Molar Septum Expansion Protocol with the Densah Burs

Step 1:

Separate molar roots at the urcatlon without compromising the
integrity of the septum. Perform atraumatic mesial and distal root
extraction. Degranulate tissue to expose septum area.

Step 2:

Use a pilot drill that is 1.3 mm -1.5 mm, in clockwise mode, in the center of the septum to a depth that is 1 mm deeper than the planned implant
length.

Step 3:

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 to 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). As it is in ridge expansion cases with
Osseodensification, you may over-expand the osteotomy so the last
Densah@ Bur diameter is slightly larger than the planned implant major
diameter. As the bur diameter increases, the bone expands to reach the
final osteotomy diameter.

Step 4:

Implant placement should be either at the crest level or sub-crest level
depending on its connection type.

Step 5:

Fill the gap with a bone graft material if needed; preferably an allograft
with a 70/30 cancellous/cortical ratio. Seal the gap with biologics or a
collagen plug and a large healing abutment and possibly place
interrupted suture on top.

Step 6:

Place implant.
Place the implant into the osteotomy. 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.