Can this Bicon implant be saved?

Last Updated: Feb 13, 2019

Tooth #4 has a periapical abscess that has extended to the apex of the adjacent implant in #5 position. Implant #5 has lost some bone which has exposed some threads and I believe may have no bone distally between itself and root of #4. #4 needs to be removed, but can the implant be salvaged or is it better to remove implant #5?

Here’s the full story:
81 y/o male patient walked into my office with chief complaint part of his crown on his front tooth chipped and he just wanted it repaired. Turns out he only has 1 maxillary natural tooth remaining. The rest of the maxillary teeth are replaced with implant bridges. On upper right side there is a 3 unit bridge supported by implant in #3 position, natural tooth #4, and implant #5 position. An anterior implant bridge is supported by implant #6, implant #8, implant #11. Left implant bridge is supported by implant #12 and implant #14. Implants are all Bicon, reported by patient to be greater than 10 years old. There is heavy wear on these bridges with several porcelain chips/fractures. Most of the porcelain is chipped off pontic #9. He has very poor oral hygiene. During the examination I noticed purulence coming from palatal of #4. Recurrent decay is present at the margin of #4 with deep pocketing between #4 and implant #5. Radiographs were taken revealing periapical pathology #4 extending to the apex of implant #5. The placement of implant #5 is obviously too close to tooth #4. The implant #5 has lost some bone and has exposed threads. The other implants appear to have good bone around them. #4 obviously needs to be removed, but should implant #5 also be removed or can it be salvaged? If we try to salvage it what would be the best regenerative material options? Does it make sense to try something like this knowing that it will be next to impossible to debride above the implant’s apex? Even if bone can be regenerated around implant there will still be exposed threads so how does this factor in the decision process?

I believe removing the implant and making a new bridge that will need to replace the existing upper right bridge and anterior bridge would be better, but how hard will it be to remove the implant? We are also subjecting the patient to a lot more treatment and much higher expense. I guess another option may be to remove the implant and convert the upper to an implant supported fixed/detachable prosthesis of some sort.
Your thoughts/suggestions would be greatly appreciated.

11 Comments on Can this Bicon implant be saved?

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Richard Hughes DDS

02/14/2019

Do you have a full series or a pano?

Dr. Gerald Rudick

02/14/2019

Richard Hughes is correct....how can we be expected to comment on a case when we are presented with a series of disjointed xrays…. a panorex or CT scan would be very beneficial to properly analyse the situation......some photos would also help.

Dr Dale Gerke, BDS, BScDe

02/14/2019

As has been suggested, there is not enough information to give a meaningful comment. However by guessing, my recommendation would be to start with the basics. 1 get a cone beam radiograph 2 get some good hygiene started (scaling but also maintenance) 3 remove the bridges (could be tricky – they seem to be cemented on rather than screwed) 4 record all gingival pockets 5 probably removed #4 since it is likely the lesion is due to #4 and #5 being too close together (as best I can see) 6 perhaps curette the #5 when you extract #4 (hard to say from what you have shown us) 7 re-evaluate after healing (2-3 months) 8 discuss progress and possibly outcome and options with the patient Given the patient’s age, your expectations can be less than if he was 20-30 years old. However I suspect there is no way round any treatment being expensive. There will be extensive time required by you. Also lab fees (may be new or possibly repair work). So there is no point getting too aggressive with treatment planning if the patient cannot proceed. I think your suggestion of removing the bridges and using a removable denture on locators or balls is very reasonable. But you need to see what the patient thinks and also find out how all the implants are going after basic cleaning. However if you carry out this plan, at least he would then be able to more easily clean the implants and probably not require any more implant surgery (even if #5 was lost).

Dr. Moe

02/14/2019

Quick question, How about not removing the bridge, just do a buccal flap and remove #4, Currette all infection like doing an Apico and then debride,clean, disinfect, and bone graft? And possibly an abx course. I think that would be the most conservative for the patient, right? Just thinking out loud. My $0.02

Dr Dale Gerke, BDS, BScDe

02/15/2019

Not a bad plan. Obviously if the bridge is easily removed then that would be the preferable way to go. However failing that – your plan is worth a go. If it is not possible to get access to #4 then the next easiest option is to section the bridge at #4 and remove the tooth and preferably curette and graft #5 and then allow healing and re-evaluate. Depending on what eventuates, there are different paths to consider. However I repeat my comment above; I am not certain there is an inexpensive way to provide the required treatment. I am sure all options with require time and consequent costs.

Dr. Moe

02/15/2019

Dr. Gerke, Thanks for your reply. When I look at the x-ray again, you are right, he might need to remove #5 implant because after removal of #4, there might not be any interproximal bone there. My comment was just a variation on your treatment, I try to do the most conservative thing for patients, especially if they are of advanced age and don't have finances to go through the whole surgery and prosthetic phase. But, then I clarify it to them that this is "trying" not guaranteeing that it will work. If it does, great we saved you some money and discomfort, if not, well then we can always go more aggressive. Thanks again for all your valued, experienced contribution on this blog. Always good to learn from more experienced practitioners.

aDMD

02/14/2019

Does anyone have experience with Bicon implant system? What I have found out is that the abutments are not screwed into the implants, instead they are ‘hammered’ into the impant. This essentially ‘welds’ then into place, not retrievable at all. So to remove bridge only option is to cut it from the implants. Bridge has metal coping, so metal on metal abutments- very difficult to identify coping from abutment when cutting. Risk of damage to abutment is very possible, then what? #5 implant will probably be lost after #4 is removed, or at least have to operate with the assumption this is a real possibility so a plan needs to be in place to address that. Use the other implants to make a new longer bridge? Would be good option if any other implant system. With Bicon looks like will have to cut off bridge from abutments... not a fun day, especially if any abutments get damaged. For now what about sectioning the bridge mesial to #3, removing #4 and either treating implant #5 or removing it, and making an interim removable partial denture?

LSDDDS

02/15/2019

Check with Bicon first. I believe they are removable with forceps..

LSDDDS

02/15/2019

Check with Bicon first. May be removable

Scott Keadle DDS

02/15/2019

The bridges may be screwed on to multi unit abutments. If the insertion path draw was acceptable, the bridges may have been cemented onto standard abutments, in which case you’d have to cut the bridge from the abutments. All Bicon abutments are removable and replaceable, but do not have any clocking index.

Dr.Jamal.Hemmati

02/25/2019

I personally think it's a good idea to consider especially age and from the other side cost of the patient. So be conservative is the most reliable treatment. At first stage of treatment the bridge Should be taken out for extraction of #4,and check the mobility of #5implan.If the latter has no mobility it's better to keep the implant in place and after extraction of #4 and use bone material and maintain,give this chance to salvage #5 implant. Good luck.

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