Osseodensification is a novel bone preservation technique that uses specially designed densifying burs to compress and densify bone at the implant site rather than removing it. This increases primary stability and bone density compared to conventional drilling. The densifying burs cut bone in one direction and densify it in the other, creating an autografted layer along the osteotomy walls. Studies have found osseodensification enhances implant stability, reduces treatment time, and facilitates placement in low-density bone or ridge expansion. However, it is an expensive technique that requires specialized burs and training.

1. OSSEODENSIFICATION

2. CONTENTS
Introduction
Definition
Concept of osseodensification
Characteristics of densah bur
Osseodensification vs conventional osteotomy
Advantages
Disadvantages
Conclusion
References

4. Primary stability is accomplished when there
is no micro-movement of implant in its
completely seated position. This allows the
implant to mechanically interlock with the
bone tissue until secondary stability is
achieved.

5. PRIMARY AND SECONDARY STABILITY
Due to surgical trauma, 1 mm of bone around
the implant body gets devitalised, resorbed and
remodelled in the initial period of
osseointegration, this will decrease the primary
stability.
Later bone starts forming around implant
body, thereby increasing the BIC
This biologic stability of the implant known
as secondary stability leads to an
osseointegrated implant .

6. IMPLANT STABILITY
SECONDARY STABILITY
•PRIMARY STABILITY
•BONE REMODLLING
•IMPLANT SURFACE
CHARACTERISTICS
PRIMARY STABILITY
•IMPLANT DESIGN
•BONE QUANTITY/QUALITY
•SURGICAL TECHNIQUE

7. 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.

8. METHODS TO INCREASE THE
PRIMARY STABILITY
Underpreparation of
the implant bed
Stepped osteotomy of
implant bed
Bone condensation
technique
Osseodensification

10. 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.

11. DEFINITION
Osseo densification (OD) is a newly developed
technique which creates an autograft layer of
condensed bone at the periphery of the
implant bed with the help of particularly
designed burs.

13. CONCEPT OF OSSEODENSIFICATION
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.

14. 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.

15. 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.
• Rotates at 800-1500 RPM ,has multiple flutes
within tapered geometry.

18. • 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.

19. TRADITIONAL VS
OSSEODENSIFICATION

20. TECHNIQUE OSSEODENSIFICATION
TECHNIQUE
TRADITIONAL DRILLING
TECHNIQUE
Bone
excavation
Non- excavation, bone
preservation method- autografting
of bone
Involves cutting and excavation
Bur design Taper design with more than four
lands and flutes to guide
osteotomy without chatter
Regular twist drills with only two
to four lands to guide osteotomy
Osteotomy Precise , 0.5mm smaller than
traditional drilling.
Not always precise may be
elliptical or elongated.
Heat
generation
Reduced with copious saline
irrigation and bouncing pumping
motion of bur.
During rotatory cutting is crucial
factor in osseointegration
Narrow
ridges
Facilitates expansion of narrow
ridges and facilitates larger
diameter implant placement
Larger diameter implant
placement can result in bone
dehiscence and fenestration

21. 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.
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

25. • 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

26. ADVANTAGES

27. 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.

28. POST OPERATIVE BONE DENSITY

29. 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.

31. 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.

32. 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.

34. DISADVANTAGES
OD does not work with dense cortical bone as
cortical bone is a non dynamic tissue which lacks
plasticity.
Densification of xenografts should be avoided
because they behave biomechanically different
than the bone tissue, as they have only inorganic
content and they just provide the bulk without
any viscoelasticity.
Expensive procedure, requires additional
armamentarium &clinical expertise

35. DISCUSSION
 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.
 Lahen B et al., in their study examined the effect of OD on
the primary stability and early osseointegration of
implants. After 6 weeks histometric analysis was done
which showed positive effects.

36.  Lopez CD et al., in their study assessed the
biomechanical and histological effects of OD surgical
instrumentation in a spine model animal study and
concluded that this technique can potentially improve
the safety and success rates of bony drilling at all sites
of low bone density and limited bone volume.
 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

37. CONCLUSION
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 with decreased
treatment time.

38. REFERENCES
• Huwais S, Meyer EG. Osseodensification: A novel approach in
implant preparation to increase primary stability, bone mineral
density and bone to implant contact. Int J Oral Maxillofac Implants.
2017;32(1):27-36.
• 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(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.