Digital Implant Planning and Implant Placement with Internal Sinus Lift Using Versah Osseodensification

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Posted on By Hamid Kazemi In Implants

In this video, Dr. H. Ryan Kazemi demonstrates serial treatment process for a patient with non-restorable posterior tooth with lesion of endodontic origin. The treatment scenario included an initial atraumatic extraction and site preservation graft. Then after a 4 month healing period, a complete 3-D digital implant planning was performed and surgical guide fabricated. Finally an ideal size implant was placed using single stage internal sinus lift with Versah Osseodensification technique.

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10 Comments

While nice surgical skills had been demonstrated I do have few concerns.
I do not understand the role of the surgical guide in this case.
Its not designed for use with Densah burs and it had not been used "as a true guide" during the osteotomy and placement of the implant.
And my biggest concern is a high risk for the loss of the buccal bone volume long term.
Per our previous discussion on this topic, buccal gingival recession around teeth is a BIG risk factor for the loss of the buccal bone volume.
http://forum.dentalxp.com/case/details/multiple-recession-defects-around-teeth/7186#


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Thank you Anton. You are correct. The surgical guide is not specific for use with Densah burs. The guide was designed for fully guided approach using Biohorizons implant. However in such circumstances where guidance and OD is intended, the surgical guide can be used to orient the osteotomy using the initial pilot drills from the implant set and then followed by the Densah burs- providing it is continually checked and verified during the procedure. It does take more attention and time indeed. The buccal bone thickness was adequate as diagnosed on 3-D planning and soft tissue thickness was also verified and noted to be of thick biotype. Good bone and soft tissue thickness present- both support good long term outcome.


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Great job my friend....do you utilize theOD method often in these situations? when would you abort and go with a traditional lateral access? regards and see you in Florida at XP. Mo


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Thanks Mo. I use OD sinus lift technique when looking for 3-5 mm of additional bone height. It has been very predictable in over 50 cases I have monitored thus far. Can one do more? probably, but the membrane thickness and quality is not measurable as it is a blind technique, higher lifts, in my opinion, may have increased risks of tear. I am sure it works in some situations, but not sure if we have the evidence to support its predictability. Generally for lifts more than 5 mm, I resort to lateral window approach to give me the control and access necessary. See you in Florida- look forward.


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First Congratulations for the successful treatment and execution.
I only have two remarks- Osseodensification is done at a speed of 800-1200 and not in a slow speed as shown here. With a slow speed you can't achieve bone plasticity required for osseodensification.
2.It is recommended to use a material with a collagen content and not xenograft.

Other than that- perfect. I would go with OD in almost every case of more than 2mm of residual bone height.


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Thank you Ziv. The speed used here is 1000 RPM- well within the recommended range and as you mentioned, important in bone modification for this technique. This was primarily a sinus lift goal and secondarily OD. The alternatives for bone graft material for sinus lift in general include autogenous, allogeneic, and xenogeneic bones- sometimes in combination depending on type of sinus lift, degree of defect, and classification. For internal sinus lift, I have used both combination grafts as well as allogeneic and Xenogeneic bone alone with great success. Of course bone histology, composition, and stability will be different. Question is how that effect the long term success. What is your experience?


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ZIv, I think slower speed makes more sense for sinus elevation. OD is the secondary goal here.


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Ziv; I thought the speeds were 1200-1500 RPM
Also, don't you use a synthetic bone....Novabone?
regards Mo


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Ryan ,


Nice work and utilization of multiple techniques how much commend you on showing the integration of CBCT &. Wax up & implant studio impressive for us oral surgeons! Also the OD of the siteis impressive-What I believe you also shown is double grafting first autograph method and then adding bone to the side and grafting and a very slow around 200 RPM speed in order to distribute the bone under the sinus membrane- A few questions for you do you think the thread pattern has any benefit in or any role as far as a slightly more aggressive like you said here giving a good primary stability in the residual bone or do you think a “milder” thread pattern Will make a difference secondly did you use a platform switched or tapered plus here to be able to snug the tissue around her healing abutment? Lastly I’m placement of these molars be in that we usually get fairly nice tissue stability have you placed the scan body and scanned for future abutment & crown fabrication?

Let’s chat in Florida !!


Cheers,

Richard


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Hello to everyone,
Our friend Hamid is wonderful in OD and SINUS LIFTING work. This kit has also densah every problem :) Turkey's already upset that I missed the Ziv Mazor course, my question; Where can I get the densah kit? If you help me, please.


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