Ridge Expansion Protocol with Modified Ridge Split

Overview:

Osseodensification will not create the tissue, it may only optimize and preserve what already exists. There is a need for ≥ 2 mm of trabecular-bone core and ≥ 1/1 trabecular/cortical bone ratio to achieve a predictable plastic expansion. The more cortical bone there is, the more trabecular core is needed to facilitate predictable expansion. The ideal minimum ridge to expand is 4 mm (2 mm trabecular core + 1mm cortex on each side). This protocol is indicated to expand a ridge with a narrow crest and wider base. It is not indicated in resorbed ridge with a narrow base. 

Densah Sinus Lift Protocol I

Overview:

Use Densah® Burs in full step increments. For example: 2.0, 3.0, 4.0, 5.0. 

Measure bone height to sinus floor.

Take pilot drill to 1 mm below the sinus floor.

Densah® Bur (2.0) in OD mode (CCW) to sinus floor.

Enter the sinus with Densah® Bur (3.0) in OD mode (CCW) in 1 mm increments to a maximum level of 3 mm past the sinus floor.

Densah® Bur (4.0),  (5.0) in OD mode (CCW) to maximum level of 3 mm past the sinus floor if needed.

Densah Sinus Lift Protocol II

Overview:

Use Densah® Burs in full step increments. For example: 2.0, 3.0, 4.0, 5.0. 

Measure bone height to sinus floor.

Take Densah® Bur (2.0) in OD mode (CCW) to sinus floor.

Enter the sinus with Densah® Bur (3.0) in OD mode (CCW) in 1 mm increments to a maximum level of 3 mm past the sinus floor.

Densah® Bur (4.0),  (5.0) in OD mode (CCW) up to 3 mm past the sinus floor if needed.

Use the last Densah® Bur in low speed with no irrigation to gently propel well hydrated allograft.

Overview:

Implant Stability must be mainly providd by the apical portion of the socket.  

Atraumatic tooth extraction with no or minimal flap reflection.

Implant diameter to be slightly wider than the tooth apex.

Final Densah® Bur diameter to be ≥ apical diameter of the apex.

Use a well hydrated allograft (cancellous/cortical) to fill the socket.

Use Densah® Bur that is one step smaller than the last one used to prepare the osteotomy, to compact the allograft.

Implant stability must be mainly achieved by the apical portion of the extraction socket.

Overview:

Separate molar roots at the furcation without compromising the integrity of the septum. Implant placement should be either at the crest or sub-crest level. Fill the gap with a bone graft material if needed; preferably an allograft with a 70/30 cancellous/cortical ratio. 

Overview:

For cases with initial ridge width of < 3.0mm. Graft the newly formed socket with a 70/30 cancellous/cortical combination allograft. Allow healing for 3-6 month, re-enter the site to prepare for implant placement using Osseodensification with the Densah® Burs.  

Overview:

The Versah® C-Guide® Guided surgery is an innovative system that allows for adequate irrigation, proper visualization of the osteotomy expansion/preparation, freedom to luxate the Densah Bur® and the ability to manage multiple sites with dierent preparation depths and diameter with precision. 

Overview:

ZAGA™ Type I-III starts within the alveolar bone

and follows predominantly the posterior – lateral sinus wall path. In these cases, the anterior maxillary wall is concave. The implant head is located within the alveolar crest and most of the body has either an intra sinus or extra sinus path. The implant contacts bone in the coronal alveolar bone and apical zygoma bone. The middle part of the implant body may contact bone in the lateral sinus wall depending on the concavity of the lateral sinus wall. 

Overview:

ZAGA™ Type IV follows an extra-maxillary path. The maxilla and alveolar bone show extreme vertical and horizontal atrophy. The implant head is located buccal to the alveolar crest usually in a “channel” osteotomy. There is either no osteotomy, or a minimal osteotomy in the form of a “channel” at this level. Most of the zygomatic implant body has an extra sinus/extra-maxillary path. The coronal part of the zygomatic implant is extra-maxillary usually in a “channel” whereas the apical part of the implant is surrounded by bone in a “tunnel” osteotomy in the zygomatic bone. The zygomatic implant contacts bone in the zygomatic bone and part of the external lateral sinus wall. 

Overview:

Indicated in cases with poor-quality soft tissue due to fracture and infection in post-extraction sockets in combination with severe bone loss. IDR I Protocol will be introducing a new perspective to manage these compromised sockets using flapless surgery in a simple way based on biological response. 

Overview:

Indicated in cases with total loss of buccal wall in combination with thin periodontal biotype or gingival recession. IDR II Protocol will explain how to manage compromised sockets with low or no remaining bone in combination with immediate implant placement, bone reconstruction and provisional fabrication in a single procedure using a combination of bone and soft tissue graft harvested from maxillary tuberosity. 

Overview:

Indicated in cases of fractured teeth where implant trajectory may not coincide the root canal trajectory.

Overview:

Use the Densah Burs to create the implant osteotomy in correct 3D position lungual to the shield. Place implant 1.5mm below the shield and facial bone crest level. Use bone graft to fill the jump gap if necessary. Create custom healing abutment or provisional crown conforming to extraction socket periphery.  

Overview:

Indicated for upper molar sites with a minimum of 4mm wide septum 

Utilize CBCT imaging to measure ridge width and distance to the sinus floor.

Flapless atrumatic tooth extraction with minimum trauma to preserve septum.

Osseodensification instrumentation using Densah  Burs in CCW (800-1500 rpm) to expand the septum and lift the sinus membrane simultaneously.

Implant Placement.

Graft the socket around the implant with the appropriate bone graft materials.

Seal the socket with a large/wide healing abutment.