Can this implant restoration be upgraded?
I inherited this patient a couple of years ago, with what appears to be a Bicon implant #11. The non cemented, friction fit retention of this implant and abutment design is bothersome for the patient. Does anyone know of a solution to upgrade this to a more conventional and stable abutment?
Thank you for any responses.
17 Comments on Can this implant restoration be upgraded?
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Francois Pelletier
5/23/2017
What is the problem exactly? What is the patient's complaint?
Brian Rhoney
5/23/2017
Unfortunately the design is the design, you can't do anything to change that. What is the problem the patient is having?
If that problem is insurmountable then the only option to change this is to explant and put something more suitable in.
H. Ryan Kazemi
5/23/2017
I agree with Brian. The Bicon abutment can not be altered. The only other option, if there is compelling reason to do so, is explantation which is not easy for Bicon implants. The reverse torque approach for explantation works well on screw type implants, but not so much for press-fit type of implants like Bicon. Of course it can be tried. Otherwise it requires bone removal which can be difficult, particularly when it is so close to adjacent root. Here is a link to a recent case I published (Removal of a Poorly Positioned Bicon Dental Implant in a Patient With Atypical Symptoms):
LSDDDS
5/23/2017
Have you contacted Bicon?
I had a similar Bicon case my Periodontist did on #11 that periodically loosened and/or came out. He made her a standard full upper night aguard and it seems to have worked
No doubt you have checked occlusion and parafunction.
I believe creating a post hole and making a cemented casting was suggested as a last ditch solution.
We agree with Dr Kazemi. Removal is problematic.
Dr Kamil
5/23/2017
My suggestion is to make use of a platform switching if Bicon system have, after witch you may restore with a better prosthesis.
Ed Dergosits
5/23/2017
All Bicon abutments are platform switched like the one shown here.
Don Rothenberg
5/23/2017
It looks like the implant has a 3mm post. Is the problem that it keeps coming out?
If that's the case, then the dentist who placed the implant should have used a Max 2.5 mm post which has a much stronger abutment to implant attachment.
I think it would be very difficult to remove the implant at this point in time. I have removed two integrated Bicon implants since 1986, all for various reasons and it is quite a chore. My suggestion,if that's the problem, that it keeps coming out, is to make a new crown with mesial and distal wings like a small Maryland bridge. This will prevent any rotation which is what dislodges the abutment from the implant. If you have any questions please contact me.
Gregori Kurtzman, DDS, MA
5/23/2017
If the restoration and abutment keep loosening check the proximal contacts this may not be allowing the abutment to be tapped in and get the proper frictional fit.
LSDDDS
5/23/2017
Or cut a lingual channel with wire and composite splint to #10 & 12?
Or full coverage splint?
Anything to avoid removal
Ed Dergosits
5/23/2017
It is never a good idea to splint an implant restoration to the adjacent teeth. The teeth move under function and the implant does not.
Rand
5/23/2017
One of the easiest ways to dislodge a Morse Taper connection is to tap from a 90 degree angle, then twist and pull. This is why I personally decided long ago to never use Bicon to replace an anterior tooth. The lateral forces will constantly stress the connection. On the other hand, posterior teeth with vertical forces are ideal for Bicon. Wish there was an easy answer for you.
Don Rothenberg
5/23/2017
If one uses Bicon Max 2.5 it will not come out.
We've done hundreds with no problem.
Ani tsai
5/23/2017
Agree, 2.5mm post has less degree of taper and almost parallels, that will not easy loose and come out. Think about the reasons of the abutment loose first, always. You might don't understand the system totally. If abutment not setting totally or well, it will loose easily, checked contact to find any tight contact and push implant crown during occlusion from adjacent teeth (because nature teeth have PDL and have very minor movements during occlusion). If seating is nothing wrong, then check occlusion again. Occlusion, occlusions, still occlusions. Not just in CO, check all range of movement, grinding. Remove all possible lateral force during parafuntion movement, that lateral force will loose abutment after a while. Even more than that is occlusion is very dynamic, once a while check it again. It even possible due to patient personal life change the effect to occlusion and then cause problem. Find the cause of problem, think about it, adjust it, resolve it. It will work. Especially this x-ray show bone level still in stable condition. You don't want to remove it, it will be nightmares for you if you do so. Because you need remove almost all the bone around implant. It is not have abutment loose in screw fixed implants system. All of abutment will loose if occlusion is not in correct. The damage to implant/ abutment connection even bigger. It take too much time to discuss, sorry, I need to stop in here
Arrif Lalani
5/24/2017
Assume the problem is the crown keeps coming out? In most cases when this has happened with Bicon crowns I have found the contact point to be the problem. Rather then take the implant out which to me would be the last last resort why not remake the crown? Better still get advice from Bicon or even better get someone who uses Bicon to have a look and see if they can fix the problem? It then stops being your problem. A 3mm post should be very difficult to remove. I could not justify the resultant damage from removing what looks like a healthy integrated implant?
varsanoclinic
5/24/2017
you can try an abutment with smaller well and try to cement it
Sam Barr
5/24/2017
The problem with Morse taper abutments is that they can loosen when the forces directed on them are lateral...just ask any auto mechanic how they loosen morse tapers...they hit them on the side with a hammer.
Every time this thing has gone in and out, there is likely fretting corrosion, and everything gets looser still. If a new abutment doesn't hold well, it is possible that the internal aspect of the implant is worn a little. In that case, relieve the post for cement space, and cement the thing, as long as your patient understands the entire implant may end up having to come out.
Aron Marcus
5/25/2017
Do not use cement to retain the abutment as it will prevent the locking taper from engaging
I have had this problem in the past and resolved it by making a new restoration on a new abutment as I suspected the abutment was damaged.
As stated before check contacts are passive and lateral and protrusive excursions.
