We all have our favorite brands and products that we rely on for quality and consistency. A clinician may gravitate toward certain implants for their designs, the biocompatibility of their materials, or their applicability to a number of clinical situations. We develop confidence in products we trust. But how many of us believe so strongly in a product that we are willing to forego the comfort of simply being a consumer and take on the risk of being its owner? What journey inspires that decision, and what unique qualities must the product have to inspire such dedication? This is the Bicon story.
The Shortest Implant with the Longest History
When Vincent Morgan first began working with dental implants, he was frustrated by their shortcomings.
“My journey began shortly after graduating from dental school in 1970,” he recalls, “when I treated a young Irish girl. She held out the hope that one day a dentist would be able to insert two posts into her jaw to support prosthetic teeth for her congenitally missing maxillary lateral incisors. At the time, I considered this hope foolish and advised her to abandon it and prepare for bridges instead.
“Several weeks after my conversation with that young lady, the dentist with whom I shared my practice lost the last of his posterior maxillary teeth. If he had been a patient rather than a colleague, we would have advised the extraction of his remaining anterior teeth and the fabrication of a denture. However, since he was more than a patient, we decided to purchase two newly marketed Miter titanium blade implants. With no training of any sort and only common sense and logic as our guides, we successfully inserted the two blade implants into his posterior maxilla. Beginner’s luck being what it is, these blade implants were still functional some 20 years later.”
It is far more reasonable to take treatment risks with a knowledgeable colleague than a patient, and those two successful implants inspired Dr Morgan and his colleague to become more involved with implant dentistry. Their first experience with an implant designed by Thomas Driskell came in the mid-1970s with his Synthodont implant system (Miter); their paths would converge again in 1992 after Mr Driskell created the implant that would become the antecedent of all modern Bicon implants.
Thomas Driskell’s Discovery
Mr Driskell’s first PRF implant.
One of Mr Driskell’s early smooth implant designs with a very literal reproduction of the roots of a human molar.
In 1968, the conflict in Vietnam was beginning to escalate. As a result, Thomas Driskell and his team at the Battelle Memorial Institute in Columbus, Ohio, were tasked by the United States Army to develop a rapid and effective solution for replacing missing teeth in a combat or field situation. Driskell’s initial implant designs were smooth and closely mimicked the structure of mammalian teeth, but since they were not consistently successful, he began testing a variety of designs. By testing each design, he discovered that a bifurcated and grooved or finned design resulted in greater bone-to-implant contact than other designs—including screw-root form (SRF) implants. The finned design, referred to as plateau-root form (PRF), permitted occlusal loads to be transferred onto the bone that infiltrated the space between grooves.
After Battelle, Mr Driskell took his PRF implant design to Miter, where it became the Synthodont implant that Dr Morgan would later use in his dental practice. Mr Driskell revised his design further and created a submergible titanium implant with a removable abutment, the Titanodont (Miter). He and his partners then formed a company called DB Bioengineering, and in 1985, they received premarket notification for the DB Precision Fin Implant System. This implant had a PRF design, locking-taper implant-abutment interface, sloping shoulder, short overall length, and—most importantly—no screws. Two years after its entry to the market, DB Bioengineering was sold to Stryker Corporation, and their implant was renamed the Stryker Precision Fin Implant. Soon after, it found its way to Dr Morgan’s clinic.
The Synthodont (Miter), a freestanding, nonsubmergible implant made from high-density alumina.
The Titanodont (Miter), a submergible titanium implant with a removable abutment.
The DB Precision Fin implant (DB Bioengineering), which later became the Stryker Precision Fin implant.
The Beginning and Future of Bicon
By 1992, Dr Morgan and his colleagues had placed over 2,500 SRF implants and had become frustrated with their inherent shortcomings. When they were introduced to the Stryker implant, it was a perfect fit.
“At last,” Dr Morgan recalls, “we had found what we were looking for—a design characterized by logic and simplicity.”
Dr Morgan and his colleagues quickly became the dental practice with the most experience using the Stryker implant. However, even they could not predict that 2 years later, in 1994, the fate of the implant would fall into their hands.
“It all started at a dinner meeting with Stryker’s product manager. He appeared to lack enthusiasm for the implant, which greatly concerned me. I got into contact with one of Stryker’s presidents, Ron Ellenbass. He listened to my concerns without commenting. Within a fortnight he called again and complimented me for recognizing that the product manager was no longer enthusiastic about their implant. In fact, Stryker had just decided to sell their implant line. He knew that whoever purchased it would have to work with us because we were their most knowledgeable users, but it was clear he did not consider us a potential purchaser. After asking Mr Ellenbass to think of our patients while he cashed in his stock options, we politely ended our conversation. Not 2 weeks later he called again and encouraged us to purchase the implant. And, as improbable as it seemed at the time, we did.”
Fortunately, Dr Morgan and his colleague were able to find an investor to provide the startup capital to purchase the implant. Their story mimics the classic plot of small-time consumers banding together to take over a company. In Dr Morgan’s case, the decision to buy the Stryker implant was both economically and ideologically motivated. Why should it fall to him and his clinic to educate the new purchaser while others reaped the financial benefits? But, more importantly, how would this unstable chain of ownership—being passed from disinterested to inexperienced hands—affect the implant’s future? Would the new owner’s support for the implant dwindle the way Stryker’s did, or would they believe in its future the way Dr Morgan did? The risk Dr Morgan could not afford to take was allowing the implant to fail. He could not afford to lose a life-changing treatment option for his patients.
“We were dentists, not businessmen,” Dr Morgan explains. “But we knew firsthand the unmatched clinical capabilities and merits of Thomas Driskell’s implant. We knew the implant itself would make up for and overcome our inexperience and shortcomings, and it turns out that we were correct. We started as dabblers in implantology in a small dental practice; we are now an international medical device company in 90 countries.”
A selection of Bicon SHORT implants.
Despite the industry’s preference for screw-retained implants, Bicon continues to thrive with their PRF implants. A professor in Zurich once greeted Dr Morgan by saying, “I know Bicon is a viable organization, for dead fish cannot swim against the stream. You have been going against the collective beliefs of the profession for decades, and now they are copying your ideas.”
When asked whether we are approaching the ceiling for innovation in implant dentistry, Dr Morgan has this to say: “As long as an implant performs as well as current Bicon implants, there is no reason why we should be afraid of going shorter. History tends to mock those who make definitive statements regarding technology or innovation—there is always room for improvement and innovation. That being said, the Bicon implant is the culmination of almost half a century of innovation and ingenuity; if we have indeed reached the peak of innovation, then the Bicon implant would certainly be at the pinnacle.”
As for the future of Bicon and its PRF implants, Dr Morgan says they will continue looking and moving in the best direction they know: forward.
Vincent J. Morgan, DMD, graduated from the Tufts University School of Dental Medicine in 1970. In 1994, he was part of a group that purchased the Bicon Implant System from Stryker Implants. He currently serves as president of Bicon, LLC. He also leads the prosthetic team at the Implant Dentistry Centre located at the Bicon headquarters in Boston, Massachusetts, where he is responsible in part for the development of many of the restorative techniques of the Bicon Dental Implant System.
The Bicon Short Implant: A Thirty-Year Perspective
Edited by Vincent Morgan
This book is a succinct and accessible compilation of over 30 years of knowledge concerning the Bicon system. It offers not only a history of dental implants and the science of osseointegration but also a vast collection of clinical examples that demonstrate Bicon’s capabilities. Bicon implants provide versatile, reliable treatment for a wide variety of clinical situations; they can successfully be placed in atrophic jaws, in sites that would require extensive bone grafting with longer implants, in tissue that has been compromised by medical conditions, and even in adolescent jaws that are still developing. With its proven track record of success, the Bicon system provides treatment opportunities for the benefit of clinicians, technicians, and patients by offering simple, predictable, and effective techniques. With everything from historical and theoretical origins to detailed step-by-step surgical and restorative guides, this book is a must-read for anyone interested in implantology.
336 pp; 1,800 illus; ©2017; ISBN 978-0-86715-728-4 (B7284); US $192