Inserting and Seating Bicon Integrated Abutment Crowns (IACs) and Extra-Orally Cemented Crowns [HD]

Hi, I’m Drauseo Speratti and it’s a pleasure to have the opportunity to talk to you again. Inserting and seating a crown over a Bicon implant is a simple procedure. However, some clinicians may experience some difficulties doing so, especially those who are not familiar with the system. There are two methods for inserting and sealing a crown, but prior to discussing these methods we should always make sure the implant well is clean and free of any particles. Also, if the abutment is not taken directly from sterile packaging it should be steam cleaned, ultrasonically cleaned or wiped clean with alcohol to remove any contaminants prior to its insertion into the well of an implant. The first and probably easiest way to do this procedure is using the new universal abutments. The procedure begins at the time of uncovering of the implant. With the soft tissue open, you can insert the universal abutment, tap it in place, snap on the healing cap or temporization sleeve and wait for the soft tissue to heal prior to taking an impression. The second method, after uncovering the implant, a healing or temporary abutment is inserted. After the crown fabrication by the lab, we remove the abutment that was keeping the soft tissue open and insert the crown in place. Prior to inserting the abutments we should use the sulcus former corresponding to the abutment that we are inserting. For both methods we must check bone impingement, soft tissue blanching or impingement, interproximal contacts, proper tapping, seating forces and finally the occlusal adjustment. When inserting a crown you may notice that it is loose or occlusal discrepancy which may suggest that it is not fully seated. On these situations, we should take a radiograph to verify the proper seating of the crown. However, a radiograph cannot confirm precisely if the crown is fully seated since when you tap a crown in place, the shaft will move inside the implant well about a tenth to a quarter of a millimeter depending upon the diameter of the implant well or the diameter of course of the abutment shaft. Our eyes can actually tell if the abutment has seated a tenth or a quarter of a millimeter. So the radiograph will tell us if at least we are in the ballpark of the crown insertion or we are completely off showing there is bone is impinging upon the hemispherical base of the abutment preventing the abutment to be close to the proper and final position. So therefore, we have to verify the hemispherical base of the abutment is touching the adjacent bone. At the same time, we need to look for soft tissue blanching. If one or both conditions is noticed, we should remove the crown, insert the corresponding guide pin into the implant well and use a sulcus former. The diameter of the sulcus former should be chosen according to the abutment being used for the final restoration. If using a five series universal abutment, as an example, we use the five series sulcus formers. You can connect the sulcus formers with a threaded knob or a straight handle instrument, depending upon the area in the mouth or your personal preference. Both have the same function. Then, insert the guide pin into the implant well. Slide the former through the guide pin, pushing hard until it hits the edge of the guide pin and rotate clockwise until there is no more resistance from the bone or soft tissue. This is a very safe procedure since the guide pin protects the implant preventing any unnecessary bone cuts or more than necessary elimination of bone. After using the sulcus former, remove the guide pin and reinsert the crown. If you still notice any soft tissue blanching, use a relief incision in order to cut the tissue fibers. This will make the soft tissue loose and facilitate the insertion of the crown. After inserting the crown without any soft tissue or bone interferences, it’s time for us to make sure the interproximal contacts are adequate. You may check the contacts using a small piece of floss, which should pass through the interproximal contacts with the same resistance as natural teeth contacts. If the contacts are too tight, use a polishing or metal strip to correct the contact. If contacts are too tight to use a strip or you are restoring with a porcelain crown, remove the crown, place an articulating paper in between the crowns and adjust the marked areas until it is adequate. After adjusting the contacts, tap the crown in place. For posterior restorations with the mesial and distal tooth adjacent to it, the patient can just bite down a cotton swab and the crown will be seated. Alternatively, they can be tapped using the straight or offset handle instrument connected to a plastic healing abutment or with a small piece of a wood tongue depressor. For maxillary anterior restorations, a jig must be made by the lab or by the clinician in order to tap the crown on the long axis of the abutment shaft. More about the jig fabrication can be seen on the Bicon website. We have detailed instructions about it. We should give six steps for tapping the crowns in place. These are gentle taps, with a force similar to dropping a one ounce weight from approximately eight inches high. After tapping, the interproximal contacts should be rechecked and readjusted if needed, since they may change. After all the previously mentioned steps are successfully completed, we will address the occlusion. The occlusion should only be addressed after everything else has been checked. It should be adjusted in all extreme excursions while the patient is in a clenching position. After making all these adjustments, your crown will be securely seated. For more information, please visit the Bicon website. Hope you have enjoyed this video. Thank you for watching.