Using the Dental Implant Fixture to Tap the Bone
Dr. C. asks:
Is there any harm in tapping a dental implant osteotomy site with the implant itself? For example, if a dental implant is inserted into the osteotomy site and binds up before it is fully seated, is it considered acceptable to continue torquing down the implant? You can then loosen it, then torque it down again to “tap” the bone and allow the implant to insert deeper into the osteotomy site?
If this is done in an alternating fashion for a reasonable distance (3mm or so), I have found that the dental implant can be inserted to the desired depth and torque down to 35 Ncm creating excellent primary stability. Anybody else have experience with this technique? Any thoughts?
7 Comments on Using the Dental Implant Fixture to Tap the Bone
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This works in softer bone. But in denser bone you can get to a point where the implant will not tighten any further and will bot loosen, either. I have had this happen twice. I was forced to use enough force to remove the implant that the implant itself could no longer be used due to deformation. The bone was okay and after appropriate tapping with the intended burs, the next implant went to place properly. In softer bone, I will routinely stop at smaller diameter burs and let the implant tap the bone as you describe. But no more in the mandible.
Why make life more complicated?If you're in type I bone and feel you need to tap,then take the extra step and tap with the proper instrument.It will take you less time than doing it the way you describe.It would also be most prudent to handle the implant as little as possible.When the fixture is removed from the packaging it should be going right into the osteotomy and stay there.I'm uncomfortable with the notion of handling the implant so much .
i've tried it once or twice with acceptable results, the only problem i had faced was that patient experienced dull ache over that area for about 10 days post-op. although he was fine after that.
The Answer to the question is that the Taper of the Implant and the dimensions of the drills determine whether a bone tap is needed. Implant Direct does not even make bone taps. Our combination of an evenly tapered implant body (like the Screw-Vent) used with the straight intermediate drill for soft bone and the step final drill for dense bone results in easy insertion regardless of soft or hard bone. A study by Shalabi, COIR April 2006 also showed that putting a tapered implant into an undersized socket also resulted in increased bone attachment and torque removal. If the bone is dense, then use the final sizing drill which is 3.4mmD, stepping down to 2.8mmD. This will allow the narrow end and the wide end to engage with 0.15mm (3.7-3.4=0.3/2 = 0.15mm or .006" or the thickness of two human hairs - THUS ELIMINATING THE NEED FOR A BONE TAP. In dense bone, this is all the engagement that is required to get good initial stability.
Do it all the time in softer bone. I have had excellent results as long as I do not over-tighten as it is going down. I will do it many times, slowly expanding the osteotomy. When I get past the desired position, I back it up and leave it loose. This gives me the advantage that I don't have to lose bone after the initial drills. Also allows for larger implants in smaller ridges. Don't do it in mandible as it is too dense.
Use yout tap in the mandible and allow implants to self tap in the maxilla. Density of bone is the issue. Rule of thumb, is to not force anything. What are you referring to when you say, torque the implant to 35 Ncm? Implants do not need to be torqued!
dr.med, dr med. dent Ales
i use use usually the tappering one-piece implants, specially designed, in post-extractive situations, both in maxilla or in mandibula eventually with an appropriate drill dimension, and with contemporary insertion of sintetic bone among the loops ofthe implant. so i obtain an implant that can support quasi immediatly a temporary crown and also estimate how muche time i neeed for the definitive crown. soft or hard bone , it depends from yuor ability to drill, eventually, to enlarge the natural hole that yuo have in front.