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As director of both the research and development department and the oral hygiene department at MALO CLINIC in Lisbon in Portugal, Dr Miguel de Araújo Nobre has more than 20 years’ experience as a clinical researcher and has co-authored over 100 scientific publications in international peer-reviewed journals and six book chapters. In this interview, he outlines the promising results of a pilot study that he and Dr Ana Ferro, head of the department of oral surgery, periodontics and implant treatment at the clinic, are currently conducting on Nobel Biocare’s Xeal abutment surface and TiUltra implant surface with All-on-4 treatment.
Dr de Araújo Nobre, what made you adopt the Xeal and TiUltra surfaces?
We have previous experience using anodised surfaces—we started using Nobel Biocare’s TiUnite implant surface a long time ago—and have up to 18 years’ follow-up data that prove that it is a reliable long-term option. For these new Xeal and TiUltra surfaces, we scrutinised the research beforehand and were particularly interested in the Mucointegration concept. From our point of view, it fills a gap in implant dentistry in relation to the peri-implant complex.
Can you tell us about the aim of this pilot study?
The aim of the study is to evaluate the clinical outcomes, at three years, of full-arch rehabilitations conducted with the All-on-4 treatment concept using NobelParallel Conical Connection implants with the TiUltra surface and Multi-unit Abutments with the Xeal surface. It’s an ongoing study with 16 patients.
Could you summarise the key results?
We achieved a 100% survival rate for both implant and abutment with a mean marginal bone loss of just 0.46 mm after one year. Though some mechanical complications occurred with provisional prosthesis screw fractures, there was an absence of biological complications and a good and stable soft tissue response. In a nutshell, these are good results.
We have learned over the years that, if a stable maintenance protocol is kept up, the majority of implant failures normally occur in the first or second year of follow-up. Registering a 100% survival rate during the first year of follow-up is very promising. From a researcher’s point of view, the one-year survival rate is an important indicator of potential long-term success.
Regarding the marginal bone loss results, what can clinicians learn from this, particularly regarding long-term outcomes?
Often the marginal bone loss level is a predictor of long-term outcome success. When you place an implant, the implant failure likelihood tends to decrease over time. At the same time, the probability of pockets of marginal bone loss increases. This is the difference between early and late implant failure. For this study, we recorded an average of 0.46 mm of marginal bone loss after one year—0.57 mm in the maxilla and 0.19 mm in the mandible. From our perspective, this was a very pleasant surprise.
EuroPerio attendees can find out more about Nobel Biocare’s products at booth E.01. Watch a clinical case video of the All-on-4 treatment concept from the study (case courtesy of Dr Ana Ferro).