Implant-Level Impression, Laboratory Fabrication, and Insertion of a Full-Arch Maxillary Telescopic TRINIA® Prosthesis on Three Universal Abutments and Retentive Copings in Only Two Restorative Visits

Posted on November 12, 2019 in Integrated Abutment Crowns™, SHORT® Implants

This treatment demonstrates the full-arch implant-level impression, laboratory fabrication, and insertion of a full-arch maxillary telescopic TRINIA® prosthesis supported by only two 4.0 x 6.0mm Bicon SHORT® Implants, and one 5.0 x 6.0mm Bicon SHORT® Implant in only two clinical visits, with a chairside reline of the prosthesis and using three prefabricated Retentive Copings.

17-Year Follow Up for Two Immediately Loaded Maxillary Central Incisors

Posted on October 16, 2019 in Extraction, Immediate Placement, Immediate Stabilization and Function, Integrated Abutment Crowns™, Restorative, Surgical

This case demonstrates the extraction of two failed endodontically-treated maxillary central incisors, the immediate surgical placement and stabilization of two 5.0 x 8.0mm Bicon SHORT® Implants, and their subsequent restoration with two Integrated Abutment Crowns™ (IACs). This case also includes 6-year and 17-year follow-up radiographs and clinical images demonstrating not only impressive long-term bone maintenance, but also superior gingival aesthetics that last.

Three-Year Radiographic Evaluation of the Placement of a 4.0 x 6.0mm Bicon SHORT® Implant Without Grafting and With Subsequent Bone Gain

Posted on July 24, 2019 in Integrated Abutment Crowns™, Restorative, SHORT® Implants

Radiographs of a 72-year-old male’s treatment demonstrate the placement of a 4.0 x 6.0mm Bicon SHORT® Implant without grafting and with subsequent bone gain after 34 months. The restoration of the mandibular right central incisor features a 19.5mm-long Integrated Abutment Crown™ (IAC) with a Crown-to-Implant Ratio (CIR) of 3.25 to 1.

Two-Stage Placement of a 5.0 x 6.0mm Bicon SHORT® Implant for a Maxillary Left Second Premolar and its Restoration with an Integrated Abutment Crown™ (IAC)

Posted on July 1, 2019 in Integrated Abutment Crowns™, Restorative, SHORT® Implants, Surgical, Two Stage, Uncovering

This treatment demonstrates the two-stage placement of a 5.0 x 6.0mm Bicon SHORT® Implant for a maxillary left second premolar, the making of its full arch implant-level transfer impression, and its restoration with an Integrated Abutment Crown™ (IAC).

Two-Stage Placement of a 4.5 x 8.0mm Bicon SHORT® Implant for a Maxillary Right Central Incisor Five Months After Grafting a Large Buccal Defect with SynthoGraft™

Posted on February 25, 2019 in Integrated Abutment Crowns™, Restorative, SHORT® Implants, Surgical, Two Stage

This treatment demonstrates the two-stage placement of a 4.5 x 8.0mm Bicon SHORT® Implant for a maxillary right central incisor five months after grafting a large buccal defect and using SynthoGraft™, a Collagen Membrane, and a Collagen Plug. Also shown is the making of a full arch implant-level transfer impression and the subsequent restoration of the implant with an Integrated Abutment Crown™ (IAC).

One-Stage Placement of a 5.0 x 8.0mm Bicon SHORT® Implant for a Maxillary Left First Molar and its Restoration with an Integrated Abutment Crown™ (IAC)

Posted on February 14, 2019 in Integrated Abutment Crowns™, One Stage, Restorative, SHORT® Implants, Surgical

This treatment demonstrates the placement of a 5.0 x 8.0mm Bicon SHORT® Implant for a maxillary left first molar using the one-stage surgical technique, the restoration with a full arch implant-level transfer impression, and the insertion of an Integrated Abutment Crown™ (IAC).

Two-Stage Placement of a 5.0 x 6.0mm Bicon SHORT® Implant with an Internal Sinus Lift Procedure using Guided Surgery for a Maxillary Right First Molar and its Restoration with an Integrated Abutment Crown™ (IAC)

Posted on January 10, 2019 in Integrated Abutment Crowns™, Restorative, SHORT® Implants, Surgical, Two Stage

This treatment demonstrates the two-stage placement of a 5.0 x 6.0mm Bicon SHORT® Implant with an internal sinus lift procedure using guided surgery for a maxillary right first molar and its restoration with an Integrated Abutment Crown™ (IAC). Guided surgery designed for a 5.0 x 5.0mm Bicon SHORT® Implant was used to minimize the risk of sinus perforation and expedite the placement of the 5.0 x 6.0mm Bicon SHORT® Implant with an internal sinus lift procedure. The osteotomy was deepened using incrementally longer Guided Surgery Reamers through the orifice of a 5.0mm Guide Ring until the length of the intended implant was achieved. The top of the Guide Ring is designed to be 12.0mm above the top of the implant when the implant is placed 2.0 to 3.0mm below the alveolar crest of bone.

Guide for Digitally Fabricated Crowns

Posted on December 28, 2018 in Integrated Abutment Crowns™

The fabrication of a digital crown for a Bicon implant begins by achieving a digital image of a virtual or tangible prosthetic model with a Bicon Implant Analog or Universal Abutment Transfer Die. The model can be achieved digitally by the preferred method of intraorally scanning a 2.0mm, 2.5 mm, or 3.0mm white Scan Post seated in the well of an implant. The following link provides a video with an explanation of the clinical techniques for intraoral scanning using a Scan Post, as well as making implant-level and abutment-level conventional transfer impressions: VIDEO » Immediate Placement and Restoration of a Maxillary First Molar with an Extra-Orally Cemented Lithium Disilicate Crown

[1-9] Once the digital scan file has been secured and entered into either the 3Shape or exocad design software, the appropriate Universal Abutment file can be selected from the CAD software’s digital abutment library to commence the designing of the crown.

[10-13] When designing, be cognizant of the minimum dimensions indicated by the intended material’s manufacturer, as well as their recommended post-milling treatment of their material. The designed STL file can then be sent to a milling machine for fabrication.

[14-17] Commonly used materials for digital crowns are Hybrid Ceramics, such as Enamic by Vita, Shofu Block HC Hard by Shofu, IPS e.max (a lithium disilicate ceramic), and Zirconia. Although a crown may be fabricated without a physical model, it may be more practical for those unfamiliar with digital dentistry to have a physical model to facilitate their confirming or adjusting the crown’s interproximal and occlusal contacts.

[18-19] Our preference is to use the Shofu Block HC Hard, since it can be readily modified chairside, either by reduction or addition, on the day of its insertion or any day, even years into the future. Additionally, it can withstand forces of shear, whereas the other materials do not provide for these clinical capabilities. The Shofu Block HC Hard is currently available in three shades (A2LT, A3.5LT, A4LT) and the following three sizes: Small (10.0mm x 12.0mm x 16.0mm), Medium (12.0mm x 14.0mm x 18.0mm), and Large (14.5mm x 14.5mm x 18.0mm).

[20-28] Additionally, our preference is to bond and to extraorally cement a CAD/CAM crown to a modified or unmodified Universal Abutment with resin cement for insertion as a single unit.

[29-39] After removing the extraneous resin cement from the Universal Abutment and removing the Temporary Abutment from the well of the implant, the Universal Abutment with the extraorally cemented CAD/CAM crown is placed into the well of the implant. Once the restoration is initially positioned, the patient may seat it by applying occlusal pressure with a cotton swab. Alternatively, the crown could be seated with a gentle tap. After confirming the appropriateness of the interproximal and occlusal contacts, a radiograph should be taken to complete the treatment.

[40-45] Rather than intraoral scanning, an implant-level conventional transfer impression may be made with a titanium Impression Post and a plastic Impression Sleeve.

[46-51] A third way to intraorally record an impression is to make an abutment-level conventional transfer impression, which utilizes a Universal Abutment and plastic Abutment-level Impression Sleeve. A fourth way is to scan the actual abutment intraorally.

Subsequently, physical impressions can be poured into stone with a titanium Implant Analog or a Universal Abutment Transfer Die, or digitally scanned for the printing of an actual physical model. The poured or printed model with an Implant Analog or a Universal Abutment Transfer Die may be digitally scanned to achieve a digital image of the abutment and prosthetic model. The digital scanning of an actual abutment, preferably a modified or unmodified Universal Abutment, is less desirable but still a feasible option. The abutment should have the widest diameter to fill the mesiodistal edentulous space without encroaching upon the adjacent interdental papillae.

Guided Surgery with Two-Stage Technique for the Restoration of a 5.0 x 8.0mm Bicon SHORT® Implant for a Mandibular Right First Molar with an Integrated Abutment Crown™ (IAC)

Posted on December 7, 2018 in Integrated Abutment Crowns™, Restorative, SHORT® Implants, Surgical, Two Stage, Uncovering

Using the Bicon Guided Surgery Technique, a 5.0 x 8.0mm Bicon SHORT® Implant was placed with a two-stage surgery for a mandibular right first molar and restored with an Integrated Abutment Crown™ (IAC). This technique employs a Spade Drill to initially establish the osteotomy to the diameter of the intended implant. Subsequently, the osteotomy was deepened using incrementally longer Guided Surgery Reamers through the orifice of a 5.0mm Guide Ring until the length of the intended implant was achieved. The top of the Guide Ring was designed to be 15.0mm above the top of the implant when the implant is placed 2.0 to 3.0mm below the alveolar crest of bone.

Restoration of a Maxillary Left Second Premolar with a 4.5 x 5.0mm Bicon SHORT® Implant Using the Two-Stage Technique with SynthoGraft™ and a Collagen Membrane

Posted on November 26, 2018 in Integrated Abutment Crowns™, Restorative, SHORT® Implants, Surgical, Two Stage, Uncovering

This treatment demonstrates the restoration of a maxillary left second premolar with a 4.5 x 5.0mm Bicon SHORT® Implant using the two-stage technique with SynthoGraft™ and a Collagen Membrane, as well as the subsequent uncovering, full arch implant-level transfer impression, and insertion of an Integrated Abutment Crown™ (IAC).