Crestal Lift with Densah Burs--My thought!

17 Rating(s).


Posted on By Emil DDS In Implants

There is a buzz on this site with the Densah Bur and I would like to present a case using my protocol . In my opinion the implant with this design will tent the membrane and no need for grafting .
In this case, no PRF--no graft ---no perf of the membrane as tested with valsalva.
Implant placed a 5.5x85. Megagen in a >5mm crestal bone height.

Drill sequence
1525 to 4mm in clockwise
1828 to 5mm in counterclockwise
2535 to 5mm in counterclockwise
2838 to 5mm in counterclockwise
3535 to 5mm in counterclockwise
3848 to 6mm in counterclockwise which decorticated the sinus floor
4555 to 6mm in counterclockwise in counterclockwise

All of the drills were used with a vertical stop.

I will post a 6 month follow CBCT



start
5.22 mm of crestal height

5.5x8.5 Anyridge ISQ of 65
6 month follow-up


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21 Comments

Emil. Very solid protocol. Simple and safe. I was wondering why you selected a 5.5 x 8.5 rather than a 6.0 x 8.5? Great case! Thank you for sharing. Best regards. Chuck.


Reply

Hi Chuck

I think a 5.5 or 6.0 will not be clinically significant.

I guess the only difference would be an additional .5mm of bone on the labial of the implant.

Thank-you for your kind reply

Emil


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Emil. I have limited experience with the AnyRidge implant, but have noticed the more aggressive thread patern of the 5.5 to be problemic when insertion torque values are high. In addition, I find the apical geometry of the 6.0 to be more efficient in management of the sinus floor. Personally I avoid the 5.0 or 5.5 if possible. I guess you haven't experienced issues with the more aggressive threads? Best regards. Chuck


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Chuck why even go for such a wide implant. Makes no sense to me. We always teach to place an implant that is narrow as possible but wide as necessary. A 4mm MegaGen would suffice. Why go larger as you take away more bone. The more bone you have on the buccal the safer the situation over the long term. If you have an external he's then I understand the need for a wider implant to reduce the micro motion of the connection. But MegaGen has a morse taper so no need to go wide. And using the Densar burs you will increase the stability of the implant with the drill process and you could underprep as well if needed. In my opinion this is one of the biggest mistakes that is made in the posterior and more often will lead to soft tissue issues later on as shown in my last post. I also agree with the author of this post. The threads of the 5,5 and the 6 are identical. It offers no better retention.


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Howie. I agree it isn't necessarily a good idea to use a wider implant if the bone isn't adequate and yes it is my preference not to go beyond 4mm with the AnyRidge implant if possible. BTW the implant body and thread macro geometry of 5.5 and 6.0 are different. Only the cutting edges are the same. In fact Dr Kim was the person who first brought this to my attention when speaking at a Megagen CE event in Pittsburgh. Finally I couldn't emphisize enough how important it is NOT to combine osseodensification and undersized site preparation.
OSSEODENSIFICATION + OSSEOCOMPRESSION = DISASTER
I look forward to finally meeting you. Cheers my friend. Chuck


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Chuck

I am confused by your comments. To my knowledge the apical portion of the 5.5 is the same as the 6.0.

You are correct in saying I have not had problems with the aggressive threads.

I will be in Florida at the XP meeting and would like to meet with you to discuss these issues more.

I can be reached at 309-287-4186

Emil


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Emil:

Nice protocol. It is slightly different from Versah Protocol. I have noticed that you have decorticated the sinus floor at a later stage in the procedure with a wider Densah bur. Your modification has allowed for a safe membrane lift with a minimal autogenous bone deposit in the sinus. I like it. Love to see the 6 months follow-up.

In comparison, the sinus auto-grafting protocol (the Densah Lift) calls for an earlier decortication of the sinus floor. In your case example, the determined working length is 5 mm which is the bony height below the sinus floor. The Densah lift protocol is as follow:
1- 1.7 mm pilot to 4 mm.
2- DB VT1525 CCW rotation to decorticate the floor without going into the sinus. (to 5 mm)
3- DB VT2535 CCW rotation to modulate the sinus floor and go to (7-8 mm) depth (3mm beyond the working length)
3- DB VT3545 CCW rotation to further widen the osteotomy and modulate the sinus floor and go to (8 mm) depth.
4- DB VT4555 CC Rotation to additionally widen the osteotomy and to modulate the sinus floor and go up to (8 mm). AT anytime the Densah Bur must not enter into the sinus more than 3 mm.
5- Place the implant.

The early decortication will allow the Hydrodynamic wave to lift the membrane and deposit autogenous bone that is shaved off the osteotomy walls with the sequencing burs.

In cases with less than 5 mm bone height below the sinus floor, I tend to skip step 1 and 2 and start with wider DB (VT2535) to decorticate the sinus floor and follow it with wider DBs to lift the membrane and deposit the autograft.

The DB will produce up to 3 mm lift only with autogenous graft deposit. If more than 3 mm lift is required, an allograft is needed.

Salah


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Salah.My protocol is as yours. My only deviations are in regard to occasional addition of allografts to further take advantage of the HYDRODYNAMIC WAVE. I refer to it as the DENSAH WAVE. You're too modest. Surfs up "Ride the wave" my friend:-).Chuck


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Thanks Salah bi have been looking for that protocol. May I make one suggestion. Rename the bits so it's easier to understand the conversation. Regards Howie.
Ps enjoying the concept and can physically see it work.


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Howard:

We did. We added the average diameter. So you can call them by that if you wish.

VT1525 = 2.0
VT2535 = 3.0
VT3545 = 4.0
VT4555 = 5.0

VT1828 = 2.3
VT2838 = 3.3
VT3848 = 4.3
VT4858 = 5.3

VS2228 = 2.5
VS3238 = 3.5
VS4248 = 4.5
VS5258 = 5.5

Salah


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The original crest height was around 5.22 mm. I placed an 8.5mm Anyridge Implant. For those not familiar with the Anyridge implant they are 1mm shorter than the the actual length. Therefore, an 8.5mm implant is actually 7.5mm in length.

With the vertical stop, the bur did not penetrate more than 1mm from the original floor heightl




Reply

Salah
Yes a slight deviation from your protocol and I do have a reason why!

1. With the CBCT I did not feel there would be a need for grafting with the placement. Therefore, I waited until the larger drill size to decorticate the floor. I understand the advantage of early decortication to benefit from the hydro effect of the Densah burs in reverse with water but the difference I feel was not clinically significant.
2. The floor was 5.22 and I placed an implant which has an actual length of 7.5 due to the wide ridge
3. The drill did not penetrate more that 1mm past the floor of the sinus. With penetration there was a large cushion of autografted bone.

Emil




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Great discussion.... Thanks Mo


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Emil,

Do you know if these burs can be purchased in Europe??

Regards


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Andoni:

Very soon. March 2016.
Now, We can only ship to US Address. Please call Jessica at Versah and she will help.

Salah


Reply

I cannot answer that question. Sorry!

Emil


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In cases where a slight lift of the floor without decortication of the whole floor the Densah Bur has worked well for me.

Here is a case that you can see the change in the floor with the Densah bur. Similar to what I have seen using motorized osteotomes.


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Here is a case where the floor was lifted or molded without decortication similar to what I see with the motorized osteotome.


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6 month follow-up


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Emil,
Beautiful perfect case. The control Xray result is just confirming the quality of implant position and, the use of Densah drill and superior sinus limit.
A great service for your patient.
Keep in touch.
Armando


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Armando

I enjoyed our time in New York and thank-you for sharing some of your "secrets" of the digital world.

I look forward to your presentation in January at the Osseodensification Symposium


Reply


360 Imaging
Salvin