Osteotomy Site Preparation: Use Hollow osteotomy drills with internal irrigation?

We have always used internal irrigation with Saline ( not water ) and I feel it helps substantially with post-op pain and swelling . Having used many types of internally irrigate drills over the years my favourite is still the tri-blade flat edged type ( from mid 80s ) as it can deflect any soft tissue or vessels . 95 % of patients here do not require any pain medication the following day and yes they all get a call. As for cooling it to 5 degrees have heard of that but do not do it . Peter

Dear Dr P, Despite what indivisual reps will tell you, all modern implant systems have approximately the same integration rates with no significant differences in integration rates between them. Most (well over half) current implant systems use external irrigation for their drills. Therfore the one thing you can say with some degree of confidence is that internal irrigation does not significantly increase the integration of implants. Nothing controversial so far... Internally irrigated drills are more expensive to buy, harder to maintain/sterilise and have no added benefit to integration. Some people like them, some people don't. Try them out and see for yourself, but they are most certainly NOT a necessity. Kind Regards, Bill Schaeffer

Does not make a difference.

I have used both and it does not seem to matter in terms of your succes rate

I have not used irrigation for 5 years with no change in successful integration. Please see: Flanagan D. Osteotomy irrigation: is it necessary? Implant Dentistry 2010 June 19(3):241-249

Dr Flanagan. While I do not dispute your claim and I certainly take you for your word what you have stated defies a major tenet of implant dentistry. If what you say is true (even in type 1 bone?) I am flabbergasted.

The statistics appear to show that implants placed into very dense bone, such as seen in the lower anterior region, have a slightly lower integration rate than in areas where the bone is less dense. This I believe is due to the increased risk of overheating the bone when drilling in very dense bone. In these areas the bone can be extremely dense and the osteotomy preparation can be very difficult. In such cases I believe that you need everything going for you to avoid overheating the bone, and so I suggest that internal irrigation is recommended in these cases. Also in cases where a very long implant is being placed,internal irrigation is adviseable. Probably in all other cases there is not much difference in success when using internally irrigating drills or not if one is cautious when drilling, avoiding undue force, and drilling and withdrawing frequently to enable good irrigation and avoiding heat buil up.

The type of irrigation does not affect the success rate, as long as the basics of osteotomy preparation like sharp drills, avoid excessive force, avoid continuous drilling, sufficient coolant, are followed. I have seen flapless protocols with surgical guides being followed without internal irrigation. One problem reported with internally irrigated drills is the difficulty in maintaining & sterilizing them.

having used internal irrigation since forever, (20years), i can say with confidence that you will not get overheating in the apex of your ostrotomy, something that you will see in some cases of external irrigation (FAST SURGEONS). So it does make sense.

We do every case under general and irrigate with internal and external autoirrigators and with assistant irrigation. I, always was under the impression, that it was the single most important thing that we can do, aside from slow/short duration cutting, to avoid burning bone. Sorry for run ons! Too much Faulkner! It seems as if the companies are getting cheaper and this is not a good way to cut cost! Am I getting " black balled" ? My deals aren't going through. Anderson, you could only be so lucky! Bv

I use external irrigation and very sharp burs. I usually do not use an implant longer than 11.5 mm. I don't exceed 300 rpm. I don't have the bone dieback/ necrosis issues.

Why no longer than 11.5 mm.. Do you" not buy "the suggested 13mm minimum for softer maxillary bone? Bv

Looknatvthe Bicon protocol. It is low RPN and no irrigation method. I have never had a failure with a Bicon/ Stryker Implant! Go figure.

Just have not needed anything longer. The 11.5 mm seems to work just fine. I have used longer in the past.

Baker, in soft bone I do several things. One is to use osteotomes to compress the bone. The second is to place Osteogen into the osteotomy ( forced mineralization), which should improve the bone quality. The third , I use a Bicon implant, nothing less than 8 mm in length and usually 5 mm wide. If you have not used them, it takes a while to gain confidence in them. I sat on the fence for two years prior to committing to Stryker/Bicon. I do no use the ultra short Bicons. I have not had any integration or bone loss problems with them. Just do not use them singly in the anterior. The abutments dislodge from time to time. In the posterior maxilla or mandible, when there is less bone vertically the 5x8 Bicon is a workhorse.

This is why I'm on the site! Hard to argue the high success rate. Bv

all the same no differences

The Bicon slow rpm (30-50 rpm) is nice, but the ace in the hole is the ability to hand prep and control the cut to a segment of the radius. i.e., the hand reamers have but one vertical cut and the rest is flat and expansive. So you can use a 1/4 to 1/2 twist and cut only the side of the prep hole you want while keeping the flat "safe" side against critical structures and thin plates. Over the years, I've become more confident in the shorter Bicon implants and have place only a couple 11 mm ones (to engage the apex to hold it still for clot integration on the other end). Mostly now place 5mm to 8 mm long Bicons and they are very predictable and convenient in their ability to integrate with only clot contact. John