Drilling Hole for Implant Fixture: Proper Handpiece Settings?

Every drill has a recommendation for speed settings. I don't think air water syringe is a good idea. Torque is a question in the case, when you place the implant with a contraangle. I would place my first implant by hand.( torque wrench ) Correct torque is also the question of implant system. With 3.5mm Replace do not set it over 40Ncm. ImplantDirect,Zimmer TSV, Nobel Active....... can be more. (just for example)

Dr. V, Do not take this the wrong way- but it does not sound like you should be placing an implant at this time. Have you taken any course? The questions you are asking are very, very basic. Just asking if you need irrigation, shows that you are woefully uninformed and not ready. Too many are jumping into placing implants(not talking about minis), without the knowlege they need. How does the saying go- "You do not know, what you do not know". That can be a dangerous thing. Please get either someone experienced to mentor you, or take a good surgical course on implants.

What system are you using? The settings for your motor are all given in the manual which you should be able to download even if the supplier can't give you a hardcopy. If you still have questions, the practitioner(s) in charge of training for that system you're using should be able to help. If you don't have an attachment on your handpiece, just get your assistant to syringe sterile saline onto the drills from a 20ml syringe.

I'm about to do my first heart transplant, do you think I should clamp off the veins with 10 lbs of pressure or 20? Listen to Charles get a mentor until you have no questions for this list.

Dr. Schlesinger is 100% correct in his assessment. Defer this procedure to someone else, then get training. With a class you will migrate from 'I don't know what I don't know' to 'I know what I don't know' and then looking back, it would scare you to even have thought about doing the procedure.

I could not agree more with Charles. Please do not be offended but I think you need to have a stronger foundation before you start. I have gone to numerous implant courses in the USA and in Europe and each time have come back realizing how much more there is to learn. I also have assisted at many implant surgeries while my patients were being treated and I can tell from your questions that you need to learn more. Sign up for some of the big name courses out there, Misch, Picos, Salama, etc... and get a good feel for what you are getting into. Implant dentistry is very rewarding but many "oops" can happen if you are unprepared and leave you with a bitter taste.....

Oh. My. God.

To DRMA: you have some mis-information on Replace. Its rupture strength is 150N with deformation occurring at 120N. The company's torque wrench tops out at 45NCM which would therefore be the highest recommended torque value even though the implant can withstand over 3 times that amount. To Dr. V.: Is the water from your 3-way syringe sterile? What speed and torque does the manufacturer for the implant recommend? With all due respect, if you did not even think of asking those questions you should not be placing implants without first taking a solid course.

Why not leave the implant placement to the specialist? That is why they go for the extra training. As you said above there are programs to learn proper technique. You cannot learn it in a weekend. It takes years!

Dr V., fIRST OF ALL-NO WATER FROM THE AIR WATER SYRINGE. yOU CAN USE A 50 ML. SYRINGE WITH RINGERS LACTATE, NORMAL SALINE , D5W BUT NO DISTILLED WATER. Distilled water will lyse cells. Internal irrigation vs external irrigation, I have used both and even no irrigation with equal results. As per rpms, you may prepare with 300 to 1200. I like 300. Place the implant with about 15 rpms (very slow). Read the instructions and have the sales rep go over it with you.

To David Levitt Dr levitt, I believe the maximum value for torque advised with the replace system is not related to its overall strength but is related to its shape and avoiding surgical complications rather than implant deformation. If you exceed 35-45 NCm depending on whom you beleive you will increase the chances of crushing the bone and generating necrosis around your freshly placed implant.

I have been reading comments and questions from this site for the past 3 months. When I see a question like this it makes me wonder about my profession.The prior posts are correct. If this is your question you should not be doing this procedure.

I agree with everyone. Respectfully, That question should not even be asked in the context it was. I went to the Maxicourse and didnt even order a surgical unit until after the course, and still I have to go over things beforehand. Still do. Check the settings. I do all placements by hand. There are definite differences in opinions in handpiece speed. Misch and Sharawry have done studies supporting higher spoeeds than the manufacturers. Locante and others do osteotomies with no sterile H2O at 40-50rpms. But go to school first. You have time. Even with that, the first one still draws a little adrenaline out. But go to school. Subscribe to a bunch of journals and take courses. Its only the right thing to do before launcing into implants. You will be killed in the courts if anything happens. And it will without proper training. It happens when you have training, so listen to what everyone has said. Bill

I agree, Dr. V should not place anything until the questions are answered in training, not on a message board. But to presume only a "specialist" can screw into bone is ludicrous! What do you think a prefab post/core is? No self-respecting dentist would refer out a basic post/core to a "specialist". That's essentially what an implant is. A general dentist should practice generally all dentistry, or at least be able to do so. This bull crap about general dentists being retarded and unable to screw in a little post, or instrument a canal, or extract a tooth is absolute lunacy. What the hell did we study for four years? (excepting Harvard, but that's another story)

in my country we make 6 years of university and at least 1 to 5 year of residency and belive me that we study a lot so it's very normal for a general dentist to put implants IF is well prepared and knows what to do.if he starts to ask simple questions that means he must go to study first and than work.also i saw some maxillofacial specialists who can make very hard operations(removing tumors,etc)and when they make an implant or a periodontology operation suck a lot!so depend on what you know and how good you are in a field.cheers.