Differences between the Nobel Active and Nobel Parallel Conical Connection?

My questions are regarding the Nobel Biocare implant system. I am a fairly experienced with implants, and have worked with Hiossen, Biohorizons, etc, and now I am starting with the Nobel System, mainly the NobelActive and NobelParallel Conical Connection. I have attended an introductory course explaining the various components but still have several questions remaining after using about 50 of these implants. My questions are the following:

1)The NobelActive and NobelParallel Conical Connection have the exact same use for immediate extraction and function. So why have 2 types of implants for the same indication? Which one do you choose and why, in immediate extraction and loading cases?

2)The drill sequence of both these implants is identical. While I do understand using a screw tap in hard bone sequence for the NobelParallel Conical Connection, do you use screw tap in NobelActive also?

3)Do you ever underprepare the osteotomy for a Parallel CC? What I mean by this question Is, does it have any cutting threads at all?

4)In immediate extraction and loading cases, where you have chosen the Parallel CC over the NobelActive (for whatever reason), in case of hard bone, do you end with a screw tap even then? If yes, does it give enough stability/torque to immediately load after screw tapping?

7 Comments on Differences between the Nobel Active and Nobel Parallel Conical Connection?

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mwjdds, ms
I'm a prosthodontist, used both implants for many years. Here's my 2 cents on the restorative end of things: 1) I have noticed more crestal bone loss with the nobel active. I primarily use the active system in the fully edentulous maxillary cases where we are immediately extracting, implanting and provisionalizing, where we need maximum initial stability in soft bone. I like the nobel cc implant for all other situations including fully edentulous healed ridges both maxilla and mandible. The nobel cc implant seems to have less bone remodeling at the crestal bone level and I feel more comfortable with this system when replacing teeth in the esthetic zone or where I hope to have minimal bone remodeling. Also, remember when using a conical connection implant to use original manufacturers components. The seat of the abutment into the conical interface is a key component of the implant/abutment complex (unlike the older flat top designs of the trilobe and external hex). I have seen aftermarket products fracture because they don't fully engage the conical section of the implant and so introduce higher stresses to the walls of the implant, the cone of the abutment and the abutment screw. The nobel conical connection is my favorite nobel system. What a huge improvement over the trilobe system!
Thank you so much for your answer.Im looking for little more specifics for answers to my other questions
sb oms
The two implants have the same connection. The shapes and indications of the implants are completely different, and the drilling protocols are not the same. I've placed hundreds of each. Active implants are designed for high primary stability in extraction sockets (where bone implant contact is minimal. ) They are also for poor density bone. (type 3/4). It is a tapered implant. Designed with a wedge effect and big threads to increase primary stability. The drilling protocol depends on the situation. Extraction sockets need different drill sequences, and poor density bone should be under-drilled (width, not length.) Follow the drill recommendations in the surgical kit. I do not tap immediate extraction preps (except in very rare cases with very dense palatal or lingual bone). If you tap, you will lose your primary stability. The parallel implant is for different indications. In my hands, It is for dense bone. The osteotomy is more demanding for precision. It must be tapped in all but the softest bone. In dense bone, the cortical drill must also be used, or your implant won't completely seat. Again, follow the recommendations on the surgical kit.The lead threads do not really cut. I use it for immediate load all the time, but the same rules regarding primary stability apply. Primary stability in a parallel implant comes from the implant bottoming out in the osteotomy, and the parallel surfaces of the implant contacting the osteotomy walls. If you overdrill a parallel prep, your implant will spin and have little primary stability. I find the osteotomy is a bit more challenging to prepare., and still I sometimes have to remove an implant that will not seat, re-prep, tap, and seat the implant properly. I also like this parallel shape when adjacent tooth roots could be damaged in a narrow site.
Thank you so much for such a well detailed answer.Answers everything.
So what I understand of this is that you don't use the parallel cc for immediate extraction and placements?What if it's a lower molar immediate extraction and placement where you have dense bone,so active is pretty much out,but even using the parallel would be tough as it doesn't cut on its own.So what do you do?And do you use active in the mandible at all? Thanks
sb oms
I don't like immediate bone level lower molar implants. They are very deep, (due to the differing lingual/buccal bone heights) and I don't like having implant/abutment junctions that low. I actually use Straumann tissue level implants in all my lower molar sites (immediate and standard). While some may say this is old fashioned, the incidence of peri-implantitis is almost non-existent. The wide diameter platform makes tissue management easy. I've done many immediate maxillary molars with the active implant. Its a good shape and good design for this procedure.
Greg Kammeyer, DDS, MS, D
Since the conversation drifted to immediate molar implants: The only use I've found for the Trilobe implant is using the 6mm for immediate molars. My referring doctors and I have found that decreases/eliminates proximal food impaction. Much like the others I favor Active in the maxillae and paralleled walled implants in the mandible. I also rarely tap the bone for any of Nobels implants. If I feel I need to tap, I may not drill the tap all the way to the apex, allowing more bone spreading with implant insertion. With dense lingual bone I will modify the cortical prep with a Lindaman burr which helps prevent the implant from drifting into the extraction socket.

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