Dr. Otmar Elsäßer, MD, DMD
MKG Solitude, Germany
Thank you very much, Mauro, for your introduction. And thank you, Bicon company, that I can be here in this beautiful location. Congratulations, Bicon, for the 40th anniversary and birthday. What happened else in 1985, I have a personal connection to this year, as it is also my birth year. Here we see Mauro and me at the presentation in Germany. And on the left side the implant, thank you for that. On the right side you see me as a child for forty years ago. I think the resemblance of the 5×5 shorty is undeniable. Our team of doctors include about fifteen doctors and we are only doing surgery. We have ten oral surgeons and five maxillofacial surgeons in our clinic. Our clinic includes both. It includes private practice and we have departments in two hospitals in the Greater Stuttgart area. The advantages from Bicon has been proven more than for forty years. But clear proof is the fact the three known implant manufacturers are following suit. We have here from Camlog, the Conelog seven millimeters. Also some years older, the Ankylos six point six millimeters and for example the Straumann with three millimeters, four millimeters and six millimeters. As we are doing surgical for many dentists, we often base our work on the desired implant system. Therefore we work with about twelve implant systems, I choose often the right system but it’s hard for me to give the Bicon system to the German dentist. They are a little bit fearful of this. However the Bicon system for me is a rescue system which offers good and easy solution in challenging situations. And of course if I want to avoid a complex bone augmentation. Many paths lead to the goal. The advantages of short implants lies for me in the time savings and in the reduced surgical efforts and thus the lower costs. Furthermore, the current signs are increasingly showing almost comparable survival data with the standard implants. Here we see another case, a normal case from three single tooth implants in the atrophied posterior region. We see there’s no stress to the bone and we can save with one implant a lot of bone chips. Also the placement from the shorty five millimeters is very easy. You see the abrasive dentition and the special effect from this case is that we need reconstruction of the vertical height. This is possible with the Bicon implant, this bite elevation, 1:6 implant to crown ratio. I’m feeling comfortable with this system in such cases. Similarly to the dorsal maxilla, it’s very easy to go with the Bicon short. We can solve the situation very gently, if you do a minimally internal sinus lift. And to completely avoid a sinus lift in the dorsal maxilla, it’s six millimeters enough to the floor from the sinus bottom, and then we can avoid a sinus lift with the Bicon implant. This is for me very interesting for the recurrent chronic sinusitis and of course for the sumthatriate and such things. The Bicon implant works excellently in many situations where the other screwed implants reach their limits. This headline is also very good. The shortage have become established, and I think for the future it will become established too. The definition of short implants, the last fifteen years has changed consistently. About ten millimeters or shorter, it was in twenty eleven, and now it’s eight millimeters and shorter, and the definition of ultra short implants is now focused. And I think in a few years, definition from short implants is about six millimeters shorter. In the new guideline from the German Society of Implantologists, we have, this has recently published some important findings. One of the main issues was the implant treatment for older people, for older people and for multimorbid people. And they consist that short implants seen as an alternative to the augmentation, And we have comparable survival data as standard implants, of course combined with the lower risk. And we had a targeted treatment for especially multi morbid patients, patients after radiotherapy and bisphosphonates. Now I want to focus on cases that require pre operative jaw bone building. Here we see a typical situation which requires a bone building. It’s a very narrow bone ridge and on the right you see the x-ray after the bone building. The techniques are diverse. We have the Khoury technique of course, with the micro screws and the autologous bone blocks. You see in the clinic cases. And what I often do is the CAD/CAM allogeneic bone blocks. It works for me also excellent. The 3D printed meshes and also on top the combination from each technique. The last ten years in our clinic we are doing about approximately seventy persons from the bone with the PRGF, stabilized sticky bone augmentation, you see on the right side. Here again you can see this is the final bone augmentation and I take it without any stabilization. It’s comparable with the Bicon system. The Bicon system is very easy and works excellent and here is the range of application, also very excellent, and the technique is very efficient. I turn to the four cases that that needs absolutely an augmentation, even with the Bicon implants. First of all, it’s a patient with very narrow jaw ridge, under two millimeters in the mandible front. Second case is the low bone height to the inferior alveolar nerve, under four millimeters. And third case is the possibility of simultaneous augmentation. Last case, a low bone height combined with a narrow average combination. This is a sixty year old female patient taking bisphosphonates over years. And here we have to weight the risk of jaw necrosis and the failure with the indication for the patients. The patient couldn’t wear her prosthetics and the suffering was immense. So we jointly decided to do a risky augmentation. Here you see the x-ray in the mandible front. We solved the case with the allogeneic bone blocks in a container technique with micro screws and filled the gap with autologous bone chips and some allogeneic cancellous graft. In the front we do the PRGF as a stabilization. And do the fibrin membrane. And this is after the surgical treatment. Here’s the x-ray. And this is about one or two weeks after the treatment. From a case with bisphosphonates. I think it’s a nightmare scenario for every surgeon. Then we do the revision and make new procedure. These are the implants, about six months later we choose some Ankylos implants because of the dentist has chosen, and takes some telescopic prosthesis. The second case is a low bone height in the dorsal mandible and not about three millimeters to the inferior alveolar nerve. The patient wanted, fortunately, a removable prosthetics and he wanted to retain his front teeth. Here in the dorsal mandible we see about three to four millimeter from the bone. And with a fixed prosthetics, we can’t avoid the bone management here. Near the front region we have a little bit more bone and then we decided us for the removable prosthesis that we placed on each side two Bicon implants. This is the situation before the surgery. And here you see the Bicon implants placed in the front area. For all users, especially in Germany, they fear lack of indexing. We have the possibility with our technician that we blocked the telescope, you see on the photos, and on the right you see the angulated abutment, with a fixed abutment and indexing. And these are screwed together with a block telescopics. The third case is a low bone height and this is a patient who undergone very complex augmentation in Romania and she lost the whole graft due to an infection. You see still the micro screws. And we have about five millimeters to the inferior alveolar nerve. This is a case with five millimeters in the mandible to the alve nerve. We can choose the crestal sinus lift abutment from Bicon and it’s for us easy to make a vertical augmentation with the autologous bone chips and with PRGF. If we have no primary stability, I took the ten screws between the implants there. And this is the x-ray after the treatment, we are very near to the nerve. The fourth case is a combination, a low bone height with a narrow alveolar ridge. Also in the mandibular. You will see the x-ray in the right mandible and we have a very thin narrow alveolar ridge over great distance, about one millimeter. And the nerve is about six millimeters from the crestal bone. Here we can’t do a vertical augmentation because there is no atrophy vertically, it’s an anatomical case with some loss from very less height. You see the operation, and we have to lateral the nerve and the ramus anteriors. And we fix the augmentation with autologous bone blocks, longitudinal splits, as a stabilization. And on top with the PRGF, stabilized augmentation with Bio-Oss and autologous chips. This was one week after the treatment. And we have here the three implants placed in the mandible. I think if we want to avoid bone management, we can, exceptional, place the Bicon implants if we are very near to the nerve, we can place it crestally. These are cases from my first Bicon implants, was very afraid of injuring the nerve, and I get crestally with the placement. And the situations remain stable, Even if have flat, vestibular, or high floor button to the mouth. And I have a lot of cases in my examination here. As a summary, the current guidelines have once again confirmed that the use of short implants offers enormous benefits in multi morbid and elderly patients, and is therefore recommended. With the help of Bicon implants, the extensive augmentation can be partially avoided. And in getting older and older patient population increasingly requires justification for augmentation in standard implants. For the future, very important. The Bicon system has consistently provided the solution in challenging situations. But we need a bone management before, if the alveolar ridge is narrow, then thickness with two millimeters. And we have an under jaw less than four millimeters in the mandibular, we need a pre operative augmentation from four to five millimeters. Simultaneous augmentation can be possible and five millimeters is exceptional case when we can put implants crestally. Thank you for your attention.