Use of Densah drill on integrated implantology.

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Posted on By armando ponzi In Digital Scanning & CAD/CAM

A CBCT together with intraoral scanner impression were used to have a complete data set for production of stent. The amount of bone (7mm implant on the project) may not provide sufficient initial stability. A custom abutment was studied and split into two area subgingival and supragingival.
We produced just the subgingival area one, the abutment acting as a custom healing cap.
The densah drill allowed to optimize the site : a 10mm implant was positioned and a subcrestal elevation of 3 mm from the initial planning.
The future abutment will incorpored the same digital subgingival morphology and it will be expanded on prosthetic area, to hold the crown.
Densah drill are an invaluable tool here as they provide predictable sinus elevation, simplflifyng procedure and osseodensification improved the torque of insertion and merging them with digital planning provide a degree of liberty from range.(accuracy required to mount implant and abutment )
The complete abutment was not planned on this clinical case but the question I would like to share is would you do a single step with immediate abutment(1A1 and provisional?

initial case photo
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21 Comments


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Armando; Great case for discussion. We have also been working on this protocol to shape tissue during integration or maintain it from extraction site....using 3D printing of custom healing abutments....great idea here...
Can you describe in detail your OD Lift sequence/protocol of burs and relate them to the Lift??
Thanks Mo


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How far have we come in technology that we can do so many benefits for US. If you would like to know the cost of Dental implants here in India check this out : https://www.dentalimplantcostguide.com/india/


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Mo,
It is a great news for me that you are making studies and planning about abutment production before surgery.
IMO, it is a fundamental key for a 'one time healing' process or 'one time visit' concept.
I am considering now the opportunity of doing it as post-production: with intraoral scanner and scan transfer immediately after the surgery: the milling machine takes about 12 minutes to have the custom abutment.
We need to improve on planning area.
Densah drill allowed to modify my planning (implant is longer,deeper and wider) in a simple predictable way.
I am using Salah protocol with biomaterial as I lift about 4/5 mm.
Armando.
BTW, I hope meeting you on Treviso next 1st October!


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Armando: planification here makes the difference. Also the special healling abutment with the same emergency profile that the final abutment. Good idea!!
This will be the way to the 1A1T on a digital world.
Regards my friend
Jorge


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Jorge,
You got the message right! I wanted to share this new and 'simple' way to deal some topics: digital makes easy for dentist and patients.but it is like PET, a long process and we need a lot to learn on the field.
Best regards, my friend.
Armando


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Armondo

Ciao!

Nice presentation!

In answer to your question ?

The complete abutment was not planned on this clinical case but the question I would like to share is would you do a single step with immediate abutment(1A1 and provisional?

I feel the risk-reward ratio is not in favor to produce an immediate abutment and crown in an non-esthetic zone of the mouth. Perhaps in the anterior esthetic zone this can be a consideration.

I feel the custom healing abutment is a fantastic way to develop the soft tissue for the final abutment .

Best
Emil


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Emil,
Thanks for your comments.
I agree with you, in posterior area it can be not an easy task to balance an immediate crown.
But we can develop new ideas to manager the tissue immediately, and that can provide a great service on next clinical step.
Hope we meet again in future, my friend.
Warm regards to you and Marisa.
Armando


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Armando. This digital model is most practical. Now we need to engineer an attachment design to secure final restoration without reliance upon cement or removal of this abutment :-). Well done as always my friend. Chuck


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Chuck,
We all missed you here!: People like you should never go on holidays:).
Couldn't agree more with your thoughts. Engeneering this area is mandatory as send the right input too, my friend.
Good to hear from you.
Armando


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Armondo, This may be pie in the sky today, but the ultimate would be to copy the emergence profile of the tooth prior to extraction or to copy and mirror the contra-lateral tooth so as to mill an exact duplicate of nature. From the CBCT, the rootform and emergence profile is known. From the STL file a pre-op clincial crown is known. If the emergence profile could be selectively milled, you would have it. Nature duplicated!! Thanks for the sharing your wisdom.


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Terry,
Thanks for your valuable thoughts.Digital makes become possibile many of our guess and thoughts.
I personally try and think in terms of integrated data.
On that sense your idea requires a biological favourable behaviour.
Guessing game is how biology works on daily case and how to integrate that data on digital.
Best regards.
Armando


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Armando!

Ahh- so nice! love the digital plan- few questions: I may not have understood- did you scan and mill after placement or milled ahead of time based on you pre op guide - do you think you could have milled form zirconia? - is it non engaging ? could you use same file and just enenalarge or design the coronal portion of the healing abutment without new digital impression?

I saw Salah yesterday at my AAOMS meeting and we chatted a bit- Densah and PET and DIgital = brilliance -

PODD concept - PET OD and Digital - lets do it

Carry on my friend!

Cheers,

Richard


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Richard
I love the PODD acronym you thought !!
Let' s start using it , sounds great!
On this specific case the abutment was planned before.
But I am working to have it ready with in 1 hour from implant insertion: in this case post production.
Much easier....only problem is machine, engeneering process. But we should start that soon and I will let you know more about it.
BTW, send me your email.
Warm regards.
Armando


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Armando yes we will come up with a series of pet acronyms and my email is rjmartin.mac@mc.com

Cheers

Richard


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Standard drill designs used in dental implantology are made to excavate bone to create room for the implant to be placed. The goal is to achieve implant stability, which is believed to increase implant osseointegration success. This is more important now because many clinicians are implementing immediate-loading protocols into treatment. Removing bone is contrary to achieving the implant stability desired. Standard drill designs, in twist or fluted shapes, cut bone effectively but typically do not produce a precise circumferential osteotomy. Osteotomies may become elongated and elliptical due to chatter of the drills. Implant insertion torque is then reduced, leading to poor implant stability and potential lack of integration. Osteotomies drilled into narrow bone locations may produce dehiscence buccally or lingually, which also reduces implant stability and requires an additional bone grafting procedure, adding cost and healing time to treatment.You can know everything at http://www.drismaelkhouly.com/


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From the beginning of dental implantology, standard dental drills have been
used to prepare osteotomies. As these drills are functionally multi-purpose
and therefore satisfactory to achieving osteotomies, osteotomy preparation techniques have no doubt been lacking in several ways. Standard drill designs used in dental implantology are made to excavate bone to create room for an implant to be placed. Using this technique, drills tipped with twisted or flute shaped heads cut bone adequately but are not necessarily spatially accurate. This drill technique effectively creates the space needed for osteotomies however, it does not allow for a precise circumferential osteotomy which would ensure higher stability at the site. Osteotomies may become elongated due to standard drill use in which case implant insertion torque is reduced resulting in poor primary stability and potentially weak integration. Dehiscence may also occur when drilling narrow bone and thus additional bone grafting measures would be required to obtain more stability, consequently adding to overall costs and treatment time. Though implant dentistry has been thriving despite the stretched efforts of standard drilling, it is no secret that a more efficient and exclusive technique would be greatly welcomed.You can visit at https://www.dentistanyc.com/ for more information.


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3Shape
Hu-Friedy