Nobel Biocare Letter - (Page 4) Nobel Biocare’s Real Issue Justifying High Prices in the United States, and even Higher prices in Canada (33% Average Exchange Rate) Nobel Biocare Dental Implant Products US Canadian Exchange RePlant from ID US Canadian Rate List List +33% av. on List Price List Price Price Price 07/09/07 Exact Daily Rate (5%) +26% +34% +32% $452.75 $150.00 $157.50 Included Included Included Included Nobel Biocare Slide #2 Nobel cites to Implant Direct Newsletter reference to compatibility but claims Implant Direct’s recommendation for insertion with their instruments is inconsistent ImplantDirect tooling claim Replace Implant $350.00 $441.00 + Cover Screw $ 46.00 $ 61.75 +Transfer $ 56.75 $ 75.00 Total Cost Angled Abutment Gold Engaging Abutment Snappy Straight Abutment $452.75 $557.75 $150.00 $157.50 ImplantDirect claims their RePlant Implants are compatible with Replace Tapered Drills RePlant published Instructions for Use “RePlant Implants are inserted using Nobel Biocare’s drills and surgical instruments for the Replace Tapered Implants” $217.00 $247.00 13% $85.00 $89.25 However, a deviation to the protocol is indicated on their website $202.00 $247.00 27% $100.00 $105.00 “To minimize the risk of fracture of the top of the 3.5mmD and 4.3mmD RePlant implants during insertioin, it is recommended to use Nobel’s procedures for insertion into dense bone, regardless of the quality of the bone.” $191.00 $272.00 42% $85 $89.25 The Newsletter offers free implant or abutment Dentists can see for themselves the Compatibility The RePlant Implants’ outside thread diameter and taper match's Nobel’s Replace dimensions, providing surgical compatibility with Nobel’s drills. Differences in thread design are immaterial to insertion, even when using Nobel’s bone tap in dense bone, because the RePlant is designed with a vertical, self-tapping cutting groove, unlike the Nobel Replace implant. The Trilobe internal connection geometry and dimensions of the RePlant implants also match the Nobel Replace implants, providing prosthetic cross-compatibility between the two systems. The walls for the 3.5mmD and 4.3mmD RePlant and Replace implants are relatively thin. To minimize the risk of fractures during insertion, Nobel added a warning to the label of the 3.5mmD Replace implant not to exceed 45Ncm of torque during insertion. To avoid the risk of a dentist misinterpreting the density of the bone, Implant Direct suggested using Nobel’s dense bone surgical protocol for the small diameter implants, which included use of the bone tap for the shorter implants. This was discretionary and would not significantly compromise initial stability because the RePlant, having a different thread design than the Replace bone tap, was in effect still being inserted self-tapping. Implant Direct’s RePlus Trilobe implant utilizes a soft bone and hard bone surgical protocol so that in soft bone, the tapered implant will be inserted into an undersized socket for bone compression and increased stability, a desired factor in immediate loading. This is made possible by the use of straight step drills with an evenly tapered implant, and is not a prescribed protocol for the NobelReplace implants although many dentists elect to use this technique based on their experience. In conducting the insertion torque tests to respond to Nobel’s false claims, Implant Direct learned that the combination of a self-tapping implant design made from titanium alloy, and inserted with an aluminum fixture-mount that would strip before damaging the implant, offered the opportunity for optimizing insertion torque regardless if the bone was soft, hard or something in between. This has lead to a revision of the RePlant Surgical Protocol that Nobel cited to as circumstantial evidence of a lack of surgical compatibility. (Refer to the torque and strength chart on page 11). Testing reveals that there is a lower amount of torque required to fracture the RePlant implant if Nobel’s insertion tool is not fully seated in the trilobe. Inserting the 4.3mmD RePlant implant using Nobel’s dense bone protocol, required only 34.46Ncm of torque using oak (Implant Direct test) and 96Ncm of torque in “foam” (Nobel test). RePlant implants are packaged on aluminum fixture-mounts that engage the Trilobe in the implant and are designed and intended for inserting the implant using a ratchet, drill or handle available from Implant Direct. It also serves as a closed-tray transfer. The aluminum fixture mount for the 4.3mmD RePlant implant can withstand 114Ncm of torque before stripping, substantially below the fracture torque of 145.5Ncm for the 3.5mmD RePlant. Determination of the quality of bone is subjective. Self-tapping insertion of the RePlant implant can be attempted in all qualities of bone as long as its aluminum Fixture-mount functions as a safety guage. If excessive resistance is met, the aluminum Fixture-mount will strip, protecting the implant. If this occures, unscrew the implant using Nobel’s Trilobe insertion tool, enlarge the socket using either the NobelReplace’s dense bone dills or bone tap, and re-insert the implant. The Fixture-mount will be unusable as a transfer. Implant Direct’s Surgical Protocol for insertion of RePlant Implants with NobelReplace Instruments: TYPE 4 BONE: In soft bone, only enlarge the socket using Nobel’s recommended intermediate drill for the specific diameter implant, followed by self-tapping insertion using the RePlant Aluminum Fixture-mount to protect the implant. TYPE 2-3 BONE: In medium density bone, enlarge the socket using the recommended final drill for the specific diameter implant, followed by self-tapping insertion using the RePlant Aluminum Fixture-mount to protect the implant. TYPE 1 BONE: Use NobelReplace’s dense bone surgical protocol. Optional Protocol: Insert RePlant self-tapping using the RePlant Aluminum Fixture-mount as a safety gauge. If it strips, unscrew the implant using NobelReplace insertion tools, resize the socket using NobelReplace’s dense bone surgical protocol and re-insert the RePlant Implant. 4
Table of Contents Feed for the Digital Edition of Nobel Biocare Letter Nobel Biocare Letter Nobel Biocare Letter - (Page 1) Nobel Biocare Letter - (Page 2) Nobel Biocare Letter - (Page 3) Nobel Biocare Letter - (Page 4) Nobel Biocare Letter - (Page 5) Nobel Biocare Letter - (Page 6) Nobel Biocare Letter - (Page 7) Nobel Biocare Letter - (Page 8) Nobel Biocare Letter - (Page 9) Nobel Biocare Letter - (Page 10) Nobel Biocare Letter - (Page 11) Nobel Biocare Letter - (Page 12)
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