Bone Density In Maxofacial Surgery Techniques osseodensification in Dental Implantology.

Osseodensification parameters will be covered extensively in our Alveolar Ridge Augmentation: Single Tooth to Full Arch Reconstruction and our Sinus Grafting dental implant courses.

Revolutionizing Implant Dentistry: Oral Surgery Osseodensification

Oral surgery osseodensification is changing dental implant procedures. This technique, developed in 2013 by Dr. Salah Huwais, is transforming how dentists prepare implant sites and improve patient outcomes. Osseodensification is becoming popular among dental professionals worldwide, changing how we think about bone preparation for implants.

It was a privilege to be part of Versah Symposium 1.0 and now 2.0. I have enjoyed the camaraderie, which makes this very special. As Salah mentioned, it is a true team effort, and together we are making things happen. All the credit goes to Salah with his ingenuity and his great engineering team and staff.

The charge I have is to share with you some of my clinical material over the past four-plus years. I have been involved with the osseodensification technology. The only regret I have is that I literally avoided DR. Salah for about a year, and I regret that because I could have added another year to my repertoire of cases. He was very persistent in getting me to try the burs, and it took an embarrassing moment at a trade show for me to finally give in. That five minutes transformed my outlook on implant dentistry.

When I saw publications by Paulo Coelho and Paulo Trizzi, my friends from way back, and as I drilled into this porcine tibia, I realized the difference in insertion torque with a traditional protocol versus the Versah. I saw a dramatic change, and I thought, "Wow, I missed the boat." It's been a fun journey, and I'd like to share with you some clinical cases and different arenas of what I do every day.

My team at Pikos Institue is blessed with great people. There are four of us as surgeons, including my periodontist daughter, who trained with Rodrigo, and our prosthodontist, Dr. Philip Hedger. We have a great team of clinicians under one roof, and my institute has been fun. 

I have enjoyed the educational element. I am a clinician at heart, first and foremost. I love what I do, practicing four days a week and enjoying it immensely.

I could have retired eight or nine years ago, but the institute has been fun because part of my life is in education. I have enjoyed that, with individuals from all over the world for many years. It has been thirty-five years of private practice, and I think it is important to emphasize a few items to understand the context from where I am coming from.

Although I have placed implants from day one, literally since 1983, it was about twenty-three years ago that I decided to focus on implant-based surgical reconstruction as an oral surgeon. Having associates allowed me to give up orthognathic surgery and other typical oral maxillofacial practices. That was the best decision ever made in my life.

The second-best decision was sitting down for what I do, taught to me by a dear friend in year one of my practice. I have been able to sit and do my work, and it has been fun. I am active four days a week, and I use a number of implant systems, primarily four. But I only use one type of bur for all of my cases, every day, with no exceptions, except for guided cases where the burs aren't long enough.

I have integrated this technology into my courses over the past three-plus years. I will not teach anything that I am not doing with confidence and having a track record. We must have evidence-based practices, but we also must be clinically relevant. This has resulted in a true paradigm shift for me, equal in importance to cone beam CT. That is the impact it has had on me, my career, and more importantly, the patients I have treated over the years.

The word "paradigm" comes from a Greek root, meaning pattern. The paradigm shift is the pattern we now see, and we must understand this to appreciate the images I will share with you. This technology has been revolutionary for us all. I have been able to utilize it in such a manner that all the cases I do with bone work can now be looked at from a different perspective because of this great technology.

From a surgeon's perspective, the question might be to drill or to densify. Rodrigo alluded to this well. We cannot densify everything, but we can adapt to different circumstances. Primary implant stability is at the heart of what we do in implant dentistry from a surgical and restorative perspective. If we do not have this primary stability long-term, our cases will not last.

We have different ways to attain primary stability, such as the drilling protocol, under-preparing osteotomies, implant texture, and type. 

The longer the implant, the better in terms of greater bone implant contact, especially cortical bone with full arch immediate cases. Now we have osteodensification, which accelerates the healing process by preserving bone bulk, mineral density, and collagen integrity.

For surgeons, there is a huge safety control element with proprioceptive feedback. When Salah first mentioned "haptic feedback," I did not know what it meant, but now I appreciate it. It is neat to be brain-guided and have a quantification of what you are doing. 

The perfect circle is what we get, especially when drilling D1 and D2 bone. The tolerances of these drills are amazing, and nothing compares.

For those interested in this technology, there is a lot of literature to read. One article made a huge difference for me, “validating the biomechanical property concept of osseodensification”. The clinical applications I would like to share include implant placement in native bone, intermediate implant extraction sites, ridge expansion, implant placement in bone grafted sites, sinus grafting, and full arch immediate reconstruction cases.

In native bone, we can utilize the osseodensification approach, which has made a huge difference for me. We can densify or not, depending on the proprioceptive response. The workshop is highly recommended for those who have not been through it, as some things are not intuitive.

In extraction sites, the perfect starter bur is now available, allowing for precise osteotomy preparation. Ridge expansion cases require membrane use, and the protocol is well-documented online. Using this technology with PRF has been a game-changer for larger augmentation cases.

In mandibular cases with extraction sites, we can create osteotomies using the densification protocol. In the posterior maxilla, issues can arise if not careful, but drilling through the tooth can be effective. Predictably engaging sockets is now possible, and the approach to sinus membrane is more visible, which I prefer.

Ridge expansion requires protecting the facial plate, and xenografts have specific applications. In bone grafted sites, BMP technology is used for specific cases with complete blowouts. The protocol for block bone grafts has evolved, and adding a GBR element has reduced bone loss.

In sinus grafts, the lateral approach is sometimes necessary, but the Crestle approach is preferred when possible. The thinness of the sinus membrane requires careful handling, and the use of LPRF improves angiogenesis.

In summary, osseodensification has been an amazing technology with unbelievable value. Salah's research and his team's work have been instrumental. The safety and efficacy of this technology are validated, and it applies to every case I do. Primary stability is crucial, and the haptic feedback provides a safety element.

I love what I do, and as long as I'm able, I will continue. Family is important, and having a grandchild has been a joy. Do not forget the folks at home; it is important to balance work and family life. Thank you again, Salah, for this opportunity. Dr. Michael A Pikos Oral Surgeon

As a Creator of Dental Implant Courses Why Does DR. Pikos Use Osseodensification

Key Benefits of Osseodensification

• Increases bone density around implant sites
• Improves primary implant stability
• Preserves bone volume during drilling
• Enhances bone-to-implant contact
• Potentially reduces healing time
• Minimizes the need for additional bone grafting procedures
• Improves implant success rates in challenging cases
• Allows for immediate implant placement in some situations

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What is Osseodensification?

Osseodensification is a bone preparation technique that preserves and compacts bone tissue during implant site preparation. Unlike traditional drilling methods that remove bone, osseodensification uses special burs to compress and autograft bone outwards. 

This creates a denser bone layer around the implant site, leading to improved stability and faster healing. The technique uses a special drill bit called a Densah® Bur, which rotates in a non-cutting direction to create a controlled plastic deformation of bone tissue. This unique approach maintains the existing bone and increases its density, providing a stronger foundation for dental implants.

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Key Benefits of Osseodensification

Osseodensification offers several big advantages for both patients and dental professionals, changing how we approach implant dentistry:

• Increased bone density around implant sites: The compaction technique significantly improves the quality of bone surrounding the implant, providing better support.
• Improved primary implant stability: The denser bone created by osseodensification leads to better initial implant stability, which is crucial for successful osseointegration.
• Preserved bone volume: Unlike traditional drilling methods that remove bone, osseodensification conserves and enhances existing bone structure.
• Faster healing times: The enhanced bone density and stability can lead to quicker osseointegration and reduced overall healing periods.
• Reduced need for bone grafting in some cases: By optimizing existing bone, osseodensification may eliminate or minimize the need for additional bone grafting procedures in certain patients.
• Enhanced osteogenic potential: The technique stimulates bone cells, promoting faster and more robust bone formation around the implant.
• Improved implant success rates: The combination of these benefits contributes to higher overall success rates for dental implant procedures.

These benefits make osseodensification particularly useful in areas with low bone density or where traditional implant techniques might be challenging, such as in the back of the upper jaw or in patients with poor bone quality due to various factors like age or medical conditions.

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The Science Behind Osseodensification

Osseodensification works on the principle of viscoelastic and plastic deformation of bone. When a specialized bur is rotated at high speed in a counterclockwise direction, it creates a compression wave that pushes bone particles outward. This process results in:

• Increased bone mineral density around the osteotomy site: The compaction of bone particles leads to a higher concentration of minerals in the surrounding area.
• Preservation of bone volume: Unlike traditional drilling that removes bone, osseodensification maintains and even increases bone volume.
• Enhanced bone viscoelasticity: The technique improves the bone's ability to deform and recover, contributing to better implant stability.
• Improved bone-to-implant contact: The denser bone created by osseodensification allows for greater surface contact between the implant and surrounding bone tissue.
• Stimulation of bone metabolism: The controlled stress applied to bone cells during the process can trigger osteogenic activity, promoting faster bone formation and remodeling.

The scientific principles behind osseodensification have been validated through numerous studies, showing its effectiveness in improving implant stability and success rates. Learn more about the science of osseodensification at Pikos Institute, where cutting-edge research and clinical applications are regularly explored and taught.

Clinical Applications of Osseodensification

Osseodensification has many uses in oral surgery and implantology, making it a versatile and valuable technique for dental professionals:

• Immediate implant placement: The enhanced stability provided by osseodensification allows for more predictable outcomes in immediate implant cases.
• Ridge expansion procedures: The technique can be used to gently expand narrow alveolar ridges, creating space for implant placement without the need for extensive grafting.
• Sinus lift augmentation: Osseodensification can be used in crestal approach sinus lifts, allowing for gentle elevation of the sinus membrane with reduced risk of perforation.
• Improving implant stability in low-density bone: Particularly useful in areas like the back of the upper jaw, where bone quality is often poor.
• Socket preservation: The technique can be used right after tooth extraction to prepare the site for future implant placement while preserving alveolar bone.
• Management of extraction sockets with buccal wall defects: Osseodensification can help in the reconstruction of damaged extraction sites.
• Facilitation of orthodontic mini-implant placement: The improved stability can benefit temporary anchorage devices used in orthodontics.

These applications make osseodensification a versatile tool for dental implant specialists, allowing for more predictable outcomes in challenging cases and expanding the range of treatment options available to patients.

Osseodensification Training at Pikos Institute

To master the osseodensification technique, proper training is essential. Pikos Institute offers comprehensive courses on advanced dental implant procedures, including osseodensification. These courses provide both theoretical knowledge and hands-on experience to help dental professionals implement this innovative technique in their practices. The training programs at Pikos Institute cover:

• In-depth understanding of the biological principles behind osseodensification
• Hands-on practice with specialized equipment, including Densah® Burs
• Case selection criteria and treatment planning for osseodensification procedures
• Advanced techniques for managing complex cases using osseodensification
• Integration of osseodensification with other advanced implant procedures
• Post-operative care and long-term follow-up protocols for osseodensification cases

By taking these courses, dental professionals can gain the confidence and skills necessary to use osseodensification in their clinical practice, ultimately improving patient outcomes and expanding their treatment capabilities.

As dental implantology continues to evolve, techniques like these are leading the way for more predictable, efficient, and patient-friendly treatments. 

By embracing these advancements and continually updating your skills, you can provide the best possible care for your patients and stay ahead in the competitive field of oral surgery. The future of implant dentistry looks bright, and osseodensification is playing a crucial role in shaping that future, offering new possibilities for both dentists and patients alike.