INTRODUCTORYSURGICAL MANUALUSNARROWIMPLANTS™

INTRODUCTORYSURGICAL MANUAL
Table of Contents
THE BICON DESIGN ......................................................................................................... 1–2
TREATMENT PLANNING ..............................................................................................3–8

Anatomic Sites .......................................................................................................... 3
Mandible and Maxilla ........................................................................................... 4
Bone Classification ................................................................................................. 5
Implant Size Selection .......................................................................................... 6
Surgical Templates .............................................................................................7–8
INSTRUMENTATION ..................................................................................................... 9–18

Comprehensive Surgical Kit ...................................................................... 9–10
Advanced Surgical Kit ........................................................................................11
Introductory Surgical Kit ...................................................................................12
Guided Kits ...............................................................................................................12
Restorative Kit .................................................................................................. 13–14
Pilot Drills ....................................................................................................................15
Latch Reamers .........................................................................................................16
Hand Reamers .........................................................................................................17
Threaded Instrumentation Interchangeability ....................................18
IMPLANT BASICS .......................................................................................................... 19-20

Implant Packaging ................................................................................................19
Removing Implant from Packaging ...........................................................20
Transporting Implant to Osteotomy ..........................................................20
TECHNIQUES ....................................................................................................................21–29

Two-Stage Surgery .......................................................................................21–23
Implant-level Impressions ................................................................................24
One-Stage Surgery ...................................................................................... 25–26
Two-Stage Guided Surgery .....................................................................27–28
Immediate Implant Placement .....................................................................29SURGICAL TIPS .......................................................................................................................30

Reaming on a Slope ........................................................................................... 30
Drilling in a Maxillary Anterior Extraction Site ..................................... 30

THE BICON DESIGNTHE BICON DESIGN was created in 1985 not as a
research project to study osseointegration, but rather asa means to restore dentition.

Scannable Temporary Abutments allow theclinician to fabricate the prosthesis while theimplant is integrating.

Bicon is different — but different by design.
The different shape, different geometry, and different
surgical protocols lead to different clinical capabilities
and different long-term results.

The 1.5˚ locking taper with no screws allows
for 360˚ abutment positioning, extraoral
cementation, and CAD/CAM restorations withsuperior aesthetics. No screws results in lessmaintenance.

The design has remained consistent and unchanged
since 1985, and has truly passed the test of time.

The 1.5˚ locking taper allows for subcrestal
implant placement and eliminates the bacterial
flux present in threaded implants with screw
components. Note the lack of inflammation after
10 years when the abutment is removed.

1mm

10µm

The 1.5˚ locking taper connection provides a sealat the implant to abutment interface, avoiding
the microbial leakage issues that can result in
inflammation.

The sloping shoulder and subcrestal implant
placement provides more room for bone overthe implant, a sensible narrow emergence, andsupport for papillae.

HAVERSIAN BONE

BICON IMPLANT

The fins and plateaus offer at least 30% more
surface area than a threaded implant of the same
dimensions and provides for the callus formationof haversian bone between the fins of theimplant, which allows for shorter implants.

Slow-speed drilling without irrigation is moreconvenient for clinician and patient alike, andallows for autogenous bone harvesting.

1

THE BICON DESIGNBICON IS A TIME-PROVEN SOLUTION
DESIGN■■

Fins and plateaus■

PROTOCOLS■

Sloping shoulder■

Narrow emergence■■

1.5˚ locking taper
■

■

■

+

Hemispherical base

CAPABILITIES■Autogenous bone harvesting■

Subcrestal implant placement■■

Avoid grafting

Shorter implants

Patient acceptance

Simple techniques

Lack of inflammation■

Extraoral cementation■

Bone gain

Superior aesthetics■

Scannable Temporary
Abutments■■

Support for papillae■

RESULTS

Haversian bone360˚ abutment positioning
■

+
■

■

No screws

Solid abutments

Slow-speed drilling=

Fabricate prosthesis during
implant integration

■

■

■

Reduced costs

Less maintenance

Fewer appointments■■

Saved timeMore referrals“The Bicon Dental Implant System is fabulous. Its simplicity and decreased costs have pleased our referring
dentists and their patients. Consequently, our implant case load has improved dramatically.”
Robert S. Johnson | Oral and Maxillofacial Surgeon • St. Petersburg, FL • 2009

REAL-WORLD RESULTS WITH BICON IMPLANTS

2009

2022

Bicon implants can often GAIN bone, while threaded implantsystems routinely lose bone over time.

Bicon’s sloping shoulder provides room for bone to support
interdental papillae resulting in gingival aesthetics that last.

SELECTED RESEARCH

THE BICON SHORT IMPLANT
A THIRTY-YEAR PERSPECTIVE
ISBN: 978-0-86715-781-9

Cheng, Y-C., Ewers, R., Morgan, K., Hirayama, M., Murcko, L., Morgan, J., Edmara, T., Bergamo, P., Bonfante, E., Antiresorptive
Therapy and Dental Implant Survival: An up to 20-Year Retrospective Cohort Study in Women, Clinical Oral Investigations,
August 2022
Urdaneta, R.A., Daher, S., Leary, J., Emanuel, K., Chuang, S.K., The Survival of Ultrashort Locking-Taper Implants, Int J Oral
Maxillofac Implants, 2012 May/June; 27(3):644-654
Urdaneta, R.A., Daher, S., Leary J., Emanuel K., Chuang, S.K., Tovar, L.A., Factors Associated with Crestal Bone Gain on SingleTooth Locking-Taper Implants: The Effect of NSAIDs, Int J Oral Maxillofac Implants, 2011 September/October;26(5):1063-1078
Birdi, H., Schulte, J., Kovacs, A., Weed, M., Chuang, SK, Crown-to-Implant Ratios of Short-Length Implants, J Oral Implantol, 2010;
36(6):425-433
Urdaneta, R., Rodriguez, S., McNeil, C., Weed, M., and Chuang, S., The Effect of Increased Crown-to-Implant Ratio on SingleTooth Locking-Taper Implants, Int J Oral Maxillofac Implants, 2010 July/August;25(4):729-743
Venuleo, C., Chuang, S.K., Weed, M., Dibart, S., Long Term Bone Level Stability on SHORT® Implants: A Radiographic Follow up
Study, Indian Journal of Maxillofacial and Oral Surgery, 2008 September;7(3):340-345.
Schulte, J., Flores, A., and Weed, M., Crown-to-Implant Ratios of Single Tooth Implant-Supported Restorations, J Prosthet Dent,
2007 July; 98(1):1-5
Gentile, M., Chuang, S.K., and Dodson, T., Survival Estimates and Risk Factors for Failure with 6.0 x 5.7mm Implants, Int J Oral
Maxillofac Implants, 2005 November/December;20(6):930-937
Bozkaya, D., Müftü, S., and Muftu, A., Evaluation of Load Transfer Characteristics of Five Different Implant Systems in Compact
Bone at Different Load Levels by Finite Element Analysis, J Prosthet Dent, 2004 December;92(6):523-530

2

TREATMENT PLANNING

ANATOMIC SITES

Implant dentistry is a prosthetic treatment with a surgical component:
The anatomic limitations, positioning, and trajectory of the intended implant, as well as
the functional and aesthetic needs of the intended prosthesis, must be clearly understood— prior to the subcrestal placement of the implant.
Therefore, it is paramount for a clinician to not only have a comfortable, practicalknowledge of oral anatomy but also to precisely identify the relative anatomic sites andconditions of each patient via radiographic or CBCT imaging and clinical observation.
It is essential to identify the following anatomic sites and patient conditions
before initiating any surgery:

Anatomic Sites:■■

Size and shape of alveolar ridge andpalatal vault
Floor and septa of maxillary andnasal sinuses

Patient Conditions:■

Height of the inter occlusal freeway space■

Edentulous space

■

■

■

■

■

Examine patient with mouth closed toascertain if there is enough inter-occlusal
space for the intended prosthesis.
A frenectomy or alveolectomy may beadvisable to improve the surgical site.
Radiographically visualize maxillary sinus,
nasal floor, and inferior alveolar nerve relative
to the intended site.
Although usually not necessary, Cone Beam
Computed Tomography (CBCT) can be ofvalue in determining the feasibility of an
implant site — especially where there isminimal bone and/or concern as to the exact
location of anatomic structures.

Anatomic relationship between themandible and maxilla (Class I, Class II,
Class III)■

Incisive foramen■

Path of inferior alveolar and mental nerves■

Bone pathology or resorption■

Mylohyoid line and submandibular fossa■

Quality and quantity of mucosa■

Sublingual fossa with its sublingual artery■

Medical history and status

Cone Beam Computed Tomography (CBCT)

Note: Relation of the intended prosthesis to the bone that will support it3

TREATMENT PLANNING

MANDIBLE AND MAXILLA

Anatomic Sites of Concern in the Mandible
Care must be taken to avoid the inferior
alveolar nerve and the mental foramina in
the premolar region, since the mandibular
nerve is often coronally inclined in this area.

Inferior Alveolar Nerve

Mylohyoid Line

Mental Foramen
Incisal Branches

Submandibular Fossa
Sublingual Fossa

Care must be taken to avoid thepenetration of the submandibular fossa
which is located below the mylohyoidline, and especially the sublingual spacewith the sublingual artery in the anterior
mandible. Inadvertent penetration may be
avoided by appropriately directing the pilot
drill and reamers toward the buccal andmonitoring the area with finger pressure
while drilling.
In general, 2.0mm of bone should separate
the apex of the implant osteotomy and the
mandibular canal.

Anatomic Sites of Concern in the Maxilla
The location of the maxillary sinus,
nasal floor, and incisive foramen must
be positively identified to avoid the
inadvertent penetration with a reamer oran implant.

Maxillary Sinus

Nasal Floor

Incisive Foramen

4

TREATMENT PLANNING
BONE TYPEDESCRIPTIONTYPE I

Flute of a 3.5mm reamer bur filledwith bone and minimal blood

TYPE IITYPE IIITYPE IV

GRAFT

5BONE CLASSIFICATIONDENSE CORTICAL

POROUS CORTICAL
AND COARSE TRABECULAR
Flute of a 3.5mm reamer bur filled withblood wetted bone

POROUS CORTICALAND FINE TRABECULAR
Flute of a 3.5mm reamer bur only partiallyfilled with blood wetted bone

INTEGRATION TIMEMINIMUM OF
4 MONTHSMINIMUM OF
3 MONTHSMINIMUM OF
3 MONTHSFINE TRABECULAR
Flute of a 3.5mm reamer bur
devoid of bone

SYNTHETIC
Inorganic material, such as SynthoGraft®
(beta tricalcium phosphate)

MINIMUM OF
4-5 MONTHSTREATMENT PLANNING

IMPLANT SIZE SELECTION

2.0mm Well

2.0

3x6

NARROW*™™

IMPLANTS

3 x 8 3.5 x 8 3.5 x 11

3.0mm

2.5mm Well

4x5

3.5mm

4x6

4x8

3.0mm Well

4 x 11®

™

2.5

4.5 x 54.0mm

4.5 x 6

4.5 x 83.0

4.5 x 11

5x5

5x6

4.5mm

5x8

5.0mm

5 x 11

6x5

6x6

6x8

6.0mm

MANDIBLE

MAXILLAIMPLANT SIZE RECOMMENDATIONS
®

3.0

2.5 *

4.5 x 5.0mm
4.5 x 6.0mm
5.0 x 5.0mm
5.0 x 6.0mm
6.0 x 5.0mm
6.0 x 6.0mm
4.5 x 5.0mm
4.5 x 6.0mm
5.0 x 5.0mm
5.0 x 6.0mm®

3.0

NARROW

IMPLANTS

2.0
4.0 x 6.0mm
4.0 x 8.0mm
4.5 x 8.0mm

NOTE: 2.5mm well implants have been
designed exclusively for maxillary anterior
single-unit restorations. For any otherrestoration, including maxillary anterior splinted
prostheses, overdentures, or fixed-removableapplications, it is strongly recommended to
avoid 2.5mm well implants.
In posterior sites, the 2.5mm post abutments
may be too retentive and not easily removed.
For maxillary anterior implants, anticipate
the need for bone grafting or ridge splitting
techniques.

™

4.5 x 5.0mm
4.5 x 6.0mm
5.0 x 5.0mm
5.0 x 6.0mm
6.0 x 5.0mm
6.0 x 6.0mm
4.5 x 5.0mm
4.5 x 6.0mm
5.0 x 5.0mm
5.0 x 6.0mm
4.5 x 6.0mm
5.0 x 6.0mm
3.0 x 6.0mm
3.0 x 8.0mm
3.5 x 8.0mm

The adjacent charts contain recommended
implant sizes only. Actual clinical conditions
and the clinician’s assessment of the patient
should be the main criteria for choosing
the size of an implant for a particular area.
In general, it is better to use a 5.0mm
SHORT® Implant than a longer length sothat the implant may be positioned 2.0 to
3.0mm below the alveolar crest.
The width of the alveolar bone may beassessed with a CBCT scan, periodontal
probe, or caliper. It is advisable to have
1.0mm of bone surrounding an implant fora long-term favorable prognosis.

NOTE: The 3.0 and 3.5mm diameter implants
are generally for mandibular anterior teeth.
If practical, their use should be avoided formaxillary anterior and all posterior teeth.
It is advisable to have at least 1.0mm ofbone around the implant. Therefore, anadvisable bone width of 5.5mm is necessary to
comfortably accommodate a 3.5mm implant,
unless ridge splitting or grafting techniques are
employed to widen the site.

6

TREATMENT PLANNINGSURGICAL TEMPLATESSURGICAL TEMPLATESKEYS TO SUCCESS

Implant dentistry is a prosthetic treatment with a surgical component. Accurate
placement of an implant requires the awareness of its intended prosthetic restoration.
Surgical guides should efficiently facilitate the placement of the implant within bone sothat its abutment is positioned in the middle of the intended prosthetic tooth. Mounted
study models and a diagnostic wax-up of the teeth to be replaced are usually necessary
for the fabrication of a template for multiple implant placements.
Although the location and availability of bone shall dictate the ultimate trajectory of
the pilot drill, clinicians should strive to stay within the center of the intended tooth andwithin 10 degrees of the trajectory of the intended prosthesis.
Using the adjacent teeth as a guide is a simple way of appropriately positioning the pilot
drill for single implant placements. Position the pilot drill in the middle of the edentulous
space and parallel to the adjacent teeth. To avoid a parallax issue, it may be helpful toview the positioning of the pilot drill from both sides of the patient, prior to drilling.

■

■

■

■

The trajectory of the pilot drill will be thetrajectory of the implant and the trajectory ofa straight abutment.
The final implant osteotomy, to the extent
possible, should be centered in the middle ofthe intended prosthetic tooth.
An appropriate mesio-distal positioning of apilot osteotomy is more critical than a slightly
off-axis trajectory.
Stabilize the template on adjacent teeth,
alveolar, and palate or alternatively withscrews.

Vacuum-Formed Template12

1. After making an impression andsubsequent cast of the diagnostic
wax-up of the intended restoration, avacuum-formed template is preparedon the cast from thin template stock
which is commonly used for thechairside fabrication of transitional
restorations.

2. Drill a hole in the middle of the incisal
Placing the pilot drill through a perforation in the center of a tooth of a vacuum-formed
plastic template facilitates its appropriate positioning for multiple implants.

or occlusal surface of the template in
the location of the intended tooth. If
possible, trim the template to include
at least one tooth distal and three orfour teeth mesial to the area of theintended replacement.

Template from Stone Model
12

1. Using a duplicated stone model of thediagnostic wax-up, draw a line throughthe incisal edge and occlusal surfacesof the teeth and another line in thecenter of each tooth to be replaced,intersecting the incisal or occlusal line.
Remove the lingual half of the teeth tobe replaced.

2. Fabricate a guide by molding acrylic
3A

onto the lingual aspect of the modelup to the level of the central fossa orincisal edge of the teeth to be restored.

3. Cut a 2.5mm wide groove in the acrylic
corresponding to the middle of eachintended tooth to be replaced.

A. OPTION: Alternatively, digitally scan
the dentition or stone model andcreate the template via a CAD/CAM
workflow with either milling or 3D
printing techniques.
7

TREATMENT PLANNINGSURGICAL TEMPLATES

Template from Existing Prosthesis
1

2

3

4

For larger edentulous areas, fabricate a
template by using an existing removable
prosthesis. When fabricating the template,the buccal aspect is inclined from theincisal edge or central fossa of the teeth
back to the crest of the alveolar ridge,
which is represented on a duplicatedprosthesis as the greatest concavity on thealveolar ridge side of the prosthesis.

1. Insert denture into impression material
in denture duplicator and apply
separating medium.

2. Fill other side with impression material,
close, and allow impression material toset.

3. Open and remove denture.
4. Fill impression material mold withacrylic, close, and allow acrylic to set.

56

5. Open and remove duplicated denture.
6. Draw a line in the middle of each
tooth and a line representing greatest
concavity on the tissue side.

7. Cut a 2.5mm wide groove in centerof each tooth joining the lines
representing the middle of each toothand greatest concavity of the tissue
side.

7

8

8. Remove the buccal acrylic along theslope joining the two lines representing
the middle of each tooth and greatest
concavity of the tissue side.

9. Trim excess incisal length to prevent

interference with head of handpiece.

10. The template determines mesio-

910

distal positioning. Availability ofbone determines final bucco-lingual
angulation.

NOTE: Alternatively, digitally scan theprosthesis and create the template via a
CAD/CAM workflow with either milling or
3D printing techniques. See example on
Page 7, Step A.

8

INSTRUMENTATIONCOMPREHENSIVE SURGICAL KIT

1

2
3
5
4

6

11
8

7

12
14
13

15
9

10
18
16

17

COMPREHENSIVE SURGICAL KIT (260-101-098)
1 Shoulder Depth Gauge

Designed to be used with the Double-Ended Instrument Holder to facilitate selecting theproper abutment height.

2 Removal Wrench

Designed to unfasten hand reamers, osteotomes, chisels and bone expanders from a threaded
straight handle, threaded offset handle, or a threaded knob.

3 Double-Ended Osteotomy Depth Gauge

Designed to facilitate the measuring of an osteotomy’s depth.

4 Threaded Straight Handle

Designed to be used with all threaded instrumentation: hand reamers, sulcus formers, inserters/
retrievers, tissue punches, osteotomes, chisels, bone expanders, and seating tips.

5 Implant Inserters / Retrievers

Designed to be used with either a threaded knob or a threaded straight handle to assist in theplacement and retrieval of implants depending upon the clinical situation. It is essential for aclinician to understand how an implant is disengaged from the inserter/retriever instrument prior
to using it intraorally. See Page 20.

6 Threaded Offset Handle

Designed to be used with implant and abutment seating tips when direct access is not practical.

Designed to prepare an osteotomy without irrigation at a maximum speed of 50RPM and toharvest autogenous bone for grafting. Markings are positioned at 6.0, 8.0, 11.0, and 14.0mm.
Extended latch reamers are also available to accommodate clinical situations.

9

3.5

7 Latch Reamers8 Latch Reamer Extension

Designed to extend a latch reamer to facilitate access when adjacent teeth interfere with the
handpiece. If the latch reamer is not fully engaged in the latch extension prior to being used, thelatch reamer may become jammed or damaged.

9 Pilot Drills

Designed to prepare the initial pilot osteotomy at 1,100 RPM and to establish the osteotomy’s
trajectory. Available in two lengths. Markings are positioned at 6.0, 8.0, 11.0, and 14.0mm.

Standard
Extended

10 Healing Plug Removal Instrument

Designed to facilitate the removal of the previously cut black healing plug from the implant’s wellduring the second stage surgical procedure.

11 Paralleling Pin

Designed as an aid to correctly align pilot osteotomies and implants. For multiple implant
placements, they may be stepped from the initial osteotomy to the subsequent osteotomies sothat the pilot drill can be aligned parallel to the Paralleling Pin.

12 Osteotomes

3.5

Designed to be fastened to either a threaded straight handle or an offset handle and are used toprepare an osteotomy, especially for internal sinus lift procedures and ridge expansions. Available
in diameters corresponding to implant diameters.

13 Implant / Abutment Seating Tips

Designed for use with a threaded straight or offset handle to facilitate the correct seating of an
implant or abutment. When using the implant seating tips, it is imperative that the seating tips be
fully seated to the bottom of the implant’s well.

2.0mm 2.5mm 3.0mm

4.0mm

6.5mm

14 Threaded Instrument Adapter

Designed to be fastened to hand reamers and sulcus formers, allowing them to be attached to alatch contra-angle handpiece.

Designed to be fastened to a threaded straight handle to manually prepare an osteotomy. They
can also be attached to a Threaded Instrument Adapter for use with a latch contra-angle handpiece.

4.0

15 Hand Reamers

16 Standard Guide Pins

Designed to be used as a guide for the sulcus formers. They are available in three sizes
corresponding to the diameters of the internal connections of Bicon’s implants. They may also
be used to assess the trajectory of an implant in addition to examining how well an implant has
osseointegrated. NOTE: Guide Pins – Tall Post are available for deeply-positioned implants which
require long post abutments.

17 Sulcus Formers

Designed to remove any soft tissue or bone above the implant that could prevent the correct
engagement of the abutment’s locking taper connection to the implant. They are used inconjunction with the guide pins in #16 above. They are available in diameters consistent with thehemispherical base of the intended abutment.

18 Threaded Knob

Designed to be used with threaded instrumentation (sulcus formers, inserters/retrievers, tissue
punches, and hand reamers) where there is limited access.

Surgical Mallet (Not depicted in kit picture)
Used along with other instruments to facilitate applying the appropriate force for seating an
abutment into the well of an implant, or an implant into an osteotomy. The mallet is also used withother instruments such as bone expanders or chisels.
Silicone Dappen Dish (Not depicted in kit picture)
Designed to hold harvested autogenous bone and synthetic bone grafting material.
Healing Plug Cutter (Not depicted in kit picture)
Designed to score a healing plug intraorally at the level of bone and to cut the plug either
intra or extraorally.

NOTE: The instrument tray may be sterilized at temperatures up to 273° F (134° C).
10

INSTRUMENTATIONADVANCED SURGICAL KIT

2

1

3

4

5

ADVANCED SURGICAL KIT (260-101-095)
Bicon’s Advanced Surgical Kit contains all of the instruments in the Comprehensive Surgical Kit, plus the following:

1 Shoulder Depth Gauge with Double-Ended Instrument Holder
Designed to facilitate selecting the proper abutment height.

2 Silicone Dappen Dish

Designed to hold harvested autogenous bone and synthetic bone grafting material.

Designed to be fastened to threaded handles to facilitate the preparation of an osteotomy,
especially for internal sinus lift procedures and ridge expansions.

4 Expanding Chisels

Designed to be fastened to threaded handles to facilitate the preparation of an osteotomy with aridge expansion.

5 Extended Latch Reamers

Designed to facilitate access when adjacent teeth interfere with the handpiece while offering theconvenience of not having to use a latch reamer extension. Markings are positioned at 6.0, 8.0, 11.0,
and 14.0mm.

NOTE: The instrument tray may be sterilized at temperatures up to 273° F (134° C).
11

3.5

3 Bone Expanders

INTRODUCTORY SURGICAL KIT & GUIDED KITS
INTRODUCTORY SURGICAL KIT (260-101-057)
Bicon’s Introductory Surgical Kit contains all of the instruments in the Comprehensive Surgical Kit,
except for the following:• Shoulder Depth Gauge• Removal Wrench• Implant Inserters / Retrievers• Extended Pilot Drill• Osteotomes• 6.5mm Seating Tip• Threaded Instrument Adapter• Hand Reamers• 7 Series Sulcus Former• Healing Plug Cutter

GuidedPILOT DRILL STOP KIT (260-101-099)
When the anatomy permits, Bicon’s 2.0mm diameter Pilot Drill Stop Kit allows experienced andnovice clinicians alike to confidently drill a 2.0mm pilot osteotomy to a precise depth. The drills
are Stainless steel with a titanium-nitride coated tip, and are offered with seven incremental stops
ranging from 5.0mm–11.0mm.

GUIDED SURGERY KITS AND GUIDE RINGSDesigned for guided placement of an implant of a specific diameter using
a CAD/CAM fabricated surgical guide with a titanium guide ring. Notethat guided surgery is often not practical due to the lack of available bone.
Using only a pilot drill with either a CAD/CAM fabricated or traditional
Bicon custom guide can be more beneficial, since their use provide forridge widening and internal sinus lift procedures.

5.0mm

6.0mm

8.0mm

11.0mm2.0mm

2.0mm Guided Pilot Drill Kit
260-101-820

3.0mm

4.0mm

4.5mm

5.0mm

Guide Rings (not included with kits)

Ø3.0
8.0

Ø3.0
6.0

3.0mm Guided Surgery Kit
260-101-830

4.0mm Guided Surgery Kit
260-101-840

4.5mm Guided Surgery Kit
260-101-845

5.0mm Guided Surgery Kit
260-101-850

12

INSTRUMENTATIONRESTORATIVE KIT

1

2

3

4
6

7

8

9

5

10

11

RESTORATIVE KIT (260-101-096)
1 Instrument Holder

Designed with a threaded end for fastening the 2.0 and 2.5mm Abutment Prep Holder Tips andany threaded instrument. Its locking taper end is designed to hold a 3.0mm post abutment or theShoulder Depth Gauge.

2 Shoulder Depth Gauge

Designed to facilitate selecting an appropriate abutment height. It may be attached to the locking
taper end of the Instrument Holder.

3 Threaded Straight Handle

Designed to be used with all threaded instrumentation: hand reamers, sulcus formers, inserters/
retrievers, tissue punches, osteotomes, chisels, bone expanders, and seating tips.

4 Threaded Offset Handle

Designed to be used with implant and abutment seating tips when direct access is not possible.

5 Healing Plug Removal Instrument

Designed to facilitate the removal of the previously cut black healing plug from the implant’s wellduring the second stage surgical procedure.

6 2.0mm Implant/Angled Abutment Seating Tip

Designed for use with a threaded straight or offset handle to facilitate the correct seating of an
implant or an abutment.

13

12

13

7 Standard Abutment Seating Tip

Designed for use with a threaded straight or offset handle to facilitate the correct seating ofan abutment.

8 Large Abutment Seating Tip

Designed for use with a threaded straight or offset handle to facilitate the correct seating ofan abutment.

9 Crown Seating Tip

Designed for use with a threaded straight or offset handle and a custom thermoplastic seating
jig to facilitate directing the seating forces in the long axis of the implant well for an extraorally
cemented crown.

10 Abutment Prep Holder Tips

Designed to be fastened to the instrument holder for securing a 2.0 or 2.5mm post abutment
while it is being modified. The holes facilitate the removal of the seated abutment from the tip byplacing an instrument through the hole and lifting.

11 Standard Guide Pins

Designed to be used as a guide for the sulcus formers. They are available in three sizes
corresponding to the diameters of the internal connections of Bicon’s implants. They may also
be used to assess the trajectory of an implant in addition to examining how well an implant has
osseointegrated. NOTE: Guide Pins – Tall Post are available for deeply-positioned implants which
require long post abutments.

12 Sulcus Formers

Designed to remove any soft tissue or bone above the implant that could prevent the correct
engagement of the abutment’s locking taper connection to the implant. They are used inconjunction with the guide pins in #11 above. They are available in diameters consistent with thehemispherical base of the intended abutment.

4

5

6

7

13 Threaded Knob

Designed to be used with threaded instrumentation (sulcus formers, inserters/retrievers, tissue
punches, and hand reamers) where there is limited access.

Surgical Mallet (Not depicted in kit picture)
Used along with other instruments to facilitate applying the appropriate force for seating an
abutment into the well of an implant, or an implant into an osteotomy. The mallet is also used withother instruments such as bone expanders or chisels.

Abutment Carrying Forceps (Not depicted in kit picture)
Designed to transport abutments and other components intraorally.

NOTE: The instrument tray may be sterilized at temperatures up to 273° F (134° C).

14

INSTRUMENTATIONPILOT DRILLS

Pilot Drill Markings!

NOTE: PRIOR TO USING A PILOTDRILL, IT IS IMPERATIVE THAT ITSDEPTH MARKINGS ARE IDENTIFIEDAND UNDERSTOOD.
NO ASSUMPTION SHOULD BE MADE ABOUT
THE HEIGHT OF THE FIRST MARKING.

14.0mm11.0mm8.0mm
6.0mm

Drilling Depths
Once the appropriate trajectory of the 2.0mm pilot drill is confirmed, continue drilling to the appropriate depth. Bicon implants may beplaced at varying depths depending upon the anatomy. The ideal positioning of a Bicon implant is 2.0–3.0mm below the crestal bone.
For optimal aesthetics in the anterior region, place the implant 5.0mm below the buccal gingiva.
For certain anatomically-challenging areas, implants may be placed at the crestal bone.
For immediately-placed implants in extraction sites, place the implant 4.0–5.0mm below the crestal bone to allow for somebone resorption.
Drilling depths for 5.0mm implants
range between 5.0mm to 8.0mm.
In this example, a 7.0mm depth has
been chosen.

Drilling depths for 6.0mm implants
range between 6.0mm to 9.0mm. In
this example, an 8.0mm depth has
been chosen.

7.0mm
5.0mm

5.0mm
LengthDrilling depths for 8.0mm implants
range between 8.0mm to 11.0mm.
In this example, an 11.0mm depth
has been chosen.
11.0mm

8.0mm
6.0mm

6.0mm
Length

8.0mm

8.0mm
LengthPilot Drill Types and Indications
Standard Pilot Drill: The most commonly used pilot drill.
Extended Pilot Drill: Facilitates access when adjacent teeth interfere with the handpiece
without having to use a latch extension.
Pilot Drill with Stops: When the anatomy permits — such as in cases with a flat and evenridge — pilot drills with stops can provide experienced and novice clinicians alike an extra
layer of precision and confidence.
2.0mm Standard
Pilot Drill

15

2.0mm Extended
Pilot Drill

2.0mm Pilot Drill
with 6.0mm Stop

INSTRUMENTATIONLATCH REAMERS

Latch Reamer Markings

14.0mm11.0mm8.0mm
6.0mm

2.5mm 3.0mm 3.5mm

4.0mm

4.5mm

5.0mm

5.5mm

6.0mm

After the pilot osteotomy has been
prepared, the latch reamers are usedsequentially beginning with a 2.5mm
diameter and ending with the diameter ofthe intended implant. Latch reamers arecolor-coded according to their diameterand have horizontal markings at 6.0, 8.0,
11.0, and 14.0mm. It is imperative that thedepth indicators on the latch reamers
are known and understood prior to theiruse. No assumptions should be madeabout the height of the first marking
on any latch reamer. If there is any doubt
about the markings on any drill or reamer,take a measurement prior to using it.
NOTE: Latch reamers have a tapered andnon-cutting tip. They are intended to only
widen an osteotomy, and not to deepen it.

Latch Reaming Depths
Once the pilot osteotomy is completed, continue reaming to the appropriate depth. Bicon implants may be placed at varying depths
depending upon the anatomy. The ideal positioning of a Bicon implant is 2.0–3.0mm below the crestal bone.
For optimal aesthetics in the anterior region, place the implant 5.0mm below the buccal gingiva.
For certain anatomically-challenging areas, implants may be placed at the crestal bone.
For immediately-placed implants in extraction sites, place the implant 4.0–5.0mm below the crestal bone to allow for somebone resorption.
Reaming depths for 5.0mm
implants range between 5.0mm to8.0mm. In this example, a 7.0mm
depth has been chosen.

Reaming depths for 6.0mm
implants range between 6.0mm
to 9.0mm. In this example, an
8.0mm depth has been chosen.

7.0mm
5.0mm

5.0mm
LengthReaming depths for 8.0mm
implants range between 8.0mm
to 11.0mm. In this example, an
11.0mm depth has been chosen.

8.0mm
6.0mm

6.0mm
Length11.0mm8.0mm

8.0mm
Length16

INSTRUMENTATION

HAND REAMERS

Hand Reamer Markings

14.0mm11.0mm8.0mm
6.0mm

2.5mm 3.0mm 3.5mm

4.0mm

4.5mm

5.0mm

5.5mm

6.0mm

After the pilot osteotomy has been
prepared, the hand reamers are usedsequentially beginning with a 2.5mm
diameter and ending with the diameter ofthe intended implant. Hand reamers arecolor-coded according to their diameterand have horizontal markings at 6.0, 8.0,
11.0, and 14.0mm. It is imperative that thedepth indicators on the hand reamers
are known and understood prior to theiruse. No assumptions should be madeabout the height of the first marking
on any hand reamer. If there is any doubt
about the markings on any drill or reamer,take a measurement prior to using it.

Hand Reamers vs. Latch Reamers

Sharp Cutting Tip

3.5mm Hand Reamer

Blunt Non-Cutting Tip

3.5mm Latch Reamer

NOTE: Hand reamers have a sharp cutting
tip and can both widen and deepen an
osteotomy. Latch reamers have a tapered,
non-cutting tip and are intended only towiden an osteotomy and not to deepen it.
A hand reamer can afford a high level ofcontrol when encountering challenging
conditions such as thin facial bone orminimal bone between the osteotomy
and adjacent teeth or implants. It can also
be invaluable when working within theconfines of a fresh maxillary anterior socket,
in which the hand reamer can be used
to enlarge the osteotomy by engaging
only the palatal aspect of the socket while
avoiding the fragile buccal wall.

Hand Reaming Depths
Once the pilot osteotomy is completed, continue reaming to the appropriate depth. Bicon implants may be placed at varying depths
depending upon the anatomy. The ideal positioning of a Bicon implant is 2.0–3.0mm below the crestal bone.
For optimal aesthetics in the anterior region, place the implant 5.0mm below the buccal gingiva.
For certain anatomically-challenging areas, implants may be placed at the crestal bone.
For immediately-placed implants in extraction sites, place the implant 4.0–5.0mm below the crestal bone to allow for somebone resorption.

5.0mm
7.0mm

Reaming depths for 5.0mm
implants range between 5.0mm to8.0mm. In this example, a 7.0mm
depth has been chosen.

178.0mm Length

6.0mm
Length5.0mm
Length

6.0mm
8.0mm

Reaming depths for 6.0mm
implants range between 6.0mm
to 9.0mm. In this example, an
8.0mm depth has been chosen.

8.0mm
11.0mmReaming depths for 8.0mm
implants range between 8.0mm
to 11.0mm. In this example, an
11.0mm depth has been chosen.

INSTRUMENTATIONTHREADED INSTRUMENTATION

Threaded Instrumentation Interchangeability
Bicon’s threaded instrumentation offers interchangeability withthreaded components. The Threaded Straight Handle can beused with all threaded components, while the Threaded Knoband Threaded Offset Handle can be used with some threaded
components.

Implant Inserters/Retrievers

5

Sulcus Formers

Tissue Punches
Threaded Knob
Implant Seating Tips

Abutment Seating Tips

Curved Chisels
Threaded Straight Handle

5.5

Expanding Chisels

Bone Expanders

Threaded Offset Handle

4.0

Hand Reamers

25 RPM

Osteotomes

MAXIMUM!"#$%&'()%*+',+-

Crown Seating Tip

Threaded
Straight
HandleThreaded
Instrument
Adapter

INTERCHANGEABILITY EXAMPLE: If a clinician chooses to use a hand reamer, there are
options available depending upon the clinical situation or preference.
For the mandible, attach the hand reamer to a threaded instrument adapter and use witha latch contra-angle handpiece. NOTE: For this method, do not exceed 25 RPM.
For the maxilla, attach the hand reamer to a threaded straight handle.

18

IMPLANT BASICS

IMPLANT PACKAGING

Key Information on Implant Packaging
FRONT
1 QR code (part number and lot number)

2
1

2 Product part number

5

3 Manufacturing lot number

3
4

4 English product description
5 Use by date

INNER STERILE BLISTER PACK
1 Product part number
1

2

3
4
5
6

2 Do not use if package is damaged
3 English product description
4 Manufacturing lot number
5 Date of manufacture
6 Use by date

NOTE: Place label in patient’s record.

1

BACK

16

2

1 Product part number

3
17

4

2 English product description

5

3 French product description

6

4 Spanish product description

7

5 Italian product description

8

6 Portuguese product description
7 German product description
9

8 Chinese product description
9 Bar code (GTIN*, expiration date, and lot number)
10 By prescription only
11 Product is packaged sterile
12 Do not resterilize
13 Caution: read enclosed information
14 Single use only

10

11

12

13

14

15

15 Do not use if package is damaged
16 European CE Mark17 Medical device*Global Trade Item Number

19

IMPLANT BASICS

TRANSPORTING IMPLANT

Removing Implant from Packaging
1

1. While wearing sterile gloves, the2assistant removes the sterile Tyvek®
blister pack from the cardboard
folder, carefully peels back the Tyvek®
backing of the blister pack, and allows
the inner sterile poly bag to fall freely
onto a sterile tray. Do not contaminate
the poly bag. Place the label in thepatient’s record.

2. Cut the implant’s inner sterile poly bagwith a pair of sterile scissors.

Transporting Implant to Osteotomy with Healing Plug1

1. It is safe to hold the implant through2

the poly bag while wearing sterile
gloves.

2. Remove implant from poly bag

grasping the black healing plug, andplace the implant into the osteotomy
until it is stable.

Transporting Implant to Osteotomy with Implant Inserter/Retriever
1

1. An implant inserter/retriever can be2Upper Knob
Lower Knob

Outer Barrel
Shaft

used to transport the implant to the
osteotomy. Prior to using the implant
inserter/retriever, a clinician should befamiliar with how an implant is both
attached to and dislodged from the
instrument.

2. Grasp the upper knob on the implant

inserter/retriever and rotate the lower
knob counterclockwise. The outerbarrel of the implant inserter/retriever
will descend, gently pushing theimplant off the shaft.

20

TWO-STAGE SURGERY

PLACEMENT

Single Tooth » Osteotomy Preparation and Implant Insertion • 5.0 x 6.0mm SHORT® Implant1

1. For the two-stage surgical technique, a

2
2.0mm
6.0mm

8.0mm

full-thickness, envelope, or scalloped
flap may be used depending on theclinician’s preference.

2. PRIOR TO USING A PILOT DRILL, IT IS

FULL-THICKNESS

3

ENVELOPE

SCALLOPED4

IMPERATIVE THAT ITS MARKINGS ARE
IDENTIFIED AND UNDERSTOOD! Placethe implant 2.0–3.0mm below the crestof bone. For this demonstration, weare placing a 5.0 x 6.0mm implant at an
8.0mm depth.

3. Drill 2.0mm pilot hole at 1,100 RPM

with irrigation. Regardless of implant
length, initially drill to only a depth of
6.0mm.

4. Use a paralleling pin to confirm

5

trajectory of initial pilot hole, making
sure the pin aligns with the opposing
tooth. Then, drill the pilot hole to adepth 2.0–3.0mm deeper than thechosen implant when practical. In thisdemonstration, a final depth of 8.0mm
was chosen.

5. Widen the osteotomy with sequentiallywider reamers without irrigation
at a maximum of 50 RPM. For thisdemonstration, a 5.0 x 6.0mm implant
was selected so the final reamer has adiameter of 5.0mm.

621

6. Harvest autogenous boneintermittently from the flutes of thereamer burs and from osteotomy as
it is progressively widened. Collectharvested bone into a silicone dappen
dish and cover it with moist gauze forlater use in Step 11.

TWO-STAGE SURGERY

PLACEMENT (continued)

Single Tooth » Osteotomy Preparation and Implant Insertion • 5.0 x 6.0mm SHORT® Implant (continued)
7

8

9

10

7. While wearing sterile gloves, theassistant removes the sterile Tyvek®
blister pack from the cardboard
folder, carefully peels back the Tyvek®
backing of the blister pack, and allows
the inner sterile poly bag to fall freely
onto a sterile tray. Do not contaminate
the poly bag. Place the label in thepatient’s record. Cut the implant’s innersterile poly bag with a pair of sterilescissors.

8. It is safe to hold the implant throughthe poly bag. Remove the implant frompoly bag by grasping the black healing
plug, and place the implant into the
osteotomy until it is stable. Other
methods of transporting an implant
to the osteotomy are presented onPage 20.

1112

9. In denser bone, it is often necessary

to tap the implant into place. Remove
the healing plug and tap with anappropriate implant seating tip
attached to a threaded handle to be
sure the implant is fully seated into the
osteotomy.

10. Replace the healing plug, and gently

mark the shaft intraorally at the crest ofbone using the healing plug cutter.

11. Cut healing plug either extraorally or

13

Sutureintraorally at the marked bone level
above in Step 9. Cutting the plug
extraorally affords the clinician theability to remove any sharp edges fromthe cut healing plug that could irritate
soft tissue. Then use a periodontal
probe to transport the cut healing plugback into the implant well.

12. Using a Woodson or comparable

instrument, place harvested bone from
Step 6 over implant shoulder.

13. Close and wait a minimum of 3–4

months for osseointegration according
to bone quality. For more information
on bone quality, refer to page 5.

22

TWO-STAGE SURGERYUNCOVERING

Single Tooth » Implant Uncovering and Abutment Placement • 5.0 x 6.0mm SHORT® Implant
12

1. Expose the implant in aesthetic areas

with a semilunar crestal incision. Other
flap designs may be used for different
areas or clinical situations.

2. Remove healing plug with a healing

plug removal instrument. Alternatively,
use a scaler or endodontic file.

SEMILUNAR

3

3. Gently place appropriate guide pin

STRAIGHT4

to check integration and angulation.
Select a sulcus former corresponding
to the hemispherical base of thechosen abutment.

4. Slide sulcus former onto guide pin

applying apical pressure. Remove
excess bone with sulcus former
attached to either threaded knob,
straight handle, or threaded instrument
adapter used with a handpiece.

5. Flush and clean the implant well of any
5

6

debris with water. Dry the implant wellwith a cotton-tipped swab.

6. Insert the appropriate scannabletemporary abutment according to
the diameter of the implant well andintended abutment and scan it.

A

C

B

D

A. OPTION: Insert the selected abutment
with light finger pressure only. Use atemplate to confirm appropriatenessof abutment prior to engagement oflocking taper connection.
B. Tap on abutment at least 3 times inlong axis of abutment post to fully
engage locking taper. Snap healing
cap onto abutment, and, if necessary,
replace flap and suture in place. If
you are creating a transitional
prosthesis: place temporization
sleeve onto abutment and modify, if
necessary, then proceed to next steps.
C. Inject acrylic around temporization
sleeve and into the template. Place
template with acrylic to form
transitional prosthesis.
D. After polymerization, remove andpolish acrylic and snap transitional
prosthesis back in place to help form
the gingival sulcus. Replace flap andsuture in place, if necessary. Wait forsoft tissue healing prior to taking final
impression.

23

IMPLANT-LEVEL IMPRESSIONS
Conventional Implant-Level Impression
1

2

1. Insert the corresponding diameter

metal impression post into the well of
the implant with only finger pressure.
Snap the corresponding plastic
impression sleeve onto metal post.

2. Inject impression material around the3plastic sleeve. After the impression hasset, remove the impression with thesleeve within it. If the metal impression
post is dislodged with the sleeve,
repeat the impression since the axial
position of the implant may not havebeen accurately recorded.

4

3. Remove metal post from implant andinsert it into a corresponding implantanalog, prior to inserting them as aunit into the plastic sleeve within theimpression for the pouring of a stone
model.

Note color coding of impression components:
2.0 2.0mm Well

2.5 2.5mm Well

4. The laboratory pours a soft tissue

model and selects the widest diameter
permanent abutment that supports
the interdental papillae without
encroaching upon them.

3.0 3.0mm Well

Digital Implant-Level Impression with a Digital Scan Post
1

2

1. Insert digital scan post corresponding

to the diameter of the implant welland scan it. The dimples designate thepost/well diameter.

2.0mm Post

2. Design and fabricate the final

2.5mm Post

restoration with the CAD/CAM
software of your choice.

3.0mm Post

Digital Implant-Level Impression with a Scannable Temporary Abutment
152

1. Insert the appropriate scannabletemporary abutment according to thediameter of the implant well and final
abutment and scan it. The dimples andcolor designate the post/well diameterand the laser marking designates theabutment diameterand height.

2.0mm Post

5T
2.5mm Post

5T
3.0mm Post

2. Design and fabricate the final

restoration with the CAD/CAM
software of your choice.

NOTE: For Abutment-Level Impressions, please see the Bicon Restorative Manual.
24

ONE-STAGE SURGERY
Single Tooth » Osteotomy Preparation and Implant/Abutment Insertion • 5.0 x 6.0mm SHORT® Implant1

1. For the one-stage surgical technique, a2

a scalloped or punch flap may be used
for non-extraction sites.

3.0mm
6.0mm

SCALLOPED

3

PUNCH

4

9.0mm

2. PRIOR TO USING A PILOT DRILL, IT IS

IMPERATIVE THAT ITS MARKINGS ARE
IDENTIFIED AND UNDERSTOOD! For
the one-stage technique, place theimplant 3.0mm below the crest ofbone. For this demonstration, we are
placing a 5.0 x 6.0mm implant at a
9.0mm depth.

3. Drill 2.0mm pilot hole at 1,100 RPM

with irrigation. Regardless of theintended implant length, initially drill
to only a depth of 6.0mm.

4. It may be helpful to place an abutment
with a 2.0mm post into pilot holeand confirm appropriateness with a
vacu-press template. Once confirmed,
drill the pilot hole to a depth 3.0mm
deeper than the chosen implant whenpractical, in this demonstration a final
depth of 9.0mm.

55. Widen the osteotomy with sequentiallywider reamers without irrigation
at a maximum of 50 RPM. For thisdemonstration, a 5.0 x 6.0mm implant
was selected so the final reamer has adiameter of 5.0mm.

67

6. Harvest autogenous boneintermittently from the flutes of thereamer burs and from osteotomy as
it is progressively widened. Collectharvested bone into a silicone dappen
dish and cover it with moist gauze forlater use in Step 14.

7. While wearing sterile gloves, theassistant removes the sterile Tyvek®
blister pack from the cardboard
folder, carefully peels back the Tyvek®
backing of the blister pack, and allows
the inner sterile poly bag to fall freely
onto a sterile tray. Do not contaminate
the poly bag. Place the label in thepatient’s record. Cut the implant’s innersterile poly bag with a pair of sterilescissors.

25

ONE-STAGE SURGERY(continued)

Single Tooth » Osteotomy Preparation and Implant/Abutment Insertion • 5.0 x 6.0mm SHORT® Implant (continued)
89

8. It is safe to hold the implant throughthe poly bag. Remove implant frompoly bag by grasping the black healing
plug, and place the implant into the
osteotomy until it is stable. If necessary,
tap the implant to seat it fully. Methodsof transporting an implant to the
osteotomy are presented on Page 20.

9. In denser bone, it is often required to
10

A

tap the implant into place. Remove
the healing plug and tap with anappropriate implant seating tip
attached to a threaded handle to be
sure the implant is fully seated into the
osteotomy.

10. Place appropriate scannable temporary
abutment into the implant. Gently tap
on abutment to engage locking taper.
Proceed to Step 11.

B

12

11

13

A. OPTION: Alternatively to Steps 8-10,
remove the black healing plug fromthe implant and replace it with anappropriate scannable temporary
abutment.
B. Insert implant with scannabletemporary abutment into osteotomy
as a unit. Gently tap on abutment toengage locking taper. During thisstep, some clinicians prefer to place
harvested bone or PRF (platelet-richfibrin) graft between the abutment andimplant prior to inserting them into the
osteotomy as a unit.

11. Using a Woodson or comparable

instrument, carefully place harvested
bone from Step 6 over implantshoulder.

12. Trim excess tissue, if necessary. Wait
for a minimum of 3–4 months forosseointegration before removing
scannable temporary abutment.

13. At this point or at any time during

osseointegration, you can scan thescannable temporary abutment for
the fabrication of the final restoration,
reducing chairtime and patient visits.

26

TWO-STAGE GUIDED SURGERY
5.0mm Guided Surgery Kit

GUIDED SURGERY
Guided surgery can be an effective and efficient surgical technique if there is ample bone,
especially for novice implant clinicians.
It is important to definitively stabilize the CBCT-designed surgical guide on the remaining
teeth or with screws fastened to the bone.
Many experienced clinicians prefer to use CBCT-designed surgical guides for use with
the Guided Pilot Drill only, especially where there is minimal bone available. This affords
the opportunity to use various techniques, such as ridge widening and internal sinus lift
procedures, which are the hallmark of Bicon’s hand reamers and surgical protocols.

Single Tooth » Guided Osteotomy Preparation and Implant Placement • 5.0 x 6.0mm Implant1

1. With a CBCT scan, choose an2

appropriate Bicon implant from thesoftware, and position it so that it lies
parallel with the adjacent teeth toallow for the use of a straight abutment.
After finalizing the design, send thescan to a guide-fabricating laboratory.

2. Place the guide over the adjacent teeth

and verify its fit and stability before
proceeding. Note the intended implant
placement and the 5.0mm color-coded
guide ring embedded within the guide.

43

3. Use the guided tissue punch to removea circular piece of mucosa and keep
it moist so that it may be replaced.
Alternatively, use the guided tissue
punch to mark the osteotomy site andthen create a flap with a scalpel.

4. Use the guided spade drill rotating at
56
5.0 x 5.0mm
Guided Reamer

5.0 x 6.0mm
Guided Reamer

5.0mm
5.0 x 5.0mm
Implant

5.0 x 8.0mm
Guided Reamer

6.0mm
5.0 x 6.0mm
Implant

5.0 x 11.0mm
Guided Reamer

8.0mm
5.0 x 8.0mm
Implant

11.0mm

5.0 x 11.0mm
Implant

5.0 x 5.0mm

5.0 x 6.0mm

400 RPM with irrigation to create theinitial osteotomy. The drill is advanced
into the osteotomy until it contacts thecolor-coded ring. When the corticalbone is dense, one should initially use
a standard pilot drill to penetrate thecortical bone and then proceed withthe guided spade drill.

5. To deepen the osteotomy, use theguided reamers sequentially until
the final intended implant length isachieved.

6. For the depicted 5.0 x 6.0mm implant

placement, start with the 5.0 x 5.0mm
guided reamer and finish with the 5.0
x 6.0mm guided reamer. Rotate thereamers at 50 RPM without irrigationand harvest autogenous bone as it
accumulates within the reamer flute.

27

TWO-STAGE GUIDED SURGERY(continued)

Single Tooth » Guided Osteotomy Preparation and Implant Placement • 5.0 x 6.0mm Implant (continued)
7

7. Open the sterile implant packaging,8

remove healing plug, and place guided
inserter into implant and rotate thelower knob counterclockwise until it isflush with the top of the implant.

8. Note that the guided inserter should sit
INCORRECT

9

CORRECT

flush with the top of the implant prior
to insertion.

9. Place the guided inserter throughthe guide and rotate the lower knob
counterclockwise to disengage theimplant.

10

10. Remove the guide, and place a cut
healing plug into the well of theimplant.

11. Using a Woodson or comparable

instrument, carefully place harvested
bone from Step 6 over the implantshoulder. Replace the circular pieceof mucosa or flap and suture in place.
Wait for a minimum of 3–4 months forosseointegration.

11

Guided Surgery Sequence Planning for a 5.0 x 6.0mm Implant

Ø5.0
5.0

Ø5.0
6.0

Ø5.0
8.0

Ø5.0
11.0 12.0mm

5.0mm
7.0mm

5.0mm

6.0mm

5.0 x 6.0mm

8.0mm
11.0mm28

IMMEDIATE IMPLANT PLACEMENT
Single Tooth » Osteotomy Preparation and Implant Insertion • 5.0 x 6.0mm SHORT® Implant
2

1

4.0mm
6.0mm

10.0mmExperienced clinicians vary significantly intheir preferred techniques. The following
considerations may be helpful:

4

3

The immediate placement of Bicon
implants into extraction sites using the one
or two-stage technique is a very practicaland successful technique. However, it may
not be prudent for inexperienced clinicians
to do so until they have mastered someof the nuances of placing Bicon implants,
especially in sites with a furcation.

1. For sites with a furcation, the anatomy● ●●of available bone dictates whether toplace the implant in the septal bone of
the furcation site or a root socket.

2. Place the implant 4.0–5.0mm below
Maxillary First Premolar

the crest of bone to allow for bone
resorption.

Maxillary Molar

5

3. For a maxillary first premolar, place6in the palatal socket using the one or
two-stage technique.

4. For a maxillary molar, preferably placein the septal bone of the trifurcationsite or alternatively in the palatal root
using the one or two-stage technique.
Use hand reamers or osteotomes
to facilitate centering the implant’s
trajectory.

●●

Mandibular Molar

7

8

5. For a mandibular molar, place in the
Collagen Plugseptal bone of the bifurcation siteor distal root using the one or twostage technique. Use hand reamers or
osteotomes to facilitate centering theimplant’s trajectory.

6. Transport and insert implant as

described on page 20. Cut healing plugat an appropriate level as depicted in
Steps 9–10 on Page 22.

7. Place harvested bone or SynthoGraft®
over the implant. There is no need tograft the root sockets.

8. Cover the site with a Collagen Plug or

PRF (platelet-rich fibrin) graft. Someclinicians prefer to use the periosteumof a split-thickness flap (envelope flap),a Scannable Temporary Abutment, or a
Sinus Lift Abutment.

29

SURGICAL TIPS
Drilling on a Slope
1

2

While reaming on a slope, reamers caninadvertently move lower on the slope,which is usually distally or buccally.
Additionally, reamers inadvertently moveaway from more dense bone, which isusually from the palatal or lingual bone
toward the buccal.

1. The pilot osteotomy should be3

4

positioned in the middle of theedentulous space which usually aligns
with the opposing tooth. To facilitate
this positioning and avoid parallax,
view the pilot drill from both sidesof the patient. A poorly positioned
osteotomy may result in the need touse an angled abutment, malocclusion,or a crown with a cantilever.

2. Because the reamers have a beveled
5

6

tip, contacting the higher bone on one
side inadvertently moves the reamer
and the osteotomy away from thehigher bone of the slope.

3. This downhill drift can continue witheach successive reamer.

4. This can continue until the final reamer,
resulting in an osteotomy that is off
center from the initial pilot hole.

5. To avoid this, briefly and gently use

a 4.0mm round bur at high speed toform a countersink at the orifice of thepilot hole. This “funnel” shape allows
the reamer to contact bone on bothsides simultaneously and guides thereamer into the center of the pilot hole.

6. The lingual to buccal drift depictedin the preceding steps can also occur
from mesial to distal. Note the crownwith a mesial cantilever and theintended implant placement.

Drilling in a Maxillary Anterior Extraction Site
12

1. Initially drill with the pilot drill palatally
3.0–4.0mm coronally to the apexof the extraction socket. This initial
angulation can vary between 25˚and 45˚ depending upon the clinicalsituation.

2. Immediately upon the pilot drill’s

engagement of the bone, change thedrill’s trajectory to be more parallelwith the adjacent teeth and the
proposed restoration.
30

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