Guided Expansion Graft

• USE PILOT DRILL IN (CW) MODE AND DRILL TO IMPLANT DEPTH AND ANGULATION
• USE THE SUBSEQUENT DENSAH@ BURS IN SMALLER INCREMENTS TO EXPAND THE OSTEOTOMY AND TO INCREASE BONE PLASTICITY
• FINAL EXPANSION DIAMETER SHOULD NOT EXCEED THE PLUS ONE FORMULA (INITIAL RIDGE WIDTH + 1 MM)
• GRAFT THE NEWLY FORMED SOCKET WITH A 70/30 CANCELLOUS/CORTICAL COMBINATION ALLOGRAFT
• ALLOW HEALING FOR 3-6 MONTHS
• RE-ENTER THE SITE TO PREPARE FOR IMPLANT PLACEMENT USING OSSEODENSIFICATION WITH THE DENSAH@ BURS

Step 1:

Flap the soft tissue using the technique indicated for the implant
position. Drill to implant depth and angulation using a narrow Pilot Drill
preferably 1.3 mm - 1.5 mm. (CW speed 1000 rpm with copious irrigation).

Step 2:

Depending upon the implant type and diameter, follow the
corresponding Implant System Drilling Protocol starting with the
smallest Densah@ Bur to 1 mm deeper than the intended implant length.
Run the Densah@ Burs in OD mode (counterclockwise, drill speed 1000
rpm with copious irrigation). Use the subsequent Densah@ Burs in
smaller increments to increase bone plasticity and expand the
osteotomy. For example, use Densah@ Bur (2.0) after the pilot then
expand with Densah@ Bur (2.3) then move to Densah@ Bur (2.5) before
introducing the Densah@ Bur (3.0).

Step 3:

Increase osteotomy diameter in small increments until reaching the
intended expansion. As the bur diameter increases, the bone will slowly
expand to the final expansion diameter. Final expansion diameter
should not exceed the plus 1 formula (initial ridge width +1 mm). For
example, if you start with a 3 mm ridge, the maximum expected final
osteotomy diameter is not to exceed (3+1) = 4 mm.

Step 4:

Graft the newly formed socket/osteotomy including surrounding area
with your preferred bone allograft materials, preferably a 70/30
cancellous/cortical ratio. Use membrane and try to achieve tension free
pri mary closure. Allow healing for 3-6 months.

Step 5:

Re-enter the site and perform Osseodensification to facilitate further
expansion if needed and place the implant. Use the Densah@ Burs in
smaller increments. Do not under-prep the osteotomy beyond 0.5 mm -
0.7 mm in the maxilla or 0.2 mm - 0.5 mm in the mandible.

Step 6:

If using the surgical motor to tap the implant into place, the unit may
stop when reaching the placement torque maximum. Finish placing the
implant to depth with a torque indicating wrench. The proper diameter
implants should be included in the treatment plan and on hand at the
surgical appointment.