Overview:
Minimum residual bone height 4-5 mm. Minimum alveolar width needed = 5 mm
Use Densah® Burs in full step increments. For example: 2.0 mm, 3.0 mm, 4.0 mm, 5.0 mm.
• MEASURE BONE HEIGHT TO SINUS FLOOR
• AVOID USING A PILOT DRILL
• DENSAH® BUR (2.0) OD MODE TO SINUS FLOOR
• ENTER WITH DENSAH® BUR (3.0) OD MODE UP TO 3 MM PAST THE SINUS FLOOR
• DENSAH® BUR (4.0), (5.0) OD MODE UP TO 3 MM PAST THE SINUS FLOOR TO FURTHER EXPAND THE OSTEOTOMY
• USE DENSAH® BURS IN FULL STEP INCREMENTS FOR EXAMPLE: 2.0 MM, 3.0 MM, 4.0 MM, 5.0 MM
• USE THE LAST DENSAH® BUR IN LOW SPEED TO GENTLY PROPEL WELL HYDRATED ALLOGRAFT
Step 1:
Measure bone height to sinus floor. Flap the soft tissue using instruments and technique normally used.
Step 2:
Densah® Bur (2.0) OD Mode to sinus floor. Avoid using a pilot drill. Depending upon the implant type and diameter selected for the site, begin with the narrowest Densah® Bur (2.0). Change the surgical motor to reverse (counterclockwise drill speed 800-1500 rpm–Densifying Mode with copious irrigation). Begin running the bur into the osteotomy until reaching the dense sinus floor. Confirm Bur position with a radiograph.
Step 3:
Enter with Densah® Bur (3.0) OD mode up to 3 mm past the sinus floor.
Use the next wider Densah® Bur (3.0) and advance it into the previously created osteotomy with modulating pressure and a pumping motion. When feeling the haptic feedback of the bur reaching the dense sinus floor, modulate pressure with a pumping motion to advance past the sinus floor in 1 mm increments, up to 3 mm. Maximum bur advancement past the sinus floor, at any stage, must not exceed 3 mm. Bone will be pushed toward the apical end and will begin to gently lift the membrane and autograft compacted bone up to 3 mm. Confirm the bur vertical position with a radiograph.
Step 4:
Densah Bur (4.0), (5.0) OD mode up to 3 mm past the sinus floor. Use the sequential wider Densah® Burs in Densifying Mode (Counterclockwise drill speed 800-1500 rpm) with copious irrigation with pumping motion to achieve additional width with maximum membrane lift of 3 mm (in 1 mm increments) to reach final desired width for implant placement. Densah® Burs must not advance more than 3 mm past the sinus floor at all times regardless of the Densah® Bur diameter.
Step 5:
Propel allograft.
After achieving the final planned osteotomy diameter, fill the osteotomy with a well hydrated, mainly cancellous, allograft. Use the last Densah® Bur used in step 4 in Densifying Mode (Counterclockwise) with low speed 150-200 rpm with no irrigation to propel the allograft into the sinus. The Densah® Bur must only facilitate the allograft material compaction to further lift the sinus membrane, and not to advance beyond the sinus floor more than 2-3 mm. Repeat the graft propelling step to facilitate additional membrane lift as needed according to implant length.
Step 6:
Place implant.
Place the implant into the osteotomy. If using the surgical motor to tap the implant into place, the unit may stop when reaching the placement torque maximum. Finish placing the implant to depth with a torque indicating wrench.
* Data on file, visit versah.com/our-science/ for Maxillary Sinus Graft studies
** Clinician judgement and experience should be applied in conjunction with this clinical practice suggestive use protocol
10518 rev02 updated: 05/2023