Restoring Our Implants

The System

We place Nobel Biocare implants only: NobelActive and NobelReplace Conical Connection. Both use Nobel’s conical connection, and platform sizes are noted on every letter. Keeping to one system means your lab sees the same components on every case from us, and there is never a question about which driver or scan body fits.

Who Does What

Step	Austin Periodontal Associates	Your office
Planning	Cone-beam CT, digital plan against the intended tooth, surgical guide where indicated	Send the restorative plan, a wax-up or STL when the case is in the esthetic zone
Placement	Implant placement, grafting as needed, provisional if requested	Provisional if you prefer to make it
Healing	Check visits during integration	Nothing required
Uncovery	We uncover and place the healing abutment	Nothing required
Ready to restore	We confirm integration clinically and radiographically and send the letter	Impression or scan, abutment, crown
Final scan	We take it at the ready-to-restore visit if you ask us to, and send the file to you and your lab	Or you take it in your office
Maintenance	Alternating with you; every implant we place is checked at our recall visits	Alternating recall

We do not use resonance frequency (ISQ) numbers to declare an implant ready. Readiness is judged on time since placement, bone density at placement, the radiograph, and the absence of any clinical sign, which is what the letter reports. That radiograph, together with the one you take when the final crown is seated, is what the 2017 World Workshop consensus report on peri-implant diseases asks every implant to have on file: baseline radiographic and probing measurements at completion of the prosthesis, and a further film after a period of loading to fix the bone level reference that every later film is read against.

What the Ready-to-Restore Letter Contains

• Implant line, diameter, length, and platform, with the lot number
• Insertion torque at placement and whether the site was grafted
• Healing abutment height and tissue thickness at uncovery
• The scan body and abutment we recommend for the case, screw-retained where the angle allows
• Torque values from Nobel Biocare’s torque guide for the components listed, which sets 35 Ncm for the prosthetic screws of final restorations and hand tightening or 15 Ncm for temporary components
• Radiograph at the ready-to-restore visit
• Anything else you should know before the crown: occlusion notes, esthetic-zone tissue, the patient’s home-care status

Our Policy if an Implant Fails

An implant placed here that fails early, meaning it does not integrate or is lost within the first year, is replaced at no surgical cost after the site has healed and, if needed, been grafted. After the crown is on, we evaluate the cause with you first, because late problems usually trace to something specific: occlusion, the restoration or cement, the patient’s cleaning, or a change in health. We treat peri-implant disease on any implant, ours or not, and we tell the patient and you plainly what we found. The alternating interval we propose is set with the meta-analysis by Monje and colleagues in mind, which found reason to claim a minimum peri-implant maintenance interval of five to six months, tightened for the patient’s own risk.

Lab and Components

We do not recommend a particular lab; use the one you trust. Any lab that restores Nobel Biocare implants has the parts. If your office does not restore implants often, call and we will walk your assistant or lab through the case before the impression appointment.

How to refer · Referral criteria · Why refer to APA