Dr. Stefano Carelli, DDS, DMD, MD
Dental Implant Center Roma; Rome, Italy
I am very, very happy to be here with you all on this day, very important for Bicon. And because Catania for me is a second home. So this is is my contents of the conference, logical and predictable solution tools cases where screw implantology give up. And, before starting, I wanted to make a premise. I have inserted many Bicon in these years where the screw implant failed. And after many years, they are still working. So we started. Are you familiar with the Marquez case? Good. After the March 2021 incident, it suffered a fracture of the right humerus and that the surgical team opted for a rigid synthesis to allow a rapid return, a competitive active. For this type of fracture, a titanium plate was selected with the addition of 12 screws to ensure that the fragment remained a aligned and secure when subjected to heavy loads. Marquez started training right after the operation and relying on a completely secure plan. Shortly after, the champion received approval from the medical commission to return to the field. And what was the result? The method of synthesis failed and broke down. What was the reason? Was the synthesis medium not positioned correctly? Wasn’t that a good method of synthesis? They issue lies in the bone healing process, which did not have enough time to consolidate. This resulted in its rupture. It’s the same what happen when we screw an implant into the bone. We have a forced system everywhere, forced system, and we have different healing times and different bone quality. Forced implant and different, it’s very different, the passive implant. And we know very well importance of the bone quality. Do you know Cicconetti yesterday said with the bone quality. In this morning, very well said on the bone quality. So what should the correct indication have been? More stress forced osteosynthesis or less stress passive osteosynthesis. Absolutely. Less stress. As happens in the healing process around a Bicon. If we determine less stress on the bone, we get best quality in faster time. So about bone quality, I show you this case of a sinus lift checked up at 13 years old. Look at the bone around the implant. So where is the bone that support the implant? Look, distal, vestibular, vestibular. We can see the quantity of of bone reduced. It’s the lock at the inside the platform. It’s a challenge a challenge quality. Oversize, it it could not be so stable. The quality of of the bone makes the difference. This is one of the reason why often do colleagues ask us for help. When screw implant give up. So now let me introduce you to Zeljka. From Belgrade. Father is a dentist. This was her situation in 2009 at the age of twenty nine. And, how you can see her state of health, her bulimic. Here in 2012. That’s incredible. Another other implants are inserted. In 2015, moved to Novara for the work. Dr. Marco Viana take care of her. At the age thirty five, the last teeth were removed and two additional lower implants were inserted, two Nobel Biocare implants. In April, she was using a temporary prosthetics. Dr. Viana is concerned about the thinning of gum tissue and we refer the patient to a periodontist. She underwent a gum regeneration procedure. This is the result in October. In December, Dr. Viana was concerned and asked the periodontist for clarification. And the periodontist answered him, why? No problem. We have thickened the keratinized tissue. No? We have thickened it and increased the stability on the tissues. But in May, the patient begin to worry and send self referral to Dr. Marco Viana. This is the situation in May. In July 2021, the situation began be becoming serious at this point. But Dr. Viana, a light bulb turns on. What is happening with this implant? Why did the bone remain stable? Why? While other underwent remodeling. Why? This implant was already present in the 2009, and she was twenty nine years old. This implant is a wonderful, is fantastic. It’s happened just to be a Bicon. So Dr. Viana remembers seeing me in Milano at a conference, and so he contacted me and asked if I can help him. I tell him, OK, to send me a dental scan. So we can see where the position on the implant. We can see the remodeling in the the the vestibular part lost the bone. In this implant, the vestibular part lost the bone. In this, the same look at in this implant or around the whole implant. Remodeling and the lost bone. Here, the same is the regeneration bone before. But let’s note that even around the Bicon implant, even, where is the bone? It’s a lot it’s very, very little. In the vestibular part, where is the bone? Inside, only inside the platform. So in October 2021, inside the the pandemic, I joined him in Novara. Let’s start the surgery. A big clinic, four hundred meter. We can observe the gum tissue around the Bicon. The old implant, we can. And we remove three screw implant, and we insert five Bicon. Here are the dimension of the implant that were inserted. Here are 4.0 x 5.0mm, 3.5 x 8.0mm, 4.0 x 8.0mm, 4.0 x 6.0mm, 4.0 x 5.0mm. And look the level the bone in the whole implant. Take a dental scan. Make a dental scan at the the stop of the surgery. And we here, we can see how the implant are positioned. Look. The first platform, vestibular inside the bone. The first the regeneration, the first platform, vestibular in the bone. Here, all implant in the bone. The first platform, vestibular in the bone. Look at the old implant. Where is the bone? So all the implant are positioned inside the bone structure. We know. Look at inside the bone. And they were covered with autogenous bone. So arrived in after recovery in March 2022. Removing the last screw implant and uncovering of the Bicon. Let’s look at the health of the tissue, soft tissue, surrounding the Bicon the whole Bicon implant. We remove the healing plug, and we observe how all implants are covered with new bone. Because we every time, when put the implant in the bone, regeneration the new bone. So let’s take an analog impression during the same session. Take impression. Oh, okay. Plaster model. Plaster model by Perpetuini Paolo Laboratory. Choice of abutment, application of abutment, immediate delivery of provisional denture at the same time. Check, May 2022. Customization of three anterior abutments with Paolo. Applications of customized abutment. Look at the soft tissue here. So, definitive prosthesis. Thank you, Paolo, for a good, good work, a good prosthesis. The, the dentist is a technique. So cementation of secondary copings in the prosthesis. Look, final prosthesis delivery. Final lower denture. At this time, for first time, she had a definitive prosthesis. So we started here. We have arrived here. We, started here, we have arrived here. Where is the opportunity here? All thanks to the old implant. October 2021, May 2022. Dr. Marco Viana sent me a photo of check-in on February 2025. Two years and nine months later, we can see the stability of soft tissue over time. But I like, let’s analyze with you the effect on bone tissues by examining each implant individually. Implant number one. Here we can see how little bone exists in the vestibular part. Where is the bone? I don’t know. In the platform? Comparison with the old implant. Number two, here too, we can observe that we do not have high amounts of bone in the vestibular part. The same. Look at it. Where is the bone? I don’t know. In the platform. Comparison with the old implant. Number three, here, we have a little more. A little more. Ready. Comparison with the old implant. Number four. Here, a little more. Comparison with the number four implant. Number five, here also also not excessive. Look in the profile vestibular in the sloping shoulder. Number five, comparison of implant. And look at. Here we must focus on the small thickness of the vestibular bone that fills only the osteogenesis chambers. Look. Before, you remember before, when Dr. Marco sent me the dental scan. And we can see the stability on the bone in at least twenty years. That’s incredible, I don’t know, July 2021, February 2025. But the bone quality, the same stability over time in the clinic, no, in the investigation, in the study, in the clinic patient. So I would like you to be focused at the bone level and particular around the old implant. At 2012, at 2015, look where the bone level around the old implant. 2021, what’s happened? Bone level, bone level around the Bicon. So 2025 bone level, stability on the bone level, and definitive prosthesis. Here, very happy. We have not had any changes on the old implant in whole here that stay in the bone. So the final consideration, I think I think short passive implants, we can be the logical and the predictable solution in cases where forced implantology often fails. So to conclude, I can tell you that today I celebrate 30 years with Bicon. And that in all these years, I have inserted more than 20,000 implants. And, if you want, come down. Of course, I am joking. Of course. But I have brought you some historical I have inserted. Do you know record the Stryker in the years inserted. So I conclude. I’d like would like to thank Vincent for his support and the trust he’s always placed in me. Thank you, Vincent. And, dear Vincent, we were very young. Look, we were very young. Thank you, Vincent. Thank you, Mauro. Thank you, Manuela. Thank you too. Thanks.