3.0 Nobel Active for Narrow Spaces or Astra 3.0?

The problem with both the Astra and NobelActive 3.0mm implants is their strength. Nobel's tiunite surface only can be formed on CP titanium - don't know if Astra also uses this weaker (than alloy) material. The long bevel of both their conical connections thins the already very thin walls. The NobelActive 3.0mmD implant only recommends 15Nm of torque for the abutment screw further indicating its weakness and reducing the stability of the abutment - don't know about Astra. Contrast both of these with either the 3.2mmD Legacy implant with a 45deg. lead-in bevel or the InterActive made from titanium alloy. While the InterActive has a 3.0mm NobelActive compatible platform, its overall body width of 3.2mm provides added strength. Both of these Implant Direct Implants recommend 30Nm of torque for abutment attachment.

I agree with Gerald in that you are compromising strength when you go to the 3.0 and there are some other options you may want to explore. There are some solid implants that can be used in small spaces that do quite well. Tatum for example. Depending on how narrow your "very narrow" space is you may have to compromise a little on aesthetics for some strength.

Dr. Niznick is spot on. I have placed and restored Nobel 3.0 Active and the 3.2 mm body Reactive. The reactive has the "purple" narrow platform which gives you more strength and more Prothetic options. Dave

Dave, Do you mean the ReActive which has the 3.7mm Diameter body of a Legacy 3 implant but with a trip-lobe connection, or do you mean the 3.2mm Diameter InterActive with the NobelActive conical platform? The InterActive implants have many advantages compared to NobelActive including: 1. The neck diameter remains the major diameter of the implant, and does not taper in further weakening the implant and creating a gap between the implant and bone, 2. The body of the InterActive implant is a gentle 2 degree taper so that it slowly expands bone, compared to the 9 degree taper of the NobelActive that can not easily be placed in dense bone, 3. The InterActive has a long self-tapping groove with its cutting edge facing clockwise to assist in insertion, whereas the NobelActive had its cutting edge facing counter-clockwise to help unscrew the implant when it will not fully seat in dense bone, 4. The apical end of the InterActive is rounded whereas on the NobelActive, it is flat and sharp, increasing the chance that it will perforate a sinus or allow the implant to change alignment from the prepared socket, something Nobel touts as an advantage, but the time to change the trajectory of an implant is during site preparation not insertion. 5. The NobelActive cost 3X as much as the interActive....and both are being sold to dental professionals by Danaher controlled companies.

trying to keep this simple. I prefer the Bicon 3.0, which has been around for quite awhile. It is not only strong but also promotes bone regeneration or growth which we see in many Bicon cases. I like simple...so do my patients. Hope this helps!

There is a difference between simple and simplistic. Try to do a transfer with a bike on the does not have any indexing hex. As for preserving bone, the design of the Bicon requires countersinking the implant millimeter tube all the crest just so the abutment will be sub gingival and then often requires contouring the crest of the ridge so that the abutment can fully seat. You are not preserving bone with the Bicon but in fact have given up 1-2mm of good bone contact with the Crestal cortical bone as soon as you insert it. This could be critical in the maxillary posterior where there may only be 4 mm of bone below the sinus floor. What you want is to increase initial stability in these limited bone situations - micro threads extending to the top of the implant will maximize bone contact and thread engagement. You won't get that with a pressfit implant with an internal Morse taper like the Bicon

Bicon auto-corrected to "bike-on" -maybe it was trying to tell me that placing the Bicon was like riding a bike - and we all know the risks of falling off a bike, especially at my age.

Hello Just Check out the amazing Anthogyr 2.8 device! No screw but impaction of the abutment! I have used it many times with great pleasure! For those who don't know Anthogyr is a big french implant company which I have no interest in. Best regards from France

Interesting discussion! I'm about to start a study Around 3.0 mm implants one and two-piece.. I'm thinking of biohorizons company.. Any ideas of previous experience with their implants???

You guys. These are all very good suggestions but I think we have gotten off the initial question that I had. Does the compression of the bone in a narrow ridge with the Active design something to be concerned about and place a non compressive type implant instead?

The wider Nobel active implants have an extreme taper of about 9° and are inserted into "soft bone" ... ( not inside iPhone)

Nothing is like an Astra. highly depending implant in my opinion.

Have had times when either one worked well and others when it was questionable. I am thinking of the bone biology and seems that the more aggressive thread design of the Nobel Active will make it more likely to compress bone and cause necrosis. However, it has a benefit of having a taper to it that the Astra implant does not. For those of us that have more one system in the office, trying to find a way to make a right decision.

first off I think the readers of this forum need to know that Dr. Niznick is the developer of the corevent/Zimmer implant and the developer and innovator of the Implant Direct company. I do not disagree with anything Dr. Niznick is saying its just that he's promoting his implant company and I think the readers have a right to know that. Secondly, a lot of my surgical colleagues that place a lot of nobelactive implants have discussed the difficulty in placing such an aggressive thread pitch in dense bone like the anterior mandible. The Astra implant with its less agressive thread is an excellent choice. I also like a two piece design so I can customize the abutment if needed. This cannot be done on any of the one piece implants. In terms of strength, any narrower diameter implant is going to be placed in low stress areas most likely protected by adjacent teeth so ultimate fatigue strength of the material may be a moot point.

Bicon 3.0 x 6.0, the smallest two piece implant available in the market. Primary stability is not too important unless we want to do immediate loading. I think the problem here is the limited space. With screw type implant, one might get good initial stability, but the compression of the bone will make the bone dying / resorbing in the future. This specially will be a nightmare in the front area. Why people still do immediate loading in the esthetic zone while delayed loading will result in better and more predictable esthetic. What do you think dr. Niznick?

I too have seen the nobel replace 3.5 fracture but primarily on insertion into dense bone. Restoratively I've seen 5 or 6 of the 3.5mm corevent internal hexed implants fracture under function; primarily in the posterior region under heavy occlusal loads. So, any smaller diameter implant when placed under heavy load whether on insertion or under function has the potential to fracture especially at the thin walls surrounding the internal connection. One piece implants are not immune either. How many mini implants have fractured under heavy function? Small diameter implants have a very specific indication; small bone volume, small stresses. Now, to answer the original question without marketing any particular implant company, I agree with all previous statements that aggressive thread pitches are fine for soft bone like the maxilla but difficult in more dense bone like the anterior mandible. Dr. Steve Parel, a highly regarded Prosthodontist, has discussed this exact issue and has moved away from aggressive thread designs in the anterior mandible. In regards to one vs. two piece, when the patient is partially edentulous, a two piece can be very handy since the surgeon is using a small diameter implant most likely due to bone topography and can only place the implant along the flare of the maxilla or mandible and not able to reorient according to ideal restorative angle. So give me a two piece any day so I can reorient the abutment to an ideal path of insertion. And remember, don't use small diameter implants in high stress areas

Immediate load of a single tooth replacement is the holy grail of implants. The key is to achieve at least 30 Ncm of initial torque during insertion and that can only be measured while inserting a threaded Implant thereby excluding the Bicon which is a push in Implant. I am very skeptical about concerns about basing ones Implant design choice based on avoiding over-compressing bone. Soft bone will compact while screwing in a tapered implant into an undersized socket and this is been shown in an article by Shalabi to increase the percentage of bone contact with the Implant surface after healing. In dense bone, if the socket isn't big enough or the taper on the implant is too great, the implant will just not seat, the labial plate will fracture, the hex on the implant will fracture or the hex tool will strip. Implant direct's implants have a gentle 2 to 3° taper compared to the Nobel active is 9°. We offer drills for soft or hard bone surgical protocols with additional drills to open up the crest of the ridge to the actual diameter the implant in very dense bone. I recently had the root of my maxillary central fracture and had my dentist do an immediate insertion HA coated legacy Implant. I much preferred this to a flipper for three months. The Implant now has a final restoration and the entire case can be viewed on Dr. August de Olivera's Facebook page.