Surgical procedures

NobelActive®

TiUltra™

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Contents

Introduction 4
Surgical procedure 5
Surgical access 5
Drill sequence 6
Implant insertion 11
Finalization of implant surgery 16
Advanced surgical procedure 17
NobelActive TiUltra 3.0 17
Implant orientation adjustments 18
Stabilization in wide sockets 19
Active placement in extraction sockets 20
Appendices 22
Manual torque wrench 22
Cleaning and sterilization 23

4NobelActive® TiUltra™ Manual // Introduction

Introduction

The scope of this surgical procedures manual is to provide acomprehensive overview of the surgical steps and options
during the placement of NobelActive® TiUltra™ implants.
This surgical procedures manual does not replace theInstructions For Use (IFU).
Please review the Instructions For Use, including Indications forUse, Contraindications, Warnings and Cautions before using the
products.
Instructions For Use are available at ifu.nobelbiocare.com.
For a full list of article numbers and for ordering information,refer to the Product overview – Conical connection implants andprosthetics, available at nobelbiocare.com or contact a Nobel
Biocare representative.

Note: In order to improve readability, Nobel Biocare does not
use ™ or ® in the running text. By doing so, however, Nobel
Biocare does not waive any right to the trademark or registered
mark and nothing herein shall be construed to the contrary.

NobelActive® TiUltra™ Manual // Surgical procedure

Surgical accessStandard flap procedure
Used when it is necessary:– to observe the underlying alveolar bone and adjacentanatomical structures.
– to place bone and/or connective tissue grafts.

Flapless procedure
May be used when:– there is sufficient quantity and quality of alveolar boneand soft tissue.
– it is not necessary to raise a flap to safely direct drilling
procedure in relation to the anatomy.
When using a flapless approach:– Add soft tissue height to drill depth.
– Confirm available bone and significant anatomical
landmarks, such as blood vessels, nerves and concavities.
Use conventional diagnostic tools, such as radiographic
imaging, probing and palpation, and 3D imaging if
indicated.

Warning: Besides the mandatory precautions for any surgery such as asepsis, during drilling in the jawbone, one must avoid
damage to nerves and vessels by referring to anatomical knowledge and preoperative radiographs.

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NobelActive® TiUltra™ Manual // Surgical procedure

Drill sequence

Caution: All instruments and tooling used during proceduremust be maintained in good condition and care must be
taken that instrumentation does not damage implants or othercomponents.
Drills are made of stainless steel with a diamond-like carbon(DLC) coating, which gives them their black color. They areused with external irrigation and are available in three lengths:
7–10 mm, 7–15 mm and 10–18 mm.

0.5 mm
15 mm
13 mm
10 mm

RP 4.3 × 13 mm

7 mm

0 mm

Caution: Twist Drills and Twist Step Drills
extend up to 1 mm longer than the implant
when seated. Allow for this additional length
when drilling near vital anatomical structures(please see the figure above for drillreference lines).
All measurements from the tip of the drill tothe bottom edge of the marking.

1 mm– Use an in-and-out motion and drill the bone for 1–2 seconds.
– Move the drill up without stopping the handpiece motor.
This allows the irrigation to flush away debris.
– Proceed until the desired depth reference line is reached.
– Screw Taps are available for dense bone situations to avoid
excessive torque during implant insertion (max. 70 Ncm for
NP, RP, and WP and 45 Ncm for 3.0 implants).
– Stop drilling if there is no irrigation.
– When using a drill extension shaft, it is important to
supplement cooling at the tip of the drill with manual
irrigation.
– Drills are delivered sterile and are for single use only.
– Screw Taps are delivered sterile and for multiple use.
Re-sterilize according to cleaning and sterilization
guidelines.
Caution: Drills are for single use and must not be
reprocessed. Reprocessing could cause loss of mechanical,
chemical and/or biological characteristics.
Reuse could cause local or systemic infection.
Depth measurement system:
The parallel drills have a true depth measurement system. All
drills and components are marked to prepare the site to thecorrect depth and obtain a secure and predictable position.
Note: The marks on the Twist Drills and Twist Step Drills
indicate actual millimeter lengths and correspond to theimplant collar. Final vertical positioning depends on several
clinical parameters, including esthetics, tissue thickness andavailable vertical space.
When using a flapless approach: Measure soft tissue
thickness with a probe. Add-on soft tissue thickness todrilling depth for correct site preparation.

NobelActive® TiUltra™ Manual // Surgical procedure

Drill protocols according to bone quality*
Recommended to ensure optimized primary implantstability when planning for Immediate Function.
Platform∅ Implant

Soft Bone
Type IV

Medium Bone
Type II-III

Dense Bone
Type I

3.0

∅ 3.0

1.5

2.0

2.0
2.4/2.8

NP

∅ 3.5

2.0
(2.4/2.8)

2.0
2.4/2.8(2.8/3.2)

2.0
2.4/2.8
2.8/3.2

RP

∅ 4.3

2.0
2.4/2.8(2.8/3.2)

2.0
2.4/2.8
3.2/3.6

2.0
2.4/2.8
3.2/3.6(3.8/4.2)

RP

∅ 5.0

2.0
2.4/2.8
3.2/3.6

2.0
2.4/2.8
3.2/3.6
3.8/4.2

2.0
2.4/2.8
3.2/3.6
3.8/4.2(4.2/4.6)

WP

∅ 5.5

2.0
2.4/2.8
3.2/3.6(3.8/4.2)

2.0
2.4/2.8
3.2/3.6
3.8/4.2
4.2/4.6(4.2/5.0)

2.0
2.4/2.8
3.2/3.6
3.8/4.2
4.2/5.0
Screw Tap

Note: All data is stated in mm.
Drills within brackets (- -) denote widening of the cortex only, not drilling to the full drilling depth.

Drilling must proceed at high speed (max. 2000 rpm for Twist
Drills and Twist Step Drills) under constant and profuse
external irrigation by sterile saline at room temperature.
Dense bone considerations
Screw Taps should be used if the standard dense bone
protocol is not sufficient to fully seat the implant without
exceeding the recommended maximum insertion torque(max. 70 Ncm for NP, RP and WP and 45 Ncm for 3.0­implants).

* According to classification by Lekholm U, Zarb GA. Patient selection and preparation.
In: Brånemark PI, Zarb GA, Albrektsson T, editors: Tissue-integrated prostheses:
Osseointegration in clinical dentistry. Quintessence, Chicago, 1985, pp 199-209.

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NobelActive® TiUltra™ Manual // Surgical procedure

Flapless procedure
Choose between the following two options and continue
with the drill sequence on page 9, starting with step 4.

Option A– Drill to the appropriate depth using the Twist Drill with Tip∅ 2 mm. A drill stop can be used.
Maximum speed

2000 rpm

Measure the soft tissue thickness with a probe. Add thistissue thickness to the drilling depth for correct site
preparation. Be aware of anatomical landmarks.

Option B– To facilitate initial soft tissue penetration and creation of acrestal starting point (also after flap preparation), the Precision
Drill can be used before Twist Drill with Tip ∅ 2 mm.
– Drill with the Precision Drill through soft tissue and into thealveolar crest.
Maximum speed

2000 rpm∅ 2 mm10 mm

NobelActive® TiUltra™ Manual // Surgical procedure

Flap procedure
The following illustrations show the drill sequence forNobelActive TiUltra RP 4.3 in medium and dense bone. For otherimplant diameters and bone densities, see page 7. For specificinformation regarding NobelActive 3.0, see page 17.
1 Raise a flap
When using a flap procedure, make an incision and raise a flap.

2 Drill with Precision Drill
To facilitate creation of a crestal starting point, the Precision
Drill can be used before Twist Drill with Tip ∅ 2.0mm.
Maximum speed

2000 rpm

3 Drill with Twist Drill with Tip ∅ 2 mm
Drill to the appropriate depth using the Twist Drill with Tip∅ 2 mm. A drill stop can be used.
Maximum speed

2000 rpm

4 Check osteotomy direction
Check correct direction using Direction Indicator∅ 2.0/2.4–2.8 mm.
– If applicable, take a radiograph to verify correct direction.
– When placing multiple implants, proceed to the next
implant site before continuing to the next drill sequence.

5 Drill with Twist Step Drills– Continue site preparation using Twist Step Drill ∅ 2.4/2.8 mm.
– Check orientation using Direction Indicator ∅ 2.0/2.4–2.8 mm.
– Finalize site preparation using Twist Step Drill ∅ 3.2/3.6 mm.
Maximum speed

2000 rpm

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6 Determine implant length
Use Depth Probe to verify the desired depth has beenachieved (including soft tissue thickness, if applicable).

7 For dense bone only: widen cortex
Widen cortex to full cortex depth using Twist Step Drill∅ 3.8/4.2 mm. Do not drill to full drilling depth.
Maximum speed

2000 rpm

8 Use of Screw Tap in dense bone– Place Screw Tap RP 4.3 into prepared implant site using low
speed (25 rpm).
– Apply firm pressure and begin rotating the Screw Tap slowly.
When the threads engage, allow Screw Tap to feed withoutpressure to defined depth (until all threads on the Screw Tap
have engaged bone).
– Switch the handpiece to reverse mode and back the screw
tap out.
Low speed 25rpm
Please note that the Screw Tap WP 5.5 11.5–15 mm has a
special depth marking indicating the defined depth.

Special depth marking for the Screw Tap
WP 5.5 11.5–15mm

NobelActive® TiUltra™ Manual // Surgical procedure

Implant insertion

1 Unpack implant
Each implant comes in a double sterile packaging: theimplant held in an inner titanium vial (fig. 1) that is packed
in a plastic vial with screw top lid, which acts as the firststerile barrier (fig. 2). The plastic vial with screw top lid ispacked in a blister sealed with a lid, which is the second
sterile barrier (fig. 3). The blister is packed together with an
implant card and patient record labels in a cardboard
box (fig. 4).
The cardboard box and the blister have a printed label withproduct data including diameter and length.
The vial is laser marked with implant data including name,diameter and length (fig. 1). The inner titanium vial cap iscolor coded to identify the implant diameter.
Open the box and ensure implant card and patient recordlabels are removed.
Peel off the sealed blister lid in order to open it and allow
the plastic vial onto the sterile field.
Unscrew the lid and take out the sterile titanium vial, thenlift off the color-coded cap to gain access to the implant.
Record the implant size and LOT number on the patient’s
profile records with the provided peel-off labels available inthe box. After surgery provide the implant card, completedwith the implant information, to the patient to keep for
future reference.

Fig. 1 - Inner vial

Fig. 2 - Plastic vial

Fig. 4 - Cardboard box

Fig. 3 - Blister

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NobelActive® TiUltra™ Manual // Surgical procedure

2 Choose insertion instrument
Depending on the clinical situation and accessibility, there arethree different options for inserting the implant:
A With a NobelActive Manual Torque Wrench Surgical
B With a Surgical Driver
C With a drilling unit and contra-angle

A NobelActive Manual Torque Wrench Surgical– In the anterior region it is recommended to use the manual
surgical driver to facilitate good control during insertion andangulation changes.
– The surgical driver is intended to be used while grasped
with fingertips only to avoid excessive insertion torque.
– It is possible to start the implant insertion manually,using the NobelActive Implant Driver and Surgical
Wrench Adapter.
– For NobelActive 3.0, the NobelReplace Manual Torque
Wrench Surgical or the Manual Torque Wrench Prosthetic
with Surgical Wrench Adapter can also be used, as theyboth have a 45 Ncm marking.
– See page 22 for more information on how to operate theManual torque wrench.

B Surgical Driver

C Drilling unit with contra-angle

3 Pick up implant– Connect the appropriate implant driver to the insertion
instrument.
– Pick up the implant from the titanium vial by applying lightpressure on the implant driver and carefully turning the vial
counterclockwise until the implant driver is fully seated.
The implant drivers have markings to facilitate the insertion of
the driver into the implant.
Make sure that the implant driver is fully seated.

A

B

C

NobelActive® TiUltra™ Manual // Surgical procedure

4 Insert implant– Begin inserting the implant into the osteotomy.
– When using a drilling unit, start inserting the implant using low
speed: max 25 rpm.
Caution: Never exceed insertion torque of 45 Ncm for aNobelActive TiUltra 3.0 implant and 70 Ncm for NobelActive
TiUltra 3.5, 4.3, 5.0 and 5.5 implants. Overtightening an implant
may lead to damage of the implant, fracture or necrosis of thebone site. If a Surgical Driver is used to insert the implant,
special care needs to be taken to avoid over tightening.

Low speed 25 rpm

A

Max. torque 45 Ncm for NobelActive TiUltra 3.0
Max. torque 70 Ncm for NobelActive TiUltra 3.5, 4.3, 5.0 and 5.5

B

C

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NobelActive® TiUltra™ Manual // Surgical procedure

5 Tighten manually– Connect the NobelActive Manual Torque Wrench Surgicalto the Manual Torque Wrench Adapter and place the implantto final depth. See page 22 for more information on how
to operate the Manual torque wrench.
– For Immediate Function, the implant should be able towithstand a final torque of 35–45 Ncm for NobelActive
TiUltra 3.0 implant and 35–70 Ncm for NobelActive TiUltra
3.5, 4.3, 5.0, and 5.5 implants.
– Remove driver with an easy upward motion.
If insufficient stability is attained for Immediate Function, do
not load the implant. Wait for sufficient conventional healing(one- or two-stage approach).
Procedure for implant placement in dense bone:
If the implant gets stuck during implant insertion or the
maximum torque is achieved before fully seated (45 Ncm forNobelActive TiUltra 3.0 or 70 Ncm for NobelActive TiUltra
3.5, 4.3, 5.0, and 5.5):a) Rotate the implant counterclockwise approximately ½
turn enabling use of self-tapping capacity of theimplant; orb) Back out the implant and widen the site with a wider
drill according to drill protocol; orc) Select a NobelActive Screw Tap which matches thediameter of the implant and desired drilling depth(see figure).

Markings for 35, 45 and 70 Ncm.

Place the Screw Tap into the prepared implant site using low
speed (25 rpm).
Apply firm pressure and begin rotating the Screw Tap slowly.
When the threads engage, allow Screw Tap to feed withoutpressure to defined depth.
Switch the drill device with handpiece to reverse mode andback the Screw Tap out.
Continue with implant installation until desired position isachieved using max 45 Ncm insertion torque for NobelActive
TiUltra 3.0 implant or max 70 Ncm for NobelActive TiUltra
3.5, 4.3, 5.0. and 5.5 implants.
Caution: Never exceed insertion torque of 45 Ncm for aNobelActive TiUltra 3.0 implant and 70 Ncm for NobelActive
TiUltra 3.5, 4.3, 5.0 and 5.5 implants.

Drill depth for Screw Taps (fig1 for 3.0, 3.5, 4.3 and 5.0; fig2 and fig3 for 5.5)

NobelActive® TiUltra™ Manual // Surgical procedure

6 Final implant placement– Available abutment margin height needs to be consideredduring the planning of implant placement to assure
appropriate seating depth of the implant relative to theavailable soft tissue thickness and the planned emergence ofthe restoration.
– For maximized esthetic results place the implant between
0 – 1 mm below buccal bone.
– When placing the implant, align one of the black hex
indicators on the implant driver parallel to the buccal wall.
This ensures that one of the flat sides of the hexagon isparallel to the buccal side, ensuring preferred prosthetic
abutment orientation.
– The implant driver has a 3 mm height indicator to facilitate
vertical implant positioning.
– If the implant driver is difficult to remove, slightly rotate it
counterclockwise before lifting it up.

3 mm

{

Hex and height indicators on implant driver

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NobelActive® TiUltra™ Manual // Surgical procedure

Finalization of implant surgery

There are three options for finalizing the implant surgery.

Two-stage delayed function

One-stage delayed function

One-stage Immediate Function

Use Screwdriver Unigrip to connect
a cover screw to the implant. Suture
the tissue flap using the desired
technique.

Use Screwdriver Unigrip to connecta healing abutment to the implant. If
applicable, suture back the soft tissue.

Provisionalize the implant for
immediate esthetics and function,using Nobel Biocare temporary or
final abutments.

If the final restoration is an implant-level NobelProcera Implant Bridge or a non-engaging GoldAdapt Abutment, usea Healing Abutment Bridge to prevent tissue overgrowth on the horizontal implant platform.
NobelActive TiUltra implants are compatible with temporary and final abutments featuring the Nobel Biocare ConicalConnection.
Caution: Please note the NobelActive TiUltra implant platform color is yellow for all implant sizes and does not reflect Nobel
Biocare's platform color-coding.
For a detailed overview of the latest available conical connection restorative options, refer to the Product overview – Conicalconnection implants and prosthetics available at nobelbiocare.com and review their respective Instructions For Use available
at ifu.nobelbiocare.com

NobelActive® TiUltra™ Manual // Advanced surgical procedures

NobelActive TiUltra 3.0

Indications– Lateral incisors in the maxilla– Lateral and central incisors in the mandible– Single-unit applications in the above-mentioned positions
1 Prepare implant site
Prepare the implant site according to drill protocol (see page 7).
2 Pick up implant
Open the implant package and pick up the implant from the innercasing with the implant driver for NobelActive TiUltra 3.0.
3 Place and tighten implant– Insert the implant with low speed, maximum 25 rpm, using drillingmachine or by hand using Manual Torque Wrench Surgical.
– Tighten the implant with an insertion torque of maximum 45 Ncm(see marking on torque wrench). For Immediate Function aminimum installation torque of 35 Ncm is required.
Insertion torque for NobelActive TiUltra 3.0:
Due to the narrow implant diameter and narrow implant abutment
connection the maximum insertion torque for NobelActive TiUltra
3.0 differs from the entire NobelActive TiUltra assortment. The
maximum insertion torque for the 3.0 implant is 45 Ncm and the
maximum prosthetic abutment tightening torque is 15 Ncm.
Caution: Never exceed insertion torque of 45 Ncm for the implantand 15 Ncm prosthetic tightening torque for the abutment screw.
Overtightening of implant may lead to damage of the implant,
fracture or necrosis of the bone site. Overtightening of theabutment screw may lead to screw fracture.
Please refer to Procedure for Implant Placement in Dense Bone on
page 7 for additional information
For NobelActive TiUltra 3.0, the NobelReplace Manual Torque
Wrench Surgical or the Manual Torque Wrench Prosthetic with
Surgical Wrench Adapter can also be used, as they both have a
45 Ncm marking.
4 Temporary restoration
Depending on the surgical protocol of choice, place a cover screw
or abutment and suture.
Caution: All prosthetic components for NobelActive 3.0 must be
tightened to 15 Ncm only using a Screwdriver Machine Unigrip andManual Torque Wrench Prosthetic. Overtightening may lead toscrew fracture.

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NobelActive® TiUltra™ Manual // Advanced surgical procedures

Implant orientation adjustments

The self-drilling capacity of NobelActive TiUltra makes it
possible to change direction of the implant during implant
placement. This helps to facilitate parallelism between
implants and optimize implant placement in the anterior zone.
If a further change in implant alignment is desired after placing
the implant:– Reverse 2–3 turns.
– Start to insert the implant into the new direction as
described previously. Do not exceed 70 Ncm for NP, RP and
WP and 45 Ncm for 3.0 implants.
– Continue the insertion until the implant is fully seated in thedesired position.
If experiencing strong resistance
Excessive torque while inserting the implant must be avoided.
It can cause deformation of the implant or connection andmay result in excessive compression of the bone.
– If strong resistance (max. 70 Ncm for NP, RP and WP and
45 Ncm for 3.0 implants) is encountered at any point during
insertion, rotate the implant counterclockwise approximately½ turn to enable the self-tapping capacity of the implant,
then continue to insert the implant.
– If there is still strong resistance, remove the implant andplace it back into the titanium casing. Widen the implantsite according to the drill protocol or use Screw Tap matching
the diameter of the implant.
Please refer to Procedure for Implant Placement in Dense
Bone on page 14 for additional information

NobelActive® TiUltra™ Manual // Advanced surgical procedures

Stabilization in wide sockets

Due to the special design of the NobelActive TiUltra implant,
it is possible to insert it into underprepared sites allowing thebone condensing feature of the implant to take effect.
– In these situations, a one-stage or Immediate Function
surgical approach is not recommended.
– NobelActive 3.0 implants are not indicated for posterior use.
– NobelActive NP implants are not recommended forposterior use.
Procedure– Drill apically in the extraction socket, using Twist Drill with
Tip ∅ 2 mm or Precision Drill.
– Depending on the diameter of the implant and the bonedensity, continue site preparation following the drill protocol.
– Start inserting the implant into the under-prepared site as
described previously. Do not exceed 70 Ncm. Due to theunique thread design and bone-condensing capacity,
sufficient retention and stabilization may be achieved.
– Bone augmentation may immediately follow implant
placement if indicated.
– Place a cover screw and suture.
If experiencing strong resistance
Excessive torque while inserting the implant must be avoided.
It can cause deformation of the implant or connection andmay result in excessive compression of the bone.
– If strong resistance (max. 70 Ncm for NP, RP and WP
implants) is encountered at any point during insertion,
rotate the implant counter-clockwise approximately 1/2 aturn to enable the self-tapping capacity of the implant, thencontinue to ­insert the implant.
– If there is still strong resistance, remove the implant andplace it back into the titanium casing. Widen the implantsite according to the drill protocol or use Screw Tapmatching the diameter of the implant.
Please refer to Procedure for Implant Placement in Dense
Bone on page 14 for additional information

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NobelActive® TiUltra™ Manual // Advanced surgical procedures

Active placement in extraction sockets

Achieving esthetic results in the anterior can be challenging.
The buccal bone plate is usually very thin and often missing
entirely, and maintaining bone height and soft tissue
architecture requires at least 1.5 mm of bone thickness
buccal to the implant.
In order to achieve the desired results, bone augmentationmust often be performed prior to implant placement. In manycases NobelActive TiUltra simplifies this procedure.
The implant’s ability to self-drill and actively change direction
allows stabilization adjacent to the palatal wall, leaving ample
space for bone augmentation on the buccal aspect.

1 Option: Create starting point
For creation of a starting point in the palatal wall of theextraction socket, use the Precision Drill.
Maximum speed

2000 rpm

2 Prepare implant site
– For maxillary anterior teeth, the objective is to utilize bonepalatal to the remaining socket in the apical 1/3 to ½ forstabilization of the implant. The palatal wall is firstpenetrated from a more perpendicular approach to gain astarting point with either the Precision Drill or the Twist Drill
with Tip ∅ 2 mm.
– Continue to drill with the Twist Drill with Tip ∅ 2 mm while
gradually changing the direction to a more vertical direction.
– Depending on implant diameter and bone density, continue
to drill as described above, following the drill protocol.
When using a flapless procedure, measure the soft tissue
thickness with a probe. Add this tissue thickness to thedrilling depth for correct site preparation. Be aware ofanatomical landmarks.

The tooth is extracted and the socket
is prepared in the regular manner.

NobelActive® TiUltra™ Manual // Advanced surgical procedures

3 Insert implant– Begin inserting the implant at the same angle as for the initial
drilling. Do not exceed 70 Ncm for NP, RP and WP and
45 Ncm for 3.0 implants.
– Continue implant insertion to final position, while graduallychanging the angulation.
If experiencing strong resistance
Excessive torque while inserting the implant must be avoided.
It can cause deformation of the implant or connection andmay result in e
­ xcessive compression of the bone.
– If strong resistance (max. 70 Ncm for NP, RP and WP and
45 Ncm for 3.0 implants) is encountered at any point during
insertion, rotate the implant counterclockwise
approximately ½ turn to enable the self-tapping capacityof the implant, then continue to insert the implant.
– If there is still strong resistance, remove the implant andplace it back into the titanium casing. Widen the implantsite according to the drill protocol or use Screw Tapmatching the diameter of the implant.
Please refer to Procedure for Implant Placement in Dense
Bone on page 14 for additional information

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NobelActive® TiUltra™ Manual // Appendices

Manual torque wrench

For the surgeon, the torque required to place implants
provides insight into the primary stability of the implant.
For restorative procedures, tightening the abutment andprosthetic screws to the recommended torque specifications
will more effectively control screw-joint integrity during
patient function.

Manual Torque Wrench Surgical
Intended for tightening or adjusting implant position.
– Insert Implant Driver Conical Connection.

Use of the Manual Torque Wrench Surgical– Assemble the torque wrench by inserting the implant driver.
– To tighten an implant, adjust the direction indicator sothat the arrow is pointing toward the level arm and rotate
clockwise.
– To loosen an implant, adjust the direction indicator so thatthe arrow is pointing away from the level arm and rotate
counterclockwise.
Warning: If force is applied to the main body of the Manual
Torque Wrench Surgical and not to the lever arm, the applied
torque cannot be measured. High forces may cause overcompression of the bone leading to bone resorption,
especially in case of a thin buccal/lingual marginal bone crest.

The manual torque wrench is a convenient tool for achieving
the desired torque.

NobelActive® TiUltra™ Manual // Appendices

Cleaning and sterilization

Implants
NobelActive TiUltra has been sterilized using irradiation and isintended for single use only. Do not use after the labeledexpiration date.
Warning: Do not use device if the packaging has beendamaged or previously opened.
Caution: NobelActive TiUltra is a single use product andmust not be reprocessed. Reprocessing could cause loss of
mechanical, chemical and/or biological characteristics. Reuse
could cause local or systemic infection.

Twist and Twist Step Drills, Precision Drill and Screw Taps
Twist Drills and Twist Step Drills are delivered sterile and forsingle use only. Screw Taps are delivered sterile and reusable.

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GMT72260 © Nobel Biocare USA, LLC, 2020. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident
from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale.
All product images are for illustration purposes only and may not be an exact representation of the product. Please contact the local Nobel Biocare sales office for current
product assortment and availability.
Caution: Federal (United States) law or the law in your jurisdiction restricts this device to sale by or on the order of a dentist or a physician. See Instructions For Use for fullprescribing information, including indications, contraindications, warnings and precautions.