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NOBELDIRECT®

Groovy

NobelGuide™

perfect planning for perfect teeth

procedures & products

The procedures described herein must only be performed using components and instruments provided by Nobel Biocare.

Nobel Biocare reserves the right to make any necessary alterations to the methods and procedures stated in this manual.

Nobel Biocare is in compliance withISO 13485:1996 and Council Directive 93/42/EEC

Canadian Medical Devices Regulation

0086

For USA only: Federal law restricts this device to sale by or on the order of a licensed dentist or physician.All products are subject to change without notice.

Some products may not be available in all markets. Please contact your local Nobel Biocare officefor current product assortment and availability

First from Nobel Biocare. NOBELPERFECT® (NP, RP, WP), NOBELDIRECT® (NP, RP, WP), Brånemark System®,, NOBELSPEEDY™ and

NOBELREPLACE™ Implants. A complete assortment with FDA clearance for Immediate Function™

in all single, partial and fully edentulous restorations in the mandible and maxilla.

Nobel Biocare AB and all production units are certified according to the Environmental Management System ISO 14001

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table of contents

Beautiful Teeth Now™. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

NOBELDIRECT® Groovy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Guided NOBELDIRECT® Depth Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Product Reference Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Pre-Operative ConsiderationsAnatomic/Biologic Design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Treatment Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9NOBELDIRECT® Implant Placement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Immediate Function™

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Step-by-Step Laboratory Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Products You Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Step-by-Step Surgical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Products You Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Quick Check Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Recommended Finalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

AppendicesKits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Cleaning and Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Product Catalog . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Reference Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

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For abstracts, study references and for more information,please visit our website; www.nobelbiocare.com

Congratulations! You have made an excellent choice. Welcome to the Nobel Biocare family.

Nobel Biocare is providing dentists with more choices than ever before. But our goals remain the same:

• To ensure that your patients leave the treatment room satisfied, comfortable, with beautiful teeth and with a renewed quality of life.

• To help your practice run more smoothly, efficiently and profitably.

The NobelGuide™ treatment concept from Nobel Biocare providesvarious methods by which to transform pre-planned treatment intoclinical reality.

This manual is designed to provide quick access to important information regarding clinical treatments, procedures and optionsfor the NobelGuide™ solution based on the NOBELDIRECT® Groovyimplant systems. For more information, please see the NOBELDIRECT®

Groovy and NOBELDIRECT® Oval manual.

Important! While the NobelGuide™ methods described herein give youthe opportunity to pre-plan and realize patient cases, medical responsibilityfor planning and treatment remains that of the clinician.

beautiful teeth now™

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∅ 5.0 mm 8 10 13

∅ 4.3 mm 8 10 13

∅ 3.5 mm – 10 13

• Universal implant indicated for both single and multiplesites throughout the entire mouth.

• Threaded one-piece implants (machined from a single piece of titanium) with integrated abutments

• One-stage transgingival placement. Most often flapless,with minimal surgical invasion

• Tapered design mimics the tooth root leading to easy sur-gical procedure – especially in situations with ImmediateFunction™, immediate placement after extraction, and anesthetic implant position

• Restoration angulations should not exceed 10° (NP) 15° (WP)

• Note: For Guided NOBELDIRECT® procedure, multiple implants must be parallel as they are placed via the Surgical Template.

Platforms

To facilitate treatment planning, NOBELDIRECT® Groovy im-plants are organized according to a “platform concept”.

Narrow Platform: Limited interdental space. Not enough alveolar bone for an RP implant.

Regular Platform: From single anterior tooth loss to full arch restorative solutions.

Wide Platform: Where additional loading can be expected. Wider diameter implant/abut-ment posts to build “molar size” crowns. In soft bone to create more initial stability.

Note: NOBELDIRECT® Groovy implants with 16 mm length are not available for theNobelGuide™ procedure.

Platform Platform Lengthsdiameter

NOBELDIRECT® Groovy

6

8 mm

10 mm

13 mm

Twist Drill w Tip ∅ 2 × 7–15 mm

guided NOBELDIRECT® depth reference

Drill to 15 mmdrill line





Twist Step Drill ∅ 2.4/2.8 × 7–15 mm



Drill to the fulldrill length


Drill to the fulldrill length

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Drill Tapered RP

4.3 × 8 mm, 4.3 × 10 mm, 4.3 × 13 mm

Drill to top of hub

1.5 mm max

Implant Placement

Components for Guided NOBELDIRECT® are designed to give correct height measurements whenused on 2 mm soft tissue thickness, when used in conjunction with other soft tissue thicknesses thishas to be compensated for.

Images show placement of NOBELDIRECT® Groovy RP 4.3

8

TissuePunch WP

TissuePunch

Guide WP

∅ 2.4/2.8 mm

TwistStep drill

∅ 4.3 mmDrill

Tapered

∅ 5.0 mmDrill

Tapered

∅ 5.0 mmDenseBoneDrill

Tapered(optional)

∅ 2.0 mmTwist Drillwith tip

Screw tapTapered WP

(optional)

Implant Driver

RP/WP/6.05.0 × 13 mm

Implant

TissuePunch RP

TissuePunch

Guide RP

∅ 2.4/2.8 mm

TwistStep drill

∅ 4.3 mmDrill

Tapered

∅ 4.3 mmDenseBoneDrill

Tapered(optional)

Screw tapTapered RP

(optional)


Implant Driver

RP/WP/6.04.3 × 13 mm

Implant

product reference line

TissuePunch NP

TissuePunch

Guide NP

∅ 2.4/2.8 mm

TwistStep drill

∅ 3.5 mmDrill

Tapered

∅ 3.5 mmDenseBone Drill

Tapered(optional)

Screw tapTapered NP

(optional)


Implant Driver NP

3.5 × 13 mmImplant

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Anatomic/Biologic Design

NOBELDIRECT® Implant and Abutment in One-Piece

The NOBELDIRECT® Groovy implant features a revolutionary new one-piece design that is user-friendly, cost-effective, biologically soundand esthetically stable. The implant is machined from a single pieceof titanium, incorporating both the implant body and an integralfixed abutment.

Treatment Planning

As with any dental procedure, diagnosis and treatment planning areessential. Documentation needed are single X-rays with parallel technique, panograph, CT-scan in difficult cases diagnostic castsmounted in centric relation occlusion that display all the landmarksincluding vestibules as well as past dental history of patient.

• Adequate bone must exist to achieve primary stability

• If teeth need to be extracted, they must be treatment planned forimmediate implant placement or heal for at least 6 months beforeplacing implants.

• If a sinus lift is necessary to insert proper implant, the diagnosismust determine if an internal or external sinus lift is needed.

• Functional, periodontal and endodontic problems, with remainingteeth, must be treated in advance of surgical procedures.

• Gingival grafting may be needed if zone of gingival and/or vestibular depth are inadequate.

• No apical disorder/inflammation at the area of the implant site

pre-operative considerations

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flapflapless flapflapless

NOBELDIRECT® Implant Placement

The height of the interproximal soft tissue and the bone usuallyvaries from mesial to distal on each tooth. Always use highest pointof soft tissue (flapless procedure) or highest point of bone (flap pro-cedure) to guide your drills and implant placements.

Use flapless technique when:

• There is sufficient quantity and quality of alveolar bone and soft tissue.

• It is not necessary to raise a flap to safely direct the drilling procedure in relation to the anatomy.

Use flap technique when:

• It is necessary to observe the underlying alveolar bone and adjacentanatomical structures.

• Facial concavities exist; place an instrument below the facial flapand the drill to protect the soft tissue

Caution! Confirm available bone and significant anatomical landmarkssuch as blood vessels, nerves and concavities. Use conventional diagnostictools such as radiographic imaging, probing and palpation.


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Bone extensions anchored in the poresof TiUnite™ as seen after removal of theimplant.

High resolution of the proteins at theconnective tissue-TiUnite™ interface.

Bone growth on the TiUnite™ Surface(SEM at 8.5 months of healing; human histology). Courtesy of Dr Peter Schüpbach and DrRoland Glauser

Immediate Function™

The Immediate Function™ procedure with Nobel Biocare implants is clinically proven, and success rates are equivalent to or better thanthose of conventional implant protocols*. The results from studiesshow that Immediate Function™ is possible in all oral regions.

Inclusion/Exclusion Criteria• Good gingival/periodontal/periapical status of adjacent teeth• Favorable and stable occlusal relationship• No apical disorder/inflammation at the implant site• Good bone volume and density• No pronounced bruxism

As with any procedure, it is the responsibility of the healthcareprovider to determine the benefits and risks of Immediate Function™,compared with delayed loading for a given patient and implant site.

The following points should be considered when performing thetreatment:

High initial implant stabilityDifferent bone qualities and quantities and preparation techniquesinfluence the level of stability. Implants should be well anchored inthe bone and should be able to withstand a tightening torque of35–45 Ncm without further rotation.

Controlled loadsReduce potential load factors such as cantilevers, lateral occlusal contact, unstable occlusion and severe bruxism. Splinted implantsare preferred to non-splinted ones.

Osseoconductive implant surfacesThe TiUnite™ surface on Nobel Biocare Implants has been shown to support the healing process and better maintenance of the initial implant stability than machined titanium implants. TiUnite™ is a highly osseoconductive surface and is recommended for ImmediateFunction™.

Post-surgery and oral hygieneThe post-surgery follow-up is the same as for any surgery in the area.Antibiotics on the day of surgery and some days post-surgery may beindicated.

Final restorationThe final restoration may be placed after individual clinical considera-tions, mainly depending on tissue healing.

* Abstracts of studies are available at www.nobelbiocare.com


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step-by-step laboratory procedure

The surgeon and/or restorative dentist needs to work with the labo-ratory technician to assure all the surgical and prosthetic requirementsare considered.

Note: Medical responsibility for planning and treatment remains that ofthe clinician

Wax up

• Make a diagnostic wax up to determine location and size of replacement teeth and when possible, try to use fixed prostheticsfor aesthetics, phonetics and function. The gingival margins of thewax up must be on the gingival and be approximately by the sizeof the Guided Sleeve.

• When the wax up is completed, use a sharp instrument to mark theplaster cast on the facial gingival margin of the wax up on theabutment teeth. This will serve as a reference mark for placing theGuided Sleeves NOBELDIRECT®. The sleeve should be placed on thelingual edge of this reference mark.

• Duplicate the diagnostic wax up.

• Remove the wax up and place the Guided Sleeves as described below.

Rules for placing Guide Sleeve NOBELDIRECT® on the edentulous areas;

• Never relieve the cast under the sleeve and/or in pontic areas; i.e.,always place the Guided Sleeve on the highest peaks of tissue atthe implant site.

• When possible, place at least three sleeves on each side of the arch.

Placing Guided Sleeves

Place Guided Sleeve NOBELDIRECT® on the reference marks made onthe wax up.

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Placing Guided Sleeves (continued)

• If teeth are to be extracted and immediate implants placed, theteeth to be extracted should be ground off 1 mm below the high-est papillae and a Guided Sleeve NOBELDIRECT® of appropriate sizeplaced into this space.

Note: Save the papillae

Achieving proper angulation

• To check parallelism, insert a Guided Laboratory Drill Guide NOBELDIRECT® ∅ 2 mm in each sleeve and place a Guided FixationPin NOBELDIRECT® 2 × 15 mm in the Laboratory Drill Guide so parallelism can be obtained.

• Use hard setting wax to hold the sleeves in place.

Surgical Template

• A Surgical Template can now be made to include all sleeves. Be certain to use as many stable landmarks as possible to stabilizethe surgical template in the patient’s mouth (i.e., palate, vestibule,ridges, occlusals of remaining teeth).

Note: Do not make a facial flange on the Surgical Template in edentu-lous areas. This will allow the surgeon to reflect a facial flap if needed toprotect the facial tissue from drills.

• Secure the top flange of the Guided Sleeve in acrylic.

• When necessary, send the patients for a CT scan with surgical template in patient's mouth to check available bone for primary stability of implant.

Note: Facial bone is a minor factor for primary stability.

• Make adjustments of sleeves, if needed.


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Pin placement

• Place the Surgical Template on the model and use the Guided Laboratory Drill Guide NOBELDIRECT® ∅ 2 mm to drill a holethrough the guide and into the plaster the full depth of a Twist Drill w Tip.

• Repeat this procedure for each of the sleeves.

Guided Abutment Replica

• Remove Surgical Template from model. Place a Guided Fixation Pin NOBELDIRECT® 2 × 15mm in each of the holes.

• Place the correct size of Guided Abutment Replica NOBELDIRECT®

over each Guided Fixation Pin.

Note: The Guided Abutment Replica is 0.5 mm larger in diameter thanimplant to be placed, to allow room for relining material.

Wax out undercut

• Secure the Guided Abutment Replica in place when seated on thehighest peak of tissue with hard wax and wax out any apical under-cut that exist below the Laboratory Abutment.

Note: Don’t extend wax out beyond the apical size of the Guided Abutment Replica.

• Duplicate this model

15

Products you need

Guided Sleeve NOBELDIRECT®

Guided Abutment Replica NOBELDIRECT®

Guided Fixation Pin NOBELDIRECT® 2 × 15 mm

Twist Drill w Tip

Guided Laboratory Drill Guide NOBELDIRECT®

Provisional Restoration

• The provisional should be finished to the gingival margin of theplaster cast rather than to the apical part of the abutment. Thiswill provide the best aesthetics and phonetics when inserted inpatient’s mouth.

• The duplicate model made from the original wax-up can be used to facilitate fabrication of the provisionals.

• Remember function, phonetics and aesthetics are all of the utmostconcern.

• Clean the Surgical Template and the provisional(s) and send to the clinic.


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Step by Step Surgical Procedure

• Medical responsibility for planning and treatment remainsthat of the clinician. It is the responsibility of the clinicianto check and verify that the implant position on the model,in relation to radiographs and clinical measurements.

• The Surgical Template should be disinfected according tonormal procedures for non-autoclavable products.

• Components for NobelGuide™ NOBELDIRECT® are designed togive correct height measurements when used on 2 mmsoft tissue thickness. When used in conjunction with othersoft tissue thicknesses this has to be compensated for inthe planning and setup of the surgical guide.

Check Surgical Template

Place Surgical Template over edentulous areas and check forsecure and positive fit. Alter or reline if necessary, becausethe final placement of implants and provisional will dependon the accuracy of the fit of the Surgical Template

Important: Procedure describes drill protocol and placementfor NobelDirect® Groovy RP 4.3 × 13 mm. Refer to page 6 forcorrect drill depths and drill sequences according to the lengthand diameter of implant.

Drill ∅ 22 mm Pilot Hole

• Place a Guided Drill Guide NOBELDIRECT® ∅ 2 mm in onesleeve, on each side of the surgery guide, if placing bilateralimplants.

Note: If space is limited for the Guided Drill Guides, use GuidedLaboratory Drill Guides. Extra attention should be paid to theneed to secure these small items in position in the guide sleevewith some wax or similar.

• Use Twist Drill w Tip ∅ 2 × 10–15 mm and drill the 15mm drill line through the soft tissue and into the alveolarbone.

Anchoring Surgical Template

• Place a Guided Fixation Pin NOBELDIRECT® 2 × 15 mm intobone in each of the pilot holes to hold the surgical template secure while the other pilot holes are drilled.

• Drill ∅ 2 mm for each remaining sleeves.

step-by-step surgical procedure

Flapless

17

Tissue Punch

• Remove the Surgical Template, place the correct sized Tissue Punch Guide from the NobelDirect® Kit in the pilotholes and cut the gingival incisions using the correspon-ding Tissue Punch. Repeat for all pilot holes.

Caution: If there is a compromise in the width of the alveolarridge on the facial which would cause the facial gingival to becompromised with the Soft Tissue Punch, make an incisionmesial-distal through the middle of the pilot hole and reflect asmall facial flap. Once the flap is reflected, place an elevator be-tween the tissue and the Soft Tissue Punch Guide so that thetrephine only cuts the lingual tissue and not the facial.

Note: When this procedure is necessary, you must relieve theflange on the Surgical Template so the flap can also be protect-ed during the preparation of the osteotomy and placement ofthe implant.

Tissue Plug

• Use a 15C blade to cut around the punch cuts to assureyou have reached the alveolar bone and remove the tissueplugs. Repeat for all areas.

Anchoring Surgical Template

• Replace Surgical Template and secure with Guided DrillGuide ∅ 2 mm and Fixation Pin 2 × 15 mm on both sides,if applicable.

Note: If space is limited for the Guided Drill Guides, use Guided Laboratory Drill Guides. Extra attention should be paidto the need to secure these small items in position in the guidesleeve with some wax or similar.

800 rpmHigh speed


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Drill ∅ 2.8 mm Hole

• Place the Guided Drill Guide NOBELDIRECT® ∅ 2.8 mm intoeach sleeve and drill the 2.8 mm osteotomy to proper depthwith your Twist Step Drill 2.4/2.8 × 7–18 mm. Refer topage 6 for correct depth measurements.

800 rpmHigh speed

Drill Tapered

• Drill all osteotomies, except for the sleeves holding theSurgical Template in place, using Drill Tapered ∅ 4.3 mm.

• When drilling the osteotomy, the top of the hub on thedrill must be flush with the top of the sleeve to have theproper depth

Note: Refer to page 8 for correct drill sequence according to diameter of implant.

800 rpmHigh speed

OPTIONAL- Dense Bone Drills

• Dense Bone Drill Tapered is only needed for 13 mm.

• Drill one pass through the Surgical Template into the prepared site.

Dense Bone Protocol

In dense or locally dense bone, Dense Bone Drills andScrew Tap may be required.

800 rpmHigh speed

19


OPTIONAL – Screw Taps

• Remove the Surgical Template.

• Place Screw Tap Tapered into prepared implant site usinglow speed (25 rpm).

• Apply firm pressure and begin rotating the screw tapslowly. When threads engage, allow screw tap to feedwithout pressure.

For 8 mm implants, proceed to first height marking. For10 and 13 mm implants proceed to second height marking.See Product Reference Line on page 8 for correct depthmeasurments.

• Switch hand piece to reverse mode and back screw tap out.

Max 45 NcmLow speed

Implant Placement

• Connect the Implant Driver NOBELDIRECT® RP/WP/6.0

• Place implants in all positions through the sleeves. Do notexceed 45 Ncm.

• The top of the abutment must be no more than 1.5 mmextending above the top of the sleeve for proper verticalplacement. This will secure the surgery guide for the remaining osteotomies and implant placements.

• Remove the Guided Fixation Pin and drill the remaining osteotomies as described before and place the remainingimplants.

Removal of Surgical Template

• Once all implants are in position, remove the surgeryguide and suture any facial flaps that were reflected.

Max 45 NcmLow speed

10, 138

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Prosthetic Procedure – Temporization

• Try in the provisional and grossly check the occlusion.

• Reline the inside of the provisionals and insert over the implants. Make sure the patient closes in centric relation occlusion while the reline material sets.

• Remove the provisional and trim the excess reline.

• Replace the provisional and recheck occlusion. Adjust if necessary.

Products you need

Guided Drill Guide NOBELDIRECT® ∅ 2 mm

Twist Drill w Tip 2 × 7–15 mm

Guided Drill Guide NOBELDIRECT® ∅ 2.8 mm

Twist Step Drill 2.4/2.8 × 7-15 mm

Drill Tapered ∅ 4.3 mm

Guided Fixation Pin NOBELDIRECT® 2 × 15 mm

Handle for Guided Drill Guide

21

Quick Check Step by Step

1. Check fit of Surgical Template

2. Place (1) Guided Drill Guide NOBELDIRECT® ∅ 2 mm orGuided Laboratory Drill Guides on each side of arch ifpossible

3. Use Twist Drill w Tip ∅ 2 to place hole through the tissueand into the alveolar bone

4. Place a Guided Fixation Pin NOBELDIRECT® 2 × 15 mm ineach pilot hole to secure the Surgical Template

5. Make rest of the pilot holes

6. Remove the Surgical Template

7. Place Tissue Punch Guide in pilot hole, use Tissue Punchto cut gingival incision and remove tissue plug

8. Replace Surgical Template and secure with (1) GuidedFixation Pin NOBELDIRECT® 2 × 15 mm in each side

9. Place a Guided Drill Guide NOBELDIRECT® ∅ 2.8 mm in aSleeve and drill 2.8 mm Pilot Hole using Twist Step Drill2.4/2.8 10-18 mm

10. Repeat this in all locations, except those securing theSurgical Template

11. Drill osteotomies in each Sleeve. If dense bone is encountered, use Dense Bone Drill through sleeveand/or remove Surgical Template and use Screw Tap

12. Place implant(s) to secure Surgical Template

13. Remove Guided Fixation Pins and Guided Drill Guidesfrom securing sites

14. Use Guided Drill Guide NOBELDIRECT® ∅ 2.8 mm to drill2.8 mm Pilot Hole

15. Drill remaining osteotomes and place implants

16. Remove Surgical Template and try in provisional

Quick Check Step by Step

22

Prepless MarginsPrepless prosthetics is possible on NOBELDIRECT® Groovy. A margincan be created on the dye without preparation of the gingivalmargin. The final restoration can be made with knife-edge mar-gins by using Procera® Crowns Zirconia and for parallel implantsProcera® Bridge Zirconia.

Retraction cords• Use a double retraction cord technique

• Place a 0.5 mm cord first, only 1.5 mm beneath the marginalgingiva 360° around the implant.

• Then place a 0.7–1 mm cord on top of the 0.5 mm cord, flushwith the gingival margin 360° around the implant.

• Round off sharp corners on top of implant.

Note: If needed, make alteration for esthetics and anti-rotationallocking (planes) before the impression is taken.

Impression• Wait for 5 minutes; remove only the largest retraction cord.• Take the impression, before removing the smaller cord.• Remove the smaller cord.

Laboratory Procedure• Fabricate a stone model as for any crown impression.• Ditch out dies using the small retraction cord as guideline for

the apical margin of the crown. • Ditch out die no deeper than 0.5 mm and with a minimum

length of 1.5 mm, to facilitate scanning procedure.• Use a Procera® Scanner and order a Procera® Crown Zirconia• Finalize with NobelRondo® Zirconia

Cement Final Restoration

• Remove temporization.• Cement the Procera® Crown Zirconia restoration.

Note! Temporary cementation must not be used.

Recommended Finalization

Anti-rotationallocking

23

NOBELREPLACE™ Tapered Surgery Kit 32300

Includes instruments to perform implant surgery for NP and RP platform.

The NOBELREPLACE™ Tapered Surgery Kit includes following components:

32314 NOBELREPLACE™ Tapered Surgery Kit Box

32244 Drill w Tip Tapered 2 mm

32075 Drill Tapered NP 3.5 × 8 mm

29367 Drill Tapered 3.5 × 10 mm



32076 Drill Tapered RP 4.3 × 8 mm

29370 Drill Tapered 4,3 × 10 mm



32089 Screw Tap Tapered NP

32090 Screw Tap Tapered RP

28839 Manual Torque Wrench Surgical

31604 Implant Driver NobRpl NP Short

29508 Implant Driver NobRpl RP Short

29149 Screwdriver Manual Unigrip™ 28 mm

29164 Drill Extension Shaft

32255 Direction Indicator Tapered NP

32256 Direction Indicator Tapered RP

2042 Irrigation Needle

29532 Implant/Prosthetic Organizer

33130 NOBELREPLACE™ Tapered Wall chart

33095 NOBELREPLACE™ Tapered Radiographic Template

29543 Implant Sleeve Holder

29377 Dense Bone Drill Tapered 3.5 × 13 mm




NOBELDIRECT® Kit 32952

appendix I – kits

The NobelDirect® Kit includes following components:

32953 NOBELDIRECT® Kit Box

29634 Drill Guide NP

29635 Drill Guide RP

29636 Drill Guide WP

32674 Drill Guide 6.0

29631 Tissue Punch Guide NP

29632 Tissue Punch Guide RP

29633 Tissue Punch Guide WP

32673 Tissue Punch Guide ∅ 6

29628 Tissue Punch NP

29629 Tissue Punch RP

29630 Tissue Punch WP

32672 Tissue Punch ∅ 6

30942 Implant Driver NOBELDIRECT® NP

30943 Implant Driver NOBELDIRECT® RP/WP/6.0

33074 NOBELDIRECT® Radiographic Template

33131 NOBELDIRECT® Wall chart

24

NOBELDIRECT® Guided Surgery Kit 33234

Drill Guide Handle

The Drill Guides are attached to the Handle for DrillGuides by inserting the ball of the Drill Guides into thetip of the Handle, as indicated in the adjacent picture.The Drill Guide is locked into place by firmly tighteningthe upper part of the handle. Note that the Drill Guide isfree to rotate in the socket of the Handle before it islocked into place, this is to ensure that the Drill Guideand Handle can be positioned in such a way so that itdoes not interfere with other surgical instruments.

Note! Ensure to lock the Drill Guide into place outside of themouth of the patient in order to avoid dropping the DrillGuide into the throat of the patient.

The NOBELDIRECT® Guided Surgery Kit includes following components: Qty

33236 NOBELDIRECT® Guided Surgery Kit Box 1

33218 Guided Drill Guide NOBELDIRECT® NP to ∅ 2 mm 2

33219 Guided Drill Guide NOBELDIRECT® RP to ∅ 2 mm 2

33220 Guided Drill Guide NOBELDIRECT® WP to ∅ 2 mm 2

33221 Guided Drill Guide NOBELDIRECT® NP to ∅ 2.8 mm 1

33222 Guided Drill Guide NOBELDIRECT® RP to ∅ 2.8 mm 1

33223 Guided Drill Guide NOBELDIRECT® WP to ∅ 2.8 mm 1

33224 Guided Drill Guide NOBELDIRECT® WP to RP 1

33230 Guided Fixation Pin NOBELDIRECT® 2 × 15 mm 2

33245 Guided NOBELDIRECT® Depth Reference/Wall Chart 1

32813 Handle for Guided Drill Guide 1

appendix I – kits

25

135˚C/276˚F

Twist drill and Step drills

• Is disposable and should be discarded after use.

Instruments and Reusable Drills

• Devices must be cleaned and sterilized before intraoral usein accordance with established procedures in the hospital,clinic or office.

Principal Cleaning and Sterilization Procedure

• Clean and disinfect instruments and drills in a dishwasher. Alternatively: Disinfect, clean by hand and put in an ultrasonic cleaner.

• Dry instruments and place them in sterilization packets.

• Sterilize instruments using a steam autoclave (follow themanufacturer’s instructions).

Note: It is important to clean the irrigation hole in the drills. Use the 22 gauge needle provided in kit to remove debris. Cleandrills carefully.

Worn-out or damaged drills should be discarded and replacedwith new, sharp drills.

Contra-Angle Cleaning

• Contra-angle must be carefully cleaned immediatelyafter operation.

• Clean first in a washer or under running water. Separatehead from shank, and carefully lubricate both parts.

Alternatively, clean and lubricate in an automatic, purpose-built unit.

• Place disassembled contra-angle in double peel-open bag or in a tray, and autoclave sterilize.

Modified Abutment and Restoration

• If indicated, cleaned and sterilize modified abutments and restorations from the dental laboratory according to commonly accepted procedures for dental laboratory work.

Manual Torque Wrench

Clean parts thoroughly. Allow them to dry completely.Sterilize in a stem autoclav at 135°C for minimum hold time of 5 minutes or as recommended in the manufacturer’s instructions.

appendix II – cleaning and sterilization

26

product catalog

33234 NobelDirect® Guided Surgery KitIncludes instruments for NP, RP and WP implants

33236 NOBELDIRECT® Guided Surgery Kit Box

33218 Guided Drill Guide NOBELDIRECT® NP to ∅ 2 mm

33219 Guided Drill Guide NOBELDIRECT® RP to ∅ 2 mm

33220 Guided Drill Guide NOBELDIRECT® WP to ∅ 2 mm

33221 Guided Drill Guide NOBELDIRECT® NP to ∅ 2.8 mm

33222 Guided Drill Guide NOBELDIRECT® RP to ∅ 2.8 mm

33223 Guided Drill Guide NOBELDIRECT® WP to ∅ 2.8 mm

33224 Guided Drill Guide NOBELDIRECT® WP to RP

33230 Guided Fixation Pin NOBELDIRECT® 2 × 15 mm

33245 Guided NobelDirect® Depth Reference/Wall Chart

32813 Handle for Guided Drill Guide

Implants32635 NOBELDIRECT® Groovy NP 3.5 × 10 mm

32636 NOBELDIRECT® Groovy NP 3.5 × 13 mm

32638 NOBELDIRECT® Groovy RP 4.3 × 8 mm



32642 NOBELDIRECT® Groovy WP 5 × 8 mm



NOBELDIRECT® lab components33215 Guided Sleeve NOBELDIRECT® NP

33216 Guided Sleeve NOBELDIRECT® RP

33217 Guided Sleeve NOBELDIRECT® WP

33227 Guided Abutment Replica NOBELDIRECT® NP

33228 Guided Abutment Replica NOBELDIRECT® RP

33229 Guided Abutment Replica NOBELDIRECT® WP

33231 Guided Laboratory Drill Guide NOBELDIRECT® NP to ∅ 2 mm

33232 Guided Laboratory Drill Guide NOBELDIRECT® RP to ∅ 2 mm

33233 Guided Laboratory Drill Guide NOBELDIRECT® WP to ∅ 2 mm

Additional kits/products needed:32300 NOBELREPLACE® Tapered Surgery Kit

32952 NOBELDIRECT® Kit

32297 Twist Drill w Tip 2 × 7–15 mm

32261 Twist Step Drill 2.4/2.8 7–15 mm

32262 Twist Step Drill 2.4/2.8 10–18 mm

27

reference guide

Index in alphabetical order

Description Article Page

AAbutments

Guided Abutment Replica NOBELDIRECT® NP . . . . . . . . .33227 . . . . . . . . . . . . . . . . .14, 26Guided Abutment Replica NOBELDIRECT® RP . . . . . . . . .33228 . . . . . . . . . . . . . . . . .14, 26Guided Abutment Replica NOBELDIRECT® WP . . . . . . . .33229 . . . . . . . . . . . . . . . . .14, 26

DDrills

Twist Drill w Tip 2 × 7–15 mm . . . . . . . . . . . . . . . . .32297 . . . . . . .6, 8, 15, 16, 20, 26Twist Step Drill 2.4/2.8 7–15 mm . . . . . . . . . . . . . . .32261 . . . . . . . . . . . . .6, 8, 20, 26Twist Step Drill 2.4/2.8 10–18 mm . . . . . . . . . . . . . .32262 . . . . . . . . . . . . .6, 8, 18, 26

Drill GuideGuided Drill Guide NOBELDIRECT® NP to ∅ 2 mm . . . . .33218 . . . . .13, 14, 17, 20, 24, 26Guided Drill Guide NOBELDIRECT® RP to ∅ 2 mm . . . . .33219 . . . . .13, 14, 17, 20, 24, 26Guided Drill Guide NOBELDIRECT® WP to ∅ 2 mm . . . . .33220 . . . . .13, 14, 17, 20, 24, 26Guided Drill Guide NOBELDIRECT® NP to ∅ 2.8 mm . . .33221 . . . . . . . . . . . . . .18, 24, 26Guided Drill Guide NOBELDIRECT® RP to ∅ 2.8 mm . . . .33222 . . . . . . . . . . . . . .18, 24, 26Guided Drill Guide NOBELDIRECT® WP to ∅ 2.8 mm . . .33223 . . . . . . . . . . . . . .18, 24, 26Guided Drill Guide NOBELDIRECT® WP to RP . . . . . . . . . .33224 . . . . . . . . . . . . . . . . .24, 26

Handle for Guided Drill Guide . . . . . . . . . . . . . . . . . .32813 . . . . . . . . . . . . . .20, 24, 26

GGuided Fixation Pin NOBELDIRECT® 2 × 15 mm . . . . . . .33230 . . . . . . . .13, 14, 17, 24, 26

Guided NOBELDIRECT® Depth Reference/Wall Chart . .33245 . . . . . . . . . . . . . . . . .24, 26

Guided SleeveGuided Sleeve NOBELDIRECT® NP . . . . . . . . . . . . . . . . .33215 . . . . . . . . . . . . . .12, 13, 26Guided Sleeve NOBELDIRECT® RP . . . . . . . . . . . . . . . . . .33216 . . . . . . . . . . . . . .12, 13, 26Guided Sleeve NOBELDIRECT® WP . . . . . . . . . . . . . . . . .33217 . . . . . . . . . . . . . .12, 13, 26

IImplants

NOBELDIRECT® Groovy NP 3.5 × 10 mm . . . . . . . . . . . .32635 . . . . . . . . . . . . . . . . . .5, 26NOBELDIRECT® Groovy NP 3.5 × 13 mm . . . . . . . . . . . .32636 . . . . . . . . . . . . . . . . . .5, 26

NOBELDIRECT® Groovy RP 4.3 × 8 mm . . . . . . . . . . . . . .32638 . . . . . . . . . . . . . . . . . .5, 26NOBELDIRECT® Groovy RP 4.3 × 10 mm . . . . . . . . . . . . .32639 . . . . . . . . . . . . . . . . . .5, 26NOBELDIRECT® Groovy RP 4.3 × 13 mm . . . . . . . . . . . . .32640 . . . . . . . . . . . . . . . . . .5, 26

NOBELDIRECT® Groovy WP 5 × 8 mm . . . . . . . . . . . . . . .32642 . . . . . . . . . . . . . . . . . .5, 26NOBELDIRECT® Groovy WP 5 × 10 mm . . . . . . . . . . . . . .32643 . . . . . . . . . . . . . . . . . .5, 26NOBELDIRECT® Groovy WP 5 × 13 mm . . . . . . . . . . . . . .32644 . . . . . . . . . . . . . . . . . .5, 26

KKits

NOBELREPLACE® Tapered Surgery Kit . . . . . . . . . . . . . . .32300 . . . . . . . . . . . . . . . . .23, 26NOBELDIRECT® Guided Surgery Kit . . . . . . . . . . . . . . . .33234 . . . . . . . . . . . . . . . . .24, 26NOBELDIRECT® Guided Surgery Kit Box . . . . . . . . . . . . .33236 . . . . . . . . . . . . . . . . .24, 26NOBELDIRECT® Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32952 . . . . . . . . . . . . . . . . .23, 26

LLaboratory Drill Guide

Guided Laboratory Drill Guide NOBELDIRECT® NP to ∅ 2 mm . . . . . . . . . . . . . . . . . . . .33231 . . . . . . . . . . . . . .13, 14, 26Guided Laboratory Drill Guide NOBELDIRECT® RP to ∅ 2 mm . . . . . . . . . . . . . . . . . . . .33232 . . . . . . . . . . . . . .13, 14, 26Guided Laboratory Drill Guide NOBELDIRECT® WP to ∅ 2 mm . . . . . . . . . . . . . . . . . . . .33233 . . . . . . . . . . . . . .13, 14, 26

Index in article number order

Article Description Page

32261 . . .Twist Step Drill 2.4/2.8 7–15 mm . . . . . . . . . . . . . . . . . . . . .6, 8, 15, 16, 20, 2632262 . . .Twist Step Drill 2.4/2.8 10–18 mm . . . . . . . . . . . . . . . . . . . . . . . . . .6, 8, 20, 2632297 . . .Twist Drill w Tip 2 × 7–15 mm . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6, 8, 18, 2632300 . . .NOBELREPLACE® Tapered Surgery Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23, 2632635 . . .NOBELDIRECT® Groovy NP 3.5 × 10 mm . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5, 2632636 . . .NOBELDIRECT® Groovy NP 3.5 × 13 mm . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5, 2632638 . . .NOBELDIRECT® Groovy RP 4.3 × 8 mm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5, 2632639 . . .NOBELDIRECT® Groovy RP 4.3 × 10 mm . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5, 2632640 . . .NOBELDIRECT® Groovy RP 4.3 × 13 mm . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5, 2632642 . . .NOBELDIRECT® Groovy WP 5 × 8 mm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5, 2632643 . . .NOBELDIRECT® Groovy WP 5 × 10 mm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5, 2632644 . . .NOBELDIRECT® Groovy WP 5 × 13 mm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5, 2632813 . . .Handle for Guided Drill Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20, 24, 2632952 . . .NOBELDIRECT® Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23, 2633215 . . .Guided Sleeve NOBELDIRECT® NP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12, 13, 2633216 . . .Guided Sleeve NOBELDIRECT® RP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12, 13, 2633217 . . .Guided Sleeve NOBELDIRECT® WP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12, 13, 2633218 . . .Guided Drill Guide NOBELDIRECT® NP to ∅ 2 mm . . . . . . . .13, 14, 16, 20, 24, 2633219 . . .Guided Drill Guide NOBELDIRECT® RP to ∅ 2 mm . . . . . . . . .13, 14, 16, 20, 24, 2633220 . . .Guided Drill Guide NOBELDIRECT® WP to ∅ 2 mm . . . . . . . .13, 14, 16, 20, 24, 2633221 . . .Guided Drill Guide NOBELDIRECT® NP to ∅ 2.8 mm . . . . . . . . . . . . . . . .18, 24, 2633222 . . .Guided Drill Guide NOBELDIRECT® RP to ∅ 2.8 mm . . . . . . . . . . . . . . . .18, 24, 2633223 . . .Guided Drill Guide NOBELDIRECT® WP to ∅ 2.8 mm . . . . . . . . . . . . . . . .18, 24, 2633224 . . .Guided Drill Guide NOBELDIRECT® WP to RP . . . . . . . . . . . . . . . . . . . . . . . . .24, 2633227 . . .Guided Abutment Replica NOBELDIRECT® NP . . . . . . . . . . . . . . . . . . . . . . . .14, 2633228 . . .Guided Abutment Replica NOBELDIRECT® RP . . . . . . . . . . . . . . . . . . . . . . . .14, 2633229 . . .Guided Abutment Replica NOBELDIRECT® WP . . . . . . . . . . . . . . . . . . . . . . . .14, 2633230 . . .Guided Fixation Pin NOBELDIRECT® 2 × 15 mm . . . . . . . . . . . . .13, 14, 17, 24, 2633231 . . .Guided Laboratory Drill Guide NOBELDIRECT® NP to ∅ 2 mm . . . . . . . . .13, 14, 2633232 . . .Guided Laboratory Drill Guide NOBELDIRECT® RP to ∅ 2 mm . . . . . . . . .13, 14, 2633233 . . .Guided Laboratory Drill Guide NOBELDIRECT® WP to ∅ 2 mm . . . . . . . .13, 14, 2633234 . . .NOBELDIRECT® Guided Surgery Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24, 2633236 . . .NOBELDIRECT® Guided Surgery Kit Box . . . . . . . . . . . . . . . . . . . . . . . . . . . .24, 2633245 . . .Guided NobelDirect Depth Reference/Wall Chart . . . . . . . . . . . . . . . . . . .24, 26

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