Placement and Restoration of a Bicon MAX 2.5™ Implant

This case demonstrates the extraction and immediate placement of four point five by eight millimeter implant for a maxillary central incisor and its restoration with a Bicon integrated abutment crown. The extraction of the previously endodontically treated tooth is initiated with the judicious rocking movement of a periotome in the periodontal ligament space, while apical pressure is being applied. The use of a periotome prior to using a forceps facilitates the preservation of the alveolar bone. After removal of the tooth, it is essential to carefully curette all soft tissue remnants prior to preparing the osteotomy. The osteotomy is initiated in the middle third of the palatal socket wall. The drill is used with a pumping action to a depth of eleven millimeters, as measured from the interproximal crestal bone. A gold colored paralleling pin is placed into the pilot osteotomy to confirm the appropriateness of the osteotomy’s position and trajectory. The osteotomy is widened with the use of latch reamers attached to a four hundred:one handpiece. Beginning at two point five millimeters diameter, the osteotomy is widened in half millimeter increments using subsequently wider latch reamers rotating at fifty rpms without irrigation. Prior to placing the implant, harvested bone is removed from the osteotomy and the integrity of the osteotomy’s five walls is confirmed. The final latch reamer is the gray four point five millimeters latch reamer, which matches the diameter of the intended implant. A four point five millimeters x eight millimeters Integra CP implant is transported on an implant inserter-retriever instrument and twisted into the osteotomy. A cut, black polyethylene healing plug is transported on a periodontal probe and inserted into the well of the seated implant. Harvested autogenous bone is placed over the implant and a resorbable collagen plug is sutured in place to bridge the soft tissue gap. An immediate and three month post insertion radiographic image reveals the three millimeters sub crestal implant placement. Three months after the implant placement, the implant is uncovered and the black polyethylene healing plug is removed with a healing plug removal instrument, as if it were a cork in a wine bottle. A blue, two point five millimeters wide guide pin is inserted into the well of the implant to check for integration. And a five millimeters sulcus reamer attached to a threaded straight driver is placed onto the guide pin and rotated to shape the tissues to conform to the hemispherical base of the five millimeter diameter of the intended permanent abutment. A blue two point five millimeters impression post, with a blue plastic sleeve attached, is inserted into the well of the implant for the making of an implant level transfer impression after the placement of a single interproximal suture. Upon removal of the full arch impression, the blue plastic sleeve was appropriately retained in the impression and the blue metal impression post was retained in the well of the implant. Prior to the insertion of the laboratory fabricated cementless and screwless integrated abutment crown, the transitional crown and plastic abutment is removed from the implant well. The implant well is cleaned with a cotton applicator and the IAC is inserted. After confirmation of passive interproximal contacts, the IAC is definitively seated with a couple of gentle taps using a yellow thermoplastic custom seating jig, which was formed with a crown alignment device seated in a crown seating tip attached to a straight handle to facilitate directing the tapping forces in the long axis of the abutment post and well. A diamond polishing strip was used to establish a passive interproximal contact. Post insertion clinical and radiographic images revealed an aesthetically and functionally restored implant.