson, professor emeritus of the Department of Biomaterials of the University of Gothenburg in Sweden, and Dr Ana Ferro, director of oral surgery at MALO CLINIC in Lisbon in Portugal, discussed the research and clinical experience behind Nobel Biocare’s TiUltra implant surface and Xeal abutments. According to the experts, implantology has focused on surface roughness for bone behaviour for decades, giving far less attention to soft-tissue seal and restorative longevity. TiUltra and Xeal use chemistry and topography for tissue integration at every level.
TiUltra is a multi-zone implant surface with a gradual change in topography from collar to apex, designed to meet the needs of different tissues. Having begun working on dental implants with Per-Ingvar Brånemark in 1967, Prof. Albrektsson remains one of the most experienced and respected voices in implantology, and in his opinion, this hybrid design is “a more forgiving construction”, particularly when it comes to implant depth, because of the minimally rough collar.
The golden hue of the TiUltra collar and Xeal abutment surface is another important benefit of these surfaces, Prof. Albrektsson said. “If you have patients with a thin biotype, for instance, where the implant can sometimes shine through the tissues, then the golden hue gives it a much more aesthetic appearance than what you would have with an ordinary grey implant,” he added.
For Dr Ferro, integrating these new surfaces into her practice was “very easy” and did not involve any protocol change. Her drilling protocol in soft, medium and hard bone stayed the same, as did the goal of achieving a high level of primary stability.
Clinical importance of Mucointegration—a soft-tissue seal
Dr Ferro is leading a clinical study on NobelParallel CC TiUltra implants and Xeal multi-unit abutments with the All-on-4 treatment concept. In the pilot study, the implant survival rate after one year was 100%, marginal bone loss averaged only 0.46 mm and no biological complications were observed.
“When we evaluate our implants, we evaluate through several parameters: probing the implant, bleeding on probing and the accumulation of bacteria and plaque,” Dr Ferro said. In the pilot study, patients with a similar level of plaque accumulation displayed less bleeding on probing, fewer periodontal pockets and excellent bone response.
Long-term hygiene maintenance is essential
“One of our biggest goals is not just immediate success but long-term success,” Dr Ferro said. In practice, this means that the implants should be functional and without biological complications and that any opportunity to even slightly improve an implant’s clinical outcome should be seized.
Nothing can replace a proper clinical study and clinical documentation
Xeal and TiUltra are well-documented, clinically proven surfaces that have already been investigated in nine published studies with over 400 implants and 260 patients. Furthermore, a clinical study with 1,000 patients and with a planned five-year follow-up is currently underway.
The full interview can be viewed on Nobel Biocare’s blog.