Placing Bicon Implants in the Max Anterior Region: Do You Still Have Concerns?

I have quit using the Bicons in the anterior because of the same problem. I ended up cementing a few of them out of despiration. I have not tried the 2.5mm wells and don't intend to, since the Ankylose system is just as simple, well proven, and has the advantage of the Morse taper as well as an intermal hex. I Still like the Bicons in the posterior in many cases, particularly because the IAC crown does not wear the opposing tooth or teeth. Bicon has never been straight forward in my opinion about the max. placement problem.

The chewing stroke causes the opposing tooth to hit at an off axis point and dislodges the abutment in the anterior max and sometimes in the ant mand. The bicon is fantastic in the post max and mand. It is also great for Sommers uplift cases.

I have both 3mm and 2.5 mm Bicon wells in the anterior region. There is some care and occlusal planning involved in using the 3 mm well models anteriorly, but I've had none come loose when the wells were clean and dry and care in setting the "cold weld" was used. Other than a risk of swallowing the smooth crown/abutment, the downside risk is nothing more than the patient placing it back into position. Any contaminants inside the well will prevent the cold weld fit. Compared to Ankylose, the Bicon Morse taper is tighter fit and prevents bacterial migration. Compared to the problems of loose and broken screws, the Bicon taper's possible loosening seems a managable risk and it could prevent breakage in some situations of high stress or trauma. The newer, 2.5 mm well Bicon implants are extremely difficult to dislodge, even with great intent on the part of the doctor. I like to engage the posts, after cleaning and drying with alcohol, using an orthodontic band setter/bite stick. All fluids have a minimum fluid thickness which is inviolable. You can see the post take it's "set" that way. When tapping to seat, it is difficult to clinically confirm a full seat, other than x-ray. I also try to get a flat buccal to lingual contact area similar to what we try to set up in orthodontics, which simulates the natural interproximal wear of teeth and reduces rotational forces. In traditional crown and bridge, that problem of a lower cuspid pounding off center on an upper lateral incisor must be addressed in the treatment plan also. The lateral will always lose that battle. My guess is the reported loosening of Bicon 3 mm posts is likely associated with off center occlusion, contaminated or wet wells, point contacts, and insufficient, or unconfirmed seating procedures. John

I should add that, since I try to avoid stand alone 3.5 implants (the 2.0 well models), I've not had loosening problems. Also, I meant "film thickness" re fluids in last post.

Why would you put up with those issues and limit your esthetic options for the patient. Screw breakage is a thing of the past, when you know what to do.

If the correct seating protocol is followed there should not be any problems. There should be no interference of soft tissue or bone , so use the sulcus reamers and make crestal incisions where needed.Overtight interproximal contacts will always lead to loosening. If the abutment comes out soon after placement it is a seating problem. If it happens later it is usually an occlusion problem. Test occlusion to the extremes of movement. Occlusion changes over time and this may place additional unfavourable forces on the implant supported crown. If the rotational forces are too great the abutment will loosen. This should be regarded as a safety mechanism preventing breakage of other critical components.

Loosening of Bicon's Morse Taper abutments is exacerbated by angled abutments. Best to use Zero Degree abutments in situations susceptible to rotational torque on the 2 mm wells, and some 3 mm wells. Probably best in general to aim for in line restoration. The greater the abutment angle, the greater the rotational torque. John

In twenty years I have yet to have an implant just fall out, as you say. I also have yet to see a true indication for anything smaller than a 3.5 mm implant, and typically these are extreme cases such as lower incisor positions. From all that we know, from true scientific studies it makes no sense to place a " nail" when you can place the widest implant possible. Does anyone really believe that an overdenture is best managed with a mini- implant . While I feel like anyone can safely place implants, if they have truely put in the hours of training, I believe there are certain situations that should be referred out to an omfs/ perio. Please don't let egos get in front of good patient care. Bv/omfs

Thank you for all your input. Dr. Manuel and Herman, is max 2.5 your choice of max anteriors or do you use different implant system for anteriors? I am a beginner and would like to just start with bicon system. With careful occl/interproximal/extreme excursion adjustment (which are required regardless of any system)and proper sitting, Max 2.5 seems to be a good option in max anterior. I just like the fact that bicon uses reamer that collect autogenous bone from the site and less bone loss around shoulder. Because it preserves papila well, it seems very esthetic after crown placement without using zirconia abut. Anybody has opinion about anterior esthetic of bicon?

Bicon recommends the 2.5 mm well for anteriors and locations susceptible to rotational force. I switched to the 2.5 as soon as it was available. The 2.5 mm Morse Taper is more parallel than than on the 2 or 5 mm well models. Bicon is using this 2.5 well, 4.0 x 5.0 mm, implant over and beside the inferior alveolar nerve area and they currently feel the 2.5 mm shaft is strong enough for judicious use posteriorly. This tiny implant can also be slightly angled palatally into a tight upper lateral case. Using very slow speed and the hand reamer attachment, one can feel the cortical plate and lamina dura as well as the wall of the nerve canal. With minimal anesthesia and a lot care, this make working around delicate anatomy reliably safe and free from post op swelling problems from higher speed reamers. As to the relibility of Short implants, there are many year of research showing them to be as or MORE successful in ALL areas. Check out the Bicon research on site. I am in love with that new 4.0 x 5.0, 2.5 well and sometimes put two of them in a lower molar site with dual crowns where the 4.5 x 6.0, 3 mm well, would be too close to the walls or inf. Alv. Nerve

As to esthetics, I feel the tapered tops and tight seal give the operator the Abundant circulation necessary, and room for tissue modification during the uncovering/abutment placement procedure. The body is highly efficient in healing and aging. It does not like to make and maintain capillaries around bulges - that is how we end up with gingival scalloping in the first place. The Bicon shape wind abutment interface are so biocompatible that we routinely get bone growing over the junction and can perform Guided Bone Regeneration to rebuild a missing Facial cortical plate right over the top of the implant at placement. I think theBicon fin design allows for much greater circulation, both horizontally and even vertically thru the fin slits. This is what males them more forgiving in tight installations. With no need for screw access and only the narrow post as an obstruction, Bicons allow greater range of esthetic options than most wide-topped designs with screws.

Hi Dr K I routinely use 2.5 mm Max in anterior regions with consistent good results. The aesthetic results are exceptional and soft tissue readily adapts around the implant because there is adequate bone as a result of the sloping shoulder design and the built in platform switching. The fact that the crowns can be extra-orally cemented or delivered as integrated abutment crowns provides an ideal emergence and great gingival results. The harvested bone which is part of the placement protocol adds to the volume of crestal bone. This is a very user friendly system but as with all implant systems adequate training is essential.

After continuing to educate myself with websights such as these and obviously other literature and ce. , I am amazed that some of my comments have not "jarred" any responses. While continuing to see no mention of using standard implants in the anterior maxilla, I assumed I was possibly missing out on something. So, I went to my facility tonight and randomly pulled thirty cbct scans from my scanner and measured the area approximately 3 mm below the cej of every lateral maxillary incisor. The narrowist measurement on a very diminutive lady was 3.11 mm, with the average width being greater than 4.2 mm. . Needless to say , the central incisors were quite a bit wider. This is no coincidence . Will someone explain to me why people are placing 2 and 2.5 mm implants in these areas? Is it because the doctor doesn't believe in simple physics, bone grafting, ridge splitting? But with all sarcasm aside , I would like to know. Please respond. B. Vinci

Dr. Baker, you should read better, they refer to the abutment width post (2.0 , 2.5, and 3) not the width of the implant.

Really , look at the question being asked. There is no mention of implant diameters. My reading skills are better than satisfactory. Pardon my ignorance with regards to bicon implants. I refuse to place implants that don't have adequate research. I still believe, if you have a choice , crown to root ratio is still a significant variable , and I choose not to breech sound physics. I don't place blades , subperiosteal, or bicon implants. And I only place mini - implants for ortho cases and as temporary devices between traditional root form implants. God made tooth roots long, wide and tapered for a reason. If you are looking for appropriate implant emergence , learn to augment ridges with autogenous bone, either via onlay blocks or distraction. These bicon implants were designed for doctors with limited experience. Thanks, bv

Andres, show me in the initial question where implants diameters are mentioned. Excuse my ignorance , with regards to bicon implants. I am a firm believer in common sense physics, so just as I don't place blades and subperiosteal implants, I will not be placing bicon as well! I must assume this is a proprietary web sight, in that my last entry got deleted. Let's keep it scientific. Bv

ok, have to jump in here. Baker, you sounded like a clinician who does it based on science. you said yourself that you don't place bicon, blade..etc because they lack scientific research or violate physics. Then you went on to say " Bicon implants are designed for doctors with limited expereinces. I see this as an issue again and agian. About any procedure, the debate starts from discussing science then somewhere along the line, iends with personal opinion. " Bicon implants are designed for docs with limited expereinces " That's your opinions based on not having placed any of them at all. I used them on many occassions and they worked out well but that's still completely anedoctal, hence I don't discourage or encourage the use of it publically. You want to talk about science when you talk about bicon ( or anything ), stick with science. Not your 'UNproven' opinion.

Sergio , your exactly right . I have only seen bicon implants break, and have been referred less than five of these to remove or attempt to salvage. This does not meet credible scientific standards to make a conclusion. I do stick to the sound standards of good physics and well founded studies that support Maintaing appropriate crown to root ratios. I appreciate the intellegent feedback. Bv

Drs. manuel and Botha and sergio, I appreciate your input on Bicon system based on your experience. Although it's hard to understand one jumping into discussion with absolutely no knowledge about what Max 2.5 is, it was great to hear from sergio about his opinion on using the system. BV, better ask if you get confused. and talking about crown to root ratio, God created tooth not implant. There are many researches claiming crown to implant to ratio is not same with crown to root ratio. Study Bicon, it may make even your life way easier!

I have used Bicon for many years and the science is mostly sound. HOWEVER I would NEVER use them in the anterior maxilla again due to a small number (<10) of patients having repeated loss of the IAC. In the end I had to reimburse them and they ended up with successful bonded bridges. Managing these patients took up a significant amount of time (mine and theirs) and caused a great deal of stress all round.I will never ever place another anterior Bicon. In the past, Bicon have been rather less than candid in identifying that there is a problem using their implants in the anterior maxilla in some patients. Additionally, I have had 3 or 4 patients where molar IACs have broken leaving an abutment in the implant that is non-retrievable. Paradoxically, when you want to get them out, they won't come out!!It seems that once these abutments are firmly in place, in a molar-sited implant, they're more or less impossible to remove...Even when you tap and twist them and grab them with forceps as Bicon recommends.. Despite my comments above, I think much of what Bicon has to offer is excellent, however the system has been let down by trying to be a jack of all trades. and would certainly have a Bicon to replace my own missing molar if necessary.

Dr.chadge, I completely agree. Taking those things out is tough,at best. I recently had to cut one in half and sleep it ,after grafting about 6 mm of bone over it. By the way , I didn't place the implant,just had the pleasure of " bailing it out". Glad to see I'm not the only one seeing this problem. Bv