Placement of Two Bicon SHORT® Implants

So we will be removing the tooth number twelve, which is number two four or twenty four international And we will be placing an implant in its location and in the location of the first molar. This patient is missing bicuspids for orthodontic treatment previously. So we will be placing two implants extracting one tooth first. Okay. The area of the molar or the posterior tooth will require a sinus elevation procedure. Because of the presence of approximately three millimeters of bone or four millimeters, we will be able to perform an internal sinus lift. If the bone were less than that, we would have had to perform an internal sinus lift but with a floor transport procedure. Alright. So we will be using periotome. Periotome You introduce it in between the root and the bone, severing the periodontal ligament. It comes in two configurations. One that is for anterior interproximal. It has two ends, a straight and a curved, and one for posterior teeth. It has two curves that are a little bit offset. In this case, I use always elevation at line angles, mesial buccal, mesial palatal. Okay. And the tooth is fairly loose. We use these atraumatic extraction forceps with the inside serrations that don’t close completely. Therefore, they don’t traumatize the neck of the root. Most importantly, the buccal plate has not been traumatized or removed. Next, we will take I’m gonna remove all of the remnants of the PDL. So we collect about a quarter cc hold on. I’m showing it to you. Collect about a quarter cc of blood. That should be enough for up to half a gram of the bone graft. Leave it there. Okay. So now we will complete the development of the flap, and the assistant can suction fully now. They will see it in a second if they don’t understand what I mean. So this suture just maintains the flap open. For me to see. So Before I start drilling, I will use the pilot drill to measure the depth of my socket. And at this point, I am bottoming out at about approximately eleven millimeters from the top of the soft tissues. And the soft tissues are, about four millimeters thick. So I have only, roughly seven millimeters. So I’m gonna just drill a little bit deeper to make sure that I have fresh bone. Now we’re gonna place our implant. As you see the depression in the buccal, we’re gonna leave it and go slightly more palatal. K. So now we reduce the speed. Fifty RPM or less, which is atraumatic to the bone, doesn’t require irrigation, allows us to harvest bone, and it’s much safer to the soft tissues and to the bone and to everything. Okay? Yeah. Okay. So I’m just taking my time to make sure that we have the beginning of an osteotomy. So now we are just using the reamers at a slow speed. Okay? And we’re just going to go just about three or four millimeters or less even. Okay? This is three and a half millimeter reamer. Just three millimeters. The hand reamer, I can, you know, selectively carve one side and protect the other. One side cut cutting surface Okay. Starting to get more of the walls of the osteotomy of the socket now so we can collect more bone. Alright. We are now at four point five millimeter hand reamer. K. Two sections. K. All of this bone is being collected in a silicone dappen dish that is part of the Bicon kit. This allows us to get our bone graft, autogenous bone directly at the time of placement without any waste. Okay. So we wanna make sure we have a floor and that we still have all walls. We collect any extra bone. We don’t wanna waste it. No. Nothing. That’s just the instrument making a noise. Okay. So, again, circular reaming here, and we got nice fresh bone, nicely packed in the reamer. That’s gonna help us. Little bit more delicate task and wide. This one is a little bit more difficult because of the the slope of the reamer is a little bit different, so we need to work a little bit harder at it. So this has to fit inside the osteotomy. A lot of hammering now, hon. Okay? Suction it one more time. So this is the bone that we collected from the patient. We’ll save that to the side because I want to put it on top of the shoulder of the implant. This is the graft for the sinus lift, the white SynthoGraft. We will now be using the blood that we collected before. So and this is the depth gauge. Comes with the Bicon kit. Allows you to check, open wider, the depth of placement. Very good. Thank you. Or the depth of your osteotomy. In this case At the edge of the socket is clean and free. This is a sterile pouch. The implant comes with a black polyethylene plug that is also a carrier, that is the, the healing plug, and the implant is the gray part, the titanium part. We will cut the bag to gain access to the implant. Okay. The other one. Just the point. Okay. Okay. We push it in place. It’s a friction fit implant. And when you give it a twist, it will lock in the bone a little bit, enough for you to retrieve your black healing plug. Then seat it fully, we have an inserting point that goes inside the well of the implant. And we tap it with a small mallet, a surgical mallet. And you can hear it bottoming out. The sound is different. That’s it. Now to keep the well from filling up with bone, allowing for the connection of the abutment later, we will place the black healing plug in, but it has to be cut to to this correct length. So for that, we will just cut it. In this case, I’ll cut it outside the mouth. I’ll turn it on. I’ll cut it outside the mouth. Okay? Now after you cut it, and I’m only estimating the level of the bone. It doesn’t have to be exact. It can be a little bit short, a little bit long. I prefer to make it short if I have to make a choice. Okay. That’s it. Now, it’s like a healing screw. Only it comes with the implant, you don’t have to pay extra for it. And it’s customizable. You can make it as long and short as you need it to be. We pack it into this syringe. Okay? Then we put it inside the osteotomy. And with a little bit of pumping action and a very gentle squeezing sort of very gently squeeze you to inject Allow the soft tissues to be dissected and lifted off with the introduction. I’m introducing it very, very, very slowly because this is now doing the sinus lift. What I did before only fractured the bones. This is where the sinus is being or the sinus mucosa is lifted off of the floor of the sinus. I wanna make sure that we are in there. So I’m just using a little site dilator. It’s a smaller smaller diameter. It’s four, and the osteotomy is five. That way, it acts like doing a root canal lateral condensation spreading the graft. I’ll put a little bit more in. To do this very slowly because you’re doing the sinus lift with the bone graft, I mean. And if you do it too fast, you can tear it. I will remove the black healing plug and I will use the implant insert and retriever Because this gives me a security in that I can remove, retrieve the implant as it locks in a little bit tighter or a lot tighter into the well. So now we will start introducing the implant into the osteotomy. Slight twisting allows it to mill its way or drill its way in, and then we start tapping it. That hurting? So I wanna get it in to about three or four millimeters in, and then I’ll finish it off with another little trick that’s particular to Bicon. Okay. So now the implant is at a better depth. I wanna see if that’s enough. I may have to put it even a little bit deeper. Okay. Suction for me. So I will use this slight point now. This is a little bit more of a difficult and risky move, So I won’t advise you to do it if you haven’t done this before. Because there is no now, there is no control of the implant. If you push it too hard, it will go into the sinus. So do it very gently. And, again, we cut the abutment excuse me, the healing plug out of the mouth. That’s not the SynthoGraft. No. No. We’re just the Bone. Right? Yeah. That’s the the bone that we harvested from the area. First, let me have the scissors and open the 4-0 gut. So as you see, the Bicon feature, one of the really great advantages is the ability to graft bone over the shoulder of the implant. That way we don’t have to make a sliding buccal flap or anything