Replacement of an Eighteen-Year-Old O-Ring-Retained Mandibular Overdenture with a Telescopic TRINIA® Prosthesis with Custom Cast Copings in Three Clinical Visits

Posted on January 23, 2019 in Overdentures, Telescopic Restorations

This treatment demonstrates the use of Gothic Arch tracing to record the patient’s centric occlusal relation, as well as the clinical techniques for the insertion of a mandibular telescopic TRINIA® prosthesis with custom cast chrome cobalt copings.

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.

Laboratory Fabrication of a Full-Arch Maxillary Telescopic TRINIA® Prosthesis and its Insertion on a Demonstration Model

Posted on December 18, 2018 in SHORT® Implants

This demonstration provides detailed images and explanations of the laboratory fabrication of a custom full-arch maxillary anatomic teeth arrangement for a telescopic TRINIA® prosthesis on four Bicon SHORT® Implants using the polyceramic material, Ceramage, with the live staining sandwich technique and the simulated clinical insertion of the prosthesis on an acrylic demonstration model.

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).

Restoration of an Atrophic Mandible with Three 4.5 x 6.0mm Bicon SHORT® Implants and a Mandibular Telescopic TRINIA® Prosthesis

Posted on November 21, 2018 in Restorative, SHORT® Implants

This treatment demonstrates the restoration of an atrophic mandible with three 4.5 x 6.0mm Bicon SHORT® Implants and a mandibular telescopic TRINIA® prosthesis. Also shown is the Gothic arch technique, which was used to record the patient’s centric occlusal relation.

Restoration of a 4.5 x 8.0mm Bicon SHORT® Implant for a Maxillary Right Central Incisor Using the Two-Stage Technique with Bone Grafting

Posted on October 31, 2018 in Integrated Abutment Crowns™, Restorative, SHORT® Implants, Surgical, Two Stage

This treatment demonstrates the restoration of a 4.5 x 8.0mm Bicon SHORT® Implant for a maxillary right central incisor using the two-stage technique with bone grafting of a labial fenestration using SynthoGraft™ and autogenous bone with a Collagen Membrane.

Fabrication of a Maxillary Telescopic TRINIA® Prosthesis and a Mandibular TRINIA® Overdenture and the Subsequent Conversion of the Mandibular Brevis™ O-Ring Overdenture to a Telescopic Prosthesis After One Year in Function

Posted on September 13, 2018 in Overdentures, Restorative, SHORT® Implants, Telescopic Restorations

This treatment of a seventy-five-year-old woman, who was previously told by six clinicians that dental implants would be an impossible treatment option (despite the fact that one clinician augmented her right maxilla with graft material), clearly demonstrates the unmatched clinical capabilities of Bicon SHORT® Implants and TRINIA® metal-free CAD/CAM material. The surgical placement of two maxillary and two mandibular implants is also shown, as well as the initial prosthetic restoration of a maxillary telescopic prosthesis and a mandibular Brevis™ O-Ring-retained mandibular overdenture, and the clinical and laboratory techniques for modifying and converting the mandibular Brevis™ O-Ring overdenture to a full-arch telescopic TRINIA® prosthesis after one year in function.

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

Posted on September 12, 2018 in Integrated Abutment Crowns™, Restorative, SHORT® Implants, Surgical, Two Stage

This treatment demonstrates the restoration of a 5.0 x 5.0mm Bicon SHORT® Implant for a mandibular right second molar with an Integrated Abutment Crown™ (IAC) using guided surgery and a two-stage technique.