Placement of a Bicon SHORT® Implant on a Foam Model

Hello, my name is Shadi Daher. I am an oral and maxillofacial surgeon. And today I will illustrate the placement of a Bicon dental implant. I will show you the use of Bicon’s instrumentation and will give you some helpful tips on how to make your implant placements predictably successful. I will demonstrate the placement of an implant using a two stage technique in a foam model. Additionally, we will show clinical examples of various surgical techniques on patients throughout this video. During this demonstration, we will be placing an implant in the location of the maxillary left first molar. A two millimeter stainless steel pilot drill is usually the first surgical drill to be used. It is a two fluted twist drill with a sharp point. The pilot drill is used with a twenty to one reduction handpiece or comparable handpiece rotating at approximately eleven hundred RPM. The pilot drill will be used to establish both the osteotomy’s depth and angulation. The use of subsequent latch or hand reamers with zero point five millimeter incrementally wider diameters will only widen the initial osteotomy. Ideally, but not necessarily, a Bicon implant should be placed two millimeters below the crest of the bone to optimize its clinical capabilities. Once the pilot osteotomy’s location and angulation have been set, we must confirm them with a paralleling pin. In this case, we will place a five millimeter wide, six millimeter short implant. So the intended depth of our osteotomy will be eight millimeters. The Bicon drills and reamers that we will be using have an initial band marking that starts at six millimeters and ends at eight millimeters from the tip of the bur, with the second band marking spanning the eleven to fourteen millimeter distance from that tip. Please note that the Bicon pilot drill is available in two lengths. The standard length of thirty two millimeters and the extended length of forty millimeters, which eliminates the need to attach the pilot drill to an extender when access is limited. The band markings are identical on both pilot drills. Because the pilot drill rotates at eleven hundred revolutions per minute, it is important to have external irrigation to avoid thermal trauma to the bone. When using the pilot drill, we will use a smooth pumping action to facilitate the cooling and flushing actions of the irrigating fluid. Once the pilot osteotomy’s location and angulation have been set and before we continue with the reamers, we must confirm them with a paralleling pin. The Bicon surgical kit contains zero degree, fifteen degree, and twenty five degree paralleling pins. Once we are satisfied with the positioning of our pilot osteotomy, we will widen it to the width of the intended implant by using zero point five millimeter incrementally wider latch or hand reamers. The latch reamers are used with a four hundred to one reduction handpiece or comparable handpiece with sufficiently high torque to widen the osteotomy while rotating at only fifty revolutions per minute or less. The advantages of slow speed reaming are, it eliminates the risk of thermal trauma to the bone. It requires no irrigation for bone cooling, which enhances the clinician’s visibility, patient’s comfort, and reduces the need for suctioning. It allows for harvesting of autogenous bone. It subjects the surgical grade titanium alloy reamers to minimal wear, thus providing their use to widen over two hundred osteotomies. Each titanium reamer is color coded and numerically marked according to its diameter. We will initiate our widening of the pilot osteotomy with a two point five millimeter latch reamer. Since we will be placing a five by six millimeter implant, we will be incrementally reaming with six reamers from an initial width of two point five to a final width of five to match the diameter of the intended implant, and to a depth of eight millimeters, which will position the implant two millimeters below the bony crest. Sometimes during and always after the use of each reamer, any bone within the flutes of the reamer should be collected in a silicone dappened dish by simply sliding it down the flutes of that reamer. We will now continue widening the osteotomy by half millimeter increments until the final width of five millimeters is reached and a depth of eight millimeter is achieved. It is important to reach the intended depth of an osteotomy with each reamer or else the lower portion of the osteotomy will not be wide enough to properly seat the implant. We will now use our final reamer, the five millimeter hand reamer, as an alternative to the five millimeter latch reamer. They are designed to work with the threaded straight handle or the threaded knob. The hand reamers are similar in design to the latch reamers. However, they have only one cutting surface. They can be rotated only one hundred and eighty degrees if desired, thus allowing for the cutting of only one side of the osteotomy while expanding the other side. After using the final reamer and prior to the insertion of the implant, a curette is used to remove any bone chips that could inhibit the seeding of the implant and to evaluate the integrity of the osteotomy’s five walls. A depth gauge flared at the end with a flat bottom can be used to determine that the proper depth for the intended implant has been achieved. The center of the osteotomy can be slightly deeper than the intended depth. So we will slide the depth gauge along the wall of the osteotomy in order to feel the tapered portion of the osteotomy as the gauge will stop at the apical diameter, revealing the true depth of the osteotomy. While grasping the implant in its sterile packaging, we have three options for transferring it to the surgical site. First, we could transport and insert the implant into its osteotomy by grasping its black healing plug. Second, we could remove the healing plug and seed an abutment such as the sinus lift abutment into the well of the implant, which could then be transferred into the osteotomy site. And third, we could utilize an inserter retriever instrument or a seating tip to position the implant into its osteotomy. All of Bicon’s threaded components have interchangeable parts. The inserter retrievers are color coded green for a three millimeter implant well, blue for a two point five millimeter implant well, and red for a two millimeter implant well. We will be using a green three millimeter implant inserter retriever fastened to the threaded straight handle. The inserter retriever is introduced loosely into the implant well to slightly engage the locking taper of the implant. Then the implant is inserted into the osteotomy. When the implant is in its intended position, we will hold the threaded handle stationary while rotating the inserter retriever’s barrel counterclockwise. This will move the collar of the inserter retriever down onto the shoulder of the implant to disengage its locking taper connection. To ensure the complete seating of the implant to the intended depth of two millimeters below the bony crest, we will lightly tap it. For that, we use a seating tip that fits loosely into the implant well after having fastened it to a threaded straight handle. The healing plug cutter is used to cleanly cut the post of the black healing plug that was packaged with the implant prior to its being inserted with a perio probe to seal the well of the implant and to keep it free of bone throughout the period of osseointegration. We will now place the harvested bone from the dappen dish onto a periosteal elevator to cover the implant’s shoulder prior to closing the surgical site. This completes our two stage implant placement technique. We will uncover the implant in three months. I hope that now you can appreciate why so many dental practitioners are placing Bicon dental implants. The ease of placing and restoring a Bicon implant provides clinicians the opportunity to use a system that is simple, predictable and profitable. For more information regarding Bicon’s educational courses, product updates or techniques, please refer to bicon dot com. My name is Shadi Daher. Thank you for watching.