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Nobel Biocare Global Symposium 12 special feature Solve four common posterior region challenges Nobel Biocare offers solutions with its innovative technology by Michael Stuart, Nobel Biocare Restoring single molars is a common indi- cation for most clinicians placing implants, but that does not mean it is straightforward. In this article, we look at how to overcome four challenges frequently encountered in the posterior region. Large molar sites In the case of immediate placement, large molar extraction sockets can make it difficult to achieve sufficient stability. The need for a large molar crown means that additional considerations have to be made regarding the emergence profile. Restorations that are sig- nificantly wider than the implant platform could, at best, leave space where food can be- come trapped. At worst, they could be detri- mental to the marginal bone. In both eventu- alities, you may have patients coming back with complaints. In a bid to avoid these issues, you could use wide-platform implants, such as those found in the NobelActive and NobelParallel Conical Connection systems. You could also further improve the emergence profile by us- ing healing and temporary abutments de- signed specifically for the molar region. Limited accessibility The reduced space and light in the poste- rior region can make placing a restoration tricky. Furthermore, working at the back of the mouth means there is a high risk of the patient aspirating any small components that may come loose. Accessibility can be improved by using an abutment with an angulated screw chan- nel. Being able to position the screw access hole towards the lingual or mesial aspects makes it easier to reach. The appropriate tooling can also improve handling. Nobel Biocare’s unique Omnigrip Screwdriver is designed to maintain a strong grip on the screw to limit the possibility of it detaching in the patient’s mouth. This offers a little extra peace of mind, particularly when you are working in the posterior. Excess cement Case studies have indicated that excess cement can have a detrimental effect on periimplant tissue health. Despite the risks, a survey of 400 dentists by Wadhwani et al. found that some place up to 20 times more cement than they need.1 An overload of this scale means that up to 95 percent of the cement that is placed extrudes at the restorative margin. With this margin often below the gingival margin, this can pose significant problems, particularly in the molar region, where accessibility and visibility make removal of cement especially difficult. You can avoid this issue entirely by using a screw-retained restoration like the NobelProcera FCZ (full-contour zirconia) Im- plant Crown. As even the adapter is mechan- ically retained, the restoration is completely cement-free. Alternatively, Wadhwani et al. suggest a technique for minimizing excess cement by creating a chairside copy abut- ment that serves as a controlled applicator for the cement.1 High occlusal forces For restorations to withstand the high occlusal forces experienced in the molar re- gion, they need to be strong. Those created specifically for the posterior region, like the NobelProcera FCZ Implant Crown, are de- signed to cope with these demanding condi- tions in the long term. In addition, high forces can lead to veneer chipping. As the NobelProcera FCZ Implant Crown is a monolithic full-contour option, it overcomes this challenge too, since no veneering is required. Four problems, one complete solution In order to overcome all these challenges, we have brought innovation to the posterior region. Our new complete posterior solution combines wide-platform NobelActive and NobelParallel Conical Connection implants with anatomically shaped PEEK Temporary and Healing Abutments. For the definitive restoration, Nobel Biocare offers the high- strength, cement-free NobelProcera FCZ Im- plant Crown with the option for an angulated screw channel. In combination, these innova- tions are designed to make restoring molars easier. Reference: 1. Wadhwani, C., Hess, T., Piñeyro, A., Opler, R. & Chung, K.-H., “Cement application techniques in luting im- plant-supported crowns: a quantitative and qualitative survey”, International Journal of Oral and Maxillofacial Implants, 27/4 (2012), 859–64. The Omnigrip Screwdriver is designed to maintain a strong grip on the screw in order to limit the risk of it detaching in the patient’s mouth. The NobelProcera FCZ Implant Crown combines full-contour strength with restorative flexibility in whichever of the eight shades you choose. More to explore! Learn more about Nobel Biocare’s com- plete posterior solutions at www.nobel biocare.com. © file404/Shutterstock.com