Bicon Immediate Loading Technique Using a TRINIA® Stabilizing Prosthesis

Hello, my name is Laura Murcko. I am a clinician at the implant dentistry center in Boston. In this video, I shall speak to you about immediately placing and immediately loading Bicon dental implants, which have been successfully done for decades. This is evidenced by the treatment of a fifty five year old woman who traumatically avulsed three of her maxillary incisors while in a sporting event in the early 1990s. Three implants were immediately placed and loaded, and subsequently were successfully restored with three porcelain fused to metal restorations. After fifteen years, her porcelain restorations were readily replaced with three integrated abutment crowns. This was due to a shade disparity with her natural teeth. Also note the crestal bone gain and the healthy and aesthetic papillae. Today, the immediate loading of Bicon dental implants can be achieved with greater certitude, facility, and dispatch by using the universal abutment with their temporization sleeves and TRINIA, a fiber reinforced CAD/CAM resin material. The following clinical cases will demonstrate how these components have simplified and enhanced the immediate loading of Bicon dental implants. The treatment of a seventy five year old man began with the laboratory fabrication of a clear resin surgical guide and a TRINIA and Ceramage transitional stabilizing prosthesis. With local anesthesia, the patient’s four maxillary incisors were extracted and their sockets were curetted. The clear surgical guide was inserted and used to facilitate the positioning and drilling of the two point zero millimeter pilot osteotomy. After the initial preparation, gold colored paralleling pins were inserted into the osteotomies to confirm their trajectories prior to further incremental widening of the osteotomies with latch and hand reamers. Residual bone chips were harvested and removed from the osteotomies prior to the insertion of the implants. Two four tall profile universal abutments were gently inserted into the lateral incisor implants, and two five tall universal abutments were gently inserted into the central incisor implants. The adaptation of the TRINIA transitional stabilizing prosthesis was confirmed prior to placing the modified or reduced temporization sleeves onto the universal abutments. Once the modified temporization sleeves were seated onto the universal abutments, the adaptation of the TRINIA stabilizing prosthesis was confirmed for a second time prior to placing harvested bone around the abutments and suturing the mucosa. After suturing the mucosa, the adjacent surfaces of the natural teeth were prepared for bonding and the transitional stabilizing prosthesis was cemented with a resin cement onto the modified temporization sleeves and bonded to the prepared palatal surface of the adjacent teeth. The occlusion was confirmed and the stability of the prosthesis was checked after a couple of days and then again after a couple of weeks. After a period of three months, the stabilizing prosthesis was removed and the implants were permanently restored. The treatment of our second patient, a sixty eight year old man, began with the laboratory fabrication of a TRINIA and Ceramage transitional stabilizing prosthesis and the extraction of his two maxillary central incisors. After confirmation of the trajectory of the initial pilot osteotomies with gold colored paralleling pins, the osteotomies were incrementally widened with latch reamers. A spoon excavator was used to confirm the integrity of the osteotomy’s walls and to collect bone chips. The implants were inserted with an implant inserter retriever instrument and definitively seated with a seating tip attached to a straight driver. Blue two point five millimeter guide pins were inserted into the wells of the implants to confirm their trajectories. Then, two five tall, profile universal abutments were inserted into the wells of the implants. Prior to confirming the adaptation of the TRINIA stabilizing prosthesis. Unfortunately, the prosthesis did not fit well and necessitated changing the right straight abutment to an angled abutment prior to adapting it to the modified temporization sleeves. A white Fit Checker and a black ink marker were used to facilitate the modification of both the TRINIA prosthesis and the modified temporization sleeves prior to its being cemented with a resin cement. Thank you for having watched this video about immediately placing and immediately loading Bicon dental implants after an extraction.