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Densah® Sinus lift in the 4mm Ridge

37 Rating(s).

Posted on 11.04.2015 12:30 PM By Salah Huwais In Sinus Augmentation

Patient is missing #3 with significant maxillary sinus pneumatization.
Working depth was 4.2 mm.
No pilot was used to avoid the risk of membrane perforation.
Densah bur1 (2.3 mm) was used in CCW to enter the sinus.
Larger diameters Densah Burs were used with vertical stops and in a consecutive order to create the desired osteotomy width.
At no time densah bur would travel > 3mm beyond the sinus floor.
In this case The working length of the Densah Burs was up to 7mm.
Allograft was used to create an additional membrane lift (>3mm lift)
Implant was placed with 70ncm

Densah Sinus lift 4.2 mm ridge

Densah Sinus lift Autograft

Additional Autograft

Allograft Push

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23 Comments

rocco mele says on 11.04.2015 12:59 PM

Salah
Clean procedure. Beautiful
I don't believe that the ITV ( 70 N ) could have be obtained w SD. I am not involved w the sinus lift procedures, however do work with the same quality bone and achieve the higher IT values. OD does work....
Amazing

Rocco

Warren Jones says on 11.04.2015 01:27 PM

beautiful case, what drill stops did you use?

Salah Huwais says on 11.04.2015 07:34 PM

Rocco:

Here is 12 wks follow up. I have referred this case back for restoration at 12 wks.
Bone preservation with osseodensification works well within the established surgical parameters.

Salah

Densah Sinus lift 12 wks

Densah Sinus lift

Jorge Campos says on 11.04.2015 03:11 PM

Great Job Salah!!
Same question: what drill stops did you use?
Regards Jorge

Salah Huwais says on 11.04.2015 07:21 PM

Warren and Jorge:

The vertical stops are Verban Vertical stops. Emil has designed these stops for the Densah Burs. They became handy in this surgery.

Charles Schwimer says on 11.04.2015 04:20 PM

Salah. Excellent protocol! This has become my preference for sinus management as well. However, I would prefer implant placement slightly skewed more toward the palate. The Densah burs have become a favorite of mine. Thank you for sharing your experience. Best wishes my friend. Chuck

Salah Huwais says on 11.05.2015 11:48 PM

Chuck:

Thank you. I agree with you, looking back I think that the implant can be positioned slightly more palatal.

See you soon in Orlando:)

Salah

Ehab Moussa says on 11.04.2015 08:43 PM

Salah,

Beautiful case !
Thank you for outlining the protocol so well. I am definitely going to get the Densah burs.

Thank you for sharing.

Ehab

Salah Huwais says on 11.05.2015 11:41 AM

Ehab:

Thank you for your support. Clinical applications and results you see on this forum are reproducible. I Look forward to hearing from you about your experience with osseodensification.

Salah

Emil DDS says on 11.04.2015 10:58 PM

Salah

This presentation was simply fantastic. Less than a year ago I purchased the Densah burs and loved them. For that reason I made V.stops that do come in handy in dealing with the sinus lifts and also can be used for a keyless guided surgical approach.
This case does illustrate a "minimally invasive " protocol that is easy to perform, predictable and can be reproduced by those who follow the protocol.
Thank-you!

Emil

armando ponzi says on 11.05.2015 04:32 AM

Salah,
very didactic case. Thanks for showing it.
Do you have any CBCT of the case?
Could be interesting to see in advance sinus anatomy and if and how it would influence the final result.
I would like to try densah drill but I was wondering about how to do it from Europe..
Regards.
Armando

Salah Huwais says on 11.05.2015 11:25 AM

Armando:

Thank you, I agree that a CBCT is good to have in these cases and best to have before and after if possible. Unfortunately, in Michigan we still have limited access to CBCT in private clinics due to State regulation. A group of us is working on changing that. I will try to have a CBCT done as 6-9 months follow up for this case and share it on this forum.

Salah

Juan Alberto Ruiz says on 11.06.2015 01:25 AM

incredible. Perfectly ejecuted, the insertion torq is almost a miracle.
Congrats

Salah Huwais says on 11.07.2015 11:13 AM

Juan:

Thank you. Bone preservation and plasticity is the hero here.
Data has indicated that osseodensification creates a spring-back effect to the implant, so we see a predictable higher stability regardless of the implant macro or micro design.
In comparison, the existing model relies on parallel wall-downsized osteotomy and tapered implant shape to compress the bone and increase stability, which is an unpredictable approach, especially at 3-4 weeks.
In other words, with osseodensification the preserved bone bulk tend to create a "reverse compression" back to the implant. This "reverse compression" can be gentler on the bone and still achieve the needed stability.

Salah

ashok gowda says on 11.06.2015 02:27 AM

Great work Salah, compliments. These burs are becoming very attractive !!!. Can we use these burs in septal areas of the sinus while lifting the membrane. Thanks, Ashok.

Salah Huwais says on 11.07.2015 10:43 AM

Ashok:

Thank you for your interest and the great question! The Densah Burs will modulate the septum area predictably but may favor one side of the septum versus the other based on angulation, bone density, and ridge hight. It is difficult in my hands to autograft both sides of the septum equally unless it is a wide septum. I Personally, tend to pre-choose which side of the septum that I would autograft and allow the bur to modulate the bony structure of the septum wall and expand it laterally into the other non-grafting side.

As a protocol, Try to approach it as a steep sinus floor as this example
http://forum.dentalxp.com/case/details/osseodensification-facilitates-sinus-au/4666

Maurice Salama says on 11.07.2015 01:20 AM

Very good. dr. S

Salah Huwais says on 11.07.2015 11:44 AM

Maurice:
Thank you! Keep challenging us.
Salah

snjezana pohl says on 11.23.2015 10:41 AM

Armando,
Dense burs should be available in Europe by January 2016. I am looking forward!
Snjezana

Howard Gluckman says on 11.23.2015 05:46 AM

great case. Love the concept.

Salah Huwais says on 11.26.2015 12:33 AM

Howard
Thank you, look forward to have your input after using the burs. See you in Febraury.

Salah

Masuod Adeli says on 11.26.2015 01:44 PM

Salah,

I have been following all of the Densah Burs cases in this forum after watching your video about the osseodensification. They look really fantastic. I am counting moments to have them, although it doesn't seem possible in the near future. Anyway, I am just concerned about the durability of the burs; after how many times of use must the drill be replaced with a new one?
Thanks
Masuod

Salah Huwais says on 11.27.2015 11:32 AM

Masuod
Thank you for your interest. We are working on getting the DB available in Europe early 2016. Meanwhile, Versah can arrange a shipment in the US if you wish. The burs stay good and chatter-less in my hands for 20-25 osteotomies based on bone density and sterilization cycles. At that point, they may lose their smooth feedback and require more vertical pressure to advance into the osteotomy. Most clinicians are replacing the narrower diameter burs more often.

Salah