The Bicon SHORT® Implant Surgical Technique

Hello. My name is Shadi Daher. I’m an oral surgeon with Bicon. And today we will talk about the replacement of a missing maxillary second bicuspid. In this area, commonly the maxillary sinus is in moderate to high proximity. The options to placing implants include placing the implant at an angle to avoid the sinus. That usually compromises the angle of restoration, i.e. the angle of the abutment. If the angle of the abutment is not compromised, the floor of the sinus will have to be manipulated with an internal or lateral sinus lift. Even a shorter implant, such as a five or four and a half by eight millimeters will require the manipulation of the floor of the sinus if the angle is not compromised. Once the floor is avoided, the angle may become compromised again. So for this case, we have elected to use an ultra short implant at six millimeters that will avoid the sinus floor all together without compromising the angle of restoration. The basic Bicon technique calls for the use of a pilot bur. The pilot bur is spinning at 1,100 rpm and, therefore, requires irrigation as it will generate heat. The irrigant can be normal saline or sterile water, and it is usually external irrigation. The irrigant serves as a lubricant, it serves as a coolant, and, of course, as a cleaner for the flutes of the bur. After the pilot hole is created, it is checked with a paralleling pin. The position of the implant must be verified, either with the adjacent teeth or with a vacu-press tent or another surgical guide of your choice. If the pilot hole is to your satisfaction, you can move on to the final or finalization of the osteotomy. That is accomplished with the use of latch type or hand reamers. The reamers, just as the name implies, do not affect the angulation or the depth, i.e. the length of the implant, they will only affect the width of the osteotomy. And that width has to be optimal to the maximum that is feasible in this location, such as four and a half or five whenever possible. However, for instance, in the area of the anterior mandible, going wider than four or four and a half may be counterproductive. Keeping that in mind, in this case we have selected to place a five by six millimeter implant. The latch reamers and hand reamers, as all the Bicon surgical instruments have, a half a millimeter increment as we step wider. So the first one is 2.5 millimeter, and the following one is three millimeters, and so on. As you see the reaming at half millimeter increments only shaves a quarter millimeter off of the sides of the osteotomy. Because of the action of reaming, and because it is done under very low speed, there is no need for irrigation. The speed at which the reaming is done is 50 rpm or less. This allows for an atraumatic placement, and for harvesting of bone. Continuing up to three and a half, four, and four and a half, and finally five millimeters, we will find that a significant amount of bone can be harvested, even from the porous type of bone. This bone will be used to graft over the shoulder of the implant. After the osteotomy is satisfactorily completed, we check the presence of a floor and four walls, making sure that there was no fenestration, dehiscences or perforations– no compromise to the adjacent tooth roots. And especially in this case, no compromise of the floor of the sinus. The implant is manipulated only through the sterile plastic pouch in which it comes. It is never touched with gloved fingers or other instruments. It can be introduced in the osteotomy with the use of the black polyethylene plug that comes with it, or a insider retriever that is available in the Bicon kit. Once it’s placed completely, or if it can’t be than it can be seated with the use of the inserting tip. That tip allows for gentle taps to be used to finalize the seating into the depth of the osteotomy. The black polyethylene plug is then introduced and cut or alternatively cut outside at an approximate length, and then introduced to plug the well of the implant. Subsequently, the bone that’s harvested is placed over the shoulders of the implant and a simple closure with a figure of eight suture is accomplished. At this point an X-ray is taken, and based on the density of the bone we typically uncover the implants in a period of three months after placement. Upon uncovering the implant, the restoration is based on the sole discretion of the restoring dentist. The implant can be restored with an integrated Abutment Crown. It can also be restored with an All-Ceramic Crown, with a Porcelain fused to metal crown, and so on. Thank you for your attention. If you have any questions, please refer to the Bicon website or call Bicon. Thank you.