Dental Implant Procedures: The On 1 Concept by Nobel BioCare

David Hudnall

By David Hudnall, DMD

Since Stomadent Dental Laboratory is an exclusive provider of Noble BioCare, I have the privilege of reviewing the types of products that Nobel BioCare has to offer. The On 1 concept is a relatively new one. Maybe you have heard of it and maybe not. If it is new to you, it might be worth exploring it in greater detail. I will share what I know with you.

The idea behind the On 1 concept is to raise the prosthetic platform of the dental implant from the bone level to the level of the soft tissue. By doing this, the tissue is manipulated one time and then allowed to heal and adhere to the On 1 base. Further tissue trauma is avoided because it is not necessary to remove the On 1 base in order to take an impression or deliver the final restoration. How can this be?

Normally when an implant is placed, a healing abutment is attached to the implant at bone level. The tissue is allowed to heal and adapt to the shape of the healing abutment. When an impression is taken, the healing abutment is removed, exposing the top of the implant at bone level again. Then an impression coping is put into place. After the impression, the healing abutment is replaced.

The whole process causes bleeding in many cases. It also causes the tissue to begin healing again only to be interrupted by removing the healing abutment a second time a few weeks later to place the restoration. A lot of tissue manipulation is involved. Each time the tissue is disturbed, bacteria is introduced into the area, the connective tissue is destroyed, and apical migration of the soft tissue may occur. This can affect both the long-term health of the soft tissue and the aesthetic outcome with the final restoration in place.

The On 1 concept is basically a healing abutment that has been sliced horizontally into two separate pieces that attach together. The On 1 base makes up approximately two-thirds of the total height and the cover makes up the remaining one-third. There are two options available: one to work with short aesthetic outcomes and another for long aesthetic outcomes.

The On 1 base is never removed after its initial placement. Only the On 1 cover is removed for placement of an impression coping or for delivery of the temporary crown or final implant crown. Since the cover remains at or very slightly below the tissue level, the problems associated with removing a healing abutment, again and again, does not exist. The tissue remodels around the On 1 base one time, allowing the tissue to remain undisturbed for optimal healing.

If you would prefer to use a totally digital workflow, the On 1 concept offers an IOS cap that serves as digital intraoral scanning abutment. Using this abutment allows for an impression-free restoration to be fabricated by the dental laboratory.

On 1 is a new system. It was introduced to the dental marketplace in 2016. So, are there any independent studies that outline how it behaves clinically? I found one clinical trial that was completed in May 2019 that involved 72 participants. The trial looked at marginal bone loss around the implants and patient satisfaction with function and aesthetics among other factors. After one year, all is well according to the study. But there hasn’t been time to really test to see if Nobel BioCare’s theory actually makes a difference in clinical practice.

By keeping all of the retrievable attachments at or slightly below the tissue level, I wonder if there will be some natural recession of the tissue over time? Will we have the same aesthetic dilemma that we have with porcelain-fused-to-metal crowns? You know the one I am talking about. That ugly dark band that becomes more visible over time as the tissue migrates apically with age. Patients really hate that look. Only time will tell.

Nobel BioCare’s recommends that a primary indication for use of the On 1 concept is thin, friable tissue. They also say that On 1 is appropriate for single tooth replacement or for three-unit bridges and may be utilized with cement or screw-retained restorations, depending upon clinical indications or the preference of the clinician.

Stomadent Dental Lab is known as one of the best dental laboratories to partner with to help you utilize the latest dental implant technology. We stay abreast of emerging techniques as well as improvements to older tried and true methods. Help with your most challenging implant case is only a call or an email away!

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