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Inside Dentistry
December 2023
Volume 19, Issue 12

Following Biology to Greater Predictability in Implant Placement

David Lee Hill, DDS, on the Nobel Biocare N1™ system

As an oral and maxillofacial surgeon, a significant portion of my practice is devoted to implant dentistry and working with hard and soft tissues. I am always open to solutions that deliver better outcomes and better experiences for my patients. When I was first introduced to Nobel Biocare's N1 implant system, I was impressed with how the protocol respects the latest biologic data, delivers greater predictability, and provides a less traumatic experience for patients. To me, it was clear that the N1 system was not just about innovation, it was about purposeful innovation.

One of the most appealing aspects of the N1 system is its two-step pilot drilling and site preparation protocol. This protocol begins with the system's pilot drill, the OsseoDirector. Using the OsseoDirector can be thought of as "lining up the bullseye" to establish the desired direction and depth of the implant. The OsseoDirector also has side-cutting flutes, so clinicians can change direction while cutting an osteotomy channel that is specific to the implant.

Next, the OsseoShaper instrument is used to prepare the osteotomy using a low-speed drilling (50 rpm) approach without irrigation, which leads to greater preservation of viable tissues and a more comfortable experience for patients. Patients who have previously undergone the process of conventional osteotomy preparation and later experience the N1 system typically express surprise when the osteotomy is completed because they did not experience the expected discomfort.

By shaping the osteotomy at a low speed with zero irrigation, the OsseoShaper helps to preserve more cells at implant sites. Vital bone chips that fall into the osteotomy when the instrument is reversed capture more autogenous bone, assisting with osseodensification. With this method, we can anticipate higher rates of implant integration, which is an important step in secondary stability and the long-term success of implant-supported restorations.

The torque levels generated with the OsseoShaper guide the rest of the workflow. These also aid in the assessment of the health of the bone and serve as an early indicator of the primary stability that can be achieved, which translates to predictable insertion torque when placing the N1 Implant. Restoratively, the N1 Implant's trioval conical connection is ingenious because it allows prosthetic components to slide into place with high predictability. Furthermore, the N1 Implant is optimized for use with the N1 Base.

It is my belief that the Nobel Biocare N1 system just might usher in a new era of minimally invasive site preparation protocols. By preserving the biology of the implant site, enhancing surgical control, reducing the "zone of death" around osteotomies, and providing clinicians with greater predictability, the N1 system is indicative of where the future of implant dentistry is headed.

David Lee Hill, DDS
Oral and Maxillofacial Surgeon
Chapel Hill, North Carolina

Key Takeaways

1. The N1 system takes a minimally invasive approach to site preparation that reduces trauma and preserves more viable tissues.

2. The OsseoDirector instrument features side-cutting ability and permits greater control over the procedure.

3. The OsseoShaper instrument follows a low-speed, zero-irrigation protocol to help to reduce the "zone of death" created around implant sites by the heat and mechanical damage of conventional drilling practices.

4. By following a protocol that respects the biology of implant sites, the N1 system creates the right conditions (ie, healthy tissues and active osteocytes) for secondary stability and long-term success.

Manufacturer Information

Nobel Biocare

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