Osseodensification with Densah burs: thoughts?

I've been using these burs for about 6 months now and they have become a very useful tool in my armamentarium. I highly recommend them but there is a learning curve especially with the crestal sinus approach. The ridge expansion also works nicely and I think its better in the maxilla for obvious reasons. Check out videos on you tube, I know Ziv Mazor and Howard Gluckman are big fans.

Love them...very kind when it comes to cervical lifts...

Are they also beneficial with the more modern aggressive thread such as that of Nobel active?

They have a guide you can use to show drilling sequence for different implant systems. There is a learning curve and the vibration is a little tough on the patient. All in all a good tool. Almost all max implants are placed after this protocol is used. Been using for almost a year now. Work exactly as advertised

Unfortunately I have not had great success with the burs despite following their protocol and using plenty of irrigation. I have had 4 implants fail about 4-5 months after placement where we had good torque of 35-45Ncm. The densified bone appears to have become necrotic in these cases. Have never had this issue using other burs and have switched back to the standard Nobel implant burs and this issue has disappeared. My experience.

Colleagues: Osseodensification is a low plastic deformation of trabecular bone. It is contraindicated in cortical bone. It is a bone instrumentation method that uses a specially designed bur that works in CW to cut bone and in CCW to compact-auto graft and preserve bone. The common mistakes in using osseodensifications are; down-sizing the osteotomy, using the Densah bur in CCW mode in cortical or dense bone, and using the densah burs in traditional guided surgery, where we are only allowed one path- in and path-out, which may not create osseodesnification. The traditional model of bone drilling instrumentation is mainly related to extraction drilling that removes bone bulk to create an under-prepared cylindrical osteotomy to place a fat wedge (tapered implant) in it. This model may produce a high initial stability but also generates a constant strain in bone because the implant constantly compresses the bone tissue and may create a die-back effect. We sometimes get away with it when there is enough trabecular bone remaining to dissipate that strain. We all get in trouble when we extract enough bone bulk and get closer to the cortical walls; then high insertion torque becomes a risk. Sometimes the most stress/pressure is created at the crest, which is the zone with the least blood supply in our model. The denser the crest, the more risk of crestal bone loss. The more under-preparation we do, especially with ridge expansion/splitting, to achieve higher insertion torque, the more chance to create risky healing, especially in cortical or dense bone. Cortical bone is, biomechanically, a non-dynamic tissue. The magic is in trabecular bone and its collagen content. Trabecular bone is a viscoelastic tissue. When preserved, it may provide several advantages in our healing model. One of these benefits; It will tolerate higher insertion torque value. We have shown that preserving trabecular bone and facilitating its compaction autografting via osseodensification will create a “spring-back” effect into the osteotomy center. This effect allows for an enhanced implant initial stability. So rather than the implant consistently compresses the bone to achieve stability in the standard drilling under-preparation method, the bone would recoil and spring back to reverse-compress the implant without the need to undersize the osteotomy in the osseodensification method. Please avoid under-sizing the osteotomy with osseodensification because you do not need to. You may, even, oversize the osteotomy especially in ridge splitting or ridge expansion cases. The Densah Bur, after all, is just a tool that is designed to function as a dual action tool. In trabecular bone, use it in OD mode (CCW rotation) to preserve bone, densify it, and enhance its plasticity. In dense/cortical bone, use it in cutting mode (CW rotation) to cut bone without densifying it. The success or failure is a result of our diagnosis and our ability to manipulate nature and biology to our advantage. Biology dictates, please stay away from densifying or expanding cortical bone. Osseodensification is contra-indicated in dense or cortical bone. I encourage all to rethink bone instrumentation to preserve as much trabecular bone as possible. Please try to attend one of the osseodensification courses hosted by Versah, It will optimize your learning curve.