- 10 REASONS WHY WE BONE SOUND EVERY CASE - WHEN SHOULD YOU BONE SOUND - BONE SOUNDING THE RIGHT WAY

10 REASONS WHY WE BONE SOUND EVERY IMPLANT CASE

BONE SOUNDING ENABLE US TO:

  1. MEASURE THE TISSUE DEPTH AT THE IMPLANT SITE. SUBTRACTING THESE MEASUREMENTS FROM THE SHAPE OF A SECTIONED, POURED MODEL PROVIDES OUR "MIND'S EYE" WITH AN ACCURATE SHAPE OF THE BONY RIDGE.
  2. MAKE A BONE/RIDGE MAPPING MODEL.
  3. CHECK FOR DEEP BUCCAL FOSSA'S AND BUCCAL DEHISCENCE. THIS IS VERY IMPORTANT ESPECIALLY IN THE MAXILLA AND WHEN PLACING IMPLANTS MONTHS AFTER EXTRACTIONS.
  4. ESTABLISH A PROPER BUCCAL/LINGUAL ANGULATION OF THE PILOT HOLE.
  5. MAKE A SURGICAL STENT TO GUIDE THE PILOT DRILL.
  6. MAKE A SURGICAL PRACTICE MODEL OF THE CASE. THEN YOU CAN PERFORM THE CASE IN YOUR LAB FIRST AND TRANSFER THIS KNOWLEDGE TO THE MOUTH WITH CONFIDENCE! THIS IS IMPORTANT FOR YOUR FIRST SEVERAL CASES. ALSO, WHENEVER A KNIFE EDGE IS EXPECTED AT THE PENETRATION SPOTS AND WHEN PLACING MULTIPLE IMPLANTS AT ONCE. THIS EXERCISE IDENTIFIES WHICH CASES REQUIRE AN ORAL CT SCAN BEFORE PROCEEDING! SPEND EXTRA TIME MAKING THE STENT SO IT IS EASY FOR THE PATIENT TO PLACE IT BEFORE THE SCAN.
  7. RE-EVALUATE THE ADVANTAGE OF LAYING A FLAP WITH A SEVERE KNIFE EDGE RIDGE.
  8. CHECK AND IDENTIFY THE THICKNESS OF THE TISSUE AT THE POINT WHERE YOU EXPECT THE BUCCAL EDGE OF THE ABUTMENT MARGIN (CROWN/ABUTMENT INTERFACE) TO END. INVESTIGATION OF THIS DETAIL ALLOWS YOU TO MAKE IMPORTANT COSMETIC DECISIONS. FOR EXAMPLE:

A. DO WE NEED A NORMAL EMERGENCE PROFILE OR BUCCAL RIDGE LAP CROWN?

B. DO WE NEED TO RE-SHAPE THE TISSUE WITH GINGIVOPLASTY OR A TEMPORARY PRESSURE PONTIC?

C. DO WE NEED TO READJUST PILOT-HOLE PLACEMENT OR ANGLE?

D. DO WE NEED TO CHANGE THE IMPLANT BASED ON THE HEIGHT OF THE COLLAR IT HAS?

E. DO WE NEED TO SWITCH TO A TWO PIECE BONE LEVEL IMPLANT?

9. CHECK THE DENSITY OF THE BONE AT THE PENETRATION SITE. 3% TO 5% OF THE RIDGES DO NOT REQUIRE PILOT DRILLS WHEN USING MINIS. YOU WANT TO KNOW THIS BEFORE YOU USE A PILOT DRILL. AFTERWARDS IT IS TOO LATE AND YOU MAY HAVE TO ABORT THE CASE, BECAUSE YOU REMOVED THAT LITTLE BIT OF BONE YOU NEEDED TO ACHIEVE INITIAL STABILITY.

10. BONE SOUNDING EVERY CASE PROMOTES AND INGRAINS PROPER PROTOCOL INTO YOUR CASE WORK-UP ROUTINE.

WHEN DO WE BONE SOUND?

WHEN DO WE NEED TO PERFORM BONE SOUNDING?

  1. CASE WORK-UP APPOINTMENT. SOMETIMES I BONE SOUND AT THE FIRST CONSULT APPOINTMENT. IT HELPS ANSWER THE QUESTION, "DO I ABSOLUTELY NEED A CT SCAN OF THIS CASE BEFORE PROCEEDING?"
  2. BEFORE SURGERY TO CONFIRM EARLIER READINGS AND REFRESH OUR "MIND'S EYE" AS TO RIDGE SHAPE AND SURFACE DENSITY.
  3. DURING IMPLANT SURGERY TO REAFFIRM BONE WALL THICKNESS.
  4. AFTER IMPLANT SURGERY TO CHECK FOR BUCCAL CRACKS.
  5. AFTER EXTRACTIONS! ONE OF THE BEST TIMES TO SOUND THE BONE IS AFTER EXTRACTING A TOOTH FOR A PATIENT WHO IS HAVING AN IMPLANT PLACED. THIS IS THE BEST TIME TO CHECK THE INTEGRITY OF THE BUCCAL AND LINGUAL CORTICAL PLATES. TAKE A PHOTO NOW FOR LATER REFERENCE.

IN OTHER WORDS, KEEP YOUR ENDO EXPLORER/PERIO PROBE HOLSTERED AT ALL TIMES AND DON'T GO ANYWHERE WITHOUT IT!

MINIMALLY INVASIVE FLAPLESS SURGICAL TECHNIQUES DEMAND AN INTIMATE KNOWLEDGE OF THE IMPLANT SITE. BONE SOUNDING AND MODEL RIDGE MAPPING PROVIDE THIS KNOWLEDGE AND ENABLE US TO BE REFINED IN OUR DECISION MAKING . . . PRECISE, EFFICIENT AND CONFIDENT IN OUR SURGICAL TECHNIQUE.

BONE SOUNDING TECHNIQUE

BONE SOUNDING SHOULD BE PART OF EVERY CASE WORK-UP. HAVE AN IMPRESSION OF THE IMPLANT SITE AVAILABLE AT TIME OF BONE SOUNDING TO POUR A RIDGE MAPPING MODEL AFTER BONE SOUNDING.

  1. SKETCH THE SHAPE OF THE RIDGE IN QUESTION ON PAPER.
  2. ESTIMATE THE POINT OF ENTRANCE FOR YOUR PILOT DRILL. THIS IS THE POINT OF YOUR FIRST MEASUREMENT.
  3. MAKE YOUR ENDO EXPLORER PENETRATION PARALLEL TO ANTICIPATED ANGLE OF PILOT DRILL.
  4. THE NEXT MEASUREMENT IS 1MM OR LESS TO THE BUCCAL OF FIRST AND PARALLEL TO THE FIRST MEASUREMENT.
  5. ON NARROW RIDGES A THIRD PARALLEL MEASUREMENT TO THE BUCCAL OFTEN SLIDES 5 OR 10 MM DOWN THE BUCCAL SURFACE OF THE BONY RIDGE. WHEN THIS HAPPENS, PULL BACK ON THE EXPLORER AND GO IN AT A 45 DEGREE ANGLE. THIS IS YOUR CORNER READING OF THE RIDGE.
  6. TWO OR THREE MORE MEASUREMENTS ARE MADE PERPENDICULAR TO THE FIRST ON THE BUCCAL SURFACE.
  7. REPEAT ON THE LINGUAL/PALATAL SIDE OF THE IMPLANT SITE.

 

 

YOU WANT TO KNOW AS MUCH ABOUT THE CHARACTER OF THE BONE AS POSSIBLE. BONE SOUNDING GIVES US CLUES ABOUT DENSITY AS WELL AS SHAPE. IF THE EXPLORER PENETRATES THE BONE UPON MODERATE PRESSURE, REPEAT THE MEASUREMENTS IN THE SAME BLEED MARKS, WITH THE ROUND END OF THE PERIO PROBE TO VERIFY DEPTHS. YOU SHOULD NOT BE ABLE TO PENETRATE THE CORTICAL SURFACE OF THE BONE WITH THE PERIO PROBE USING MODERATE HAND PRESSURE. IF YOU DO, YOU MAY WANT TO USE A PILOT DRILL OF A SMALLER DIAMETER THAN THE SIZE RECOMMENDED FOR THE IMPLANT YOU ARE PLACING. THIS IS ESPECIALLY TRUE IF YOU ARE PLACING A SELF-TAPPING MINI IMPLANT.

PLACING AN IMMEDIATE LOAD IMPLANT AND A PROVISIONAL CROWN IN ONE APPOINTMENT IS THE MOST SATISFYING PROCEDURE IN DENTISTRY TODAY! EVEN WHEN YOU HAVE AN ORAL CT SCAN OF THE SITE, BONE SOUNDING AND RIDGE MAPPING EVERY CASE WILL INCREASE YOUR SUCCESS RATE!

BONE SOUNDING SETUP / PHOTO BELOW

A. MIRROR (BUT YOU KNOW THAT).

B. ENDO EXPLORER WITH ENDODONTIC STOPPER - USE FIRST FOR TISSUE DEPTH MEASUREMENT.

C. PERIO PROBE ROUND END WITH ENDODONTIC STOPPER - OFTEN WITH SOFTER RIDGES, YOU WILL FIND THE ENDODONTIC EXPLORER WILL SINK INTO THE SURFACE OF THE BONE, THEREBY DISTORTING AND EXAGGERATING YOUR SOFT TISSUE MEASUREMENTS. WHEN THIS OCCURS, FOLLOW UP WITH THE ROUND END IN THE SAME SPOT TO VERIFY THE MEASUREMENT. THE ROUND END SHOULD NOT SINK INTO THE SURFACE OF THE BONE WITH MODERATE PRESSURE. IF THE ROUND END IS ABLE TO PIERCE THE BONE AT THE POINT YOU PLAN MAKING A PILOT HOLE, YOU MUST RECONSIDER THE SIZE OF PILOT DRILL YOU PLAN ON USING OR NOT USE A DRILL AT ALL!

D. ENDODONTIC SPREADER - WITH EXTREMELY SOFT RIDGES, YOUR CHOICE IS TO ABORT THE IMPLANT PROCEDURE OR ATTEMPT IT BY SPREADING THE BONE WITH OSTEOTOMES. WHEN PLACING A NARROW DIAMETER IMPLANT, IT IS POSSIBLE TO USE A PERIO PROBE AND AN ENDODONTIC SPREADER TO CREAT A USEFULL OSTEOTOMY.

E. MM RULER - WHITE RULER WITH BLACK PRINTING SEEMS TO WORK THE BEST. CUT THE END OF THE RULER OFF AT THE ZERO MARK FOR EASY READING.

F. ENDO STOPPERS - FOR BONE SOUNDING ONLY. KEEP THEM SEPERATE FROM THE ENDO SUPPLIES. IT'S SIMPLER TO HAVE EVERYTHING TOGETHER ON SURGERY DAY.