Osseodensification Clinical Protocols
Do More with Less
Osseodensification will not create the tissue, it may only optimize and preserve what already exists. There is a need for ≥ 2 mm of trabecular-bone core and ≥ 1/1 trabecular/cortical bone ratio to achieve a predictable plastic expansion. The more cortical bone there is, the more trabecular core is needed to facilitate predictable expansion. The ideal minimum ridge to expand is 4 mm (2 mm trabecular core + 1mm cortex on each side). This protocol is indicated to expand a ridge with a narrow crest and wider base. It is not indicated in resorbed ridge with a narrow base.
Separate molar roots at the furcation without compromising the integrity of the septum. Implant placement should be either at the crest or sub-crest level. Fill the gap with a bone graft material if needed; preferably an allograft with a 70/30 cancellous/cortical ratio.
The Versah® C-Guide® Guided surgery is an innovative system that allows for adequate irrigation, proper visualization of the osteotomy expansion/preparation, freedom to luxate the Densah Bur® and the ability to manage multiple sites with dierent preparation depths and diameter with precision.
The anterior maxillary wall is slightly more concave. The pathway is totally intra-maxillary with an intra/extra-sinus approach. A tunnel osteotomy is created through the alveolar crest, into the sinus internal lateral wall, to slightly come out through that lateral wall and then re-enter again as a second tunnel osteotomy into the sinus to come out through the body of the zygoma.
In these cases the anterior maxillary wall is very concave.The pathway is intra-maxillary with a totally extra sinus path. A tunnel osteotomy is created through the alveolar crest to come out into the external maxillary wall and then re-enter again as a second tunnel osteotomy into the body of the zygoma to come out through the superolateral aspect of the body of the zygoma. Between the two tunnel osteotomies the maxillary wall is very concave and therefore, there is no groove/channel osteotomy between the two tunnel osteotomies i.e. the middle part of the implant body would not touch the most concave part of the wall.
The maxilla and alveolar bone show extreme vertical and horizontal atrophy. The pathway is extra-maxillary with totally extra sinus path. The implant head is located buccal to the alveolar crest usually in a shallow “channel” osteotomy. Most of the zygomatic implant body has an extra sinus/extra-maxillary path. The coronal part of the zygomatic implant is extra-maxillary usually in a “channel” osteotomy whereas the apical part of the implant is surrounded by bone in a “tunnel” osteotomy in the zygomatic bone. The zygomatic implant contacts bone in the zygomatic bone and part of the external lateral sinus wall.
Indicated in cases with poor-quality soft tissue due to fracture and infection in post-extraction sockets in combination with severe bone loss. IDR I Protocol will be introducing a new perspective to manage these compromised sockets using flapless surgery in a simple way based on biological response.
Indicated in cases with total loss of buccal wall in combination with thin periodontal biotype or gingival recession. IDR II Protocol will explain how to manage compromised sockets with low or no remaining bone in combination with immediate implant placement, bone reconstruction and provisional fabrication in a single procedure using a combination of bone and soft tissue graft harvested from maxillary tuberosity.
Use the Densah Burs to create the implant osteotomy in correct 3D position lungual to the shield. Place implant 1.5mm below the shield and facial bone crest level. Use bone graft to fill the jump gap if necessary. Create custom healing abutment or provisional crown conforming to extraction socket periphery.
10018 REV16 Last Updated: 05/2022