20 Years of Clinical Success with the Bicon Design

My second introduction to the Bicon system was a telephone conversation with the next speaker, Bill Grippo, who’s a periodontist. He’s in private practice in Napa in California. He’s used the Driskell Stryker Bicon implant since nineteen eighty five. Bill, be our guest. My presentation is going to be very short, and what I was asked to do is really to show some long term radiographs of cases that were done and make some comments about those cases. All these cases that you’ll see will be two stage surgical, and that’s because when these were done, that’s all we were doing was two stage. I will tell you that now I do pretty much exclusively one stage, unless there is some unusual reason, some need for some grafting or other things like that, and I think the one stage is working extremely well and haven’t had any major problems with it at all. For those of you who have heard me speak before, I used to follow these along in terms of keeping track of numbers and failures, failures, etcetera, etcetera, and I stopped at about fifteen years, and the results of those fifteen years are what you see on the board. One of the interesting things that doesn’t show on the slide, and I don’t know if it’s in the next slide, is that we didn’t have a greater failure rate in the maxilla. In fact, we had a slightly greater failure rate in the mandible than we did in the maxilla, and it’s always kind of fascinated me because every article I’ve ever written or read about implants is that the failure rate in the maxilla is always greater, and I don’t know if that’s because of the design of this implant, or what the actual reason is, but, I think that it goes to show that if we have something that’s designed well, that there really may indeed not be any difference. The patients that we saw for these fifteen years were actually ranged in ages from about seventeen or eighteen to ninety four. The X rays that you’ll see today, unfortunately, don’t span that quite an age group. It’ll be more in the range of twenty one to seventy five, and that’s because when I started to go back and try to get some of these people that we had originally done in the early years, most of them had either moved or passed away, so we did the best we could, most of the slides that you’ll see will be in the fourteen to fifteen year range. The slide on the right is at second stage, the slide on the far left is at fourteen years. I don’t know how well you can see these, I don’t know if we can see the pointer, but you can see that the bone level is really maintained around the abutment. We’re not losing bone, everything is staying extremely stable, and I would say that for the most part, this is what we’re seeing with the implants. It was interesting because last night we were talking, and I was talking to Dr. Abdullah, and the question came up was, we know that the implant was designed to be countersunk, about three millimeters, and in those situations, when we do countersink the implant, we’re seeing bone maintenance very well. The question was, if the implant is not countersunk, if it’s level with the bone or perhaps slightly above the level of the bone, what’s happening then? Well, what seems to be the consensus, and Doctor. Chapman alluded to that in his presentation, is that in some cases, we’re not only seeing that that bone level is still maintained, but that the bone level actually comes up on some of these implants and covers the shoulder of the implant. So this is an overdenture situation, again, fourteen year follow-up, this is a bar connected overdenture, we’re not seeing any significant bone damage around the necks of these implants. Another case, two posterior, as you can see, I was a little dyslexic when I placed the one not too straight there, but you can see the bone levels are maintained. Now, on the right side, you can see that implant is not placed sub crestally. You can see on the left slide that we’ve not had any significant change in the bone level even though it’s not been placed subcrestally. Another, it’s the same different lady here. This is ortho case where we had to sneak some implants into a space that was left by the orthodontist. And you can see both sides that we’ve maintained bone level all the way up to the top. Here’s a particularly interesting case. This is an older lady, she was seventy two when we did this. This was a case that there was a huge amount of periodontal damage, and as you can see, we left a tooth on the upper right that was ankle losed and basically, the lady did not want to lose the remaining anterior teeth, so we decided we would go ahead and compromise and place the implants in the posterior. What we did was a bar-retained partial denture, and I don’t know how well you can see this on the panoramic, but again, the bone levels have been maintained extremely well. What’s interesting about this case is that this is the presurgical. There was no bone in that upper posterior area on either side. It was just a shell, and these were sinus grafted. The implants were placed simultaneously with the sinus graft, and we’re still, even though it’s basically not native bone, we’re still maintaining bone level on these implants, and this lady well, this was approximately fifteen year follow-up, she’s doing extremely well. So we’re not seeing changes whether we’re doing it in grafts or in native bone, we’re maintaining bone levels. I’m obviously not a researcher, and, I’m not doing double blind studies, but just clinically, what I think is happening and the reasons why this is happening is that we’ve got the design of the sloping shoulder, which I think is critical because most implants now, when they emerge at the crest, are either wider than the body of the implant because they flare at the crest or they’re the same diameter. Well, the problem with that is that that’s the narrowest part of the bone most of the time, is the crest. So if you come through the crest and you thin out the existing bone, I think what’s going to happen is you’re going to get dieback. It it just compromises any blood supply that you might have to that bone. So having the sloping shoulder where it not only takes away from removing an excess amount of bone, but then allows you to get more bone forming in that area, I think, gives us a distinct advantage in terms of, not getting that die back. Second factor is we’re all aware of is the seal. This is and was the first implant to ever do this, and now it’s being copied significantly because, we know that this is important. We’re not getting bacterial leakage in this area, and if we don’t get bacterial leakage, again, we’re not gonna get bone loss from really periodontal reasons. The narrow neck is important. Many, many years ago, there was a study done by Bob James at Loma Linda, and it was it it dealt with basically blade implants. But what he was looking at what he was looking at, the cuff of tissue around the neck of the implant, and what he found was that as that neck is narrower, the fibers of the connective tissue are tighter. So in pinching the neck of this implant, we’re allowing those circumferential fibers to be much tighter than they would normally be, and therefore giving us another barrier to possibly bacterial invasion of that spot. The other thing that we’ve talked about, again, is the subcrestal placement. Again, it’s maybe not critical, but I think it gives us a distinct advantage. If we’ve got that the crest the top of the implant sub crestally, it not only allows us to sometimes replace it with some graft material some autogenous bone that we do take out when we prepare the site, but it gives the bone a space to grow into, and we’re not stressing the bone excessively, and I think it gives us a little bit of an advantage in that particular situation. Also, another thing that came up last night, we were talking about a lot of the implants now are switching platforms, and by that, what I mean is that they’re taking a, say, a four millimeter implant, and they’re putting a three millimeter abutment on it. Well, what they’re doing is they’re copying this. They’re trying to gain that narrow neck situation and accomplish some of the things this this implant has done, obviously, over the last twenty years. So I think what we’re seeing is that over time, other companies are, although they don’t recognize this unfortunately, are taking some of these concepts that were designed by Tom early on and trying to start to incorporate them into their implant systems. The other concept that comes up all the time is biologic width, and the first time I heard this, was a little bit shocked because I think we’re all aware of biologic width in terms of the natural teeth. We know there needs to be a certain space for the connective tissue attachment and, for the circumferential fibers, etcetera, etcetera. Well, what’s happened since implants have have been around is that traditionally, there’s always been a little bit of dieback at the neck of the implant, and that’s pretty much been from the get go with all the Brånemark research. And people would try to come up with reasons why this was happening, and all of a sudden, somebody backs into the whole situation and says, well, this is happening because the body is trying to establish biologic width. The problem with that is that we have an implant that’s not doing that. We’re maintaining bone levels, we’re not seeing excessive amounts of dieback, so if we have an existing situation that’s not doing that, then that would tend to refute this whole concept of biologic width around dental implants. I think that we have a unique situation here. We have an implant that’s been designed extremely well from the beginning. Vin has done an incredible amount of work to make this implant better as time has gone by. And I think that if you stick with the system, you’ll find that it’s going to work well for you and it’s going to serve you over many, many years. Thank you very much.