A novel approah in the implant dentustry to enhance the primary stability and clinical success of long term success !

1. NABID ANJUM
Department of Prosthodontics
PG 3rd year
Osseo Densification- A Novel Approach
In Implant Dentistry.
Prosthodont Soc 2018;18:196-200

2. CONTENTS

3. 01
02
03
04
05
06
07
08
09
10
INTRODUCTION
DEFINITION
CONCEPT OF
OSSEODENSIFICATION
OSSEODENSIFICATION VS
CONVENTIONAL OSTEOTOMY
ADVANTAGES
DISADVANTAGES
CHARACTERISTICS OF BUR
OSSEODENSIFICATION &
MANDIBLE
CONCLUSION
REFERENCES

4. Osseointegration is defined as the apparent direct attachment or
connection of an osseous tissue to an inert, alloplastic material without
intervening fibrous connective tissue.
Osseointegration is crucial for implant stability which
determines the long-term success of dental implants.
The main factor in implant placement is to achieve primary
implant stability. The factors which are mainly involved in
improving primary stability of dental implants are bone density,
surgical protocol, implant thread type, and geometry.
INTRODUCTION

5. During osteotomy preparation, the maintenance and
preservation of bone leads to enhanced primary mechanical
stability, enhanced Bone to Implant Contact (BIC), thereby
enhancing the implant secondary stability.
Standard drill designs applied during osteotomies are made to
excavate bone to create room for implant placement. They remove
away the bone effectively, however, typically do not produce a
precise circumferential osteotomy.
Unlike traditional bone drilling technologies, Osseo densification
(OD) does not excavate bone tissue. The drill designing in OD
creates an environment which enhances the initial primary stability
through densification of the osteotomy site walls by
autografting of bone.

6. DEFINITION:
Osseo densification (OD) is a new developed
technique which creates an autograft layer of
condensed bone at the periphery of the implant
bed with the help of particularly designed burs.
SALAH HUWAIS
It aims at bone preservation and compaction through non subtractive
drilling.

7. CONCEPT OF OSSEODENSIFICATION (OD)
 OD is a novel, biomechanical, non excavation osteotomy preparation
technique developed by Salah Huwais in 2013.
 For this purpose, Huwais invented specially designed densifying burs called
Densah burs.

8.  The rationale behind OD is the densification of the bone that will be in
immediate contact to the implant results in higher degree of primary
stability.
due to physical interlocking
between the bone and device,
faster new bone growth
formation due to osteoblasts
nucleating on instrumented
bone that is in close proximity
with the implant.

10. BUR TECHNOLOGY:
 Specially designed densah burs precisely cut bone in the clockwise
direction and densify bone in a non cutting counterclockwise direction
combined with copious irrigation which facilitates the surgical technique
during implant placement.
 800-1500 RPM
 Have multiple flutes within tapered
geometry.

11.  A conically tapered body with a maximum diameter adjacent the shank
and minimum diameter adjacent the apical end. This taper design controls
the expansion process, as the bur enters deeper into the osteotomy.
 The apical end includes atleast one lip to grind bone when rotated in the
counterclockwise/non-cutting/burnishing direction and cut bone when
rotated in clockwise/cutting/drilling direction.
 Hence, rather than removing the bone chips and debris, they work to move
forward the bone chips and debris inwards the implant bed.

13. OSSEODENSIFICATION PROCEDURE:
Densifying burs can be used with standard surgical engine rotating at
800-1500 rpm in the counterclockwise, non-cutting/ burnishing
direction (Densifying mode) to densify bone or in the clockwise
cutting direction (Cutting mode) as a drill to cleanly cut the bone if
needed.
A downward surgical pressure coupled with profuse saline irrigation
at the point of contact creates a compression wave inside the
osteotomy such that the bone is compressed laterally by continuously
rotating and advancing the bur.
As a result of which a densified layer is created along the walls and
base of the osteotomy, through compaction and autografting the
surrounding bone while plastically expanding the bony ridge at the
same time.

14.  Bouncing motion of the bur (in and out of the osteotomy) is
recommended, which will create a rate-dependent stress to produce a rate-
dependent strain.
 This allows the saline irrigation to gently pressurize the bone walls and
facilitates increased bone plasticity and bone expansion.
According to the study of inventors, the OD technique
increased the IT of implants to 49 Ncm approximately
in low density bone when compared to 25 Ncm in
standard conventional drilling technique.
Podaropoulos L. Increasing the stability of dental implants: the concept of osseodensification. Balk J Dent Med.
2017;133-140

15.  In soft bone, the osteotomy final preparation diameter should be prepared with Densah® Bur
with an average diameter that measures 0.5-0.7 mm smaller than the implant average diameter.
 In hard bone, the osteotomy final preparation diameter should be prepared with Densah® Bur
with an average diameter that measures 0.2-0.5 mm smaller than the implant average diameter.
 With Osseodensification, bone preservation creates a spring back effect. As a rule,
osteotomies must not be undersized beyond the above stated parameters.
According to the authors, the osseodensified osteotomy diameter was reduced
by 91% due to viscoelastic nature of deformation. This spring back effect of
bone due to viscoelasticity in OD, enhancing the BIC and primary stability.

17. ADVANTAGES:
 Compaction autografting/condensation:
• Undersized implant site preparation and the use of osteotomes to condense
bone are surgical techniques proposed to increase primary implant stability
and BIC percentage in poor density bone.
• OD maintains the bulk of bone by condensation which results in higher
BIC.

19.  Enhances Bone Density:
• A study conducted by Huwais S and Meyer EG confirmed the hypothesis
that the OD technique increase primary stability, bone mineral density and
the percentage of bone at the implant surface.
• They also concluded that, by reserving bulk bone, healing process would
be accelerated due to bone matrix, cells and biochemicals maintained and
autografted along the osteotomy surface site.

20.  Residual ridge expansion:
• The dual use capability of densifying bur in both cutting and noncutting
direction may enable the clinician to autograft the maxillary sinus and
expands any ridge in maxilla and mandible.
• Osseo densification facilitates ridge expansion while maintaining alveolar
ridge integrity, thereby allowing for total implant length placement in
autogenous bone with adequate primary stability and promotes a shorter
waiting period to the restoration.

22.  Increases residual strain:
• According to the manufacturer, the bouncing motion (in and out
movement) helps to create a rate dependent stress to produce a rate
dependent strain and allows saline irrigation to gently pressurize the bone
walls.
• These together facilitate increased bone plasticity and bone expansion.

23.  Increases implant Stability:
• The densah™ bur technology facilitates ridge expansion with maintained
alveolar ridge integrity and also allows for complete implant length
placement in autogenous bone with adequate primary stability.
• Despite compromised bone anatomy, OD preserved bone bulk and
promoted a shorter waiting period to the restoration.
• Berardini et al. and Li et al. demonstrated the ability of OD drills to
increase the % of BV and % of BIC for dental implants inserted into poor
density bone compared to conventional osteotomies, which may help in
enhancing osseointegration.
Huwais S. Enhancing implant stability with osseodensification-a case report with
2-year follow-up. Implant practice. 2015;8(1):28-34.

24. VARIOUS STUDIES PERFOMED ON HUMANS:
 Huwais S, Meyer EG. A novel osseous densification approach in implant osteotomy
preparation to increase biomechanical primary stability, bone mineral density, and
bone-to implant contact. Int J Oral Maxillofac Implants. 2017;32:27–36.
 Lipton D, Trahan W, Hasan F, et al. Osseodensification as a novel implant preparation
technique that facilitates ridge expansion by compaction autografting. Am Acad
Periodontol Sci Annu Meet. 2015
 Hofbauer A, Huwais S. Osseodensification facilitates ridge expansion with enhanced
implant stability in the maxilla: Part II case report with 2-year follow-up. Implant
Practice. 2015;8:14–20.
It was concluded that CCW osseodensification drilling significantly increased insertion and
RTV compared with standard or extraction drilling. No significant differences in ISQ readings
or temperature increase were demonstrated among the test and control groups.
28 implants were placed using the osseodensification technique in 3 groups of patients:
having 3 to 4 mm (group 1), 5 to 6 mm (group 2), and 7 to 8 mm (group 3) buccolingual bone
width. The 3 groups showed 75%, 27%, and 17% increase in bone width, respectively. The
average insertion toque was 61 N/cm, whereas the average ISQ value was 77.
They reported an implant insertion torque of more than 50 N/cm and ISQ of 67 and 81 after
3 and 6 weeks, respectively, when a single implant was placed in premolar region having 3-
mm buccolingual bone width using CCW osseodensification.

25. DISADVANTAGES:
 OD does not work with cortical bone as cortical bone is a non dynamic
tissue which lacks plasticity.
 Avoid Densifying Xenograft.

26. Osseo densification in Dense Trabecular Bone
Quality Especially in the Mandible
• Flap the soft tissue using the technique indicated for the implant position.
• It is advised to prepare the osteotomy 1.0 mm deeper than the final implant
length, using the Pilot Drill (Drill speed 800-1500 rpm with copious
irrigation).
• Depending upon the implant type and diameter selected for the site, begin
with the narrowest Densah® Bur. Set the drill motor to reverse.Begin
running the bur into the osteotomy.

27. • When feeling the haptic feedback of the bur pushing up out of the
osteotomy, modulate pressure with a pumping motion until reaching the
desired depth.
• (Densify - Preserve) after Cut (DAC) if needed: When strong resistance
may be felt. Change the drill motor to forward-Cutting Mode (Clockwise
direction at 800-1500 rpm with copious irrigation). Begin advancing the
Densah® Bur into the osteotomy until reaching the desired depth.
• Stay in the osteotomy, change the drill motor back to reverse-Densifying
Mode to densify and auto-graft the cut bone back into the osteotomy walls.

28. CONCLUSION
 Patients demand for a shorter and a faster final treatment. With the
introduction of specially designed burs, making OD possible, not only
reduces treatment time but, also gives a successful implant outcome.
 OD is a promising concept which creates an autograft layer of condensed
bone at the periphery of the implant bed with the use of densah burs that
rotate in a clockwise and anti-clockwise direction, thereby enhancing
implant stability and success.
 It is ideal for patients with poor bone quality, providing good primary
implant stability.

29. REFERENCES:
 Huwais S. Enhancing implant stability with Osseo densification-a case
report with 2-year follow-up. Implant practice. 2015;8(1):28-34.
 Huwais S, Meyer EG. Osseo densification: A novel approach in implant
preparation [21] to increase primary stability, bone mineral density and
bone to implant contact. Int J Oral Maxillofac Implants. 2017;32(1):27-36.
 Trisi P, Berardini M, Falco A, Vulpiani MP. New Osseo densification
implant site preparation method to increase bone density in low-density
bone: in vivo evaluation in sheep. Implant Dent. 2016;25(1):24-31.
 Gayathri S. “Osseo densification Technique – A Novel Bone Preservation
Method to Enhance Implant Stability”. Acta Scientific Dental Sciences 2.12
(2018): 17-22.