Placement of a 5.0 x 6.0mm Bicon SHORT® Implant

So what we will first show is the atraumatic extraction technique. And for the atraumatic extraction technique, the the mainstay is the use of periotomes. Okay. Good. And this is a straight periotome? Straight periotome, what’s called? This is the other end of the same instrument. It’s slightly angled. Those are very useful when we are working in an area that’s easily accessible, such as the aesthetic zone. Turn slightly more to me. That way I won’t have to put my head in the picture. Okay. So as you see, what we’re creating, and I’m sure you all know this, so I’ll just repeat it since I’m working with it, is creating a periodontal defect without destroying bone. That makes the tooth loose and makes it easy to remove. The periotome does not elevate or doesn’t mobilize the root at all. All it does is create space, severing the periodontal ligament is really what it does. Now to start mobilizing or moving the root, we will use a luxator. The luxator is slightly thicker than the periotome. It doesn’t elevate really. What I’m what we’re doing is trying to get in and widen that space that we created with the periotome. Don’t mind the noises. Okay? So I start feeling the tooth is moving. Notice there’s always a finger on the buccal plate because that’s the one thing we wanna protect. Now to be able to see what is going on with this tooth, we will use these very thin and internally serrated forceps You position them as apically as possible and use figure of eight luxation. What we’re trying to do is create a bit of widening in three dimensions aided by the slight swelling that happens in the PDL to remove the tooth. So it’s very gentle luxation compared to just using forceps. We have a little root tip. That’s okay. So for root tips, we have a very thin luxator. Okay. Hold that. Okay. Open as wide as you can, and come up. Can you go closer? I don’t know if you can. Do any more of a close-up. So what we do is, all all this does is, again, continue the luxation. Don’t don’t suction it. And what you have is because we mobilize the tooth very well, the little root tip comes out very easily okay? This is a two millimeter wide luxator made specifically for this We will first correct this osteotomy. Excuse me, are you okay? I just thought you were holding your stomach. So you want to make sure you remove all remnants of the PDL And we do have, in this particular case, a septum, which is a little of mountain of bone or pyramid of bone between the two root sockets, which I will remove now. We use a small round bur, and we will just round it off a little bit like so. Okay. We take off just this bit of bone. That will get in the way and will force us to be too palatal in the placement. This way, we can go right in the middle and have the implant in the proper location. Now before we So we’re going to go ahead and remove the roots of the molar in preparation for a placement of an implant later on. And, thankfully, those roots have self separated. So I’ll quickly remove them. Okay. Suction. A distal buccal root. Suction. Palatal root and mesial buccal root. Okay. Great. And clean those sockets as well. And after this, we will take some irrigation, clean the sockets while we prepare to place the implants. The one thing that I wanna before I do that is a little bit of the overgrown distal papilla that’s gonna be over the implant. I’m just going to thin it out so that we have a cleaner entry point. That’s all. Suction. Alright. The irrigant that we use is sterile water. It is hypotonic. It’s not normal saline. This helps lyse all remaining bacteria and other cells in the area. And, hopefully, the good cells will be replaced with bleeding, and the bad cells will be washed away. Good. Now we’ll go ahead and place a Bicon implant. Okay. The Bicon implant technique is is a little bit of a paradigm shift. It starts off by placing a pilot hole using zoom out just a bit so they can see. You okay? You you don’t have to do anything. Just relax. Okay. So we will use a pilot bur, which is two millimeters. Okay. It is a twist drill and made of stainless steel. Stainless steel Alright. So as we will place this first perforation, I don’t need to go very deep because it’s already close to the sinus, and it’s deep enough. I just wanna make sure that I have the perforation in the middle right at the edge of that septum we had in there. Okay. And the notches on the pilot bur correspond to lengths of implants. So we have six, eight, eleven, and fourteen. If I were to place an eight millimeter implant, I would want it to be placed approximately four to five millimeters below the edge of the gingival cuff right here. So eight plus five is about thirteen, and that’s what I will try to go to. Okay? So I don’t have to go that deep because we will put a short implant. However, because this is an extraction, I like to prepare my osteotomy, the full depth of the extraction, just so I can remove all of the tissues or or, you know, hard tissue that was in contact with a with the the infected root that was removed. K? Because we don’t have much of a perforation, we can’t use a paralleling pin. So I will maneuver into position just by using the handpiece in in my kind of estimate and and position. Okay? So this is now the second mainstay of the Bicon technique is a slow reaming with no irrigation. Use a mirror instead of that. Good. So now as we progress, the increments are pretty straightforward. It goes in half millimeter increments. So from two to two point five, which is the first reamer, to three. Okay? Are you alright? You seem to be k. So now we’re at three and a half. And as I withdraw this one, I look at the flutes and I see that there’s very little bone in the flutes. This is a typical type three bone. In other words, the bone is not absolutely dense nor is it absolutely loose or thin. So it’s a moderate type of bone. This will require an extra month of healing. Now as we start Almost at the final size. So before I go to the full size, I will take a a straight curette and, check the, that the walls will accept the very final size. I could place the four and a half millimeter wide implant, but if I could go to a five millimeters, I prefer to do that one of the other features of the Bicon system is the ability to harvest bone you saw some of it come into flutes and a lot of it, in case of extraction, stays behind in the voids that are in the socket of the extracted tooth. It’s important to harvest those. This is stuff that you don’t have to pay for. It comes in, and it allows you to cover the shoulder of the reconstruction. Okay. I’m gonna go ahead and finish this by hand. It’s fine. The hand reamer as Dr. Hirayama explained gives you a little more control. Sound to learn Japanese now, right? How do you know I said that? I I think is that what you said? Yeah. It gives you more control. Been learning Japanese secretly. Okay, so this is what we have now in end. So we end up with a significant amount of bone which will help us cover this implant, filling the whole void with the the autogenous bone. Now if you notice, the osteotomy is pretty deep. If I put a five by six millimeter implant in there, it may be too deep. But the one other feature of the Bicon implant is that we control how deep you place the implant even without screwing it in and stopping. Take a five by six, please. Now the screw type screwing friction The Bicon implant comes in a bag. It’s double sterile. It has a carrier plug, the black plug that you see that I’m holding the implant with. Okay. However, that plug doesn’t give me as much control as I like. So I will remove it. And this is what he just told you, the implant inserter retriever. Okay? I will put that in here. So this has now a handle Handle. That gives me good control to position the implant at exactly the angulation, the location, and the depth that I have intended it to be. As you can see, I can lock it in place, and then by twisting this short handle counterclockwise like so, it disengages it. Now the implant is behind. Now to make sure that I have it where I want it to be, I will use it. And so we can see with the guide pin, it’s in the proper location and angulation. Now if I wanna make sure the depth is okay, we can see that it’s just about three millimeters from the edge of the bone, which is acceptable in the aesthetic zone. Now, you have the choice of using the black healing plug and completely burying it or doing this as a one stage. When I use ultra short implants, six millimeter or shorter, I prefer to keep the implants buried. In other words, in two stage. Now before we we can bury it, we have to make sure that the well of the implant remains free of bone. So for that, we will put the black plug inside to seal it, then we put bone on top of everything. I’m gonna estimate the length. Okay. And to place it in the well, the perio probe goes in a small perforation that’s manufactured inside the black Now this is all the bone we harvested from this osteotomy. Make sure that it’s nicely particulated. In other words, in small pieces, because you don’t wanna put big pieces. And when you have a septum, you may end up with big pieces that peel off during the osteotomy process. So we just, smash it around. Okay? And by squeezing it onto the back of a Pritchard becomes easy to handle. Even if you dip it down, it doesn’t fall off. Like that? Can you do that again? Yeah. We just use a sterilized cotton tipped applicator. It’s okay. Got it. And we take a Bicon collagen plug. No. And we cut it in piece. Take a piece. Bicon collagen plug. Sometimes the touch can be too light. Right? Okay. We pack it in, and then we’ll take a suture to close over. We use resorbable suture. And it’s a crossed over any pain? Horizontal mattress or an inverted figure of eight suture. It helps hold the collagen plug down. Let me have that. Using the cotton tipped applicators allows you to sort of dab the red liquid out of the way. Also, by using this type of suturing you will avoid crossing from the edge down to the gingival sides which mimics incisions and causes unsightly scars by doing it this way, it really keeps the aesthetics undisturbed Alright. Why didn’t you use a temporary abutment when you’re doing your immediate placement? Because I was gonna bury it. The implant is very, very short. It’s we found that success of two stage six millimeter long implants is over ninety five percent, and I wanna use that. Is it because of short or long doesn’t matter? No. If it were an eight millimeter or longer, the difference in success is a lot, I think, smaller. And so we could do it that way. But since this is gonna be, you know, the temp is not gonna be immediately loaded, it doesn’t really make a a big difference which way you do it. Then why you did it one way? Because, you know, this way, I think it gives you a better aesthetics. Better aesthetics? In that, you know, you can have a better control over the bone going over it and so on. Better success. Do you do immediate immediate placement, immediate stabilization? Do you do it? We do it, yes. We do usually, in this case it would have been very much feasible, but we would normally do it with eight millimeter implants or longer because we found statistically that they are easier to control. So if you look at this X-ray now, let’s critique it. Okay? This is six millimeter long. If you look at the edge of the bone, bone? The distal because what we can really see is the mesial and distal crests. The distal crest, it’s about two millimeters above. It’s about a third of the length of the implant. About three millimeter? About two. No. No. The mesial. On the mesial is a little bit higher. Now remember something that the buccal is caved in because of the decay. So we don’t have as much depth on the buccal as it is mesial and distal. And the implant will tolerate this very well. If we were to put an eight millimeters implant, it would have been too shallow because it would have been right here and that would create a non aesthetic emergence profile. So you could place an eight millimeter implant and then do an internal lift or a six millimeter implant like this without an internal lift. Normally the initial plan would have been to do a sinus lift, a lateral sinus lift, and place implants later. Because of the Bicon short implants like the 5×6 we’ve just placed, we can do that with a one step process internal lift and 6×5.7 millimeters implant with a temporary sinus lift abutment. Now you could do this procedure now with a one stage technique and a very wide or large temporary abutment because of the way the sockets are. But if you want to maintain a better control on your osteotomy and better control on the flap, you need to have the flap healed. In other words, the socket sealed with soft tissue, with gingiva. And for that we wait eight weeks and then we can do it. I’m going to give you time for message. You want to they’re watching us? Yes. Oh. Okay. Well, alright. Well, thank you for your attention and for your questions. Those of you who have not used Bicon can obviously see how easy it is. And for those of you who have used it a lot, they probably could teach us a thing of or or two. I apologize if we were too basic. However, you see the possibilities remain wide open when you use very short implants that heal predictably. Thank you for your attention and have a great evening. Thanks doctor. Thank you. You. Thank you.