Seoul National University
Department of Oral Anatomy, School of Dental Medicine
Our first presenter is Doctor Lee from Seoul in Korea. He’s an oral and maxillofacial surgeon. He’s a graduate of the Seoul National University Dental School. He has a PhD in oral anatomy. Doctor Lee, good morning. Welcome. And thank you. Good morning, ladies and gentlemen. I’m very happy to present my implant treatment concept to our colleague Bicon users from all over the world. The subject which I’m going to present now is not a surgical matter, but a treatment concept which should be obeyed in my clinic. Dental implant treatment is becoming more desirable and successful option to dentists in their practice if it is carried out in accordance with the treatment principles and guidelines. However, practitioners sometimes face unexpected or unpleasant clinical results which could lead to failure. More and more new concepts for successful implant treatments are introduced these days. Based on personal experiences, it is strongly suggested that clinicians plan a treatment plan which excludes any amount of hazardous factors that threaten accomplishment and maintenance of the plan, rather than solely depending on a treatment concept or strategy, in order to get most desirable clinical result. Those risk factors could affect the treatment before, throughout the whole procedures, and after the treatment. Therefore, to avoid undesirable result efficiently and fundamentally, seven golden rules should be observed as follows. Rule number one, as safe as possible. Rule number two, as predictable as possible. Rule number three, as easy as possible. Rule number four, as natural as possible. Rule number five, as simple as possible. Rule number six, as economical as possible. Rule number seven, as reliable as possible. What relationships does Bicon have with my seven golden rules? Why do I want to touch on Bicon under this subject? I have a firm belief Bicon is the best way to practice my seven golden rules. From now on, let me introduce the relationships of Bicon with my Seven Golden Rules one by one. Rule number one, as safe as possible. Safe not only dentally but also medically. It is the most important thing. There should be no possibility of stress to patient’s health condition before and after the surgery. An implant is to be placed on a firm foundational bone, and at least one millimeter of bone around the site of implant should be ensured. So it is recommended that a clinician finish basic treatment to the part of the bone that is to be prepared for the site to ensure firm foundation. The final prosthesis should not give any negative effect to the functional osseointegration. Bicon’s first special feature, bone implant contact. As we all Bicon users know well, the bone implant contact of Bicon is best. Haversian bone surrounds the plate of the implants. That is, the implant design have only appositional bone. We can see very nice Haversian bone formation all along the entire pins. The point is that the surrounding Haversian bone guarantee the functional osseointegration. The second special feature is bacterially sealed locking taper system. Bacterially sealed locking taper reduces the possibility of peri inflammation and infection. The third special feature is fresh autogenous bone graft during implant placement. Less invasive surgery is the fourth special feature in Bicon system, even though the quantity of available bone is very small. For example, in posterior maxilla we can place 6.0 × 5.7mm short implant with internal sinus lift. We try to make every effort to be sure that enough bone exists to permit the safe placement and long term maintenance of the implant. Let me check out rule number two, as predictable as possible. In order to make implant treatment a real success, clinicians have to collect all the information of a patient and analyze them precisely. By doing so, clinicians provide patients with treatment that are suitable for them. In other words, tailored treatment plans are to be made to each case. A clinician should plan for the prosthesis not only satisfying his or her treatment plan, but also meeting the patient’s concern while setting up a treatment goal. During this procedure, clinicians and patients should communicate well to come to an agreement, and the plan should be visible to the patient before the actual treatment. Mounted study casts standing on the basis of a diagnostic setup, correct anatomical information about the available bone, and the bone gradation allow us to perform a best implant placement surgery. Both surgical and the vacuum formed stents enable the clinician to place the implant correctly. Bone mapping procedure. Direct bone depth probing methods are very useful in expensive methods for evaluating the quantity of available bone, as an alternative to expensive radiological tools. Bone gradation with a 3.5mm reamer cannot give us accurate information of available bone. But I’m sure it’s a very realistic, convenient method for evaluating bone quality. Rule number three, as easy as possible. This concept is developed in the dentist’s point of view. The plan and actual treatment should be feasible. In other words, a clinician should choose treatment methods which are familiar to him or her so he or she could perform to the fullest. It should be the easiest method to the clinician. How do we practice with ease? Short implant rather than a difficult surgery. It is recommended that a clinician finish base treatment to the part of the bone that is to be prepared for the site to ensure a firm foundation. For example, ridge expansion, ridge splitting. And finally, conventional prosthetic treatment is easy. Usually there are four types of available alveolar bone. General dentists can practice implant threefour of the entire cases at risk. Actually, if with the internal sinus lift, ridge expansion, and ridge splitting technique properly, general dentists can place implant in most cases except severely atrophied jawbones. Short implant. Maxillary ridge expansion or is splitting together with implant placement. Mandibular two stage ridge splitting with implant placement. These are not difficult techniques. We can do it with ease and confidence. Prosthodontic treatment. 360 degrees of universal abutment positioning and no cement, no screws, and no screwdrivers for abutment fixed connection allows us to position the abutment parallel with ease. As a dentist, we are so familiar with the conventional crown and bridge work that we can do it with ease. Rule number four, as natural as possible. It is highly recommended that the appearance of interdental or inter-implant papillae looks like that of natural dentition without an extra special plan and tissue treatment. The following three unique Bicon features make it possible. Narrow neck, extraoral cementation, integrated abutment crown. Narrow neck with a rich and dense connective tissue. Extra oral cementation. And integrated abutment crown. Rule number five. As simple as possible. On the contrary of rule number three, this rule number five is patient’s point of view. The final restoration should be easily maintained by the patient. A clinician might want to avoid any prosthetics that is fabricated by complicated methods and that could only be maintained by special equipments and by only the clinician. A process which is supported by multiple implants could bring such agony to the patient when one or more implants are malfunctioned during the repair, disabling the whole prosthesis. And it is also considered that patient lose their ability to maintain their final restorations as they get older. Conventional crown and bridge cemented with either permanently or temporarily an integrated abutment crown is best. The cementation type has nothing to do with the health of abutment. The more complex the prosthesis is, the more errors must be occurred. O-ring denture is much more convenient for patient to keep clean than most implant supported dentures, especially for older patients. Another important point is how easy to repair if the prosthesis or implant is out of function. O-ring denture functions relatively well during the repair period owing to the implant implantation like this. The rule number six, as economical as possible. The most economical way for both patient and clinician should be so ensuring the most effective result at the same time. In order to achieve that, expected lifespan of remaining natural teeth should be accurately foreseen while establishing the initial treatment plan. Which do you think is more economical? I used to fabricate the bar denture like left, but now I usually make an o-ring denture. I believe what makes dentists rich is not an expensive treatment, but an economical one. The final rule number seven. As reliable as possible. Patients and clinicians should have mutual trust to each other like mother and child. Sometimes children disobey and cause troubles, but mother always love and care her children with endless love. So we dentists must try to imitate mother, not father. And finally, clinicians should believe the implant system which they use. Thank you very much for listening.