Densah Sinus Bumps
I was out at Spear this past Thursday and Friday Mentoring Level 6a, and I got a lot of questions about Densah sinus bumps.
I have done several hundred of these over the last 3 years, and this method has been the most reliable with the least complications of any I've used.
Honestly, I rarely do lateral wall open sinus lifts anymore because I can make a guide and do these as a one stage with implant placement or a two stage where I graft first and wait.
This is a pretty standard case. I planned the Straumann implant short as we showed at level 6, drilled to the sinus floor, the used the 2.8, 3.5 etc Straumann sleeves to do the sinus bump fully guided. I drill clockwise (forward) direction up to the floor, then hit the switch for counter-clockwise (reverse for densification), and slowly pistoned with a lot of irrigation until I felt the floor give way. I did use some grafting material (Symbios hydrated in PRF) and gently moved it into the bump area using the Densah bur in reverse at 70 rpm. I then placed the implant, which went in at 45+ Ncm.
The last image was at Stage 2, after confirming integration and placing a healing cuff. We went from 4-5mm of bone to 11+mm, in 3 months as compared to 6-9 months for a lateral wall lift.
The other advantage is that I don't need any new kits. I use the burs for normal osteotomies anyway, as they are essentially universal. No osteotomes, no balloons, etc. etc.
Keep It Simple!
Nice case Doug,
Is that how you plan your guide or do you plan it with the implant 1mm short of the sinus floor? What is your general cut off for lift and placement vs grafting?
Awesome. This is something that I really want to learn more about. Are you using the sleeves from densah?
Beautiful Doug. Can you comment on which sequence Densah drills and Straumann keys you used to do the lift initially (access the sinus) since the Densah drills don’t exactly fit the Straumann keys. Did you do the initial bump with the smaller drills or the widest diameter drill. Also: When you insert the BG at 70 rpm do you do that without irrigation?
Farhad
I use Nobel implants and surgical guides. Their guided drills are +10mm to account for the depth of the guide.
Are the Densah drills long enough to work with a guide like this? They would have to be from about 12 to 20 mm long.
Thanks for posting such a nice and interesting technique.
This is how it works from a guided perspective with keys.
For Straumann and Nobel, the key sequence is nearly the same.
Plan the implant to the sinus floor, so the initial pilot drills stop there. (Nobel 2.0, Straumann 2.2)
The next sleeve for both is the 2.8. I use the 1828 (which means 1.8mm to 2.8mm wide) to open the osteotomy from 2.0 to 2.8.
The next sleeve for both is 3.5 (depending on the size implant you are using), and I use the 2535 (2.5 -3.5).
I then take the key out, put the 2535 back into the same hole I just drilled (guide still in place), and go forward to the sinus floor, the switch to backward (densification mode) to start lifting the floor.
You let the pistoning do the work, and you can gently feel the floor give way. You already know your D2, so just go 1-2mm up, no more on the first bump.
If you're putting in a molar implant, you progress up the keys and use the Densah burs through the guide to slowly bring it up 1-2mm each time.
My last drill for Straumann 4.8 is the 3848, and for Nobel 5.0 it's the 4248., then I place the implant through the guide. While you think that might be loose for the Straumann 4.8, it's not, because you densified the walls along the way.
You will probably have to remove the guide and do the last few turns under direct vision to really be certian of your depth of placement.
Doug
Does using the Densah drills for the sinus lift cause the apical portion to also densify or does it just help expand the lift both apical and lateral.
Do you use the Densah burs for slope sinus floors also. How does one use Densah burs (guided) for Camlog implants? I use the Camlog pilot drill (2.0mm) guided to the floor then use Densah burs free handed and also place the implant free hand.
Very nice case,
I just fell in love with Osseodensification and doing it more and more, however like Farhad mentioned, I have not used the guided approach and am doing the crestal sinus lifts free handed. Do you have a protocol to share? I did notice a nice elevation of the floor of the sinus in combination with an increase in width of the alveolar bone depending on the size of implant you were planning to place.
There will be a World Symposium for Osseodensification in Scottsdale, AZ. Jan 17th - 19th, Hyatt Regency at Gainey Ranch. Just FYI.
Juergen
Hey Doug. Do you take a radiograph of the sinus to verify the amount of bone grafted there before implant placement??
I personally don't either. I have also found that when I do these using a CG2 that it's helpful to have the densah bur on a stopper. So, I use my guided drill (biohorizons or Astra EV) to the1mm from the sinus floor, then slide out the master sleeve and use the Verban Drill stops on the Densah bur to press in the sinus floor incrementally. It helps me to avoid a sudden movement in case the bone of the sinus floor gives away more quickly than I expect. It takes doing some math and extra planning, and then stopping the middle to remove the sleeve, but it increases my comfort with the procedure.
I don't take a film to verify the amount of graft. You will find, however, that you need far less than you use initially.
Part of that is our natural tendency is to do the "if a little is good, a lot has to be better".
The second reason is that we discount the autogenous bone in the flutes that gets densified up into the sinus.
I only add bone if I'm moving the floor more than 2mm.
On 12/13/2018 at 7:29 am, Douglas Smail, OMFS said...I don't take a film to verify the amount of graft. You will find, however, that you need far less than you use initially.
Part of that is our natural tendency is to do the "if a little is good, a lot has to be better".
The second reason is that we discount the autogenous bone in the flutes that gets densified up into the sinus.
I only add bone if I'm moving the floor more than 2mm.
I think that's a huge advantage of the Densah drills. If you run them forward, or any drill for that matter, you have a lot of bone that gets removed in the flutes. Running them in reverse (densification), removes no bone as the flutes are always clean, and that bone is just compressed into the osteotomy site.
I was looking at the Densah site. It looks like these are the only burs you need when doing an implant. It looks like all you need to do is have the drivers for the particular implant you are using.
Going to the Densah Osseointegration Symposium in Scottsdale in January to get started with all of this. This thread has me really excited to add this to my armamentarium placing implants.
On 12/13/2018 at 10:12 am, Greg Lambert said...When using the densah burs guided are you using the verban drill stops with the CG2?
I can answer that--The answer is yes.
On 12/13/2018 at 10:12 am, Greg Lambert said...When using the densah burs guided are you using the verban drill stops with the CG2?
Been doing this for awhile now. Works wonders!
On 12/13/2018 at 11:50 am, David Honey said...On 12/13/2018 at 10:12 am, Greg Lambert said...When using the densah burs guided are you using the verban drill stops with the CG2?
Been doing this for awhile now. Works wonders!
The Verban drill stops are designed for the small, med, or large cg2 holes and work perfectly with Densah. As Josh pointed out, you do need to do little math when calculating the D2.
