Versah drill on daily dental implantology

44 Rating(s).


Posted on By armando ponzi In CBCT & CAD/CAM

The present case is a combination of planning, guided surgery and use of Versah drill.
Patient required two implants in area 36,37. CBCT and impression were superimposed and virtual
Implants positioned (both diameter 5.0). An inhouse surgical stent, universal type, was produced.
The day of surgery, with a minor flap design, the stent allowed to define implant depth , tilting and a diameter (of maximum 3.2mm). Versah drill was then used to conservatively enlarge the implant space on a osseodesification modatilty, reducing delta between vestibular and lingual bone height and outmost important, maintenance of vestibular bone thickness.
Could be a valuable option to integrate versah drill on the universal surgical stent?
Any thoughts about it?

initial planning
surgical stent

Drilling with guide
Versah drill 'effect'


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16 Comments

Great case and documentation my friend. We missed you in Florida at the XP Symposium. Do you know or can you explain biologically HOW the displaced bone within the osteotomy from the OD Densah drills remodels? thanks Mo


Reply

Hi Mou,
I felt sorry not to partecipate on such a great congress with amazing resercher and clinicians. And a great chance to meet you all.
Can you send me over your E.mail whenever. Thanks.
About Versah, I red this interesting research study about the improvement of primary stability using these drills.
I guess that as clinicians we can only express opinions about way bone remodel on osseodensification.
Two observations:
- exposed bone tend to superficial necrosis and that initiate a cascade of inflammatory response with activation of osteoclast.
-The osseodesification process tends to produce a 'laminae' all around bone surface that is basically anorganic, due to high speed of drill, that probably produces little particles pushed all around bone wall.
So, one hypothesis could be that this layer is protective for living bone and inhibits the inflammatory response and reduces the remodelling of bone.
Just an hypothesis.
Armando


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Maurice and Armando:

Please find below a link to a recent study by Trisi et al. It is published in Implant Dentistry. This study looked at ridge expansion healing with osseodensification. Also compared the mechanical property of the osteotomy in both the test group (OD) and the control group (standard drilling). This paper may have some answers to your question. By the way, it is an open source.

http://journals.lww.com/implantdent/pages/articleviewer.aspx?year=2016&issue=02000&article=00005&type=abstract

Salah


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Thank you for sharing your case! What kind of parameters did you use to utilize Densah drill in surgical guides( like diameter and length of the burs)? Gregory


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hi Gregory,
I did not send too many photos of digital planning but as you know the Stent is built on the implant data like length and diameter.
So, on this case the Stent allowed depth(11.5 & 13) and a diameter of 3.25.
The Versah drills were used not guided just to enlarge the osteotomy diameter at the implant depth already determined with Stent.
I believe that using Versa iin both fashion and guided could be an important advance on the field.
Thanks for your comments.
Armando


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Armando. Beautiful case as usual. The Versah are a valuable tool. It seems many changes are ahead. Well done. See you in Madrid my friend. Chuck


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Chuck,
thanks. It will be great to meet you in Madrid.
Armando


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Armando. Beautiful case as usual. The Versah are a valuable tool. It seems many changes are ahead. Well done. See you in Madrid my friend. Chuck


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Armando. Beautiful case as usual. The Versah burs are a valuable tool. It seems many changes are ahead. Well done. See you in Madrid my friend. Chuck


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Armando

Excellent case and beautiful photography.

How many of the Densah Burs were you able to use with the guide in place?

I see you used a key or spoon for the pilot drill. Were you able to use any of the keys with the Densah Burs?

I like the idea of a universal guided protocol with the Densah burs.


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Great case thank you for sharing.

would you please share a cross-sectional CBCT scan slices for the implants sites prior to the site preperation.

and couple of questions.

what was the protocol and sequence for drilling?

does the Versah drills have a key to be used as guided drills ( i have Straumann and Nobel guided kits)

Thank you in advance .


Reply

The two phtos show the planning screen of the two implant using Simplant.
I produced a universal stent and drilled proper implant depht and direction up to 3,25 diameter and then use Versah drill with NO stent.
You should ask Versah company if they produce any specific drill for your systems.
I personally believe that adding Densah drill to surgical stent could be of importance simplifing and making more predictable the entire procedure.
But, as far as i know, up to now the drill cannot be applied to template.
Armando

implant 36
implant 37


Reply

Armando. You touch upon an excellent point of discussion. Once your implant position and working depth is established with the stent, Densah burs can be implemented "free hand" in a predictably controlled manner. You have to try hard to go deeper with successive drilling. In addition, if you did go too deep, working depth or implant stability may be reestablished by adding allograft and repeating OD with the same size bur. Best wishes. Chuck


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Armando beatiful case as always. Would you please share with us your planing for vertical control of the osteotomies. Is the vertical positioning guided as well?
Thank you.


Reply

Yannis,
thanks for king words.
Basically you have a CBCT volume and superimpose it with a 3D model (this is done for two main reasons:- improve accuracy on stent production and reproduction of gingiva profile).
We then take a virtual implant and place it in the 'bone' according to our clinical knowledge (distance from vestibular bone and adiacent tooth, and 2mm safe distance from IAN).
Trick here is to move the sleeve up and down in order to match lenght of implant+gingiva+superior border of sleeve and make it equivalent to drill lenght -1mm that is the reduction handle thickness.
So when you go on the patient put the stent on reduction 1 drill 1 reduction 2 drill 2 reduction 3 sleeve3.
This is universal guide so it is required to use a last drill of your own implant company and compatible with the implant you are just about to place.
I hope I was sufficiently clear and useful.
Best regards.
Armando

lingual view
digital surgical stent & implant


Reply

Thank you Armando! Very clear.


Reply


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