The Logic of Bicon – Dr. Vincent J. Morgan

Hello. Thank you for joining our presentation, The Logic of Bicon from Bicon’s headquarters in Boston, Mass. I’m humbled by the fact that I was just told that there are 1,500 viewers from 75 different countries. Thank you for attending. Hopefully our presentation will benefit not only you and your family, but more importantly, your patients. I am Vin Morgan, a general dentist who has been responsible for managing Bicon since 1994. Since 1985, Bicon has had certain principles of simplicity, predictability, profitability, all based on a very strong foundation of logic. As a young student, I was advised by a Dominican friar that if something is logical, follow it; and if it is illogical, avoid it; and I’d surely be successful. Well, which is logical? We know that all implants work more or less, some better than others, and for this young lady with congenitally missing laterals, both implants seemed to be working well for her. However, which would you want to place, which would you want to have in your mouth or your daughter’s mouth? Since 1985, Bicon has had unmatched clinical capabilities achieved with less chairtime, less financial expense, and significantly less morbidity for your patients. Hopefully, this presentation will help you understand the features that I know and many Bicon users throughout the world know and have known for 35 years. Yes, 35 years the design unchanged. I placed my first implants soon after graduation when I had no formal training in implants and no instructions. We simply ordered two titanium blade implants from Miter to be placed in the posterior maxilla of a man I practiced with. And with only logic as our guide, we gave local anesthesia, reflected the flaps and made two vertical grooves in his alveolus. And beginner’s luck or whatever it was, they worked and he went to his grave with them some 14 years later. We just implemented those implants with the logic we had from our dental training as an undergraduate. Subsequent to that, we placed and restored very few implants until the 1980s. However, between 1980 and 1992, we had restored over 2,500 implants and yes, I know screw-retained implants well, too well, with one of the overriding problems with implants were screws. They simply are not a logical way of attaching a crown to an implant. They just cannot work and in 1992, I was going to cry uncle and say I give up. I could be more profitable for my family by doing prophylaxes rather than doing restorative implants because we know the problems with screws; loosening, breaking, instability. And the one issue that is seldom discussed is the odor, the foul odor associated with the bacterial flux around the screw. So fortunately, I wasn’t able to give up implants because Bob Chapman, the chairman of prosthetic dentistry at Tufts University, he also knew the problems of screws. And he had found out about an implant called the Stryker implant which he said was remarkable because it was simple. It was only two parts. He said then “It has no screw, no torque drivers, “it’s simple, Vin!” And so, we took him at his word and let’s hear what he had to say about screws– – Screws also developed a lot of bacteria around them. Any of you guys who’ve been around for a long time who’ve taken some of the old prostheses apart that are screw-retained, the odor is rather objectionable, and that’s because there’s a flux of bacteria in and out of the implant. So, when we’re looking at designs that provide not only good retention, we also look at the biologics side of it and that is that there are always gaps between a screw thread and a tap, and that’s where bacteria are going to get involved and they’re gonna multiply and they’re gonna stay around there for a long time. Any system that has got access to the oral cavity means that we’re gonna have bacteria and these bacteria have to be thought about in terms of what they might do. – So thankfully, we took Bob’s advice and we began with the Stryker implant. Our initial reaction was, as I’m sure it is to most people who initiate treatment with Bicon, it looks different. How can it work? There’s no screw, no torque drivers, how does it work? Well, we can tell you it worked. It not only worked, it worked very well and the shorter implants were much more readily accepted by patients because it was not accompanied with bone grafting materials. So, we have to compliment Tom Driskell, the inventor. He got it right at the outset. He started his research in 1968 with funding from the United States Army at Battelle Memorial Labs in Columbus, Ohio. And Tom not only developed implants, his first implant was the Synthodont, his second implant was the Titanodont, which is depicted here and it’s virtually the same design as the current Bicon, other than the fact that the male was on the implant and the female connection was on the abutment. Today, as you know, the Bicon implant has a male connection on the abutment and the female in the well of the implant. But what most people don’t realize that Tom also developed a beta-tricalcium phosphate material called SynthoGraft. And the advantage of SynthoGraft over other beta-tricalcium phosphates is that each and every particle is porous. So our compliments to Tom Driskell and his ingenuity and he certainly followed the principle of Leonardo Da Vinci who said, “Simplicity is the ultimate sophistication.” Well, Tom hit it right because his design has lasted now 35 years unchanged. Logically, think of what that means to you, the clinician. One system, that if you had chosen it in 1985, the instrument kit would still be functioning today. An implant purchased in 1985 is compatible with an abutment that is manufactured in 2020. Now, as we know, there are many companies that have been in existence since 1985 and illogically, they’re on their 13th, 14th, and some, 15th design. How can they tell you every third year that they have a better design without illogically saying, “Well, what about the implant “I bought three years ago? “What about the one I bought six years ago? “You told me that was the best.” Well, think logically for yourself. The Bicon design had many controversial elements associated with it that are now no longer controversial. People are not only accepting them, they’re copying them. And simplicity: it’s nothing more than a post and core. If you know how to take an impression and cement a crown on a natural tooth, you know the prosthetic treatment for a Bicon implant. Yes, every Bicon abutment is a custom abutment. The only difference is it doesn’t cost $700. It is a custom abutment that is easily modified because there’s no female threaded bore for a screw. It has great flexibility when combined with the fact that it has a 15-degree angled abutment. Two angled abutments will accommodate 30 degrees of divergence. Pretty simple, pretty flexible. Now, I know after marketing Bicon for 26 years, I know that everybody has a perception of their reality and it’s not easily changed. People see things and they believe it to be true. And as we all know, at one point everybody thought the world was flat. Well, clearly we know it isn’t, and yet most people have been trained by implant mentors in the academics and whoever, and they believe what they believe. And we all know that if you’re not argued into a position, it’s virtually impossible to argue you out of a position. So you either have an understanding based on belief in your mentor or whoever told you, or you have the ability to discern the truth and determine it on your own. For example, who was the first to publish the compatibility of titanium with bone? I can tell you virtually everybody in the world believes is was Brånemark. Well, he did in 1983. However, Bothe in 1940, 43 years before, Bothe in Chicago wrote about titanium and bone and he said that it was fusion, and the English word in physics means one. Fusion means one, so Bothe in 1940 said titanium and bone was one. Subsequently, in 1951, 32 years before Brånemark, Gottlieb Leventhal published his study on the compatibility of titanium and bone. And curiously, very curiously, he used the same anecdotal story that Brånemark would use 32 years later. Curious. Logical? And just to give you a perspective, Tom Driskell, the inventor of this implant, he’s clearly not as well known as Brånemark, but he had an implant in 1982 of titanium prior to Brånemark’s publication. This man, an English philosopher in the early 1900s said, “Let a man radically alter his thoughts, “and he will be astonished at the rapid transformation “it will effect in the material conditions of his life.” Well, I ask you; if you’re not currently using the Bicon implant, please consider it and then enjoy the benefits it will give you, your family, and most importantly, your patients. However, I know it’s very difficult for one to change their mind because most people cannot think for themselves. They’re led by the marketing influences; in this case of implant companies et cetera, et cetera. This German poet said, “It often requires more courage “to change one’s own opinion, “than to remain faithful to it.” So, I know it’s gonna be easy for you to just go back and do what your teacher taught you, et cetera, et cetera. Well, hopefully it won’t. In 1994, when I took over the reins of Bicon, it was only sold in the United States. Fortunately today, because of the kindness of so many talented people, from our engineers, the vendors that supply us with the product, and the mentors that we have around the world, Bicon is represented now in nearly 100 countries. Clearly not from Vinny Morgan alone. Many, many good people have advanced the system for which we’re grateful. We want you to think short; absolutely, positively, unequivocally, unabashedly, shorter is better. It’s not as good, it is better and hopefully we’ll show you that during the next hour. These are the current sizes of the Bicon implant as they’re sold today and we will tell you there’s no need to use any implant longer than a five millimeter. A five millimeter SHORT implant will support any tooth. Yes, any tooth. Longer is not better. Well, Bicon has been used continuously with an unchanged design as we mentioned for 35 years. That’s decades, and it’s been scientifically explained. A few years ago, with Quintessence Publication, we edited a book that’s now in its second edition and there’s wealth of information there if you’re so inclined to look at the facts. Additionally, there are multiple publications, hundreds of publications. Everything that I will mention to you today and have mentioned in the past has been published and these publications can be found on our website, bicon.com., along with clinical cases with longterm results, in radiographic evidence. Yes, radiographic evidence. Logically, do you know of any other dental implant that is so complete in its presentation of clinical cases? Bicon is responsible for three products: the SHORT implants we just spoke about, SynthoGraft, the beta-tricalcium phosphate material that we also mentioned and the uniqueness of it is that each and every particle is porous, but for the last 10 years, we’ve represented a material called TRINIA. It’s a metal-free, fiber-reinforced CAD/CAM resin and I will tell you in a subsequent presentation, I will explain to you that I know you will use it eventually. It’s not a matter of if you’ll use it, it’s a matter of when because its clinical capabilities are so beneficial to you and your patients, you will use it. Just a matter of time. A few years ago, I was invited by Patrick Schmidlin for a luncheon at the faculty club at the University of Zurich. And I said to Patrick, “Patrick, why did you invite us?” And he said, “I’m interested in SHORT implants.” and I said, “Well, surely Patrick, “your university represents a dental implant “that’s has just introduced a short implant.” And he said, “Yes, I know. “But it doesn’t work.” I said, “Oh.” So, we continued and then he said, “I’ve watched Bicon for a long while now “and I know you are a very viable organization.” And I said, “Patrick, why do you say that?” And he said, “Because dead fish cannot swim “against the stream and you have been going against “the collective wisdom of the profession for decades, “and now they are copying your ideas.” Well, I said, “Patrick, thank you very much “for the compliment uniquely expressed.” And it was, I was surprised. So, Patrick recognized, as many people do, though many do not admit it, that Driskell and Bicon have been the leaders. Yes, the innovators, not the imitators. So, Bicon is a solution. If you’re looking for just another implant, there are many and there are many with far less expense and clearly, no-one has the test of time and the clinical results. No-one. The companies may be 35 years old, but some of them are now marketing an implant that’s only a year or two years old and many of them, that’s what they’ve been doing for years. Telling you that they have an implant with confidence, et cetera, et cetera. No clinical proof, no time, but Bicon has been true for 35 years. Is that logical? Which would you want to choose? Something with a track record or something that a marketing person has a buzz word that catches your imagination? Well, think about when you have the problem, Bicon has the solution. Dr. Milman in Texas, he had a problem: a broken basket implant. The solution? Put a SHORT Bicon over it. And to everybody’s amazement, look at the bone. Bone gain in only four months. Logically, have you ever heard of any implant system talk about bone gain? Yes, only Bicon, and we will show you today, I’ll explain to you today various attributes of how you could enhance the possibility, the potential for bone gain. Is Bicon perfect? No, but it’s certainly better by orders of magnitude than most implant systems and we’ll show you. What would you do? Patient comes in, a young girl, and she comes in and what’s your first reaction? Well, with Bicon you say, “If you want an implant, we can do it. “An implant is nothing more than a piece of titanium “that replaces the root of the tooth. “We’ll give you a local anesthesia, “we’ll use hand instrumentation, “make an osteotomy, a hole in the bone “equal to the size of a small implant.” Other people would say, “Oh my goodness, “let’s get an orthodontic consult “and beg the orthodontist to splay the roots. “We can’t splay the roots.” But there’s the difference: minimal space, Bicon has an answer for you. That’s profitability for you, convenience for your patients. Papillae, even when teeth are close together, because of the sloping shoulder there’s room for it. You have a natural-looking tooth. Another example, only Bicon. No sinus lift. Do you want an implant? Let’s do it, we don’t have to wait nine months for bone grafting, the morbidity and the concern of the patient or even put something in my sinus. No, let’s do it, we’ll do it now, simple, straightforward. Here’s an example of a treatment by Dr. Rolf Ewers in Vienna. A 60 year-old woman who had minimal bone and she was scheduled to have a significant bone graft and they thought, well maybe we can do a sinus lift. Oops, you can’t do that with that perforation. So look at the minimal amount of bone that is there, a four by five millimeter implant. Don’t just focus on the length of the implant, focus on the volume of the implant and the volume of the crown. Bicon is a solution when you have a problem. An atrophic mandible. Well, four SHORT implants, four millimeters by five supporting a TRINIA prosthesis. Yes, note the extension. With a canine-positioned implant, you can provide your patient with first molar occlusion. Think about it, canine implant, first molar occlusion. We say with TRINIA, the longer the extension, the better. So much for Ante’s law, heresy to most of you, but reality to those of us that have been using Bicon and TRINIA for 10 years. Yes, for 10 years we can provide a distal extension of 25 and 30 millimeters. The longer the extension, the better. Splinting; why splint? What is the logic in saying it’s better to splint? Anyone who says their implant is better splinted, by the same breath they are saying their implant does not do well as a single unit. You can’t have it both ways, you just can’t. Sinus lift or no sinus lift? Once again, splinted. Why? Splinting is difficult, more difficult than a single unit, more expensive! And Brånemark originally taught bicortical placement of implants while Driskell was placing SHORT implants. Which is logical? Splinted, complicated prosthetics or simple prosthetics? Do you need one implant per tooth? No. But, if you want one implant per tooth, Bicon can provide it even for mandibular incisors. Yes, we can four implants in four mandibular incisors. For example, the patient has the money, he can have the implant. Do you need it? No. Does your wife need a Gucci handbag? No, but if you can afford it she needs it. Well, there it is: simple prosthetics, five millimeter implant, 21 millimeter crowns individually placed. But today, we’re recommending that you can place only three implants to provide a full arch occlusion on both the mandible and the maxilla. Three implants. You don’t need all on four. Three is sufficient if you’re using Bicon and people that are promoting the all on four, I understand they’re now saying maybe five or six. Long implants or SHORT implants? One piece TRINIA prosthesis. Which is more logical? And forget logic, which is moral? To me, it’s immoral to be placing long implants as depicted there and the TRINIA prosthesis one piece distal extension. This is interesting, not from necessarily the viewpoint of the patient, but rather the clinician. If you’re drilling an osteotomy around a nerve, you’re tense, every sphincter is tight and you go home at the end of the day and you’re clearly not relaxed. Why you should you be? However, if you’re capable of doing the same type of treatment, as you notice, unsplinted with SHORT implants, not close to the nerve, you relax. Tranquilo. You go home and you say, “What do you wanna do tonight?” The evening is yours, the tension is gone. Now, where’s the logic here? Poor Tom De Wit. He inherited this situation. The patient had four zygomatic implants and two of them failed. And for those of you unfamiliar with the zygomatic implant, when they fail, it’s an extra-oral failure. Yes, the pus comes out of the cheek. So, what did Tom do? They’re removed the two failed zygomatics and he replaced them with SHORT Bicons. And he restored them with the one piece TRINIA prosthesis that is screwed onto the zygomatic implants and cemented onto the TRINIA. TRINIA and Bicon, they’re a solution. Very enjoyable solution for you and for me as a clinician. Where’s the logic? Why take the chance? For what? Just because somebody markets them and somebody wants to show you they have the surgical skill? But, if a five millimeter implant does the same job, there’s no logic to justify this and whoops, yeah, out through the orbit. Now, let’s buy an inexpensive implant. Why? Why take the chance to buy an inexpensive implant, put expensive prosthetics on top of it, and what does the patient gain? Nothing! The patient in fact lost a significant amount of bone in two and half years. Incredible. But this is what is being done in people selling inexpensive implants with no logic. Ben Franklin, one of the signers of the Declaration of the United States’ Independence said, “The bitterness of poor quality remains long “after the sweetness of low price is forgotten.” So true, then and today. Remember, it’s not just the cost of an implant, but it’s the cost of all the ancillary components: surgical and prosthetic components, the cost of bone grafting material, and the real cost is potential failure. Why try something new when there’s a time-proven, 35-year proven and hopefully you’ll all appreciate at the end of this presentation that a major cost is your time. If you can treat, as we will show you, in fewer appointments than with other systems, you will see the benefits. For example, we will treat most people with prosthetics in only two visits instead of three. With TRINIA, we no longer need a frame trying. Therefore, what you’re treating in three or four visits, we’re treating in two. And we’re not only save the time of the appointment, but additionally and unseen is we do not have the risk of a potential failed appointment. So if you can eliminate a third of your potential failed appointments, you have a significant financial gain. That’s the logic of using Bicon. It’s about the benefit for you and your family. Now, high-speed drilling. Is it logical? Clearly not, whoever started high-speed drilling, shame on them. Or, you know that high speed generates heat and they knew it! So, what did they do? They said okay, let’s set up internal bore drills and we’ll irrigate. But what does the irrigation do? You have an expensive bur and that internal bore can never be cleaned. It can be sterilized, but it always will have pyrogenic properties. Also, the irrigant decreases your visibility, it’s easier to drive on a sunny day than it is a rainy day. And the irrigant requires your assistant to have a hand tied up suctioning it. But more importantly, it washes away the healing mechanism of the bone, the blood and the morphogenic proteins. Oh, but don’t worry, you can buy a bone-grafting material. But why? If you do slow drilling that Driskell first recommended 52 years ago, you have the ability to harvest autogenous bone. I’ll ask you, most dentists know what they pay for the implant. Almost no dentists knows what he pays to replace his surgical burs. The calculation was done in Belgium and if you were to replace the recommended level of osteotomies, you would add 100 Euros per osteotomy. Think about it. Buy a Bicon and another implant of the same cost and the simple fact that you’d have to replace the surgical set of burs, that other implant will cost you 100 Euros more per osteotomy. Let’s take a look at slow drilling These are the Bicon Latch reamers, They have two flutes, they will only widen, they will not deepen the osteotomy. They’re used in increasing half-millimeter increments and notice how their two flutes harvest the bone. Notice the fact that it’s almost a bloodless event, your visibility is excellent, your patient isn’t (gargling), your assistant has a free hand and you have a very relaxed surgery. That Bicon implant is seated into an osteotomy of precisely the same dimension. Therefore, there’s no pressure on the bone. And as we’ll show you, it’s not logical to use a threaded implant either. The implant well is sealed with a polyethylene plug, harvested bone, red gold going over the implant. It’s sutured and on the mandible it’s anywhere from 10 to 12 weeks to uncover it as a rule. The alternative to this will be seen in the next video, which is the one stage. But there it is, it’s sub-crestal. You see the implant, it’s ideally placed two to three millimeters below the bone. However, it can be placed at the crest of the bone as we’ll show you. The fact that it is able to placed below the crest, it is ideal for adolescents and yes, we use the Bicon implant routinely on 14 year-old adolescents. The plug is removed with a healing plug remover which is similar to a wine corkscrew. So if you drink wine, you’ll have a facility in removing the healing plug. Then, the impressions is nothing more than a round peg in a round hole. No matter how you put it in, it’s in properly with finger pressure. No torque drivers, no screws, no complexity. And this is time and we will show you the real time saving is when you insert. And our preference for the last 20 years is to use the Integrated Abutment Crown. There it is! The Integrated Abutment Crown. The abutment and the crown are one unit and it’s just seated with the pressure of a Q-tip. Our detractors will you say you get whacked with a hammer, well, you don’t. Sure you can, if somebody wants to, but just bite down on a Q-tip! How simple is that? You measure the time, it can be minutes, but it can be in seconds. How long does it take a round peg in a round hole? That’s is, that’s two years post-op. Now, let’s take a look at the one-stage technique which in this case will be a little different. We’re extracting a primary molar on a 45 year-old male, and because the roots of the primary tooth are so divergent, their furcation is gonna be very broad. So in this particular case, you’re going to see our counter-sinking the osteotomy. So, the pilot bur is placed and you don’t need digital scanning and guides, et cetera. Your best guide is to place the pilot bur in the middle of denture space, parallel to the two adjacent implants. Therefore, you don’t have to go through all the machinations of digital planning just because you have a CBCT scan. And any of you who say it’s the standard of care, I would take issue with it because we have placed and restored thousands of implants before the CBCTs were available to dentistry. So, if we succeeded for years without the use of it, don’t try and tell me now that it’s a standard of care and must be used. Sure, it’s an aid, but it’s not necessary, clearly not necessary in a situation like this if you understand what you’re doing. So, there’s the guide pin being placed into the osteotomy and this will facilitate the counter-sinking where we use a sulcus former on the Latch Reamer extension and we’re rotating it because there’s a difference in slow drilling opposed to fast drilling. There’s a tendency to inadvertently displace the bur when you’re using slow drilling, either on a slope and you have a inadvertent tendency to have the bur slide down the slope. Or, if the bone is denser on one side which it usually is on the palatal, or the lingual side of the osteotomy, the bur is inadvertently moved away from the dense bone. So counter-sinking, as you have just seen, is a means by which you can avoid that inadvertent displacement. So, you can see the bone being harvested with the Latch Reamer as we mentioned. They’re fabricated from surgical-grade titanium, and yes, they can be used for hundreds of surgeries. There’s the implant being placed with a transmucosal titanium abutment. It’ll be sutured in place and once again left for 10 weeks to 12 weeks. The previous uncovering we saw, we took the impression the day of the uncovering and we relied upon the laboratory technician to give us the emergence profile which, if you have a good technician, it’s very straightforward and then we would modify the soft tissue to accommodate the crown. Here, you’ll see that the emergence profile is given to us beautifully when you take the transmucosal abutment out, and to take the impression, once again, a simple round peg in a round hole with the sleeve, it’s done. Alternatively, you can use intraoral scanning with a white sleeve that’s placed into the implant well, and there’s the integrated abutment crown. Watch how much time. Round peg in a round hole, that’s it! Not minutes, seconds! Yes, if you’re not enjoying the savings with your restoration, think about the logic of Bicon. Think about using cementless crowns, screwless crowns with facility and dispatch. It’s a gift, only if you can think differently. Just because your mentors said longer is better, et cetera, et cetera, not necessarily true. You don’t have to use Bicon, but recognize the fact that there are thousands of people in hundreds of countries who are. So, what is the logic and what is the evidence based behind longer is better? What is the logic or evidence based between one-to-one? Well, I suggest there is none. The mechanical laws take the longest, tallest building in the world in Dubai, it goes down 50 meters and up 830 meters. Well, let’s go to the natural laws, where’s the evidence there? The giant sequoias in California, the redwoods, they go up a 100 meters and they go down three. Longer is better, one-to-one? Who says? But that isn’t dentistry, well, this is dentistry. The primary molar we all know which has a crown twice the length of its root, it can stay there for seven decades. Those of us with experience have seen it. Primary molars stay seven decades with a crown to root ratio of two-to-one. So where’s the logic, where’s the evidence base that our academics talk about? There is none, and yet I suggest to you the profession has been hoodwinked by the marketing material of implant companies. Look at the Bicon implant, is that one-to-one? No, and it has survived for decades. So, this publication was done in 2010, demonstrating that the crown of a prosthesis can be five times as long as the implant. Another example. Don’t just look at the length, look at the volume. That’s a molar, what’s the volume? Five, six, eight, 10 times the volume of the implant? Does an implant’s macro geometry dictate its clinical capabilities? And the answer is absolutely yes. If I see an implant without a sloping shoulder, I immediately discount it. So, this is the totality of the design and you need the totality of the design to achieve all the unmatched clinical capabilities of Bicon. And we will address each one of these in our presentation. So the first is the fins and the plateaus. Well, they provide a different type of healing. Most of you would not believe that better bone quality, more surface and a better distribution of the stresses. I’ll ask you the question which I’ve already given you the answer; is the bone around all titanium implants the same? Most of you would say yes, bone is bone, titanium is titanium. Well, it’s not the case, as I will show you. Is it logical to use threaded implants? Absolutely not. We know that from our own knowledge of orthodontics and I’ll show you. So, if you take a threaded implant, what does it do? It puts pressure on the bone and we know from orthodontics that bone resorbs under pressure. So why put pressure on the bone? It’s not logical. So you immediately get an osteoclastic activity with the threaded implant and then subsequently, the bone will grow back toward the titanium implant, but it grows back as appositional bone, the bone of a microfracture; whereas you take a plateaued or finned implant that goes into an osteotomy precisely the same size, you immediately get osteoblastic activity. No resorption! Driskell knew what he was doing and the bone grows back as cortical-like Haversian bone with high mechanical properties. That has been published multiple times over the last 15 years, multiple times. The principal author of these publications is Paulo Coelho from New York University. It’s all on PubMed, it’s been available for 15 years and has been ignored by the profession. Why? I don’t know, because they bought into threaded implants and it’s difficult to change the story. But there’s no logic whatsoever to use a threaded implant. Not only with the pressure on the bone, but the screw. So, let us continue. These are the histological images of human histology from Paulo Coelho and his cohorts and after 12 months, after eight years, you see the implant, after 13 years, this is human histology and what I’m impressed with is there’s a blood vessel between each and every plateau of the Bicon implant. That’s saying something, and you see their conclusion: unique healing with cortical-like bone with high mechanical properties. That is why a SHORT Bicon can work where a short other implant cannot work; it’s the bone. So, further evidence of the histology and they did so much histology, you can actually see a blood vessel within the bone between the plateaus. So, loading: you can laterally load a Bicon implant and it’s significantly different than placing a lateral load on the cylinder implant. Place a lateral load on the cylinder implant and you get a certain amount of strain on the opposite side and on the same of the apex. And everything depicted in blue is surgical risk for no gain. Yes, why have surgical risk, but no gain? Whereas a five millimeter implant, put a lateral load on it and the inferior/superior plateau will transfer the occlusal forces to the bone. Bicon is logical, the others just are not. So, should you lighten the occlusion as we’ve been advised when you see bone loss? Well, I say no. If you were to see bone loss around a Bicon implant, the first thing we look for is, is it in hypo-occlusion? And quite frequently it is. So what would we do if you see bone loss? We would put it into occlusion. And what’s the basis of the logic for that? Well, it’s Wolff’s law. Wolff, in 1892, did the seminal work on bone. Basically, he said that bone is similar to a muscle. The more you use it, it’ll change its form and increase in size, and if you do not use it, it’ll atrophy. And clearly, don’t we see that in our own alveolus? If you have no teeth and there’s no stimulation to the bone, what happens to the alveolus? It resorbs, so it’s in our own realm, if you will. So, there is the work of Wolff and it was true in 1892, a bone, as it is today, but it’s also true for the bone around the Bicon implant, or any implant. So, if you don’t know it, you’d be well-advised to learn about Wolff’s law. This is radiographic evidence of Wolff’s law. You can see it, the bone changes its form under function. Case after case, day of insertion, one year later. January 2011, August 2012, the bone changes under function. Four years after loading, 11 years, no sinus lift! Incredible, no? No, not for Bicon users. We’re not advising our patients to do lateral sinus lifts. We did; in days gone past, we’d probably do two lateral sinus lifts a week when we were doing the IMZ implant. Today, we seldom, if ever, do a lateral sinus lift. So, the other aspect is do excessive forces cause bone loss? Well, most people would say yes. Well, if that’s the case, please explain this. This man is a quadriplegic. Patient of Don Rothenburg’s in Marblehead, Mass. He placed this implant some 20 years ago, it’s now probably 25 years ago, and being a quadriplegic, this implant restoration is his surrogate hand. He puts his clothes on, opens his purse, et cetera, with this one implant. And look at the implant to bone interface. Clearly evidence that that connection is bacterially sealed. You do not need a publication and if you do, you don’t have the strength of your convictions in your logic of what you should know about bone. If that connection, which is now sub-crestal, if it were septic with a bacterial flux and micro-movement, there’d be no bone there. This is why Bicon can routinely place implants in 14 year-old adolescents, as we do. Only Bicon. Put a connection that has micro-movement in that situation and the bone would be gone. So, another mantra of the profession is that keratinized tissue is required. You must have a free gingival graft et cetera, et cetera and the patient has the expense. Well, you may, for an implant abutment connection that has a bacterial flux and has micro-movement, but you do not with the Bicon implants. We treated this patient who had an ameloblastoma and had her mandible resected and had iliac crest graft in 1994. We placed the implants and we had this proud oral mucosa. It was floor of the mouth mucosa, it was not gingiva. We had eight or nine millimeters of this proud tissue that was simply excised right back to the bone and we made a periodontal dressing covering for this bone and we stabilized it with an acrylic wafer and the patient functioned on it for two weeks, and look at the mucosa that we had to deal with after two weeks; beautiful. Now let’s watch that mucosa over 25 years. Yes, long time. We fabricated a prosthesis which, if we were doing it today, we would not bring porcelain down to the cervical abutment. We would’ve left it all with metal. And there it is after six and half years, no bone loss, and unfortunately, hygiene got pretty bad after 14 years as evidenced by the volume of calculus that’s on the front and we had inflammation and start of bone loss around the most posterior implant, as you can see there, and radiographically you’ll see the bone loss. But after 24 years, look at the mucosa. That’s oral mucosa, and there’s the bone level that started at 14 years and it continued right to 25, but it’s been stabilized now. But let’s look at the oral mucosa: no keratinized tissue. So, so much for your belief that implants need keratinized tissue to survive longterm. What you should say is implants that have micro-movement and a bacterial flux, they need or benefit from keratinized tissue. SHORT implants; well, they give you the ability to treat where others cannot. Less risk, all the benefits, they’re yours simply for using Bicon implant. The inferior alveolar nerve; look at the crown-root ratio. Not splinted. We could’ve splinted, but there’s no need. Bicon does well as a single unit. It’s not better to splint, as I told you. Can you splint? Yes, but if you know Wolff’s law, there’s no reason to splint, unless splinting helps you avoid the loosening of screws. Aha! Is that the motivation why you’ve been hoodwinked into thinking splinting is better? Think about it. Look at the implant, the size a four by five, right over the nerve. Look at the size of the crown after nine years. Another. Well, let’s go on to the universal positioning of the abutment. It’s a boon, and yet, all of you have known it since kindergarten when you were five years old when your teacher gave you a square peg for a square hole and a round peg for a round hole. At five years of age, you knew the easiest one to use was a round peg in a round hole. And that’s exactly what the connection is between a Bicon abutment and an implant. Unfortunately, many dentists think they need a hex or a hept for precise positioning and when somebody tells me that, I just smile because I know they’re not as discerning with being a dentist because I ask them: “Have you ever placed a crown lateral incisor “for patient on a natural tooth?” And they’d all say yes, you bring it to the mouth and the patient says, “No, I don’t like it. “Just a little bit, rotate it a bit.” and our defensive reaction is no, no, no; the technician knows what’s aesthetic, that’s not aesthetic. Well, who’s right? The patient. So with the Bicon, sure, where do you want it? You rotate it just a smidgen. You like it there? Okay, then, pop, tapped it. So, the 360, contrary to what most people believe, it’s a boon, it’s not a liability by any stretch of the imagination if you’re thinking logically. What does 360 give us? It gives us the extra-oral cementation. We all know one of the greatest problems with implants is cement. Well, if you have a problem with cement, don’t use it! The problem’s gone, it gives us the integrated abutment crown which I just showed you and it gives you the slight aesthetic adjustments which I just explained to you. But what you will see is using the prosthesis to transport, orient and seat an abutment. Yes, a major time saver for you and time is money and time saved is a benefit to you and your family. All you have to do is think about your family. So, an abutment, you can take an impression of that abutment, it’s nothing more than a post and core and symmetric crown, which some do. Alternatively, you could put a sleeve on it and take an indirect impression and cement the crown, or whatever you have the potential for extraneous cement. But there it is, once again, no sinus lift. Do you see how many treatments we do with no sinus lift? Remarkable! We save the patient thousands of dollars, we save time, we’re efficient! Now, you may not be, but recognize the fact that Bicon users are. So, extraneous cement. See that little bit of cement on a porcelain-fused metal crown? Yes, that tiny little bit of cement caused that exudate and bone loss. So, it’s virtually impossible for any dentist to consistently remove 360 degrees of extraneous cement. I can’t, you can’t, so to avoid it, extra-orally cement, I use the Integrated Abutment Crown. It’s logical. If it’s a problem, avoid it. This is an example of extra-orally cementing. Into the cement, cement it on the abutment, wipe away the extraneous cement, insert the abutment in the crown as a single unit. The IAC which I mentioned we have used over 20 years now, it was published, what is that? 2007, that’s 13 years ago in the “Journal of Prosthodontics” and there it is. So it’s nothing new, 13 years. If you don’t know about it, why? It’s logical, it’s a boon. So, it does entail using a polyceramic material which unfortunately, particularly in the United States, everybody’s been hoodwinked by the marketing material, my belief that we want something strong, we want something that doesn’t break: zirconia, enamic, tough, strong material. Well, maybe not. We all know that porcelain abrades the opposing teeth, so yes, you’ll iatrogenically sacrifice the opposing dentition, all because you don’t want something to break. I would suggest to you that for years now, for 20 years, there’s a better way. But everybody has their belief that only their material, their chosen material can be aesthetic. Well, I ask you, the other professional: tell the judge which is the more aesthetic restoration? Choose; one is zirconia, one is porcelain, and one is the polyceramic. Tell me which one is more aesthetic. There’s the answer, did you get it right? Same patient. We initially had hand-layered IACs when we started using IACs some 20 years ago and there’s the technique that was done. It was basically developed by Paolo Perpetuini in Roma. He developed all the techniques and there it is. Look at the papillae, look at the aesthetics. This is not zirconia, this is not porcelain, this is the polyceramic material. Now take a look at this case and the advantage of the polyceramic material. This is an patient, an adolescent, a 15 year-old male. He had no papillae, as you can see and the IAC was inserted when he was 16 and let’s follow it for the next 13 years. Eight years later, the natural teeth had continued to erupt and the implant had stayed fixed. But with the polyceramic material, you simply add to it at chairside. Can you do that with zirconia, can you do that with porcelain, can you do that with enamic? No! But there’s the advantage and look at the papillae. This is eight years after it was inserted. You wanna see age 23? Well, let’s look at 27. Look at the lack of papillas at age 15. As we have often said, hearing is one thing, seeing is believing, and doing is knowing. Prior to this presentation, many of you only heard about Bicon. Today, you’ve seen it, you’ll have to believe it. However, you won’t know it until you do it. I believe there’s a heaven, but do I know? I don’t wanna find out today, but when you do it, you will know that we are telling you the absolute truth and the benefits to you and your family. Today, fortunately we have CAD/CAM-milled IACs. Many companies have these products, these are two: SHOFU and GC and they were tested at the University of Sao Paolo in Peru by Dr. Estevam Bonfante and they’re significantly strong. So if you feel that you need something as strong as other materials, you see, there they are. And this is the technique. Digitally, they’re milled and as you’ll see later in the presentation, papillae get better in time. Look at the day of insertion the metal margin, but because of the lack of micro-movement and the lack of a bacterial flux, the papillae get better. Let’s take an example of removing three 15-year old PFMs because the lateral tooth had darkened so for aesthetic reasons, these crowns have been in for 15 years. And they’re simply removed in seconds. Could you remove three porcelain fused to metal crowns cemented on an abutment that was fastened with a screw? No, and we immediately take the impression, which is nothing more than three round pegs in three round holes. And additionally, we use the 15 year-old restoration as our temporary and then it comes time to insert, as I said, in seconds, here it is. One, two… Three. How long would it take you to insert three anterior crowns? You’d still be looking for your torque driver and we are finished. And look at the papillae, more importantly, look at the bone as you will see in the upcoming slide. There’s the bone after 15 years and readily removed. Simply twist and pull. Adding a cervical margin. We can restore this in less time than you can apologize for it and you’ll never know how many patients do not come to you because you left one of their relatives or friends with a metal margin. Since the abutment is a solid abutment, it’s a custom abutment and you just cut it back, add the polyceramic material, remove the crown in seconds, and as you can see before your eyes, insert it in seconds. Not minutes, seconds. So, how about an interproximal contact which is so important? The recent EAO consensus report said or stated that after five years, 50% of implant restorations have an open interproximal contact. Well, if 50% of them have an open interproximal contact, well, what are you doing? Telling the person how to floss in a restaurant by putting their hand over their mouth and nobody will know what they’re doing? You cannot, financially or economically, close those contacts. But with the Bicon abutment, twist and pull, out it comes, whether it was in there a day or 15 years, add to the contact. Now, hypo-occlusion. As we told you that if you have bone loss, the first thing you want to do with the Bicon is look and see if it’s in hypo-occlusion. For us, it’s easy using these polyceramic because we add them materially, we functionally drive the occlusion, and the chairside appointment is finished. What do you do? You ignore it and the patient winds up with a roller coaster occlusion. Let’s look at the merits of the hemispherical base. We didn’t appreciate the merits of this geometry initially, but we do today. The larger the hemispherical base, the better. Yes, use the widest hemispherical abutment without encroaching upon the papillae, and here’s why. We’re losing bone around that implant in the red circle, simply because the hemispherical base is not large enough. Simply change the abutment to a larger hemispherical base and yes, the bone loss reverses to bone gain. The hemispherical base is significant. Another example of it: there’s equal bone on the mesial and distal of the implant, and yet, over time the restoration had a hemispherical base in the medial, no bone loss. No hemispherical base on the distal and you can see bone loss. Simple things matter, so if you get involved with the Bicon, you really wanna learn the nuances. You just don’t shoot from the hip, not if you like your patients. So, examples of the hemispherical base: a study was done by Sung-Kiang Chuang, a retrospective study published nine years ago, 2011. And it showed that those implants with significant bone gain all had large hemispherical bases. Tell me that that implant abutment connection is not bacterially sealed. You cannot, not if you have any scientific appreciation. That abutment cannot have micro-movement and it has to be bacterially sealed. Otherwise, there’d be no bone there, and that’s after 14 years. Other examples of the hemispherical base. The merits of it. Seeing is believing. Yes, even under CBCT. And notice the position of the implant, sub-crestal. Sloping shoulder, as I mentioned to you, if an implant doesn’t have a sloping shoulder, I immediately discount it. It is not of any merit to me. – Is that we’ve got the design of the sloping shoulder which I think is critical because most implants now when they emerge at the crest are either wider than the body of the implant ’cause they flare at the crest, or they’re the same diameter. Well, the problem with that is that that’s the narrowest part of the bone most of the time, is the crest. So if you come through the crest and you thin out the existing bone, I think what’s gonna happen is you’re gonna get die back. It just compromises any blood supply that you might have to that bone. So, having the sloping shoulder where it not only takes away from removing an excess amount of bone but then allows you to get more bone forming in that area, I think gives us a distinct advantage in terms of not getting that die back. – So the geometry of the implant provides space for the bone and the bone supports the papillae. And there it is graphically, it’s obvious. Diameters of water bottles are the same, one with and one without sloping shoulder. The implants without a sloping shoulder has no room, but what’s a little thing like papillae? Papillae are meaningful. This is particularly appreciated by me because look the day of insertion, the metal and no papillae, and yet in only three weeks, you have a papilla. Lower incisors are very challenging to do aesthetically, but we will tell you the papillae improve over time Day of insertion 10 months, two years. And yes, eight years, the papillae is still there on the lower incisor. Let’s take a look at a longterm result, 17 years. This case was immediately loaded. Many people say Bicon cannot immediately load well and put into a function. Well, we’ve been doing it for years. There’s the papillae, 2002. The implants are placed. This 17 years later and there’s the papillae and the aesthetics 17 years later with integrated abutment crowns. They’re not porcelain, they’re polyceramic material. Seeing is believing. Let’s take a look at the bacterial seal, which I think is probably one of the greatest significant aspects of the Bicon implant. – This is and was the first implant to ever do this and now it’s being copied significantly because we know that this is important. We’re not getting bacterial leakage in this area and if we don’t get bacterial leakage, again, we’re not gonna get bone loss from, really, periodontal reasons. – Well, there it is. No inflammation and more importantly, no odor. And it has been studied at Boston University and at the Forsyth Clinic and published in 2005. That’s 15 years ago and it was also published in 2008, which was 12 years ago in the University of Rome. That’s what it looks like. And petechial bleeding, it cannot be confirmed with this video, but what else could it be? You remove the abutment, no bleeding and then within a matter of seconds, you get petechial bleeding. Indicative of the fact that there had to have been some type of a soft tissue attachment of the mucosa to the titanium. Should we be concerned about bacteria? We should be. This is a recent publication, well, it’s almost a year now, implicating the simple P. Gingivalis in Alzheimer’s disease. Oral bacteria, septic connections, they are important. Is it logical to have an abutment with micro-movement and bacterial flux? Absolutely, no, the profession teaches that bacteria are harmful not only to your alveolus, to your coronary arteries et cetera, and they advise you to do everything you can. You floss, you scale, you take Doxycycline, you do everything to get rid of these bacteria because they’re harmful. And yet, everybody ignores the fact that we’re putting bacterially infected reservoirs into somebody’s alveolus that can’t be treated. Where’s the logic, where’s the hypocrisy? Well, this is Dr. Zipprich, he has an excellent presentation on YouTube and he stated that he tested all threaded connections and they all had micro-movement under load. Here’s what he says about the Bicon. – [Dr. Zipprich] This Bicon interface, we can see below there is a micro gap, but the interesting thing is if we load it with 200 Newtons, the micro gap didn’t change. So there is no micro-movement inside. And this is a cheap copy of a Bicon system and we can see there is a micro gap inside of the interface. – So why would you purchase a copy of Bicon when you could have the original? Whatever dollar, or Euro or currency you saved, you’re risking a defective implant. It’s not worth it. SynthoGraft, as we mentioned, we’ll demonstrate to you its clinical capabilities. There’s a tooth that was extracted for a variety of reasons. The patient only wanted one tooth to be extracted. It was, and notice that the implant was placed at the crest of the bone facially and yet, probably 10, 12 or 15 millimeters below the crest lingually. Seeing is believing. This is 2013, the time of placement. 2014. See the implant? Adaptable to the adjacent apices of the teeth. Not the best hygiene, two years later. Look at the bone, look at the bone around the natural tooth and how it has improved. And look at the tissue. Seeing is believing. There it was at day one… And four and a half years later. Crown-root ratio. See the clinical flexibility that you have? No ridge is perfectly flat, so with Bicon you can place it below the crest of the bone on one surface and at the crest at the other. Clinical capabilities that are unmatched. SynthoGraft, another example, histological example. This man had successful implants placed. They were in a SynthoGraft, everything above the red line was the SynthoGraft material and for psychological reasons, he insisted that they be removed which provided us with this histology which you can see. Everything above the line started out as a synthetic material and then it’s virtually resolved. So, the SynthoGraft goes away in time. NARROW implants; well, they speak for themselves. Full lower incisors are capable to be done with Bicon and they’re not with others. NARROW implants. CAD/CAM fabricating IACs and we know that the papillae get better in time. And there it is. If you want four lower incisors, Bicon can deliver. Take a look at this clinical case, speaks for itself. Two teeth were fractured in a bicycle accident in 2002. Notice the lack of bone around the natural tooth in 2002. Look at it a year later after the Bicons have been placed. 2006, the bone is still there and impressively so. However, in 2007, there’s the beginning of internal resorption. Unfortunately the man moved away from Boston to Georgia and somebody treated the internal resorption by putting a implant in that had a micro-movement and a bacterial flux connection and he lost bone on that implant, whereas the original Bicon on the other side is still present. We’ll conclude with a little demonstration of TRINIA which will have a comprehensive presentation in a couple of weeks. TRINIA is a revolutionary metal-free CAD/CAM material, 40% resin and 60% fiberglass. It’s milled. Look at the virtues of it. Yes, you’ll never have a catastrophic failure with TRINIA. Two restorative visits. Round peg in a round hole. Alternatively, you can use scanning post and take a digital impression. But it’s simple, no screws, no torque drivers. And there’s no need for a frame try-in with TRINIA. The accuracy of the components, the accuracy of the digital milling, there it is, the prosthesis is orienting and seating the abutments. Think about it. They all fit and if there were any contact preventing the passive seating, you’d simply have to adjust a little black dot. So, two visits, you would most likely take three. And if it took you three visits, then you have the potential for three failed appointments. If you can eliminate one visit, you can eliminate the potential of 33% of your potential failed visits. Seeing is believing. Now you say, “Oh, that’s all well and good. “The implants were relatively parallel.” However, we will now show you a five-unit bridge that is also done in two restorative visits. There it is. Are the implants parallel? No. Impression technique, how much time is it gonna take you to do this for five units? Two round pegs in two round holes. The impression, you have to wait four minutes for the impression material to set. Clearly it recorded occlusal registration on the sleeves, then the TRINIA framework would be milled, the polyceramic material would be added to the TRINIA framework, and then, we will use the prosthesis to orient and seat the abutments. Initially, we would just seat the canine abutment, aligning the medial of a canine with the distal of the lateral. A little pressure, the abutment is in place and then go back and we put the other abutment into the prosthesis and we put the post into the implant well and then it aligns with the anterior canine. Check the occlusion, remove it and cement it. I suggest to you that each of those visits for this five-unit bridge was under a half an hour. Think about it: a five-unit bridge in only two visits of about an hour. Does that benefit you and your family and your patient? And so, in conclusion, these are the attributes of the macro-geometry of a Bicon implant that gives it its clinical capabilities. And hopefully, I’ve been able to show you the merits of it, once again, not only for your benefit, but that of your family, and more importantly, your patients. So shorter is better, drilling does not require irrigation, implants do not need primary stability, implants gain bone, well, Bicon implants do, and implants can be placed with only minimal bone. The crown-root ratio can be five-to-one or even more. Implants do not need to be splinted, it’s illogical to say it’s better to splint, unless you’re trying to avoid the loosening of screws. Implants can be placed in adolescents. Yes, routinely in 14 year-olds. So, in humility, I hope that I’ve been able to show you what we’re doing and what other people are doing for your benefit and the benefit of other people, recognizing the fact that we have unmatched clinical capabilities achieved in less chair time, less financial expense and significantly less morbidity. And remember, your time is your most valuable asset and your time is very costly. Thank you for having watched our presentation.