CLINICAL CASE

Clinical applications ofTiUltra™ implants and Xeal™
abutments in full-arch andindividual restorations

Dr. Nader SalibNader Salib
Patient73 year old, maleClinical situation
Former plastic surgeon and cancer survivor. Currently retired.
Previous fixed bridge work failing. Pt. is very esthetically consciousand desired a fixed, immediate, graftless solution for his maxilla andreplacement of 3 missing mandibular teeth
Surgical solution
Remaining teeth were extracted and infection cleared. 6 maxillary
implants (NobelActive® CC TiUltra™ and 3 mandibular implants(NobelParallel™ CC TiUltra™) were placed. A temporary fixed
prosthesis was delivered the same day.
Restorative solution
A fixed ceramic prosthesis was made for the maxillary arch, seatedon Multi-unit Abutments Xeal™, and screw retained
abutment/crowns were fabricated for the mandibular teeth
Surgery date
Dec. 1, 2020
Total treatment time
4.5 months
Tooth position
Full maxillary arch; #19, #29, #30

Photo courtesy of Nader Salib

Photo courtesy of Nader Salib

Case courtesy of Dr. Nader Salib2Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

Maxillary arch: Multiple decayed, non-restorable teeth. Multiple abscesses in bone.
Mandibular arch: Multiple missing teeth
Photo courtesy of Nader Salib

Photo courtesy of Nader Salib

CBCT: Pano view illustrating clinical situation

Photo showing multiple decayed teeth

Case courtesy of Dr. Nader Salib

3

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

Maxillary arch:

Photo courtesy of Nader Salib

Photo courtesy of Nader Salib

Photo courtesy of Nader Salib

CBCT: Pano view maxillary arch

Intraoral photos demonstrating oral health

Case courtesy of Dr. Nader Salib

4

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

Digital treatment planning with DTX Studio™ Implant software

Photo courtesy of Nader Salib

CBCT

Photo courtesy of Nader Salib

CBCT + Pt’s intraoral scan

Photo courtesy of Nader Salib

Final plan with implants andtemplate shown

Case courtesy of Dr. Nader Salib

5

Initial clinicalsituation

Treatmentplanning

SurgicalprocedureSurgicaloutcome

Temporary
prosthesis

Finalprosthesis

Digital treatment planning with DTX Studio™ Implant software

Photo courtesy of Nader Salib

CBCT

Photo courtesy of Nader Salib

CBCT + intraoral scan

Photo courtesy of Nader Salib

CBCT + intraoral scan +teeth mockup

Photo courtesy of Nader Salib

Final plan with implants
and template shown

Case courtesy of Dr. Nader Salib

6

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

Mandibular arch: 3D view of proposed implant placement with DTX Studio™ Implant software

Photo courtesy of Nader Salib

3D view: All implants planned for screw-retained restorations
with access through central fossa
Case courtesy of Dr. Nader Salib

7

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

Mandibular arch: sagittal view of proposed implant placement (NobelParallel™ CC TiUltra™)

Photo courtesy of Nader Salib#30

Photo courtesy of Nader Salib#29

Photo courtesy of Nader Salib#19
Case courtesy of Dr. Nader Salib

8

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

Planning to execution

Photo courtesy of Nader Salib

Photo courtesy of Nader Salib

Photo courtesy of Nader Salib

Maxillary and mandibular templates shown
respectively.

PO Pano X-ray demonstrating implant placement

Case courtesy of Dr. Nader Salib

9Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

Maxillary ridge reduction

Bony reduction of ridge under irrigation for esthetic and
Photo courtesy of Nader Salib
proper prosthesis design

Case courtesy of Dr. Nader Salib

10

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

Maxillary implant placement

Placement of NobelActive® TiUltra™ implants
Video courtesy of Nader Salib

Video courtesy of Nader Salib

Case courtesy of Dr. Nader Salib

11

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Mandibular implant placement

Photo courtesy of Nader Salib
Video courtesy of Nader Salib

Surgical placement of NobelParallel™ CC TiUltra™ implant
Case courtesy of Dr. Nader Salib12Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

Mandibular implant evaluation

Photo courtesy of Nader Salib

Photo courtesy of Nader Salib

4-month PO view of tissue healing

Intra-op photo of NobelParallel™ CC TiUltra™ implant placement

Case courtesy of Dr. Nader Salib

13

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

4-month PO check – maxillary treatment

4-month PO X-ray demonstrating bone levels with NobelActive® TiUltra™ surface

Photo courtesy of Nader Salib

Case courtesy of Dr. Nader Salib

14

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

4-month PO check – maxillary treatment
Photo courtesy of Nader Salib

Intra-op: Xeal™ Multi-unit Abutment placement

Photo courtesy of Nader Salib

4-month PO evaluation & integration check demonstrating gingival
health around Multi-unit Abutments with Xeal™ surface

Case courtesy of Dr. Nader Salib

15

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

4-month PO check – maxillary treatment
Photo courtesy of Nader Salib

Photo courtesy of Nader Salib

After: 4-month PO evaluation & integration check demonstrating
healthy well healed soft tissue around the Multi-unit Abutments with
Xeal™ surface
Before: Pre-op photo demonstrating gingival health

Case courtesy of Dr. Nader Salib

16

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

Temporary restorative work performed in collaboration with Dr. Dave Eggleston, prosthodontist

Photo courtesy of Nader Salib

Before treatment

Photo courtesy of Nader Salib

After treatment

Case courtesy of Dr. Nader Salib

17

Initial clinicalsituation

Treatmentplanning

Surgicalprocedure

Surgicaloutcome

Temporary
prosthesis

Finalprosthesis

Final restorative work performed in collaboration with Dr. Dave Eggleston, prosthodontist

Photo courtesy of Dave Eggleston

Photo courtesy of Dave Eggleston

Final prosthesis in patient’s mouth – the new NobelProcera® Zirconia implant Bridge

Case courtesy of Dr. Nader Salib

18

Case courtesy of Dr. Nader SalibCopying or reproducing this presentation or any portion thereof without permission is expressly prohibited.
MKT-4930 Rev. 01 (04/21, GMT 74545) © Nobel Biocare USA, LLC, 2021. All rights reserved. Disclaimer: Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in acertain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. Please contact the local Nobel Biocare sales office for current product assortment andavailability. Caution: Federal (United States) law restricts this device to sale by or on the order of a dentist or physician. See Instructions For Use for full prescribing information, including indications, contraindications, warnings and precautions.
Nobel Biocare does not take any liability for any injury or damage to any person or property arising from the use of this clinical case. This clinical case is not intended to recommend any measures, techniques, procedures or products, or giveadvice, and is not a substitute for medical training or your own clinical judgement as a healthcare professional. Viewers should never disregard professional medical advice or delay seeking medical treatment because of something they haveseen in this clinical case. Full procedure is not shown. Certain sequences have been cut.