Bicon Dental Implants Roundtable 1997 [HD]

In 1997, Bicon released a roundtable discussion video. This video featured a frank and open discussion among clinicians, sharing their real world experiences with the Bicon system. Recently, more than twenty two years later, we were pleasantly surprised to hear that clinicians around the world still refer to it today. So we present it to you now, digitized in high definition. A few things have changed since 1997. Our implants are now significantly shorter. We also offer more options for restorations, such as digital and indirect abutment level impressions, integrated abutment crowns, and TRINIA, a metal free CAD/CAM material. However, most things have remained the same. Bicon still offers unique design features and techniques that in turn provide for unmatched clinical capabilities. The Bicon design provides a locking taper implant to abutment connection, proven to be impervious to bacteria and without any micromovement. Fins and plateaus providing healing with cortical like Haversian bone with high mechanical properties and a sloping shoulder providing room for interdental papillae with healthy aesthetic gingival tissues. Bicon shot implants provide excellent bone levels, often with bone gain. Our consistent surgical protocols with slow drilling and hand instrumentation allow a clinician to place a Bicon implant purchased today with an instrument kit that was purchased in 1985 and vice versa. I don’t know of any other implant company that can say that. Bicon remains a simple, predictable and profitable solution that can reduce chair time, minimize morbidity and the need for grafting while increasing patient acceptance. We hope you enjoy this presentation. Let’s hear from a group of clinicians who have had a great deal of experience with multiple implant systems, including the Bicon system. I think the biggest problem I had with implants in general was trying to get my restorative dentist to use the implants I was placing. And I think they had a lot of problems with all the componentry with this tackle box full of screws and gadgets. Larry, you had experience with other systems, several other systems. What was your impression? Before our office started using Bicon implants, when we referred the patient back, the general dentist would be saddled with a lot of laboratory bills that I really didn’t have much to do with, and all of a sudden, some of the dentists weren’t doing implants anymore. There are a couple of areas where cost is a major factor. The first one is in the component cost and the chair time, and the screw type implants, the hex head implants, the lab fee can be about three times that of a conventional crown for instance. The costs of restoring a Bicon implant are probably a third of what the cost would be of restoring a screw type implant and the maintenance issues are just not there. When you have a man that sends you a fair amount of patients in a year and he finds out that screws break, it’s tough to keep that relationship, so I only use Bicon as you know. Joe, you’re a periodontist and I know you’ve seen literally hundreds of these Bicon cases. From a periodontal point of view, could you tell us about your experience? Actually they look wonderful. Inevitably, the tissues around the implant look superior to the tissues around the natural teeth. Almost no maintenance is required. The tissue is pink and healthy and it’s tight and it’s it’s actually appears some somewhat miraculous to me. It does. It’s extraordinary how well they look. Jack, you’re a general dentist and you’ve actually started putting some of your own implants in. A postcard appeared in my mail and that was my introduction to Bicon, which was kind of what I was looking for. I wanted something that was going to bring me to conventional dentistry once the implant was placed. Seating the abutment in the implant is a very quick and easy procedure. From there on it’s general dentistry. Bob, you know, you’ve probably had more experience than anyone here because as one of the better lab technicians, you get to see everything. I spent hours on the phone with doctors with calls about just seating the transfer coping on the hex, taking an x-ray. And if they didn’t get the cone on the x-ray right, then it would disguise the fact that the sides might be confluent but the coping wasn’t down, it was caught up on the edges. You get a couple of those in a case and then the whole thing is off, and it’s disastrous. And then it’s no wonder that the surgeons and periodontists didn’t get any more business. They were scared to death and once they got out of it they said, Phew, I’m not doing that again. Something, Norm, that I think is very interesting and that is talking about putting in a three unit bridge versus an implant. And that is the research that was just recently reported on the long term viability of abutment teeth. At the twenty year period, abutment teeth that are prepared for bridges have about a ten percent greater chance of being lost than if the teeth aren’t prepared at all. So that putting in an implant gives the patient a better chance of maintaining those teeth on either side of the edentulous space. People are really impressed. They’re not going to violate the teeth on either side. That’s a major league kind of a thing. From the standpoint of putting in a single tooth implant, it’s the reliability of the abutment that makes all the difference. And when you have a screw retained abutment, it’s going to loosen. The locking taper doesn’t loosen. We did an article on that, and the, percentage of loosening, over a four year time frame in about eighteen hundred implants was one point five percent — loosening of the abutment. And a zero point five percent fracture. And again, this was in eighteen hundred implants. So you’re looking at a two percent complication rate. When we talk about failure rate, in the literature that generally means loss of integration. But as I say, and as Bob just alluded to, if you ask your patient what’s a failed case, it’s when the tooth is in their hand. And they always call and say, my implant fell out. Yes, that’s true. The implant fell out. But that doesn’t happen with the locking taper. We have learned that optimum treatment with multiple implant cases obviously can be very expensive. You have five, six, seven, eight implants and then go right to a nice metal porcelain bridge, you’re talking about some serious money. And yet we also feel that there are ways that you can lead into that. Have any of you had any experience doing this with implants? In other words, perhaps starting with O rings and then switching over to something fixed or use a lab cured provisional bridge for a year or two until they could afford converting over. Have you ever had that experience? Yeah, essentially that we had three implants, four implants in the lower anterior with a bar and clip and an overdenture. And then the patient wanted to have a fixed prosthesis and so we put in two more implants and a temporary acrylic bridge for a year or so and then finally the porcelain fused metal bridge. You could retrofit a denture, you could go and make them new dentures next, then if they want to add more implants and go to a fixed, so it’s almost like an installment plan that can be started very inexpensively. Has anybody on the table taken the heads out? The way a locking taper works is when it’s tapped in position, it takes approximately ninety pounds of straight vertical force to remove it. However, if you twist and pull at the same time, then you can break that locking taper. It’s the same as the chuck that goes on your dental lathe. You can’t pull that off, but you can remove that chuck by spinning that little cam counterclockwise so you you can retrieve a locking taper. Norm, I just had a woman. A woman had a stroke. I put three ball attachments in the lower anterior because the woman couldn’t keep a denture and she’s she shakes a lot and things like that. And when I did it and reattached the tissue after I exposed them, the tissue shrunk down quite a bit, and they stood too high. So the woman came to my office. She wasn’t in the office six minutes. I mean, turned and pulled, put one back in, shot a dimension, tapped them in, and she was gone in no time. How did you do it, Dave? What did you… I have a a Nash forcep that’s serrated, put it right on it, turn it, and pull. It doesn’t take thirty seconds to take them out. I’ve had no problem at all replacing and changing. You were talking about retrofitting. Has anyone tried just using some soft chairside soft liner over balls for a real economy type of getting this patient some help for very little money. Yes, I had a gentleman in who had had his teeth out at the end of World War II and with the usual amount of ridge resorption, being none left when he got to me, and I had been a patient for quite some time, we tried a number of relines and very easygoing gentleman and very tolerant and he said, yeah, it’s okay. And one thing led to another, I picked up the Bicon system and I thought let’s see if he’s interested and he was. I put in four and took his old denture, just bored out the inside and seated it in. He liked it quite a bit. I have an eighty three year old woman who is quite ill, she’s in a wheelchair, so being able to retrofit her partial denture to make it more stable when she lost a tooth has made her very comfortable. I have a lot of people come in and say, well I’m seventy five or I’m sixty nine or I’m whatever age they are. If I was forty I’d have an implant. I’m too old now. First of all, those are the people that the mortgage has been paid. The kid’s tuition has been paid. A lot of these people, their entire social life is going out to eat with their friends. This is the group of people that quite frankly can best afford it. An interesting thing you can do as specialist, you have this opportunity with with the Bicon system in particular to deliver something back to the restorative dentist, which is extraordinarily easy for him to restore. A gift in a sense. The first two implants I did, I restored myself just to get a sense of how easy is this, and it had been a very long time since I had taken any impressions, and it was just as easy as was said. It was a matter of taking the impression, making the cast, trying in a coping, and away it went. There was a point about sinking the implant three or four millimeters below the the crest of bone. And I found that the advantage of that is that if you put in the proper size abutment, you don’t have as many times that you need to do soft tissue alignment with a soft tissue graft on the buccal. Because if you use the proper size abutment, you you get the contour you want. With some of the other abutment systems, it comes out. It’s flat, and you have to do a connective tissue graft or or something to bulk it out. And I found that as a big advantage. In the system. Bigger head? Yeah. You just use a bigger head, you get a nice buccal contour. Well, the whole the whole system lends itself to restoring a single tooth. The conical shape of the implant body is hidden in the bone rather than these canister shaped heads which end up giving you troubles and there’s nothing that you can put on a canister head that makes it look aesthetic. Joe, you’ve actually seen some histology of the actual sulcus or cuff, haven’t you? Yes. We find that there’s very little bone die back around the Bicon implant as opposed to most of the ones that I had placed previously. Do you think that bacterial endotoxins in that critical area has anything to do with that? There’s been a study recently, where a screw type implant was joined to its abutment head as well as a a Bicon implant with its head and both of these implants were submerged into a bacterial soup of some kind. The theory may be that there is a greater possibility of microleakage occurring, along the course of the the screw and its abutment head as opposed to the locking taper where you have a metal to metal, almost a hermetic type seal that has some impact on the bone and may, in fact, turn out to be the disposing factor that caused this, what everyone has seen with screw type implants to die back to the first thread. I’ve seen, as all of us have seen, radiographs where that bone, once it’s at the head of a Bicon implant, stays there. We’re not seeing the kind of dieback that typically occurs with a screw type implant. On the restorative side, the the friendliness of the abutment is also as important because the abutment is preferable like a tooth is prepareable. As a matter of fact, as a teacher I would almost prefer the students to start off preparing a Bicon abutment head than a tooth. It’s a process that requires very little previous experience or a lot of skill in dealing with implants because it’s so similar to preparing a natural tooth. One thing I would mention though and that is that before a surgeon does decide, or a periodontist does decide to place implants, it would be a very good idea to talk to the restorative dentist to assure that the implants are placed pretty appropriately, at least where the restorative dentist wants them. And and it’s quite simple with the stent technique that you developed, the two stents, one with the grooves in the facial surface and the other the suck down stent, to be able to determine exactly where that implant should be. But it does require input from the restorative dentist to do the diagnostic wax up or set up And then make the stents from there. And that communication starting between the two inevitably leads to further referrals. Has anyone done any congenitally missing laterals at all? And then I think the angle abutment helps in those cases because a lot of times where you have the centrals and the canines where they orthodontically haven’t been moved, again, you have limited space the further you go apically, and so you have to put the implants more palatally. In that case, the angled abutments really help. Making the osteotomy by hand is very helpful because you have such digital touch that should you actually hit a root, can feel it immediately and redirect it. Because exactly as you say, we often want to put the implant palatally and then use the angled abutment to upright it into the dental arch. One of the problems too, Norm, is that in some congenitally missing lateral cases, the space is too large. If they have other posterior teeth Yeah. You’re right. Missing as well. And the you you have a space that’s too big just for a lateral incisor. So you have to put in two teeth or restore two teeth, but there may not be sufficient room implants. So, putting in one implant and a cantilevering off of it just like we would a cantilever or lateral off a canine works very well and you can do that because again the reliability of that locking taper. So from a restorative standpoint, replacing these missing lateral incisors, can be accomplished in a couple of ways. I’ve done some congenitally missing premolars so that the restored tooth was actually closer to the size of a molar and probably half a dozen of those. It’s, once the abutment is placed, it again, it’s conventional dentistry and, the first case I did solo, it was an eighteen year old patient and there really was no complications for the first implant it was very humdrum, it went very comfortably, wasn’t stressed with it, the patient wasn’t stressed with it and was very successful, very easy to do. Claude and John, you experienced that the increasing implant practice is taking up some of the slack in the diminution of our orthognathics that has been brought on by managed health care. I think nowadays in the oral and maxillofacial surgeon’s offices, we’re going to the hospital much less and less because of managed care. Patients come in who need orthognathic surgery or TMJ surgery, etcetera, and they are just not being approved. For us, it’s helped doing implants because it it fills that that time void, that financial void for us. The number of orthognathic cases has substantially dropped in where the implant end of the practice is building. I’m not terribly disappointed. I mean, who wants to go with all the headache and, you know, the reimbursement from doing an orthognathic case when you can do implants in your office? The beauty of this system is a locking taper, and I can just say in a nutshell that it works plain and simple. Screw systems have been out a long time. If they worked, would I be using them? The Bicon locking taper system locks. The bone levels that that we’ve achieved with placement of Bicon implants are excellent. We don’t see bone loss. When you tap it in, it stays in properly. Never had a problem. Never had breakage. Never had a crown come off. It works. When I meet with colleagues from around the country, they generally tell me that they are doing some implant dentistry, but they’d really like to do more. They simply can’t understand why the restorative dentist don’t seem to be interested. I generally tell them, don’t talk to the dentist and tell them what you can do for them. Find out what they want. Find out what your restorative dentist really thinks about implant systems. Find out why only five percent of the one hundred and twelve thousand general dentists have restored five or more cases. Find out what the lab costs are when they restore implant cases as opposed to natural teeth. The answers to most of these questions is really quite simple. The restorative dentist has a hard time making money with implants. And it’s not just the component costs, which we know can be quite high, but it’s the great deal of extra chair time that it takes. It’s the excessive laboratory bills, the re dos, but mostly it’s the maintenance problems caused by hex tops and loose screws. Think about this for a minute. Connecting a crown to an implant has to be one of the most basic acts of implant dentistry. Yet after fourteen years, we still hear lectures and read articles about how to connect this and keep screws from loosening. Now, do we go to hear lectures about how to connect a scalpel blade to a handle? Of course not. The reason is that’s simple and basic and once we were shown how to do that, it required no further discussion. That’s the way we ought to be able to talk about connecting a crown to an implant. Now that’s a difficult thing to do if we’re using a hex top implant. The reason is that the physics of the configuration of a conventional hextop is flawed. And that’s well stated in this book by an engineer named Alexander Blake. Remember, the hextop was never designed as an anti rotational device. It was designed purely to turn an implant into bone. Let’s look at what a well known and very well respected independent dental research association says about the Bicon implant. That conclusion tells the whole story. When I switched to the Stryker Fin implant, which is now the Bicon implant, I doubled my referral base the first year and doubled it again the second year. If you can give your dentist a secure abutment that they can treat like a natural tooth with no screws, no lab surcharges, and with the ability to restore a single crown any place in the mouth, you won’t know what to do with all the patients that will be referred to you.