Bicon SHORT® Implants and TRINIA® on Three

I’m Rolf Ewers, and I will talk to you today about short implants and TRINIA on three. For over six years, we have experienced reliable results with full arch TRINIA prosthesis, supported by four implants. So in twenty sixteen, we decided to modify our study design and follow full arch TRINIA prosthesis supported by only three four by five millimeter short Bicon implants in the mandible. This slide demonstrates the long term follow-up of three full arch TRINIA prostheses supported by four Bicon short implants. As of January twenty twenty, the longest recall is ninety four months without issue. In December of twenty seventeen, the Journal of Oral Maxillofacial Surgery published the impressive results of our TRINIA on four study, which shows the stability of the marginal bone level. After the success of our results with TRINIA on four in twenty sixteen, we decided to study the stability of full arch prosthesis, supported by only three implants, which can be understood when comparing the stability of a three legged stool. We have used various abutments, including fixed detachable abutments, brevis abutments, and universal abutments with prefabricated retentive copings and custom cast telescopic copings. Alternatively, you may use locator abutments or bar abutments. Our statistics with nine years of recall include thirty three patients with three to four four by five millimeter Bicon short implants in the mandible, which totals one hundred and nineteen implants. Two implants did not osseointegrate, and one implant was not loaded due to nerve disturbances. Twelve of these patients have been treated with only three implants to support a full arch TRINIA prosthesis. None of these implants have been lost. In this slide, we present a sixty year old female patient who suffered nerve disturbance on her right posterior implant. It was only after this implant was loaded that the patient experienced sensational disturbances. As soon as the load was removed from the implant, the patient had no problems. The implant has remained buried for more than fifty nine months, thus this case has become one of our longest standing TRINIA on three cases. This seventy five year old patient has been edentulous since she was eighteen. As such, she has extensive bone atrophy, especially in the maxilla. Additionally, she has a class three occlusion with a protruded atrophic mandible. Positioning the three four by five millimeter Bicon implants posed no problem at all. Due to the class three occlusion, there was a major problem detected in the sagittal direction when the three implants were uncovered and the titanium impression posts were seated. The same issue is also shown with three seated fixed detachable abutments. The problem could only be solved by positioning the three abutment screws in front of the prosthetic teeth. This prosthetic design is better visualized with the image of the full arch TRINIA prosthesis on the stone model. With this solution, it was possible to achieve a normal occlusion with the two full arch prostheses, as well as a satisfactory aesthetic outcome. Due to the placement of the screws in front of the prosthetic teeth, the entire prosthesis is a cantilever or distal extension. This brings me to the special features of the revolutionary metal free CAD/CAM material TRINIA. TRINIA is composed of forty percent resin and sixty percent fiberglass. It comes in three different shapes and in two colors, pink and ivory. The greatest advantage of this material is the elasticity and flexural strength, which can be visualized on this graph. TRINIA has a comparable flexural strength to dentin, and is ten times more flexible than titanium. A cantilever is defined as a rigid structural object projecting from a vertical support, especially one in which the projection is great in relation to the depth, so that the upper part is in tension and the lower part in compression. TRINIA represents a paradigm change because it cannot, by definition, be a cantilever due to its flexibility. It should be called an extension. And when it comes to TRINIA extensions, the longer the better. This favorable attribute explains why the sixty year old patient’s treatment with the screws placed in front of her prosthetic teeth was possible. The four four by five millimeter Bicon implants were placed at an angle that was too labial, which is most evident in the lateral cephalometric radiograph. To resolve the unfavorable position of the implants, our dental technician Paolo Perpetuini positioned the abutment screws in front of the prosthetic teeth, which resulted in a very long extension of the TRINIA material. The TRINIA prosthesis has been stable for almost eight years now without any fracture of the material or the screws. The fixed detachable abutment system has proven its value, especially in difficult cases such as this. In this right side view of the full arch TRINIA prosthesis, you can see the long bilateral extensions. The implant that did not osseointegrate in the fifty five year old female patient were placed where osteosynthesis screws had been removed following the osteosynthesis stabilization of a mandible horizontal fracture. The full arch TRINIA prosthesis has now been stable for more than seven point two years without complications. I will now demonstrate the use of retentive copings and a telescopic TRINIA prosthesis for a sixty year old male patient. After placing three four by five millimeter Bicon short implants, we waited at least three months to uncover them. At the time of the uncovering, we inserted three titanium impression posts into the implants for the making of a full arch implant level transfer impression. A few days later, the laboratory finished fabricating the prosthesis. The top image shows three prefabricated retentive copings seated on their respective abutments in a soft tissue master model. And the bottom image shows the full arch TRINIA telescopic prosthesis seated on the copings and abutments in the soft tissue model. To facilitate the orienting and seating of the abutments into their desired positioning, the technician provided a resin orientation and seating jig. Once the abutments were definitively seated, the three retentive copings were placed onto their respective abutments. With resin cement in its right side bores, the TRINIA prosthesis was then seated onto the copings of their cementation. This clinical image shows the satisfactory prosthetic situation, and the panoramic radiograph shows the three well positioned implants with their abutments and full arch telescopic TRINIA prosthesis with long bilateral extensions. Despite the lack of soft tissue in the thirty two month recall image, the panoramic radiograph shows a very good bone level around the three implants. Having now had ten years of experience with TRINIA, in which time it has certainly proven very forgiving, I believe that none of our excellent results would have been possible without this unique metal free hybrid material of resin and fiberglass. By now, we know and have proven that less is certainly more, and that fiberglass resins are not only good for the wings of Boeing Dreamliners, but also for full arch dental prosthesis. With this, I would like to thank you for your attention.