Procedures manual

NobelParallel™
CONICAL CONNECTION

TiUltra™

The scope of this surgical procedures manual is toprovide a comprehensive overview of the surgical steps
and options during the placement of NobelParallel™
CC TiUltra™ implants. This surgical procedures manual
does not replace the Instructions For Use (IFU). Please
review the Instructions For Use, including Indications
For Use, Contraindications, Warnings and Cautions
before using the products. Instructions for Use areavailable at:
ifu.nobelbiocare.com
For a full list of article numbers and for ordering
information, refer to the Product overview - Conicalconnection implants and prosthetics 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 thetrademark or registered mark and nothing herein shallbe construed to the contrary.
Disclaimer Some products may not be regulatory
cleared, released or licensed for sale in all markets.
Please contact the local Nobel Biocare sales office forcurrent product assortment and availability.

Contents
Introduction 5
Quick guide 6
Implant specifications 8
Surgical procedure 11
Important considerations 12
Surgical access 13
Drill sequence 14
Depth measurement system 16
Screw taps for implant placement for medium and dense bone 17
Dense bone situations 18
Flapless procedure 20
Flap procedure 21
Implant insertion 24
Restorative procedure 29
Important considerations 30
Finalization of implant surgery and temporary restorations 34
Two-stage early/delayed function 35
One-stage early/delayed function 35
One-stage Immediate Function procedures 36
NobelParallel Conical Connection TiUltra WP posterior solution 40
PureSet™ 43
Wallchart 44
Appendices 49
Manual Torque Wrench 50
Cleaning and sterilization 52

4

5

Introduction
Quick guide 6
Implant specifications 8

NobelParallel™ CC TiUltra™ procedures manual

6

NobelParallel™ CC TiUltra™ procedures manual Introduction

Quick guide

Twist Drill with
Tip Ø 2 mm

FlaptechniqueTwist Step DrillØ 2.4/2.8 mm

Twist Step DrillØ 3.2/3.6 mm

Cortical DrillØ 4.3 mmScrew Tap
Ø 4.3 mm optional

Twist Drill with
Tip Ø 2 mm

Flapless
technique
Note The illustrations show the drill sequence forNobelParallel TiUltra Conical Connection RP 4.3 inmedium bone. For other implant diameters and bonedensities, see drill protocols on page 15.

NobelParallel™ CC TiUltra™ procedures manual Introduction

One-stage
Immediate function

Implant
level

One-stage early/
delayed function

Implant
placement
Two-stage early/
delayed function

One-stage
Immediate function

On1 concept/
Multi-unit Abutment

Abutmentlevel

One-stage early/
delayed function

7

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NobelParallel™ CC TiUltra™ procedures manual Introduction

Implant
specifications

Implant

SPECIFICATIONS

C
B A

E

D
G
F

J
I

E

H

NobelParallel™ CC TiUltra™ procedures manual Introduction

NP
3.5

RP
4.3

RP
5.0

WP
5.5

RP
5.0

E

WP
5.5

A

B

C

D

Bevel
heightRimheight

Bevel
angle

Threadpitch

3.75×7 mm

0.1

0.5

45°

1.2

3.75

3.5

6.5

2.0

3.0

3.5

3.75×8.5 mm

0.1

0.5

45°

1.2

3.75

3.5

8.0

2.0

3.0

3.5

3.75×10 mm

0.1

0.5

45°

1.2

3.75

3.5

9.5

2.0

3.0

3.5

3.75×11.5 mm

0.1

0.5

45°

1.2

3.75

3.5

11.0

2.0

3.0

3.5

3.75×13 mm

0.1

0.5

45°

1.2

3.75

3.5

12.5

2.0

3.0

3.5

3.75×15 mm

0.1

0.5

45°

1.2

3.75

3.5

14.5

2.0

3.0

3.5

Platform

NP
3.75

RP
4.3

F

Major
Major
diameter diameter
1
2G*
Overall
length

H

I

J

Tip
Abutment Bridge
diameter interface interface

3.75×18 mm

0.1

0.5

45°

1.2

3.75

3.5

17.5

2.0

3.0

3.5

4.3×7 mm

0.2

0.5

45°

1.2

4.3

4.1

6.5

2.4

3.4

3.9

4.3×8.5 mm

0.2

0.5

45°

1.2

4.3

4.1

8.0

2.4

3.4

3.9

4.3×10 mm

0.2

0.5

45°

1.2

4.3

4.1

9.5

2.4

3.4

3.9

4.3×11.5 mm

0.2

0.5

45°

1.2

4.3

4.1

11.0

2.4

3.4

3.9

4.3×13 mm

0.2

0.5

45°

1.2

4.3

4.1

12.5

2.4

3.4

3.9

4.3×15 mm

0.2

0.5

45°

1.2

4.3

4.1

14.5

2.4

3.4

3.9

4.3×18 mm

0.2

0.5

45°

1.2

4.3

4.1

17.5

2.4

3.4

3.9

5.0×7 mm

0.2

0.6

25°

1.6

5.0

4.7

6.5

2.7

3.4

3.9

5.0×8.5 mm

0.2

0.6

25°

1.6

5.0

4.7

8.0

2.7

3.4

3.9

5.0×10 mm

0.2

0.6

25°

1.6

5.0

4.7

9.5

2.7

3.4

3.9

5.0×11.5 mm

0.2

0.6

25°

1.6

5.0

4.7

11.0

2.7

3.4

3.9

5.0×13 mm

0.2

0.6

25°

1.6

5.0

4.7

12.5

2.7

3.4

3.9

5.0×15 mm

0.2

0.6

25°

1.6

5.0

4.7

14.5

2.7

3.4

3.9

5.0×18 mm

0.2

0.6

25°

1.6

5.0

4.7

17.5

2.7

3.4

3.9

5.5×7mm

0.2

0.6

45°

1.6

5.5

5.3

6.5

3.0

4.4

5.1

5.5×8.5 mm

0.2

0.6

45°

1.6

5.5

5.3

8.0

3.0

4.4

5.1

5.5×10 mm

0.2

0.6

45°

1.6

5.5

5.3

9.5

3.0

4.4

5.1

5.5×11.5 mm

0.2

0.6

45°

1.6

5.5

5.3

11.0

3.0

4.4

5.1

5.5×13 mm

0.2

0.6

45°

1.6

5.5

5.3

12.5

3.0

4.4

5.1

5.5×15 mm

0.2

0.6

45°

1.6

5.5

5.3

14.5

3.0

4.4

5.1

All measurements in mm.. Sectional measurements do not necessarily add up to total length*Please note that actual implant length is 0.5 mm shorter than indicated in name.

9

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11

Surgicalprocedure
Important considerations 12
Surgical access 13
Drill sequence 14
Depth measurement system 16
Screw taps for implant placement for medium and dense bone 17
Dense bone situations 18
Flapless procedure 20
Flap procedure 21
Implant insertion 24

NobelParallel™ CC TiUltra™ procedures manual

12NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

Important considerations
Narrow platform Limited inter-dental space. Not
enough alveolar bone for an RP implant.

Caution Particular caution should be used whenplacing narrow platform implants in the posterior
region due to risk of prosthetic overload.

Regular platform From single anterior tooth loss tofullarch restorations.
Wide platform In molar areas a wider platform might
be appropriate to maintain proper emergence profile
to support the soft tissue.

6.0

3.5

7

7.5

8

4.5

Minimal distances
Approximate minimal distances between implants(in mm) for restorative simplicity taking the average
size of the final restoration (incisors, canines,
premolars and molars) into account.
NP 3.75

NP 3.75

RP 4.3

RP 5.0WP 5.5

NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

Surgical accessStandard flap
procedure

Flapless
procedure

Used when it is necessary:

May be used when:‒ to observe the underlying alveolar bone
and adjacentanatomical structures.

‒ there is sufficient quantity and qualityof alveolar bone and soft tissue.

‒ to place bone and/or connective tissue grafts.

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

Tip When using a flapless approach add
soft tissue height to drill depth.
Warning Besides the mandatory precautions for any
surgery such as asepsis, during drilling in the jaw bone,
one must avoid damage to nerves and vessels byreferring to anatomical knowledge and preoperative
radiographs.

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NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

Drill sequence

sequence
DRILL

Demonstration of
the drill protocol for aØ 4.3 × 13 mm implantin soft, medium anddense bone.

Soft
bone
Precision Drill(optional)

Twist Drill
Ø 2.0

Twist
Step DrillØ 2.4/2.8

Twist StepDrill
Ø 3.2/3.6(optional)

Precision Drill(optional)

Twist DrillØ 2.0

Twist Step
Drill
Ø 2.4/2.8

Twist StepDrill
Ø 3.2/3.6

Cortical DrillØ 4.3

Screw Tap
Ø 4.3
(optional)

Implant
4.3 × 13

Precision Drill(optional)

Twist DrillØ 2.0

Twist Step
Drill
Ø 2.4/2.8

Twist StepDrill
Ø 3.2/3.6

Cortical DrillØ 4.3

Screw Tap
Ø 4.3

Implant
4.3 × 13

Implant
4.3 × 13

Medium
bone

Dense
bone

NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

Recommended drill sequencebased on bone quality*
During drilling proceduresbone quality should beconsidered. Recommended
drill sequences are basedon bone quality to ensure
optimal primary stability
when applying One-stage
Immeduate Function
procedures. Drills are used to
the full drilling depth.
Drilling must proceed at highspeed (max. 2000 rpm for
Twist Drills and Twist Step
Drills) under constant andprofuse irrigation by sterile
saline at room temperature.

Platform

Soft boneType IV

Medium boneType II–III

Dense boneType I

2.0[2.4/2.8]

2.0
2.4/2.8
Cortical Drill 3.75
[Screw Tap 3.75]

2.0
2.4/2.8
2.8/3.2
Cortical Drill 3.75
Screw Tap 3.75

RP
4.3

2.0
2.4/2.8[3.2/3.6]

2.0
2.4/2.8
3.2/3.6
Cortical Drill 4.3[Screw Tap 4.3]

2.0
2.4/2.8
3.2/3.6
Cortical Drill 4.3
Screw Tap 4.3

RP
5.0

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
Cortical Drill 5.0[Screw Tap 5.0]

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

2.0
2.4/2.8
3.2/3.6
4.2/4.6[4.2/5.0]

2.0
2.4/2.8
3.2/3.6
4.2/5.0
Cortical Drill 5.5[Screw Tap 5.5]

2.0
2.4/2.8
3.2/3.6
4.2/5.0
Cortical Drill 5.5
Screw Tap 5.5

NP
3.75

WP
5.5

Note All data are in mm and the drills within square brackets denoted as optional.

Preparation of osteotomy

Optional Drills‒ In dense bone situations, drill with
continuous back and forth motion.

The drill protocol has been developed to achieve an
implant insertion torque between 35 and 45 Ncm
for all bone densities. This is to ensure sufficient
primary stability to enable immediate function whereappropriate.

‒ Move the drill up without stopping
the handpiece motor. This allows theirrigation to flush away debris.

‒ Screw taps are available for dense bonesituations to avoid excessive torque during
implant insertion (max. 45 Ncm).

If bone density is inconsistent (varying between
medium and soft or medium and dense bone), optional
drills can be added to the drill protocol to ensure thetorque level does not exceed 45 Ncm. These optional
Twist Step Drills and Screw Taps are denoted above inparentheses.

Tip

Caution‒ Stop drilling if there is no irrigation.

Never exceed insertion torque of 45 Ncm for the
implants. Overtightening an implant may lead todamage of the implant, fracture or necrosis of thebone site.

‒ Proceed until the desired depth
reference line is reached.

‒ In situations where adjacent natural teeth
interfere with the contra-angle head andprevent the drill from reaching the desired
depth, a drill extension shaft may be used.
‒ Drills and Screw Taps are delivered sterile andare for single use only. Do not resterilize.

* According to classification by Lekholm U, Zarb GA. Patient selection andpreparation. 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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NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

Depth measurement system

15 mm

15 mm

13 mm

13 mm

10 mm

10 mm

7 mm

7 mm

0 mm

0 mm

1 mm

The parallel drills have a true depth measurement
system. All drills and components are marked toprepare the site to the correct depth and obtain asecure and predictable position.
Drills are available for implant lengths (laser marks)of 7–10, 7–15 and 10–18 mm. The correct diameter andlength of the drills are indicated on the label.
Note This surgical procedures manual does not replace
the Instructions For Use (IFU). Please review theInstructions For Use, including Indications For Use,
Contraindications, Warnings and Cautions before
using all products.

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.
Note The marks on Twist Drills and Twist Step Drills
indicate actual millimeter length and correspond to
the implant collar. Final vertical positioning depends on
several clinical parameters, including esthetics, tissue
thickness and available vertical space.

Twist Drills
Twist Drills are made of stainless steel with an amorphous diamond coating, which gives them their black color.
They are used with external irrigation and are available in three lengths: 7–10, 7–15 and 10–18 mm.

NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

Screw taps for implant placement
for medium and dense bone

NP
3.75

13 mm

13 mm

13 mm

10 mm

10 mm

10 mm

10 mm

7 mm

7 mm

7 mm

7 mm

RP
4.3

Note In situations where adjacent natural teeth
interfere with the contra-angle head and prevent thedrill from reaching the desired depth, a drill extension
shaft may be used.

RP
5.0

WP
5.5

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NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

Dense bone situations
GeneralIn cases of a thick cortical layer or dense bone a
Cortical Drill and/or a Screw Tap is mandatory to beable to get the implant fully seated and to releasepressure around the implant neck.
Select the Cortical Drill and/or use Screw Tapmatching the diameter of the implant.

Use of a Cortical Drill
To avoid compression around the implant neck,proceed with drilling at high speed max. 2000 rpm
and drill to appropriate depth (see page 16).
Note It is not recommended to use a cortical drill forsinus lift procedures. This is in order to maximize thepotential for primary stability.
Courtesy of Dr. Claude Authelain, France

Use of a Screw Tap
If a Screw Tap is used, place the screw tap into
prepared implant site using low speed 25 rpm anddrill to appropriate depth. Switch the drill device
with handpiece to reverse mode and remove theScrew Tap (see page 16).
Note When the depth marking of the screw tap isaligned with the implant length the apical portion
is not pre-tapped to allow direct engagement in theapical portion.
Courtesy of Dr. Claude Authelain, FranceNobelParallel™ CC TiUltra™ procedures manual Surgical procedure

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NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

Flapless procedure
Choose between the following two options andcontinue with the drill sequence on page 21,
starting with step 3.

Option A‒ Drill to the appropriate depth using the Twist
Drill with Tip Ø 2 mm. A drill stop can be used.
Maximum speed 2000 rpm
Note Measure the soft tissue thickness with the Depth
Probe. Add this tissue thickness to the drilling depth
for correct site preparation. Be aware of anatomical
landmarks.

Option B‒ To facilitate initial soft tissue penetration andcreation of a crestal starting point (also after
flap preparation), the Precision Drill can beused before Twist Drill with Tip Ø 2 mm.
‒ Drill with the precision drill through soft
tissue and into the alveolar crest.
Maximum speed 2000 rpm

Ø 2 mm10 mm

NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

Flap procedure
The following illustrations show the drill sequence for­NobelParallel Conical Connection TiUltra RP 4.3 inmedium and dense bone. For other implant diameters
and bone densities, see page 15.

1 Raise a flap
When using a flap procedure, make an incision andraise a flap.

2 Drill with Precision Drill (optional)
To facilitate creation of a crestal starting point, thePrecision Drill can be used before Twist Drill with
Tip Ø 2.0 mm.
Maximum speed 2000 rpm

3 Drill with Twist Drill with Tip Ø 2 mm
Drill to the appropriate depth using the Twist Drill with
Tip Ø 2 mm. A drill stop can be used.
Maximum speed 2000 rpm

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NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

4 Check osteotomy direction (optional)
Check correct direction using Direction IndicatorØ 2.0/2.4–2.8 mm.
Note‒ If applicable, take a radiograph to verify correct direction.
‒ When placing multiple implants, proceed to the next
implant site before continuing to next drill sequence.

5 Drill with Twist Step Drills (optional)‒ Continue site preparation using Twist
Step Drill Ø 2.4/2.8 mm.
‒ Check orientation using Direction Indicator Ø 2.0/2.4-2.8 mm.
‒ Continue site preparation using Twist Step Drill Ø 3.2/3.6 mm.
Maximum speed 2000 rpm

6 Drill with Cortical Drill
Finalize site preparation using appropriate Cortical Drill.
Note‒ In cases of a thick cortical layer or dense bone a
Cortical Drill and/or a Screw Tap is mandatory
to be able to get the implant fully seated and torelease pressure around the implant neck.
‒ It is not recommended to use a Cortical Drill
for sinus lift procedures in order to maximize
the potential for primary stability.
Maximum speed 2000 rpm and drill to appropriate depth
For more information about the use of a Cortical Drill, pleaserefer to page 18.

NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

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

8 Use of Screw Tap in dense bone
‒ In cases of a thick cortical layer or dense bone a
Cortical Drill and/or a Screw Tap is mandatory
to be able to get the implant fully seated andto release pressure around the implant neck.
‒ Place appropriate Screw Tap into
prepared implant site using low speed toappropriate reference line of implant.
‒ When the threads engage, allow Screw Tap
to ­feed without pressure to defined depth.
‒ Switch the handpiece to reverse modeand back the Screw Tap out.
‒ Continue with implant installation
until desired position achieved usingmax. 45 Ncm installation torque.
Low speed 25 rpm
For more information about the use of a Screw Tap,
please refer to page 18.

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NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

Implant insertion
1 Unpack implant
Each implant is packaged in a double sterile vial
system. The outer package has a printed label withproduct data including diameter and length. Its cap
is color-coded to identify the implant diameter. The
inner casing is also marked with implant diameterand length.
‒ Pull the red tab to disengage the plastic
shrink-rap film and unscrew the color-coded lid.

a) Inner vialb) Plastic vialc) Blister‒ Take out the sterile inner casing and lift off
the plastic cap to gain access to implant.
‒ Record the implant size and LOT number
on the patient’s chart with the twopeel-off labels from the outer vial.
d) Implant carde) Patient record labelsf) Cardboard box

The color of the implantvial cap refers to thediameter of the implant.

NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

2 Choose insertion instrument
The implants are ideally installed with low speed, max.
25 rpm, using a drilling device.
a) Drilling unit with contra-anglea) With a drilling unit and contra-angleb) With Manual Torque Wrench Surgical (optional)
Note It is possible to start the implant insertion
manually, using the Manual Torque Wrench.

b) Manual Torque Wrench SurgicalCaution Never exceed insertion torque of 45 Ncm
for the implants. Overtightening an implant may
lead to damage ­of the implant, fracture or necrosisof the bone site. If a Surgical Driver is used to insert
the implant, special care needs to be taken to avoid
overtightening.

3 Pick up implant
Connect the appropriate Implant Driver to theinsertion instrument.
Pick up the implant from the inner casing by applying
light pressure on the implant driver and carefully
turning the casing counter-clockwise until the Implant
Driver is fully seated.
Tip The Implant Drivers have markings to facilitate theinsertion of the driver into the implant.

Tip Make sure that the Implant Driver is fully seated.

a)

b)

25

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NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

4 Machined implant placement‒ Begin inserting the implant into the osteotomy.
‒ When using a drilling unit, start inserting
the implant using low speed.
Low speed 25 rpm / Max. torque 45 Ncm
Note‒ Caution Never exceed insertion torque of 45 Ncm
for the implants. Overtightening an implant
may lead to damage of the implant, fractureor necrosis of the bone site. If a Surgical Driveris used to insert the implant, special careneeds to be taken to avoid overtightening.
‒ Caution If the implant gets stuck during implantinstallation or 45 Ncm of insertion torque isachieved before it is fully seated, rotate the implant
counterclockwise using drilling device (reversemode) or Manual Torque Wrench and remove
the implant from site. Replace the implant backinto the inner casing before proceeding further.
‒ Use Screw Tap to widen the osteotomy as outlined
in step 8 (page 23) of the drill section.
‒ Pick up and insert the implant again as
outlined in steps 3 and 4 above.

NobelParallel™ CC TiUltra™ procedures manual Surgical procedure

5 Manual implant placement

If experiencing strong resistance‒ Connect the Manual Torque Wrench Surgicalto the Manual Torque Wrench Adapter
and place the implant to final depth.

Excessive torque while inserting the implant must be
avoided. It can cause deformation of the implant orconnection and may result in excessive compressionof the bone.

‒ For immediate function, the implant shouldwithstand a final insertion torque of atleast 35 Ncm. Do not exceed 45 Ncm.
‒ Remove Implant Driver.
‒ If the Implant Driver is difficult to remove, slightly
rotate it counter-clockwise before disengagaing.

If strong resistance (max 45 Ncm) is encountered at
any point during insertion, remove the implant andplace it back into the inner casing. Widen the implantsite ­according to the drill protocol or use Screw Tapmatching the diameter of the implant.

Markings for 15 Ncm, 35 Ncm
and 45 Ncm.

6 Final implant placement (optional)‒ For maximum esthetic results, place the implant on
the level of the buccal bone or 0.5 – 1 mm below (A).
‒ When placing the implant, align one of the blackhex indicators on the implant driver parallel to the
buccal wall. This ensures that one of the flat sidesof the hexagon is parallel to the buccal side (B),ensuring preferred prosthetic abutment orientation.

Note The implant driver has a 3 mm height indicator
to facilitate vertical implant positioning and six
black lines correlating to the flat sides of the implanthexagon (C).

Hex indicators

3 mm

a)

b)

c)

27

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29

Restorative
procedure
Important considerations 30
Finalization of implant surgery and temporary restorations 34
Two-stage early/delayed function 35
One-stage early/delayed function 35
One-stage Immediate Function procedures 36
NobelParallel Conical Connection TiUltra WP posterior solution 40

NobelParallel™ CC TiUltra™ procedures manual

30

NobelParallel™ CC TiUltra™ procedures manual Restorative procedure

Important considerations
Prosthetic interface‒ Dual-function prosthetic connection: internal
conical connection for abutments and external
platform for implant-level bridge restorations.
‒ Built-in platform shift

Conical seal for abutments

Multiple-unit restorations
When restoring with a NobelProcera Implant Bridge, or
any other full-arch solution, Healing Abutments Bridge
and Impression Copings Bridge must be used forplacement, uncovering and impression taking.

Impression coping seating
Proper seating of the impression coping is essential fora correct impression.
To verify that the impression copings are properly
seated, check that the groove on the impression coping
sits right at the level of the implant shoulder. Use aperpendicular radiograph if necessary.

Shoulder seating forNobelProcera Implant Bridge

NobelParallel™ CC TiUltra™ procedures manual Restorative procedure

Abutment seating
Correct positioning of the abutment is essential for theprosthetic outcome and long-lasting function. Verify
correct vertical abutment seating by using radiographic imaging.
‒ Position the abutment into the implant headand make sure the hexagonal extension engages
properly by gently turning and pushing.

2.3 mm<1 mm‒ Make sure the abutment feels secure inplace horizontally and vertically.
‒ Tighten the screw, but not to full torque.
‒ Take a radiograph to verify properand full abutment seating:‒ No apparent bone interference‒ Alignment of long axes of implant and abutment‒ No gap in conical interface‒ Space at the bottom of the connection should
appear parallel and measure less than 1 mm.
‒ Tighten the abutment screw to final
torque. Tightening torque for NP, RP
and WP abutments is 35 Ncm.
Note This surgical procedures manual does not replace
the Instructions For Use (IFU). Please review theInstructions For Use, including Indications For Use,
Contraindications, Warnings and Cautions before
using all products.

Final abutment position
with space less than 1 mm

31

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NobelParallel™ CC TiUltra™ procedures manual Restorative procedure

Reference images show NobelActive®. Same applies to NobelParallel CC TiUltra.

Example 1

Abutment not fully seated due to interfering bone. Long axes are notaligned. Gap in conical interface. Bottom space is not parallel and islarger than 1 mm.

Abutment fully seated. All above parameters are verified.

Example 2

Abutment seems to be aligned with implant but space is larger than 1  mm.

Abutment is fully seated.

NobelParallel™ CC TiUltra™ procedures manual Restorative procedure

33

34

NobelParallel™ CC TiUltra™ procedures manual Restorative procedure

Finalization of implant surgery
and temporary restorations

There are three options for finalizing the implant surgery.

Two-stageearly/delayed
functionOne-stageearly/delayed
functionOne-stage
Immediate
Function

Use Screwdriver UniGrip to connect
a cover screw to the implant.
Suture the tissue flap using thedesired technique.

Place the On1 Base Xeal andconnect the On1 Healing Cap
to it. Or connect a healing
abutment directly to the implant.
If applicable, suture back thesoft tissue.

Provisionalize the implant for
immediate esthetics and function,using Nobel Biocare On1 Temporary
Abutments or implant-leveltemporary abutments.

For further information on
this option, please check theOn1 concept Quick guide

Note If the final restoration is an implant-level NobelProcera Implant Bridge, non-engaging Universal Abutment
or non-engaging GoldAdapt Abutment, use a Healing Abutment Bridge to prevent tissue overgrowth on thehorizontal implant platform.

NobelParallel™ CC TiUltra™ procedures manual Restorative procedureTwo-stage early/delayed function
1 Uncover the implant‒ Make an incision to expose the cover screwor use the Soft Tissue Punch if there is asufficient amount of attached mucosa.
‒ Remove the cover screw using a
Screwdriver Manual ­Unigrip.

2 Remove bone overgrowth‒ In cases of bone growing over the cover screw,
remove the bone with a rotating instrument
and/or a curette. Be careful not to damage theseating for the Screwdriver Manual Unigrip.
‒ After removing the cover screw, remove any
bone around the implant platform that willhinder an abutment being fully seated on theimplant platform. This is often the case when
the implant has been placed below the bone
crest. For bone removal, use the Bone Mill Guide
and Bone Mill for the corresponding platform.
‒ The Bone Mill can be handled either
manually (with the handle for machine
instruments) or with the drilling ­machine.

One-stage early/delayed function
1 Connect healing abutment‒ Connect a suitable healing abutment to theimplant using the Screwdriver Manual Unigrip.
‒ If a flap is prepared, suture back the soft tissue.
Alternative If possible, connect the final abutmentusing corresponding screwdriver.

35

36

NobelParallel™ CC TiUltra™ procedures manual Restorative procedureOne-stage Immediate
Function procedures
Implant level,
temporary single-unit restoration
The following illustrations show the use of the
Temporary Snap Abutment Engaging (for single-unit
restorations).

1 Connect abutment to implant‒ Attach the abutment onto the implant,
check inter-occlusal space and adjust forheight and clearance if necessary.
‒ Modifications of the abutment can be
performed with a carborundum disk or carbide
bur using copious irrigation. Extraoral modification of abutment is recommended.
‒ Place the abutment onto the implant and block
the screw channel. Do not insert the screw, as theabutment is retained by the retention elements.

2 Fabricate the temporary crownconventionally (Option A)‒ Using the acrylic mold, create the temporary
crown, filling it with dental acrylic or composite
material, and seat it over the temporary abutment.
‒ Follow the material manufacturer’s
instructions regarding curing.
‒ Finalize the restoration following the conventional procedure. It is important to have a smoothsurface adjacent to the surrounding soft tissue.
‒ Create the screw access hole using the Apical
Drill and Protection Analog/Drill Guide.
OR

Provisionalization must be done in Immediate Function
cases and is also a common option to altering the soft
tissue after a healing abutment has been used (softtissue management).

NobelParallel™ CC TiUltra™ procedures manual Restorative procedure

2 Fabricate the temporary crownwith a TempShell (Option B)‒ Use a TempShell to convert it into an individualized
provisional restoration designed prior to surgery.
‒ Try-in the fit of the temporary crown seating
the wings on the neighboring teeth.
‒ Apply small amount of acrylic or composite into
the crown and reposition it in the patient’s mouth.
‒ Let the acrylic or composite cureand pick up the restoration.
‒ Finalize the crown by filling the shell with theacrylic/composite, remove the wings and polishthe restoration. It is important to have a smoothsurface adjacent to the surrounding soft tissue.
‒ Create the screw access hole using the Apical
Drill and Protection Analog/Drill Guide.

3 Connect temporary restoration‒ Connect the restoration and tighten it to 35 Ncm
using the clinical screw and Screwdriver UniGrip.
‒ Block the screw access hole using Teflon
tape and close it with composite.
‒ Fill the screw access hole with suitable material.
Tip The recommended tightening torque ismax. 35 Ncm.
Caution Never exceed the recommended maximum
tightening torque for the abutment screw.
Overtightening of the abutment may lead to ascrew fracture.

37

38

NobelParallel™ CC TiUltra™ procedures manual Restorative procedure

Implant level,
temporary multiple-unit restoration
The following illustrations show the use of the
Temporary Abutment Non-Engaging (for multiple
splinted restorations). For individual implants, use
engaging abutments.

1 Connect abutments to implants‒ Attach the abutments onto the implants andadjust for height and clearance if necessary.
‒ Fasten the abutments with guide pinsthat extend beyond the occlusal planewith the Screwdriver Manual UniGrip.
Note Abutment screw is included with the abutment.
The guide pin (available in two lengths: 20 mm[standard length] and 30 mm) has to be orderedseparately.

2 Fabricate the temporary bridge
using a TempShell (Option A)‒ Use a TempShell to convert it into an individualized
provisional restoration designed prior to surgery.
‒ Try-in the fit of the temporary bridge seating
the wings on the neighboring teeth.
‒ Apply a small amount of acrylic or composite into
the bridge and reposition it in the patient’s mouth.
‒ Let the acrylic or composite cureand pick up the restoration.
‒ Finalize the bridge by filling the shell with theacrylic/composite, remove the wings and polishthe restoration. It is important to have a smoothsurface adjacent to the surrounding soft tissue.
‒ Create the screw access hole using the Apical
Drill and Protection Analog/Drill Guide.
OR

Provisionalization must be done in Immediate Function
cases and is a common option for altering the soft
tissue after a healing abutment has been used (softtissue management).

NobelParallel™ CC TiUltra™ procedures manual Restorative procedure

2 Make acrylic template (Option B)‒ Fabricate the template from acrylic orcomposite for chairside ­temporization.
‒ Make access holes to allow guide pins to protrude.
‒ If the laboratory has made a prefabricatedprovisional bridge, make access holes to allow
the guide pins to protrude (if not alreadydone) and adjust it to the abutments.
‒ Fill template with acrylic or composite andseat it over the temporary abutments.

3 Adjust temporary restoration‒ After seating, loosen the guide pins
to remove the restoration.
‒ Trim and polish the restoration. It is
important to have a smooth surface
adjacent to the surrounding soft tissue.

4 Connect temporary restoration‒ Connect the provisional restoration withthe supplied abutment screws.
‒ Tighten to 35 Ncm using Manual Torque Wrench
Prosthetic and Screwdriver Machine UniGrip.
‒ Fill the screw access holes with suitable material.

35 Ncm39

40

NobelParallel™ CC TiUltra™ procedures manual Restorative procedure

NobelParallel Conical Connection
TiUltra WP posterior solution
Temporary single-unit restoration,
cement-retained (chairside procedure)
The following illustrations show the use of
the Temporary Abutments Anatomical PEEK
(available for Wide Platform only). Please see also
Instructions For Use for Anatomical PEEK Healing/Temporary Abutment.
Indications

Provisionalization

Temporary Abutments Anatomical PEEK are indicatedfor use with single-unit and multiple-unit cementretained temporary dental prostheses placed on
endosseous dental implants in the maxilla andmandible, for up to 180 days.

Provisionalization must be done in Immediate Function
cases and is also a common option for altering the soft
tissue after a healing abutment has been used (softtissue management).

1 Connect abutment to implant and modify ifnecessary, outside of the patient mouth‒ Select appropriate temporary abutment andcheck interocclusal space. Height and gingival
margin may be adjusted by the use of rotary
instrument (e.g. carbide or acrylic bur).
‒ Cut a small axial ‘flat’ or ‘groove’ into thetemporary abutment to assure correct positionof temporary crown during cementation.
‒ Attach the abutment onto the implant andtighten with the Screwdriver Manual Unigrip.
Note The recommended tightening torque is 35 Ncm.
Caution Never exceed the recommended maximum
tightening torque for the abutment screw.
Overtightening of the abutment may lead to ascrew fracture.

NobelParallel™ CC TiUltra™ procedures manual Restorative procedure

2 Block the screw access hole
‒ Place a resilient material of choice (gutta-percha,
silicone or temporary filling material) into the screw
access hole and fill the remaining channel withcomposite or another material of choice. This allows
for easy access to the abutment screw in the future.
‒ Apply a separating solution onto theplastic abutment in preparation for
fabricating the temporary crown.

3 Fabricate temporary crown‒ Try-in the shell crown and modify
following conventional procedures.
‒ Fill the shell crown with acrylic inpreparation for doing a reline.
‒ Remove the excess acrylic andpolish modified areas.

4 Cement the temporary crown
Make final adjustments, polish and secure withtemporary cement.
Caution In a fresh/open wound, avoid getting any
cement below the soft tissue or remove it carefully.
Consider using rubber dam or other options to prevent
excess cement.

41

42

43

PureSet™
Wallchart 44

NobelParallel™ CC TiUltra™ procedures manualWallchart

10-18 mm
Ø 2.4/2.8 (#3) 32262
Ø 2.8/3.2 (#4) 34639
Ø 3.2/3.6 (#5) 32265
Ø 3.8/4.2 (#6) 32277
Ø 4.2/4.6 (#7) 34583

7–15 mm
Ø 2.4/2.8 (#3) 32261
Ø 2.8/3.2 (#4) 34638
Ø 3.2/3.6 (#5) 32264
Ø 3.8/4.2 (#6) 32276
Ø 4.2/4.6 (#7) 34582
Ø 4.2/5.0 (#8) 37876

Screwdriver
Manual UniGrip 28 mm
29149*

Direction Indicator
32112

NobelParallel™ CC TiUltra™ procedures manual PureSet™

7–10 mm
Ø 2.4/2.8 (#3) 32260
Ø 2.8/3.2 (#4) 37873
Ø 3.2/3.6 (#5) 32263
Ø 3.8/4.2 (#6) 32275
Ø 4.2/4.6 (#7) 37874
Ø 4.2/5.0 (#8) 37875

Twist Step Drills

Twist Drills
Ø 2.0(7–10) 32296
Ø 2.0 (7–15) 32297
Ø 2.0(10 –18) 32299

44

Depth Probe 7-18 mm
37791

Precision Drill
36118

Bone Mill (with Guide) CCNP Ø4.4 37863
NP Ø5.2 37864
RP Ø5.2 37866
RP Ø6.2 37867
WP Ø6.7 37869

Bone Mill Guide CC
NP 37865
RP 37868
WP 37870

NobelActive®/
NobelParallel™ CC
PureSet™ Tray
PUR0200

Drill Extension Shaft
29164

NobelParallel™ CC TiUltra™ procedures manual PureSet™

NobelReplace Manual
Torque Wrench Surgical
28839

Cortical Drill
NP 3.75 38000
RP 4.3 38001
RP 5.0 38002
WP 5.5 38003

Implant Driver WP
28 mm 37859
37 mm 37860

Implant Driver RP
28 mm 36720
37 mm 36721

Implant Driver NP
28 mm 36718
37 mm 36719

Screw Tap
NP 3.75 (7-13) 37990
NP 3.75 (7-18) 37991
RP 4.3 (7-13) 37992
RP 4.3 (7-18) 37993
RP 5.0 (7-13) 37994
RP 5.0 (7-18) 37995
WP 5.5 (7-10) 37996
WP 5.5 (7-15) 37997* Available in other lengths

45

46

NobelParallel™ CC TiUltra™ procedures manual PureSet™

NobelParallel™ Conical Connection PureSet™

87295(The articles below can also be purchased individually)
NobelActive /NobelParallel CC PureSet Tray

PUR0200

Implant Driver Conical Connection NP 28 mm

36718

Implant Driver Conical Connection NP 37 mm

36719

Implant Driver Conical Connection RP 28 mm

36720

Implant Driver Conical Connection RP 37 mm

36721

Implant Driver Conical Connection WP 25 mm

37859

Implant Driver Conical Connection WP 37 mm

37860

Screwdriver Manual Unigrip™ 28 mm

29149

Drill Extension Shaft

29164

Direction Indicator Ø2/Ø2.4–2.8 mm (4x)32112

Implant/Prosthetic Organizer

29532

NobelReplace® Manual Torque Wrench Surgical

28839

Depth Probe 7–18mm Z-shaped

37791

Implant Sleeve Holder

29543

NobelParallel™ CC Radiographic Template

37792

NobelActive / NobelParallel CC PureSet Wall Chart

300565Note Drills and Screw Taps are available for separate purchase and are notincluded in the kit.

Bone Mill with Guide Conical Connection(To be accommodated in the PureSet™)
Bone Mill with Guide Conical Connection NP Ø4.4

37863

Bone Mill with Guide Conical Connection NP Ø5.2

37864

Bone Mill with Guide Conical Connection RP Ø5.2

37866

Bone Mill with Guide Conical Connection RP Ø6.2

37867

Bone Mill with Guide Conical Connection WP Ø6.7

37869

For more information regarding the product portfolio
see the ‘Product Overview - Conical Connection
Implants & Prosthetics’.

48

49

Appendices
Manual Torque Wrench 50
Cleaning and sterilization 52

NobelParallel™ CC TiUltra™ procedures manual

50

NobelParallel™ CC TiUltra™ procedures manual Appendices

Manual Torque Wrench
For the surgeon, the torque required to place implants
provides insight into the primary stability of theimplant. For restorative procedures, tightening theabutment and prosthetic screws to the recommended
torque specifications will more effectively control
screw-joint integrity during patient function.

Manual Torque Wrench – Surgical
Manual Torque Wrenches Surgical are indicated for use
with Nobel Biocare dental implant drivers to ensurethat the desired torque is achieved during implant
placement. They are also indicated to be used withimplant retrieval instruments and abutment screw
retrieval instruments. Manual Torque Wrenches
Surgical can be used as an alternative to machine
torque wrenches.
‒ Indicating torque values 15 Ncm and 35 Ncm‒ Insert Implant Driver Conical Connection

Manual Torque Wrench – Prosthetic
Manual Torque Wrenches Prosthetic are indicatedfor use with Nobel Biocare abutments and abutment
screws to ensure that the desired torque is achieved
during placement or removal of the abutment or
screw. Manual Torque Wrenches Prosthetic can beused as an alternative to machine torque wrenches.
‒ Indicating torque values 15 Ncm and 35 Ncm‒ Compatible with all machine screwdrivers.
‒ Insert the applicable driver

NobelParallel™ CC TiUltra™ procedures manual Appendices

Use of the Manual Torque Wrench Surgical‒ Select the corresponding Manual Torque
Wrench Adapter Surgical and insert the corresponding Implant Driver into the adapter.
‒ To tighten an implant̵ Twist the knob to ensure that the arrow ispointing in clockwise direction before tightening.
̵ Rotate the wrench clockwise as far as possible,
and then release the handle in counterclockwise direction (indicated by noise of ratchet)‒ To loosen an implant, adjust the direction indicatorin the reverse (counter clockwise) direction. Pull
the knob and simultaneously rotate it so that thearrow is pointing counter clockwise direction.
Note Using the wrench body instead of the level arm
may result in excessive torque being transferred to thescrew and/or implant site.

Max
45 Ncm51

52

NobelParallel™ CC TiUltra™ procedures manual Appendices

Cleaning and sterilization
Sterile components

Refer to the Instructions For Use (IFU1078) for
NobelParallel CC TiUltra for detailed cleaning andsterilization instructions.
ifu.nobelbiocare.com
Note Implants must never be resterilized or reused.

Implants
Implants are delivered sterile, are for single use only,
and must be used prior to the labeled expiration
date. Do not use implants if the packaging has beendamaged or previously opened.
Warning Do not use device if the packaging has beendamaged or previously opened.
Caution NobelParallel CC TiUltra implants are
single use products and must not be reprocessed.
Reprocessing could cause loss of mechanical, chemical
and / or biological characteristics. Re-use could cause
cross contamination.

Twist and Twist Step Drills, Precision
Drill and Screw Taps
Twist Drills and Twist Step Drills are delivered sterileand for single use only. Screw Taps are delivered sterile
and reusable.
Note This surgical procedures manual does not replace
the Instructions For Use (IFU). Please review theInstructions For Use, including Indications For Use,
Contraindications, Warnings and Cautions before
using all products.

NobelParallel™ CC TiUltra™ procedures manual AppendicesNon-sterile components
Caution Care and maintenance of instruments
are crucial for a successful treatment. Sterilized
instruments not only safeguard your patients andstaff against infection but are also essential for theoutcome of the total treatment.
Refer to the Instructions For Use for pureset for
detailed cleaning and sterilization instructions.
ifu.nobelbiocare.com

Abutments and plastic copings
Refer to the Instructions For Use for the abutment
or coping for detailed cleaning and sterilization
instructions.
ifu.nobelbiocare.com
Note If any temporary abutment or coping is modified
after initial cleaning and sterilization, the device must
be cleaned and sterilized again prior to intraoral use.

53

Order online
Order our complete range of
implants and prefabricatedprosthetics 24 hours a day throughthe Nobel Biocare online store.
store.nobelbiocare.com/us/en

Order by phone
Contact your sales representative
or call our customer service team.
800 322 5001

Lifetime warranty
The warranty covers all Nobel
Biocare implants including prefabricated prosthetic components.
nobelbiocare.com/warranty

nobelbiocare.com/en-us/nobelparallel
MKT-5123 Rev 00 (03/22, GMT 79289) © Nobel Biocare USA, LLC, 2022. 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 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.
Some products may not be regulatory cleared/released for sale in all markets. 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.