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The Xeal and TiUltra surfaces from Nobel Biocare have been designed to facilitate integration at all levels of the implant. (Image: Nobel Biocare)

“Science, stability, success”: Dr Graham Carmichael discusses Xeal and TiUltra surfaces

By Nobel Biocare
December 17, 2020

An award-winning clinician, researcher and director at the Brånemark Centre in Perth in Australia, Dr Graham Carmichael is a consultant prosthodontist and an adjunct clinical senior lecturer at the University of Western Australia. He has trained dentists and specialists in implant dentistry since 2006. In this interview, he discusses what he most appreciates about the Xeal abutment surface and the TiUltra implant surface and offers his opinion about their long-term potential.

Dr Graham Carmichael. (Image: Nobel Biocare)

Dr Carmichael, thank you for taking the time to talk to us. Could you please tell us a bit about your professional background?
I’m a prosthodontist and I graduated from the University of Sydney. My dental practice is primarily focused on the surgical and prosthetic components of implant treatment, though I do also conduct non-implant-based treatments. Within the dental practice, we also conduct the analysis of patient treatment outcomes, and this is an area that we’re seeking to expand in the future.

I’m also involved in various research projects relating to dental implants. One paper that I recently submitted to a journal, for example, was centred on survival and complication rates relating to reconstructions with the All-on-4 treatment concept.

When did you first find out about Xeal and TiUltra surfaces? What was it about them that interested you?
With any new product, I always want to assess the scientific evidence before starting non-research-based treatment with my patients. Some preliminary data on Xeal and TiUltra surfaces was published back in early 2019, and I found this really interesting. I started using them shortly afterwards, in April 2019.

Since then, I’ve been using TiUltra implants and Xeal abutments more extensively, and now I’m exclusively using abutments with the Xeal surface for all my full-arch reconstructions which include the All-on-4 treatment concept.

What characteristics of these surfaces most interested you?
The surface chemistry is really interesting. Surface roughness has been a key focus for many years, so it is great for me to gain more insight into how chemical properties can be modified for tissue integration.

I also like the fact that they have both been designed for integration at all levels—not just for osseointegration but also for soft-tissue integration. Having read the research, I appreciate how their characteristics have been designed to benefit my patients in this respect. It gives me confidence in achieving tissue integration, as well as in maintaining soft-tissue height.

The protective layer also keeps the surfaces pristine, which is certainly something that I appreciate and that I believe can benefit my patients.

Do you have confidence in the long-term clinical outcomes of implant treatment conducted with Xeal and TiUltra?
I have great confidence in the system to the point that I’m using only Xeal multi-unit abutments. I’m blessed at the Brånemark Centre to still be seeing some of Australia’s first implant patients from the early 1980s, so witnessing long-term success is especially important to me. These surfaces are still in their early days, but if I had any reservations or concerns at all, I certainly wouldn’t have switched over. I’m confident in the science behind this development, and the early clinical results are promising. We’ve previously seen in other studies that, if we achieve good initial implant outcomes, we can then promote long-term success, and so Xeal and TiUltra surfaces are on the right track from what I can see.

What kind of questions regarding Xeal or TiUltra have you received from trainees?
Probably the most frequently asked question I have encountered is whether the golden hue is sprayed or coated on. It then reassures clinicians when I tell them that it’s the anodisation process that has allowed this warm golden colour to form, rather than any additional material. It’s a happy consequence of using this particular technology to tailor the surface at soft-tissue level.

What do you think of the golden hue of Xeal and of the TiUltra collar?
I definitely see the benefits of this, particularly for patients with thin gingival biotypes who might be more susceptible to dark shadows associated with grey machined implant and abutment surfaces. The golden hue seems to enhance the implant appearance in these areas, to make it more natural looking.

What three words would you use to describe Xeal and TiUltra surfaces?
Science, stability, success.

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