Maxillary osteotomy implant site preparation: a less traumat
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Bone quality plays a factor with initial implant stability in immediate or delayed approaches. Implant placement in the maxilla frequently requires some site manipulation to accommodate the implant. Bone width deficit can be due to resorption in the buccal-lingual direction related to either periodontal issues with a tooth when immediate placement is planned or following healing of a prior extraction site. Bone quality due to lower density is typical of the maxilla and is usually D3 or D4 in nature.

Bone density on standard radiographs is an individual perception and equated with visual shades of gray in the planned site. Cone-beam computed technology (CBCT) offers a more accurate. The distribution in the maxilla, having less bone density then the mandible, typically presents with D3 bone in the premaxilla and D4 in the posterior maxilla.

The use of osteotomes to improve bone quality at implant sites has been reported over an extended time.Rotary handpiece-driven osteotomes have been available for an extended period of time. These were introduced to eliminate the patient sensation with mallet-driven osteotomes and give the operator more tactile control at the site.Hand osteotomes have the benefit of no heat generation found during the use of rotary osteotomes, but, as discussed, they have other issues that are eliminated with rotary osteotomes.

So, what is the solution?

The VGO Concept
The VGO (Variable Geometry Osteotomes) instruments are designed for optimal heatless lateral condensation without the potential of crestal bone overloading when using the instruments while increasing practitioner tactile feedback. The system is provided as an anterior or posterior kit in a sterilizable cassette.
The threaded tips of the anterior kit drive the tips in and additionally create micro-serrations, which increase bleeding. This, in effect, leads to more growth factors being present at the bone-to-implant interface due to the degranulation of platelets (activated state)Both kits feature the Delta Dot above or below the instrument to allow the clinician to know at a glance where exactly the tip will do work

To attain the best results, it is recommended that each case be initiated with a standard pilot osteotomy to intended full depth, followed by Tip-0, Tip-1, and so forth, until the desired osteotomy size is achieved, depending on the planned implant fixture.

The maxillary arch presents with less dense bone than found in the mandible and, thus, has less load-handling potential due to the density difference. Manipulation of the bone through osseous condensation with osteotomes improves that bone density to allow better load handling and long-term bone maintenance when compared to sites that have not had osseo compression performed. As discussed, the VGO osteotomes eliminate some of the issues with traditional osteotomes that require a mallet to advance the tip or have the potential for heat generation, as reported with rotary osteotomes. Furthermore, these instruments provide a better tactile feel for the practitioner, allowing for a better guided approach based on the site’s anatomy, along with improved safety.

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