1. OSSEODENSIFICATION: AN ANSWER TO DEFICIENT ALVEOLAR BONE?
INTRODUCTION
Maintaining bone bulk and density during the implant site preparation is essential for initial bone-implant contact and biomechanical stability. Osseodensification is a technique which increases implant primary stability in cancellous bone compared with extraction drilling.
It does not excavate bone tissue, rather, bone tissue is simultaneously compacted and auto-grafted in outwardly expanding directions from the osteotomy. Special burs have been developed for osseodensification. According to the manufacturer, these special burs demonstrated the ability to expand narrow bone ridges similarly to split crest techniques. The bur geometry, rotating in reverse mode at a rotating speed of 800 to 1500 rpm with profuse saline solution irrigation to prevent bone overheating, allows to compact the bone along the inner surface of the implant osteotomy site without cutting. The bouncing motion (in and out movement) is helpful to create a rate-dependent stress to produce a rate dependent strain, and allows saline solution pumping to gently pressurize the bone walls. This combination facilitates an increased bone plasticity and bone expansion.
Compaction Autografting in the Apex of the Osteotomy Facilitates Sinus Grafting
Compaction autografting/ Condensation
Maintains bone bulk
Higher BIC
Enhance bone density
Accelerates bone healing
Increased residual strain
Enhances osteogenic activity
Increased implant stability
MODES
MOTION
CUTTING MODE
DENSIFYING MODE
Counterclockwise (CCW)
Non-Cutting Direction
Clockwise (CW)
Cutting Direction
Bouncing-Pumping motion
REVIEW OF LITERATURE
Trisi et al. has shown that Osseodensification technique is able to increase the percent bone volume by approximately 30% around dental implants inserted in low-density bone in respect to conventional implant drilling techniques, which may play a role in enhancing implant stability and reduce micromotion
When the densifying bur is rotated at RPM in the counterclockwise non-cutting direction (Densifying mode), downward surgical pressure coupled with steady external irrigation creates a gentle compression wave inside the osteotomy that works with the fluting to generate a densified layer through compaction and autografting the surrounding bone while plastically expanding the bony ridge at the same time (Meyer, Huwais, et al., 2014)
Osseodensification technique used in the in vivo study demonstrated to be able to increase the %BV around dental implants inserted in low-density bone in respect to conventional implant drilling techniques, which may play a role in enhancing implant stability and reduce micromotion. Falco et al 2016
Salah Huwais (2015) reported a case of ridge expansion in a Seibert Class I ridge deficiency using osseodensification burs. Two implants were placed and at 1 year follow-up, radiographic examination revealed maintained crestal bone level and bone density
CONCLUSION
Osseodensification is a novel, biomechanical, non-excavation osteotomy preparation method. Unlike traditional drilling, it utilizes proprietary high-speed densifying burs to compact and autograft bone in its plastic deformation phase. The result is an expanded osteotomy with preserved and condensed bone tissue that maintains alveolar ridge integrity and allows for implant placement with enhanced stability. This technique can be recommended to enhance primary stability and possibly allow for earlier loading due to higher insertion torque value (ITV).
PRESENTER: DR. KIRTI CHAWLA
Disclaimer: The author has no commercial interests