Separate molar roots at the furcation without compromising the integrity of the septum. Perform atraumatic mesial and distal root extraction. Degranulate tissue to expose septum area.

Use a pilot drill that is 1.3 mm -1.5 mm, in clockwise mode, in the center of the septum to a depth that is 1 mm deeper than the planned implant length.

Depending upon the implant type and diameter, follow the corresponding Implant System Drilling Protocol starting with the smallest Densah® Bur to 1 mm deeper than the intended implant length. Run the Densah® Burs in OD mode (counterclockwise, drill speed 800-1500 rpm with copious irrigation). Use the subsequent Densah® Burs in smaller increments to increase bone plasticity and to expand the osteotomy. For example, use Densah® Bur (2.0) after the pilot then expand with Densah® Bur (2.3) then move to Densah® Bur (2.5) before introducing the Densah® Bur (3.0). As it is in ridge expansion cases with Osseodensification, you may over-expand the osteotomy so the last Densah® Bur diameter is slightly larger than the planned implant major diameter. As the bur diameter increases, the bone expands to reach the final osteotomy diameter.

Implant placement should be either at the crest level or sub-crest level depending on its connection type.

Fill the gap with a bone graft material if needed; preferably an allograft with a 70/30 cancellous/cortical ratio. Seal the gap with biologics or a collagen plug and a large healing abutment and possibly place interrupted suture on top.

Assess healing and soft tissue closure 6-8 weeks post placement.