Challenging Case Completed With Bicon Implant by Dr Chan Joon Yee This female patient was originally advised by her dentist to do a fixed bridge to replace her incisor which was very loose and out of position due to gum disease. However, she heard about dental implants from one of our patients and decided to consult us. On examining her, we felt inclined to agree with her other dentist. With gum disease in such an advanced state, we were quite sure that her bone quality and quantity would be poor. However, fearing that anything that happens to the supporting teeth may jeopardise her bridge, she decided to give implant dentistry a try. We extracted her loose tooth and gave her a temporary denture. 2 months after extraction, we went in and prepared the bone for implanting. As expected, there was little bone available to us. Bone is too thin to acommodate implant. A perforation in the bone has occurred Fortunately, she still had quite a thick band of bone near the top of where the implant would be placed. There is a large perforation, but only at the lower half. Bicon implant placed into bone. With the implant in place, you can see what the situation is like. Half of the implant is enclosed by bone. Half of it is exposed. From our experience, there is a good chance that a Bicon implant would work for this patient. Bone grafting material placed over the implant Thus, we went on and placed bone graft material over the exposed implant. This material attracts bone-forming cells to deposit bone that would hopefully integrate with the implant. The bone graft and underlying implant stitched under the gums and left undisturbed After the placement of bone grafting material, it is mandatory that we stitch everything out of sight and leave the area undisturbed for at least 3 months. No one-stage surgery for such cases. Second stage surgery done. Implant exposed with healing abutment placed. After waiting for 3 months, we revisited the surgical site, exposed the implant and then placed a temporary healing abutment over it. We kept our fingers crossed, but the implant was very firm and almost ready for crowning. Final crown cemented. With the impression taken, the crown is fabricated in the lab and ready in about one to two weeks. Further revision procedures can be carried out to improve the aesthetics, but the patient is satisfied with the results thus far. Total treatment costs: S$3500