Comprehensive Restorative Video

Comprehensive restorative video. Introduction Implant dentistry is primarily a prosthetic treatment with a surgical aspect. In its simplest form, the conventional or digital impression of a Bicon abutment is made and the crown is cemented onto it just like a natural tooth. No screws nor torque drivers are needed. This basic technique is familiar to every dental student even without implant training. Since nineteen eighty five, Bicon’s unchanged locking taper abutment implant connection with 360 degree positioning offers clinical advantages impossible with screw retained abutments. One key benefit is extraoral cementing of crowns eliminating the risk of inflammation from cement. The simplicity of this connection can be described as a round peg in a round hole. As this video will demonstrate, Bicon’s bacterially sealed no micromovement connection saves time for clinicians, technicians, and patients alike, whether restoring a single crown or a full arch prosthesis. Intraoral digital scanning of scannable temporary abutments further reduces not only chair time but also patient visits, lowering the chance of failed appointments. This video aims to provide you with both basic techniques and nuanced insights to help you benefit from Bicon’s remarkable efficiencies and unmatched clinical capabilities. While Bicon’s unique surgical capabilities are often highlighted, the system’s unique restorative benefits are just as significant for dentists, technicians, and especially patients. Ultimately, patients seek not just implants, but natural looking prosthetic teeth with healthy interdental papillae. The following clinical images showcase the results achievable with Bicon implants and TRINIA prosthetics. Bicon’s sloping shoulder provides room for bone to support papillae, which improve aesthetically over time. Improvement of bone and papillae over twelve years. Improvement of papillae over three weeks. Even nonparallel abutments can be restored with TRINIA and Bicon’s unique method of inserting restorations. TRINIA BRIDGE in only two clinical visits. This video demonstrates another unmatched clinical capability of the Bicon implant. Because of its locking taper connection with 360 degrees of universal abutment positioning, two significantly convergent mandibular implants can be restored with a five unit TRINIA prosthesis in only two restorative clinical visits of less than forty five minutes. Restorative treatment begins with making a conventional implant level impression with color coded impression posts and sleeves for the fabrication of a stone model. Subsequently, the model is digitally scanned for the CAD/CAM fabrication of a TRINIA framework and a nano ceramic buildup of a five unit prosthesis. During the second restorative visit, the canine abutment is inserted into the prosthesis and subsequently inserted into the implant well of the canine implant. After being appropriately positioned with the distal of the lateral incisor, the canine abutment is engaged into its implant, and the prosthesis is removed for the insertion of the angled custom milled molar abutment’s placement into the prosthesis. As the post of the molar abutment is being inserted with the prosthesis, the abutments become parallel allowing the prosthesis to be seated and checked for its appropriate fit. Then the prosthesis is removed for the application of Vaseline to its intaglio surface to facilitate the removal of extraneous cement after resin cementing of the prosthesis. Clinical and radiographic images of a five unit fixed prosthesis completed in only two clinical visits. The Bicon design was created in nineteen eighty five not as a research project to study osseointegration but rather as a means to restore dentition. Bicon is different, but different by design. The different shape, different geometry, and different surgical and restorative protocols lead to different clinical capabilities and better long term results. The design has remained consistent and unchanged since nineteen eighty five and has truly passed the test of time. One point five degree locking taper, time tested stable connection with no screws, torque drivers, or need for splinting with a proven bacterial seal. The sloping shoulder provides bone to support papillae, distributes occlusal stresses, and preserves crestal bone. The plateau design allows for the development of cortical like Haversian bone between the fins, callus bone formation, and thirty percent more surface area. Scannable temporary abutments allow the clinician to fabricate the prosthesis while the implant is integrating. The one point five degree locking taper with no screws allows for three hundred and sixty degree abutment positioning, extra oral cementation, and CAD/CAM restorations with superior aesthetics. No screws results in less maintenance. The one point five degree locking taper allows for subcrestal implant placement and eliminates bacterial flux present in threaded implants with screw components. Note the lack of inflammation after ten years when the abutment is removed. The one point five degree locking taper connection provides a seal at the implant to abutment interface, avoiding the microbial leakage issues that can result in inflammation. The sloping shoulder and subcrestal implant placement provides more room for bone over the implant, a sensible narrow emergence, and support for papillae. Hemispherical base. Bicon abutments feature a solid titanium hemispherical base designed to contact soft tissue, promoting optimal bone maintenance and growth. Note the bone gain on the mesial with the hemispherical base. Note the vast improvement in bone levels simply by changing the restoration with an abutment with a hemispherical base. Note the distinct hemispherical base and bone gain over thirteen years. Note the distinct hemispherical base and bone gain over four years. Note the distinct hemispherical base and bone gain over seventeen years. Scannable temporary abutments, temporary abutments, sinus lift abutments, thin crestal temporary abutments, universal abutments, non shouldered abutments, shouldered abutments, millable abutment blanks, laboratory abutments, fixed detachable universal abutments, FDUA transitional implants, fixed detachable abutments, TRINIA CAD/CAM material, Brevis abutments, overdenture abutments. Instrumentation. The instrument holder is designed with a threaded end for fastening the two and two point five millimeter abutment prep holder tips and any threaded instrument. Its locking taper end is designed to hold a three millimeter post abutment or the shoulder depth gauge. The shoulder depth gauge is designed to facilitate selecting an appropriate abutment height. It may be attached to the locking taper end of the instrument holder. The threaded straight handle is designed to be used with all threaded instrumentation, hand reamers, sulcus formers, inserters or retrievers, tissue punches, osteotomes, chisels, bone expanders, and seating tips. The threaded offset handle is designed to be used with implant and abutment seating tips when direct access is not possible. The two millimeter implant or angled abutment seating tip is designed for use with a threaded straight or offset handle to facilitate the correct seating of an implant or an abutment. The standard abutment seating tip is designed for use with a threaded straight or offset handle to facilitate the correct seating of an abutment. The large abutment seating tip is designed for use with a threaded straight or offset handle to facilitate the correct seating of an abutment. The crown seating tip is designed for use with a threaded straight or offset handle and a custom thermoplastic seating jig to facilitate directing the seating forces in the long axis of the implant well for an extra orally cemented crown. Abutment prep holder tips are designed to be fastened to the instrument holder for securing a two or two point five millimeter post abutment while it is being modified. The holes facilitate the removal of the seated abutment from the tip by placing an instrument through the hole and lifting. The healing plug removal instrument is designed to facilitate the removal of previously cut black healing plug from the implant’s well during the second stage surgical procedure. Standard and tall guide pins are designed to be placed into the corresponding well diameter of an implant as a guide for a sulcus former. They are available in three color coded diameters and two shaft lengths, standard and tall. They may also be used to assess the integration and trajectory of an implant. Sulcus formers are designed to remove any soft tissue or bone above the implant that could prevent the correct engagement of the abutment’s locking taper connection to the implant. They are used in conjunction with the previously mentioned guide pins. They are available in diameters consistent with the hemispherical base of the intended abutment. The threaded knob is designed to be used with threaded instrumentation, I. E, sulcus formers, inserters, and retrievers, tissue punches, and hand reamers where there is limited access. Seating abutments and crowns. Seating tips are used to facilitate the definitive engagement of the one point five degree locking taper connection with a few gentle taps on properly positioned abutments or crowns. Standard and large abutment seating tips are used with a threaded straight or offset handle to facilitate the definitive seating of an abutment. The angled abutment seating tip is used with a threaded straight or offset handle to facilitate the definitive seating in the notch of the angled abutment. The crown seating tip is used with a threaded straight or offset handle and a custom thermoplastic seating jig to facilitate directing the seating forces in the long axis of the implant well for an extra orally cemented crown. Fasten the appropriate seating tip onto a straight or offset threaded handle. Gently tap the handle with a few taps using a surgical mallet to definitively seat the abutment. The force necessary to seat an abutment is equivalent to dropping a one ounce weight the distance of eight inches. It is critical that the tapping force be directed in the long axis of the abutment post and implant well. Some angled abutments have a notch to allow for the use of an angled abutment seating tip to facilitate directing the seating force in the long axis of the abutment post and implant well. View of the crown alignment device. When definitively seating an extraorally cemented crown and abutment, it is often better to use a thermoplastic seating jig formed with a crown seating tip within a crown alignment device, especially when it is an angled abutment. The thermoplastic seating jig facilitates applying the seating force in line with the long axis of the abutment post and well of the implant. Selecting a guide pin. Guide pins are color coded by the diameter of the corresponding implant’s well, red for two millimeter, blue for two point five millimeter, or green for three millimeter. Tall shaft guide pins are two colored and sit three millimeters above the implant, which is two millimeters higher than the standard shaft guide pin. Choosing a sulcus former. Choose a color coded sulcus former with a diameter corresponding to the diameter of the intended abutment’s hemispherical base and fasten it to a threaded knob, straight handle, or threaded instrument adapter prior to placing it onto the guide pin seated in the well of the implant. Standard shaft guide pins provide for removal of tissue above the implant, which could prevent the seating of the intended abutment. Tall shaft guide pins are two millimeters taller than standard guide pins and provide for removal of tissue above the implant, which could prevent the seating of the intended abutment, avoiding unnecessary removal of crestal bone for deeply positioned implants. If there is minimal vertical clearance, seat the sulcus former and the threaded knob as a unit onto a guide pin seated in the implant’s well. If there is inadequate lateral clearance to rotate the sulcus former 360 degrees, remove one tip of the sulcus former with a carbide bur and only rotate it less than one hundred and eighty degrees. Scannable temporary abutments. Bicon’s scannable temporary abutments provide for an efficient and cost effective digital recording of an implant’s position at the time of its one stage surgical placement or later. The occlusal view of the scannable temporary abutments communicates a variety of information. The abutment color and number of dimples denote the post diameter. The numeral denotes the series, which is the approximate diameter in millimeters of the abutment, and the letter denotes the profile’s relative height. A circle around the numeral and letter denotes a tall shaft, which is the portion of the abutment post above the top of the implant. Choose either a standard or tall shaft, color coded scannable temporary abutment with the same shaft length, diameter, and profile as the intended permanent abutment. The dimensions of scannable temporary abutments are indicated by the number of dimples and black markings on their occlusal surface. Choose a scannable temporary abutment so that three hundred and sixty degrees of its circumference will be slightly above the gingival crest to facilitate its scanning, but not so high that it would interfere with the transitional prosthesis. The scannable temporary abutment may be placed during the insertion of the implant and scanned immediately or later after the healing of the soft tissues and prior to the integration of the implant. This option allows for the fabrication of a prosthesis while the implant is being integrated, which provides the opportunity of eliminating a patient visit and the anxieties associated with coordinating the patient’s prosthetic insertion visit with the completion and arrival of the prosthesis. View of the completed scan. To avoid the incorrect recording of an implant’s axial positioning, be sure the scannable temporary abutment is fully seated in the implant’s well by either using a sulcus former to remove any tissue which may be impinging on the abutment’s hemispherical base or by using a scannable temporary abutment with a tall shaft. Avoid changing any abutment on a newly placed implant, especially a blue two point five millimeter scannable temporary abutment, which is more retentive than the two millimeter and three millimeter abutments since it may remove the implant. A scanner software can automatically replace the image of the scannable temporary abutment with that of a digital scan post. Temporary abutments. Since the introduction of the scannable temporary abutment, the original titanium and PEEK temporary abutments are less popular among clinicians, especially those who are using digital scanning techniques. Except for digital scanning, they provide the same functions. The PEEK temporary abutment is easily modified intraorally if necessary. Sinus lift temporary abutments. The sinus lift abutment was originally designed to prevent an implant from entering the maxillary sinus cavity during the internal sinus lift technique. Subsequently, it is also used to prevent an implant from falling into bone voids. Sinus lift abutments are used to prevent an implant from entering the maxillary sinus or bone voids. Radiographic evidence of the efficacy of the sinus lift temporary abutment. Thin crestal temporary abutments. The thin crestal temporary abutment was designed as an enhancement to the original sinus lift abutment and it is now the preferred abutment for many clinicians. It has a thinner surface which facilitates placement under the mucosa. Available with standard and tall shafts, it also has a threaded bore which facilitates its placement and removal with its threaded screwdriver. Additionally, the threaded bore can be used with a screw to retain a membrane. Thin crestal abutments are used to avoid an implant falling into the maxillary sinus or bone voids. Universal abutments. Bicon’s universal abutments are the most popular abutment for most clinicians. They are particularly effective for CAD/CAM techniques since their design facilitates the use of intraoral digital scanning techniques but may require spraying the abutment. Their geometries are also listed in most CAD/CAM software libraries. They can be impressed either directly or indirectly using plastic sleeves with conventional impression materials. They are individually labeled on their occlusal surface indicating their series, which denotes the diameter of the hemispherical base, and their profile, which denotes the height of their hemispherical base. They are available with zero or fifteen degrees of angulation and may be significantly modified if necessary since they are a solid piece of surgical grade titanium. They are also available with tall shafts which are two millimeters taller than standard shafts and are helpful for deeply positioned implants, often avoiding the need for removing bone over the implant with sulcus formers. They are ideal for single cemented crowns, fixed bridges, and TRINIA telescopic prostheses using custom or prefabricated retentive copings. Their accessory components are color coded and conveniently facilitate their intended function. Universal abutment geometry. The series denotes the diameter of the hemispherical base. The profile denotes the height of the hemispherical base as measured from the top of the implant to the shoulder. Six l indicates low profile. Tall shaft abutments, guide pins, and scannable temporary abutments are available for deeply positioned implants. For less than ideally positioned implants, fifteen degree angled abutments are available. Choosing a universal abutment. Choose the widest abutment that supports the interproximal papillae without encroaching upon them. Choose an abutment profile according to the depth of the implant’s gingival sulcus. Choose a tall shaft abutment for deeply positioned implants. Reduce the abutment’s facial and or lingual aspect if necessary to avoid the potential of food impaction under the bulbous buccal or lingual contours of a crown. Conventional implant level impression. Choose an appropriately sized color coded titanium impression post corresponding to the diameter of the implant’s well. Insert the titanium impression post into the well of the implant with only finger pressure or with a very gentle tap, especially for two point five millimeter blue posts. Otherwise, they may be difficult to remove. Snap the appropriate color coded plastic impression sleeve into the impression post. Inject the impression material around the plastic impression sleeve to make an impression. After removal of the impression, the plastic impression sleeve should be withdrawn within the impression, and the titanium post should remain in the implant well. If the titanium post is removed within the impression material, you may not have accurately recorded the axial position of the implant. Remove the titanium impression post from the implant and insert it into an implant analog prior to inserting them as a unit into the plastic sleeve within the impression. Pour a soft tissue model and then choose an abutment with either a standard or tall shaft with an appropriate profile height for the fabrication of a prosthesis of the desired material, which is preferably cemented extra orally to avoid extraneous cement. Digital implant level impression with a digital scan post. White PEEK and color coded titanium digital scan posts serve the same function of recording the relative position of the implant in the bone. Insert a digital scan post corresponding to the diameter of the implant well and scan it. The dimples designate the post or well diameter. Insert either post with only finger pressure or with a very gentle tap, especially for the two point five millimeter posts. Otherwise, it may be difficult to remove. Design and fabricate the final restoration with the CAD/CAM software of your choice. Digital implant level impression with a scannable temporary abutment. Insert the appropriate scannable temporary abutment according to the diameter of the implant well and final abutment and scan it, making sure three hundred and sixty degrees of its circumference is visible for scanning. The dimples and color designate the post or well diameter, and the laser marking designates the abutment diameter and height. A circle around the numeral and letter denotes a tall shaft, which is used for deeply positioned implants. Scanned images provide information for the technician to fabricate the prosthesis of choice. Sending a radiograph of the implant’s position to your technician is helpful. Direct digital scanning of universal abutments. Clinical image of six series universal abutment with a standard shaft. Image of intraoral scanning. Digital image of scanned universal abutment, clinical image of the extraorally cemented crown, Indirect universal abutment level impression. Definitively seat the abutment with a gentle tapping force. Snap a colored coded impression sleeve corresponding to the unmodified universal abutment. View of a four series color coded impression sleeve snapped onto the universal abutment. Inject the impression material around the impression sleeve and make an impression. Withdraw the plastic impression sleeve in the impression. Choose an appropriately sized aluminum transfer dye and insert it into the plastic sleeve within the impression prior to pouring a conventional stone model. Fabricate the desired prosthesis. View of the final prosthesis. Indirect universal abutment level impression for a CAD/CAM hybrid ceramic crown. Seated six series tall universal abutment. Attach the corresponding green six series impression sleeve to the abutment. Inject impression material around the impression sleeve. Be sure that the plastic impression sleeve is captured in the impression material. Insert the green transfer dye into the plastic sleeve within the impression material prior to pouring a stone model for the fabrication of a CAD/CAM hybrid ceramic crown. CAD/CAM hybrid ceramic crown. Apply metal primer to the six series universal abutment prior to cementing the CAD/CAM hybrid ceramic crown. Cement the CAD/CAM hybrid ceramic crown and use dental floss to eliminate extraneous cement. Use articulating paper to confirm occlusal contacts. Buccal view of the cemented crown. Post insertion radiograph. Universal abutment healing caps. Healing cap being inserted onto a universal abutment without cement. Healing cap seated on a universal abutment, which efficiently provides a non irritating smooth surface to the mucosa. Universal abutment temporization sleeve. Insert the selected abutment with light finger pressure only. Use a template to confirm appropriateness of the abutment prior to engagement of the locking taper connection. Gently tap on the abutment in the long axis of the post to definitively engage the locking taper, then seat the temporization sleeve onto the abutment prior to trying the vacuum formed template over the sleeve. Inject acrylic around the temporization sleeve and into the template prior to placing the vacuum form template with acrylic to form the transitional prosthesis. After polymerization, remove and polish the transitional prosthesis prior to reinserting it onto the abutment. Maxillary anterior seating guide. Thermoplastic seating jig being fabricated in the crown alignment device so that the seating forces will be directed in the long axis of the abutment post and implant well. Insert the abutment crown with finger pressure for evaluation and removal of any interproximal interferences. Remove any soft or bony tissue interferences by rotating an appropriate sulcus former on an appropriate guide pin. A relieving incision is being made to facilitate the seating of a wider hemispherical abutment. Confirm the removal of bony interferences with a radiograph. Align the abutment or crown prior to confirming passive interproximal contacts with dental floss, if necessary, with an incisal orientation jig. When in doubt, always adjust a contact that you think may be too tight since non passive interproximal contacts will inhibit the engagement of the abutment’s locking taper connection. Adjust excessive contacts until dental floss can be passed through the contact area with only minimal resistance. Clean the abutment post with an alcohol wipe and the implant well with an appropriately sized cotton tipped applicator. Insert and align the abutment or crown using an incisal orientation jig when necessary. While gently squeezing the bridge of the patient’s nose with your fingers, apply an initial seating tap using a custom seating jig on a threaded straight handle to ensure that the seating forces are being directed in the long axis of the implant. Confirm passive interproximal contacts with dental floss, and if necessary, remove the prosthesis by tapping on the handle of grasping forceps to adjust any nonpassive interproximal contact area. Alternatively, a thin metal finishing strip may be used without having to remove the restoration. Initially, establish uniform maximal intercuspation and then adjust any premature contacts, including on the facial of the crown by having the patient protrude and retrude their mandible while clenching to mark the premature contact. Establish uniform contacts initially in maximal intercuspation and then in protrusive and retrusive excursions. Establish uniformly balanced contacts while the patient is clenching in all extreme excursions, including retrusive movements of the mandible from an extreme protrusive position, which may indicate the need to adjust the facial aspect of the restoration since the crown is often too thick. Non shouldered abutments. The non shouldered abutment is the original Bicon abutment, and it has been used continuously since nineteen eighty five. Solid titanium abutments can be shortened with carbide burs. A five millimeter abutment can retain a cemented crown. They are available with diameters of four, five, six point five, and seven point five millimeters, heights of five, six point five, eight, ten, and twelve millimeters with angulations of zero, fifteen, and twenty five degrees. It is essentially the same as an endodontic post and core restoration. Direct abutment level conventional impression and restoration. At the time of uncovering, place the widest non shouldered abutment that will support the papillae without encroaching upon them. Allow the soft tissue to heal prior to making a direct impression of the abutment. If necessary, the abutment may be modified intraorally with irrigation or extraorally with a number one five five seven or any carbide bur while it is being held in an abutment prep holder. Inject the impression material around the abutment for a direct impression. Pour a stone model. A try in of the casting prior to the porcelain application is advised to ensure a passive seating. Fabricate the crown conventionally and insert the crown with minimal cement. Thirty two year post insertion clinical view. Eleven year post insertion radiograph. Thirty two year post insertion radiograph. Indirect abutment level impression with plastic sleeve and ceramometal restoration. After definitively seating the abutments with a gentle tapping force, place the impression sleeves onto the unmodified abutments, then inject impression material around the sleeves to make an impression. Insert the color coded abutment transfer dyes into its corresponding plastic impression sleeves within the impression. Pour a soft tissue or stone model. Snap the appropriate impression sleeves or temporization sleeves onto the color coded transfer dyes and modify as necessary. Incorporate the sleeves into the wax pattern for the fabrication of a metal casting. Try in metal casting to confirm a passive fit. Finished crowns on the abutment transfer dyes. Clinical view of the cemented crowns. Transitional restoration with a temporization sleeve. Insert the appropriate non shouldered abutments that support the papillae without encroaching upon them. Tap the abutment in the long axis of the abutment post and implant well. Snap the appropriate temporization sleeves onto their corresponding abutments. Confirm the appropriateness of the vacuum formed template over the temporization sleeves. Inject transitional crown material around the temporization sleeves. Inject transitional material into the vacuum formed template prior to reinserting it over the temporization sleeves to form a transitional prosthesis. Remove the transitional prosthesis for polishing. Snap the completed transitional prosthesis onto the abutments. Shouldered abutments. The shouldered abutment or stealth abutment provides more space for aesthetic material. It also offers the smallest abutment, which is ideal for many mandibular and maxillary lateral incisors. They are available in diameters of three point five, four, five, and six point five millimeters, heights of one point five, three, three point five, four, and six millimeters with angulations of zero and ten degrees. Millable abutment blanks. Bicon’s millable abutment blanks provide for custom abutments while ensuring the quality and precision of the Bicon locking taper connection. They allow a clinician or technician to design and mill custom Bicon abutments with optimal gingival contours while ensuring maximum titanium contact with the gingival sulcus, especially for less than ideally positioned implants. Laboratory abutments. Laboratory abutments provide the technician a solid titanium abutment that may be manually customized. They are available in diameters of five or six point five millimeters, a height of three millimeters, and with angulations of zero and fifteen degrees. Fixed detachable universal abutments. The fixed detachable universal abutment is Bicon’s second and most popular screw retained abutment system. Like all of Bicon’s abutments, it is friction retained within the implant’s well with a one point five degree locking taper connection. Its prosthetic portion is compatible with the prosthetic portion of the universal abutment and transitional implant. It differs from the universal abutment in that it has a threaded bore for the screw retention of a prosthesis. Similar to the original fixed detachable abutment system, the threaded bore for the prosthetic retention screw is within a titanium cone, thereby preventing any lateral loading of the retention screw. Interestingly, the retention screw has only three threads, which is not only sufficient, but more conveniently confirms the passive and complete seating of a prosthesis. If a clinician desires a longer screw to fasten a prosthesis, it is a clear indicator that the prosthesis is not passively seated. Fixed detachable universal abutments are available with standard and tall shafts with angulations of zero and fifteen degrees and profiles of two and four millimeters. Hex coping screws for fixed detachable universal abutment copings. The hex coping screws are available in lengths of five and ten millimeters. They may be shortened chairside with a carbide bur to provide a functioning screw with the exact length to be just below the occlusal surface of a prosthesis. This feature provides significant time savings for a clinician since the screw can be readily seen as opposed to being submerged two to three millimeters within the prosthesis. Hex coping screws for fixed detachable universal abutment copings. Case one, occlusal view of TRINIA full arch prosthesis retained by three fixed detachable universal abutments prior to the shortening of the hex coping screws. Hex retentive coping screw being shortened with a carbide bur. Screw being shortened with carbide bur, shortened coping screw being fastened in fixed detachable universal abutment, flowable composite being light cured, Radiograph of maxillary trinia prosthesis retained with three fixed detachable universal abutments and a mandibular prosthesis retained with three retentive copings on universal abutments. Hex coping screws for fixed detachable universal abutment copings, case two. Five millimeter hex coping screw being inserted to fasten the final coping within the prosthesis to the FDUA. Five millimeter hex coping screw being fastened to the FDUA to secure the coping within the prosthesis. Hex coping screw being cut with a number three three zero carbide bur. So the top of the hex screw will be just below the occlusal surface, significantly facilitating access to it. Flowable composite being injected around the hex screw. Technique for the restoration of a four unit TRINIA bridge. Choose a fixed detachable universal abutment with its shoulder at or above the gingival crest. For dentures or non aesthetic areas, a shoulder five millimeters above the crest is acceptable. Having the shoulder above the gingival crest allows access for the coping to be fitted without interference. For a deeply placed implant, use an abutment with a tall shaft. For a less than ideally placed implant, angled abutments are available. Three screw lengths are available, retentive, five millimeter, and ten millimeter, which can be cut with a carbide bur. If a five or ten millimeter screw is being used, place a layer of Vaseline on the exterior sides of the screw before cementing the coping. The length of the screw is dictated by the height of the crown on the prosthesis. The screw should sit just below the top of the crown. Fasten the copings with an appropriately cut screw and a hex screwdriver. Confirm the fit of the prosthesis. Fasten the completed transitional prosthesis onto the fixed detachable universal abutment. After placing Vaseline only on the screws, apply resin cement to bond the copings to the TRINIA. The copings are now permanently cemented into the bores of the prosthesis. Remove any extraneous cement. Refasten the prosthesis using a shortened or non shortened hex coping screw so that it can be seen and accessed just below the occlusal surface of the prosthesis. Cover the head of the screw with a small piece of cotton and then cover with composite material. This will allow for easy access for removal of the screws. FDUA transitional implants. The fixed detachable universal abutment or FDUA transitional implants are available in eight and ten millimeter lengths with either a standard two millimeter or a tall four millimeter profile. With TRINIA or a wire reinforced PMMA prosthesis, they can provide for the immediate loading of implants by using intra orally cemented screw retained copings using the same components as Bicon’s fixed detachable universal abutments. Drill the pilot osteotomy one millimeter deeper than the intended transitional implant so the implant’s hemispherical base can gain stability by resting on the bone. Provides for a fixed prosthesis while permanent implants are healing. Passively fitting prosthesis ensured with intraorally cemented screw retained copings. Screw retained copings can be cemented to a variety of materials such as TRINIA and PMMA. Screws and prosthetic components are identical for both the fixed detachable universal abutments and FDUA transitional implants. Hex coping screws may be cut with a carbide bur so that their height will be just below the occlusal surface of a prosthesis. Immediate restoration of three FDUA transitional and four permanent implants with TRINIA and fixed detachable universal abutments. TRINIA and the components of the fixed detachable universal abutment can provide an efficient treatment for patients who do not want to have a removable prosthesis. Preoperative radiograph, preoperative clinical view, right and left preoperative profile views, vertical dimension of occlusion or VDO being recorded, A mandibular wax rim with a stylus and a maxillary wax rim with a metal plate for the Gothic arch tracing. Mandibular movements tracing the Gothic arch on a maxillary metal plate. A bite registration being made with a stylus positioned at the apex of the gothic arch tracing. Wax rims with a bite registration being removed for the articulation of models. Post extraction views. The initial osteotomy being prepared with a two millimeter pilot drill rotating at eleven hundred revolutions per minute. Blue, three point five millimeter, and gray, four point five millimeter. Hand reamers attached to a threaded instrument adapter are being rotated at fifty revolutions per minute between paralleling pins in the transitional implant osteotomies. Standard two millimeter and tall four millimeter profile FDUA transitional implants. Note, the hemispherical base of the implant is resting on bone. A two point five by eight millimeter fixed detachable transitional implant is being transported to its osteotomy with cotton pliers and is inserted into the osteotomy with a latch transitional driver. Three fully seated transitional implants as evidenced by their hemispherical base resting on alveolar bone. Opening within transitional TRINIA prosthesis to accommodate screw retained components of transitional implants, a spoon excavator being used to harvest bone from osteotomy, a four point five by six millimeter short implant with a three millimeter well being transported to the osteotomy with a black healing plug. Osteotomy being enlarged with a gray four point five millimeter latch reamer rotating at fifty revolutions per minute without irrigation. A four point five by six millimeter short implant with a three millimeter well being inserted into the osteotomy with a black healing plug. View of three green three millimeter guide pins and three transitional implants. Transitional TRINIA prosthesis being seated over guide pins and transitional implants. Occlusal view of seated TRINIA prosthesis. View of seated permanent short implants and transitional implants, surgical site being sutured, harvested bone being placed over permanent short implants adjacent to transitional implants, Clinical view of sutured site around prosthetic portion of three transitional implants. Radiographic image of four permanent short implants and three transitional implants. Coping being attached to transitional implant with a five millimeter hex coping screw. Hex screwdriver attached to a five millimeter screw transporting coping to transitional implant. View of three copings attached to the prosthetic portion of transitional implants with five millimeter hex coping screws. TRINIA prosthesis being seated over hex coping screws attached to transitional implants. Occlusal view of seated prosthesis over transitional implants. Vaseline being applied only to hex coping screws to facilitate their removal after resin cementation of the coping. Resin cement being applied to mechanically attach the copings to the TRINIA prosthesis. Additional resin cement being injected into the screw retained TRINIA prosthesis. Occlusal view of three five millimeter hex coping screws in the resin cemented TRINIA prosthesis and screw being removed. Crown removal instrument being used to facilitate the removal of the prosthesis. TRINIA prosthesis prior to the removal of a resin embedded suture. View of three mechanically cemented copings within TRINIA prosthesis after the removal of extraneous cement. Occlusal view of TRINIA prosthesis after removal of extraneous cement. Hex coping screw being removed with a hex screwdriver to adjust the flange of the prosthesis, which is impinging on the mucosa. Flange adjusted TRINIA prosthesis being seated. Hex screwdriver being used to fasten the flange modified prosthesis. Flowable composite being light cured. View of screw retained transitional TRINIA prosthesis. Post insertion panoramic radiograph of four permanent implants and a screw retained trinia prosthesis supported by three FDUA transitional implants. Four three millimeter guide pins in the wells of uncovered Bicon short implants. Note the three fixed detachable transitional implants six months after their placement. A fixed detachable universal abutment or FDUA being inserted into the three millimeter well of an uncovered Bicon short implant. View of three FDUA transitional implants and four fixed detachable universal abutments prior to making an abutment level transfer impression. Transfer coping being fastened to fixed detachable universal abutment. Resin cement being applied to transfer copings to assure their relative position during the making of a conventional open tray abutment level transfer impression. Four attached transfer copings within conventional impression material. FDUA transitional implant being removed with a transitional implant latch driver. View of four fixed detachable universal abutments and site of recently removed fixed detachable transitional implant seven months after its placement. Permanent TRINIA prosthesis with four bores for the chairside attachment of four final copings. Permanent TRINIA prosthesis being inserted onto four fixed detachable universal abutments. First final coping being seated onto fixed detachable universal abutment. Four fixed detachable universal abutments attached with four five millimeter hex coping screws. TRINIA prosthesis being seated onto copings to confirm a path of insertion and a passive seating. Images of implant clear plastic tray which is significantly easier to use. Vaseline being applied to the shaft of the screws to facilitate their removal after the resin cementing of the four fixed detachable universal abutments. Resin cement being applied to the bores of the TRINIA prosthesis, TRINIA prosthesis being inserted onto copings for their cementation to the prosthesis. TRINIA prosthesis being firmly seated onto copings for their cementation to the prosthesis. Resin cement in the bores of prosthesis being light cured, while the hex screwdrivers prevent cement from filling the hex bores of the screws. Four final copings cemented within TRINIA prosthesis prior to the removal of extraneous cement. TRINIA prosthesis being fastened to a fixed detachable universal abutment with a ten millimeter hex coping screw. Hex coping screw being shortened extraorally with a carbide bur to be slightly below the occlusal height of the prosthesis. Hex coping screws can be shortened intraorally so that they will be slightly below the occlusal height of the prosthesis. Facial view of a permanent mandibular TRINIA prosthesis. Post insertion radiograph of a permanent TRINIA prosthesis attached with fixed detachable universal abutments and copings to four Bicon short implants. Fixed detachable abutments. The fixed detachable abutment is the original abutment for screw retained prosthetics. They are available with a four millimeter diameter, heights of three millimeters and five millimeters, and angulations of zero and fifteen degrees. It is similar to the fixed detachable universal abutment, which is becoming the preferred abutment because its prosthetic components are identical to those of the FDUA transitional implant. Indirect transfer impression and restoration. Three standard shaft two millimeter guide pins in the wells of their implants to assess their osseointegration and trajectories. Clinical image of three fixed detachable abutments. Radiographic image of three fixed detachable abutments seated in the corresponding implants. Transfer coping being attached to a fixed detachable abutment with a ten millimeter hex coping screw for the making of an open tray transfer impression. Three standard analogs in a poured soft tissue stone model prior to the fabrication of a cast metal bar framework. Cast metal framework being seated on three fixed detachable copings. Hex retention screw being inserted into the threaded bore of a fixed detachable abutment to fasten the cast metal framework to the abutments. Facial view of the cast metal bar affixed to three fixed detachable abutments. TRINIA, the revolutionary metal free CAD/CAM material. TRINIA prosthetic options, prosthetic frameworks, fixed prostheses, telescopic obturator and winged provisional, removable prosthetics and transitional bridge. Three examples of diamond coated and nano diamond milling burs. Milling strategy is specific to machine and burs. Strategy for PMMA usually works well. TRINIA for digital post and cores. Note the orientation of the TRINIA fibers comprising the post and core. For post and core designs less than fifteen millimeters in length, use TRINIA EPC. Otherwise, use standard TRINIA blocks. Efficient and effective chairside digital fabrication of endodontic post and core restorations. TRINIA restorations have a similar modulus of elasticity and translucency to dentin. The post and core restoration does not have an interface since it is milled from one material. If two restorations are milled together, eight post and core restorations can be milled from one block. TRINIA’s cemented prosthesis in two clinical visits. Case one. Two five t scannable temporary abutments. Clinical image of two five t scannable temporary abutments. Digital scan. Prosthesis on two universal abutments. Scannable temporary abutment being removed from the well of its implant. Scannable temporary abutment being removed from the well of its implant. Abutments in Vaseline lined bores of resin seating jig. Abutments being definitively seated in their implant wells. Resin cement being injected into the bore of prosthesis. Clinical view of prosthesis during the patient’s second clinical visit, the patient’s smile, post insertion radiograph. TRINIA cemented prosthesis in two clinical visits. Case two. Post insertion radiograph of two one stage implant placements with scannable temporary abutments. Clinical view of two scannable temporary abutments ten days after their insertion. Intraoral digital scanning. Digital intraoral scan. TRINIA prosthesis on two universal abutments. Scannable temporary abutment being removed from its implant. Prosthesis being used to orient and initially seat abutments into the well of their implants. Prosthesis being inserted on two abutments to evaluate its fit. Interproximal contacts being confirmed with dental floss. Two modified abutments prior to being definitively seated with a resin jig. Resin jig stabilizing abutments while they are being definitively seated. Resin seating jig being removed. Prosthesis being inserted with indicator paste to reveal any impingement on the soft tissue. Premature contact of the pontic area is revealed. Crestal relieving incision was made to remove any mucosal interference with the seating of the prosthesis. Prosthesis being seated to confirm. Vaseline being applied to facilitate removal of extraneous cement. Resin cement being injected into the bore of the prosthesis. Prosthesis being cemented onto the implant abutments. Occlusal markings on cemented prosthesis, post insertion radiograph of cemented prosthesis, the patient’s smile. Laboratory considerations for TRINIA telescopic restorations with retentive copings. Confirm the initial occlusal registration with a Gothic arch tracing prior to the fabrication of an approved diagnostic wax up for the fabrication of a surgical guide to facilitate the placement of the implants in the middle of the intended tooth. Use three or four appropriately spaced implants to facilitate the fabrication of the prosthesis. Five or more implants unnecessarily complicates the prosthetics. If possible, place some implants while there are still teeth present, which will provide the technician with significant landmarks for fabricating the TRINIA prosthesis. If necessary, open the bite to achieve at least eleven millimeters of clearance from ridge to opposing occlusion for sufficient prosthetic space. If the bite vertical dimension of occlusion or VDO cannot be opened, then the universal abutment and retentive coping can be reduced. The coping can be retentive even as a three millimeter ring. Alternatively, use a retentive ring. Low profile universal abutments should not be used for full arch TRINIA prosthesis. Standard profile or taller universal abutments should be used with their shoulder minimally above the soft tissue. In non aesthetic areas, such as sublingual areas, the shoulder can be significantly higher to facilitate cleaning and mucosal health. Fabricate a facial silicone mask of a teeth arrangement to verify there is at least two millimeters for the essential thickness of TRINIA material over the retentive copings for strength. Passive copings can be used to reduce the retentiveness of a prosthesis. The universal abutments must have zero point five millimeters of divergence amongst them at their cervical area to provide for retention. The coronal aspect of a universal abutment may be reduced. Note the dotted red line to facilitate a path of insertion and withdrawal without compromising the retentiveness of the TRINIA prosthesis. Moreover, if the divergence is too great, use the custom cast copings with Cytec retentive colored inserts. Fabricate a light cured resin verification jig with retentive copings to verify that the TRINIA prosthesis will have a path of insertion and withdrawal as well as be retentive. Fabricate one or two light cured resin orientation and seating jigs. These are appropriately numerically marked coinciding with the numerical markings on the master model to indicate the sequencing for inserting each universal abutment into the corresponding well of the patient’s implants. Most often, the abutments are loosely placed into the Vaseline lined seating jig for transport and seating into the well of the implants. In certain situations, some angled abutments need to be loosely seated into the implant well and subsequently positioned by placing the jig onto it. An arrow on the model and jig can indicate this need to the clinician. Initially, digitally design and mill an inexpensive plastic substructure to manually and visually evaluate its appropriateness. If necessary, modify it as blue markings indicate prior to scanning it for the fabrication of the permanent TRINIA substructure. The blue color in the graphic shows example modifications. Note, the milled TRINIA substructure from the scan of a modified plastic substructure. The prepped teeth design facilitates the fabrication of digitally milled crowns, which will be cemented onto the TRINIA substructure. The aesthetics of the TRINIA substructure and the milled poly ceramic crowns can be enhanced by cutting back their facial surface and applying indirect poly ceramic materials. With TRINIA, canine implants can provide first molar occlusion as evidenced by the depicted twenty five millimeter extension. Clinical techniques for fabricating and inserting a maxillary and a mandibular telescopic trinia prosthesis with universal abutment copings on Bicon short implants, Preoperative and postoperative radiographs. Preoperative radiograph. Postoperative radiograph of four, four point five by eight millimeter, and four, five by six millimeter Bicon short implants. Five month postoperative radiograph of eight Bicon short implants. Full arch implant level transfer impression. A five series sulcus former attached to a threaded straight handle being rotated to remove any tissue which may prevent the seating of the five series universal abutment. Removal of temporary abutments. Inserting two blue two point five millimeter and two green three millimeter titanium impression posts in their respective implants, definitively seating two blue two point five millimeter and two green three point zero millimeter titanium impression posts in their respective implants with a gentle tap. Impression posts seated in their respective implants for the making of a full arch implant level transfer impression, color coded acrylic impression sleeves being snapped onto their corresponding impression posts. Impression material being injected around the impression posts and their corresponding acrylic impression sleeves, maxillary full arch implant level transfer impression. Impression posts seated in their respective implants for the making of a full arch implant level transfer impression, impression material being injected around the impression posts, and their corresponding acrylic impression sleeves. Mandibular full arch implant level transfer impression. Recording of vertical dimension of occlusion, VDO, and occlusal registration. Vertical dimension of occlusion being recorded. Midline being denoted with dental floss while the occlusal registration is being recorded. Impression sleeves captured within the maxillary side of occlusal registration material. Impression sleeves captured within the mandibular side of occlusal registration material. Stone model being poured around two blue and two green implant analogs seated in the maxillary full arch implant level transfer impression. Stone model being poured around two blue and two green implant analogs seated in the mandibular full arch implant level transfer impression. Maxillary and mandibular waxed teeth arrangements seated on their stone models. Four titanium temporary abutments seated in their maxillary implants. Four maxillary implant sulci. Impression post with an implant being used to stabilize the waxed teeth arrangement. Four titanium temporary abutments seated in their mandibular implants. Four, mandibular implant sulcus eye. Impression post with an implant being used to stabilize the waxed teeth arrangement, lab fabrication of verification and orientation seating jigs, occlusal registration being recorded with the maxillary, and mandibular waxed teeth arrangements, universal abutment being milled to accentuate the buccal position of the abutment, Four universal abutments in implant analogs within a maxillary stone model. Maxillary verification jig with universal abutment copings seated on four universal abutments on a stone model, two resin orientation and seating jigs on their universal abutments on a maxillary stone model, numerals indicating the sequence for the insertion of the first two maxillary universal abutments, Numerals indicating the sequence for the insertion of the second two maxillary universal abutments. Maxillary verification jig with one passive and three retentive universal abutment copings, which verifies a path of insertion and retentiveness of the final prosthesis. Four, universal abutments in implant analogs within a mandibular stone model. Mandibular verification jig with universal abutment copings seated on four universal abutments on a stone model. Two resin orientation and seating jigs on their universal abutments on a mandibular stone model. Numerals indicating the sequence for the insertion of the first two mandibular universal abutments. Numerals indicating the sequence for the insertion of the second two mandibular universal abutments. Mandibular verification jig width, one, passive, and three, retentive universal abutment copings, lab fabrication of a maxillary, and a mandibular TRINIA prosthesis. Occlusal side view of maxillary and mandibular substructures milled in a TRINIA disc. Ridge side view of maxillary and mandibular substructures milled in a trinia disc. Bonding agent being applied to a trinia substructure prior to its bonding to anterior composite denture teeth using a silicone mask. Maxillary and mandibular trinia substructures with their bonded anterior composite denture teeth in occlusion. Posterior CAD/CAM hybrid ceramic teeth milled in a disc. Occlusal view of the mandibular TRINIA substructure with bonded anterior composite denture teeth and posterior CAD/CAM hybrid ceramic teeth. Occlusal view of the finished maxillary TRINIA prosthesis on a stone model. Occlusal view of the finished mandibular TRINIA prosthesis on a stone model. Left profile view of the finished maxillary TRINIA prosthesis seated on a stone model with numerals indicating the first sequence for the insertion of the universal abutments. Right profile view of the finished maxillary TRINIA prosthesis, seated on a stone model with numerals indicating the second sequence for the insertion of the universal abutments. Facial view of the finished mandibular TRINIA prosthesis seated on a stone model with numerals indicating the sequence for the insertion of the universal abutments, definitive seating of universal abutments, Vaseline being applied to the bore of the orientation and seating jig to facilitate its removal. Two first sequenced universal abutments being transported to their implants in the Vaseline lined bores of a numerically marked orientation and seating jig. Orientation and seating jig being tapped with a standard seating tip attached to a threaded straight handle to simultaneously seat the universal abutments. Violet two point zero millimeter seating tip attached to a threaded straight handle being used to seat the anterior universal abutment while it is positioned in the orientation and seating jig. Crown removal instrument being used to remove the orientation and seating jig from the universal abutments. Standard seating tip attached to a threaded straight handle being used to definitively seat the universal abutments. Try in of maxillary TRINIA prosthesis. Universal abutments being transported to their implant in the Vaseline lined bores of a numerically marked orientation and seating jig. Orientation and seating jig being tapped with a standard seating tip to simultaneously seat the universal abutments. Violet two point zero millimeter seating tip attached to a threaded straight handle being used to seat the anterior universal abutments while it is positioned in the orientation and seating jig. Crown removal instrument being used to remove the orientation and seating jig from the universal abutments. Standard seating tip being used to definitively seat the universal abutments. Try in of mandibular TRINIA prosthesis. Intraoral cementation of retentive copings to TRINIA prosthesis. Vaseline being applied to a passive universal abutment coping to facilitate its removal from the universal abutment after its intraoral cementation into a bore of the TRINIA prosthesis. Vaseline being applied to a retentive universal abutment coping to facilitate its removal from the universal abutment after its intraoral cementation into a bore of the TRINIA prosthesis. One passive and three retentive universal abutment copings being seated on their respective universal abutments. Vaseline being applied, but not to the bores, to facilitate the removal of extraneous resin cement after its intraoral cementation to the universal abutment copings. Resin cement being applied to the bores of the maxillary prosthesis, Vaseline being applied, but not to the bores, to facilitate the removal of extraneous resin cement after its intraoral cementation to the universal abutment copings. Resin cement being applied to the bores of the mandibular prosthesis. Cotton rolls being used to apply occlusal pressure during the cementation of the maxillary and mandibular prosthesis to their universal abutment copings. Ridge view of maxillary TRINIA prosthesis with four resin cemented universal abutment copings. Ridge view of mandibular TRINIA prosthesis with four resin cemented universal abutment copings. Vaseline being applied to the mandibular prosthesis to facilitate its easy removal during occlusal adjustments. Placing the mandibular TRINIA prosthesis for occlusal adjustments. Vaseline being applied to the maxillary prosthesis to facilitate its easy removal during occlusal adjustments. Placing the maxillary trinia prosthesis for occlusal evaluation. Articulating paper being used to confirm appropriate occlusal contacts. Post insertion view of the maxillary and mandibular telescopic TRINIA prosthesis in occlusion. Occlusal view of the maxillary telescopic TRINIA prosthesis. Occlusal view of the mandibular telescopic TRINIA prosthesis. Facial view of the maxillary telescopic TRINIA prosthesis. Facial view of the mandibular telescopic TRINIA prosthesis. Patients smile with his telescopic TRINIA prosthesis, post insertion radiograph of the maxillary, and mandibular telescopic TRINIA prosthesis with anterior composite denture teeth and posterior CAD/CAM hybrid ceramic teeth. Brevis abutments. Bicon implants are ideally placed two millimeters to three millimeters or more below the crest of bone. Therefore, to accommodate the different depths of an implant below the mucosa, the brevis abutment is available in three heights of two millimeters, four millimeters, and six millimeters with angulations of zero and fifteen degrees. The lengths correspond to the height of the abutment shoulder above the implant. The Brevis housing is available with rubber O rings with enhanced retention or light retention. Although the housing may be attached in the laboratory using a black impression cap and a transfer dye, the intraoral technique is preferable for most clinicians. Use an occlusal registration jig with the opposing arch to prevent inadvertent displacement of the denture during the chairside technique. Use the fifteen degree brevis abutment to help achieve parallelism for non parallel implants. The denture should neither rock nor pivot on either the abutments or the housings prior to applying flowable acrylic to mechanically attach the o ring housings to the denture. Use a rubber dam and Vaseline to prevent acrylic from locking the denture beneath the undercut of the abutments. Place acrylic into a syringe for ease of use and greater control. It is essential for the patient to clench bilaterally on cotton rolls to ensure proper seating of the housings in the denture. Acrylic, which is too viscous, may displace the housing causing the o ring to wear prematurely. If the denture is too retentive, slightly relieve the inside of the O ring lumen with a round bur or replace with a light retention rubber O ring. Brevis chairside technique. A registration of the denture’s occlusal relationship prior to the uncovering of the implants will facilitate that the denture is not inadvertently displaced by the brevis abutments or their housing during the mechanical attachment of the housings to the denture. Uncover each implant using a small crestal incision and use the healing plug removal instrument to facilitate the removal of the black healing plug. Use a shoulder depth gauge to facilitate the selection of the abutment height. Place guide pins into the implants to determine their axial inclinations. Brevis abutments are available in heights of two, four, and six millimeters. Rotate a combination of zero degree and or fifteen degree angled abutments to achieve parallelism prior to their being seated with a gentle tap. Place soft wax in the denture to act as a pressure indicator to determine the relative position of the abutments. Alternatively, the top of the abutment may be marked with a felt tip pen to indicate the location of the abutment on the denture. Liberally relieve the denture to accommodate the brevis housings. Confirm clearance for the housings by placing the denture over the housings. Brevis housing, light rubber o rings, and enhanced rubber o rings. Prior to seating the housing onto the brevis abutment, place a piece of rubber dam onto the abutment’s shoulder to prevent acrylic from locking under the abutment. For added security, inject Vaseline under the rubber dam, Inject flowable acrylic around the brevis housings and into the relieved portions of the existing denture. Place the denture into the mouth and instruct the patient to clench bilaterally on cotton rolls to ensure proper seating of the denture. After removal of the denture with the attached housings, discard the rubber dam and remove any extraneous acrylic. Radiograph of two subcrestally positioned Bicon implants with two six millimeter Brevis abutments. Brevis indirect transfer technique. Choose and gently tap the Brevis abutments whose shoulder will be above the mucosa with either an angularity of zero or fifteen degrees to provide for parallel abutments. Seat the black plastic impression caps onto the Brevis abutments and make a conventional pickup impression of the seated impression caps. Insert the aluminum transfer dyes into the impression caps prior to the pouring of a master stone model. Block out undercuts on the model and proceed to mechanically attach the housing in the denture as shown in the Brevis chairside technique. Removing and inserting rubber O rings into Brevis housing. Remove a rubber O ring by inserting a scaler or explorer between the housing and the rubber O ring to pry the O ring from the housing. Using cotton pliers, squeeze the o ring into a figure eight and insert it into the housing. Place the entire o ring into the retentive groove within the brevis housing. If the O ring is fully inserted yet not secure in the retention lip of the housing, use an explorer to move the O ring into place. Over denture abutments. Over denture abutments are available with post diameters of two, two point five, and three millimeters and heights of one, two, three, four, and five millimeters. They are compatible with all locator prosthetic components. The locator attachment features a denture component with a skirt that easily locates the mating implant abutment. The self aligning ability of the attachment aids the patient in positioning their prosthesis in a similar manner as a guide plane created by a milled bar. The implant retained overdenture can be properly seated without damage to the attachment components. This is especially important for a patient lacking anatomical structures necessary to orient their denture due to a severely resorbed mandibular ridge. Overdenture abutments chairside technique. Insert and gently seat the overdenture abutment. Place block out spacer over the abutment. Mark the housing to indicate its location relative to the denture. Insert the denture. Black ink indicating the housing position. An acrylic bur being used to provide room for the housing. Flowable acrylic is being injected into the denture. Flowable acrylic is being injected around the housing caps. View of the denture after being cleaned and polished. Denture being inserted prior to the patient applying occlusal force while the metal housing caps are being secured into the denture. Over denture abutment housing cap, remove the processing male from the metal housing cap with the locator core tool. Use the locator core tool to hold the pink one point four kilogram retention male. Insert a pink one point four kilogram retention male into the metal housing cap. View of housing cap with its retention male. Abutment removal technique. It is essential to gain a firm purchase on the hemispherical base of the abutment, preferably with one of the depicted extraction forceps. If it is a recently integrated implant, it is prudent not to apply any torque on the abutment dislodged the implant. Therefore, after grasping the abutment’s hemispherical base, tap the handle of the forceps to apply a removal force in the long axis of the implant. If the implant is well integrated, the abutment may be removed by firmly grasping the abutment’s hemispherical base before applying a twisting or turning and removal motion on the forceps. Hi, I’m Drauseo Speratti and I’m thankful for the opportunity to speak to you. One of the most often asked questions during the many Bicon seminars and lectures we do worldwide is on how to remove an abutment from a Bicon implant. Although it’s a very simple procedure, many clinicians are a little afraid or don’t know exactly how to do these procedures. We have basically two different techniques: tapping method and the twisting/pulling motion. Both are simple and straightforward to begin. First, we use an extraction forceps. Once you grasp the crown or the abutment that you desire to remove, you use a mallet that comes with the Bicon kit and tap on the handle of the forceps until the crown or the abutment is out. The other method is the twist and pulling motion. Also, using a forceps grasping the crown or the abutment you desire to remove, you do a gentle twist and pull motion, and the crown or abutment will be removed. If you’re using a permanent restoration, it’s always advisable to use a small piece of gauze plastic in order to protect or avoid any scratching of the restoration. So people are concerned if these procedures may cause any damage or any problems to the implant well, and they don’t. The reason for having two different methods is very simple. Although the majority of the implants are integrated after a period of ten to twelve weeks, the healing between the titanium and the bone takes a little longer to be completely mature. So in order to avoid any unnecessary torque to the adjacent bone, if you’re removing an abutment from an implant that has been placed in less than a year period of time, we always advise to use the tapping method. We hope this restorative video has given you a deeper understanding of the Bicon implant system and the innovative fiber reinforced CAD/CAM restorative material TRINIA. For more insights into restorative techniques, we invite you to watch our laboratory technique video. If you have specific questions, please visit www.bicon.com.