Reliable implantation - with surgical unit Implantmed

Dr. Bergmann, does the new Implantmed surgical unit mean that manual insertion of implants with a hand ratchet is now a thing of the past once and for all?

Dr. Bergmann: Hand ratchets are indeed set to become obsolete. Nowadays, almost all implants are inserted using tools with a torque control. We employ the Implantmed unit for conventional insertions, guided insertions and when using drill templates with a torque limit and a slow speed of 15 to 20 revolutions per minute. The torque curve, the progression and the final torque – once the implant is in its final position – are documented on the display. The operator is therefore able to monitor the progression precisely throughout the insertion procedure.

...and that’s not possible when using a hand ratchet?

Dr. Bergmann: No, but it is important, as the primary stability should increase evenly, i.e., linearly. In the case of conical implants, which are slightly flared at the top, this can result in problems if the dimensions of the preparation are insufficient. The upper, wider part presses against the bone at the end of the insertion and high primary stability is not reached until the process is complete.

And this can be controlled or prevented with the Implantmed unit?

Dr. Bergmann: Yes, because you can assess the entire progression. Another important advantage is the thread-cutter function, which makes insertion into hard bony material considerably simpler. The pre-tapping reduces the compression of the jawbone while screwing in the implant.

Which other indications do you use Implantmed for?

Dr. Bergmann: Ultimately for all standard oral surgical interventions from bone augmentations to apical resections right up to extraction of wisdom teeth. Of course, for the extraction of wisdom teeth you need to use a handpiece with a higher speed than the usual FG contra-angle handpiece. Thanks to different programmes, it is also possible to set and programme the surgical protocols in advance.

When do you switch to piezo technology?

Dr. Bergmann: For sinus lifts, bone splitting and spreading as well as for bone block transplants – in other words, in all cases where precise handling of the available bone substance is required alongside atraumatic treatment of the soft tissue.

The piezo technique is indeed seen as minimally invasive, but is said to take longer...

Dr. Bergmann: Let me stop you there, if I may: the latest piezo devices actually work quickly, so that argument is no longer valid. Nowadays you can perform a sinus lift with Piezomed in around the same time as with rotating instruments, but with a considerably higher degree of safety, as the piezo technique only cuts the hard tissue – the soft tissue is preserved unharmed. In contrast to when using a rotating disk or diamond, there is no risk of nerve damage even when harvesting a bone block in the retromolar region. This makes it possible to rule out injury of the Schneiderian membrane almost entirely when preparing the sinus floor elevation. That is an immense advantage.

And yet the piezo technique still isn’t used universally? Why is that?

Dr. Bergmann: The piezo technique is continuously growing in popularity and even former piezo critics are slowly coming around. In my eye’s it’s a real hit: with the new wireless foot control, Implantmed and Piezomed can now be controlled with just one control unit. There is nothing more standing in the way, no tangled cables and the surgical position always remains the same. As such, the user can concentrate fully on the patient and the oral surgical procedure. Once you’ve tried it, you’ll never go back.

Getting back to the Implantmed unit: operators can continuously check the degree of osseointegration following insertion of the implant and document it together with the torque. Osstell ISQ is the name of the module used to measure the stability. What are the advantages?

Dr. Bergmann: Osstell is the only metrically reversible and scientifically acknowledged method for assessing the primary stability of an implant or abutment – not only during insertion of the implant, but also after healing.

During impression-taking for example...

Dr. Bergmann: …and during follow-ups. It allows us to determine how securely the implant is positioned in the bone. It’s a really simple measurement. I call it an ‘ultrasonic resistance measurement’.

How does it work exactly?

Dr. Bergmann: Once the implant is in place, a special measuring rod is screwed in. W&H cooperates closely with Osstell. There is a measuring rod available for each implant system – the SmartPeg from Osstell. You simply screw the SmartPeg into the implant, position the ISQ handpiece – it looks like a ballpoint pen – at a 90° angle to the implant, and a value appears on the display, which is linear to the extent of the strength and the osseointegration.

And what is so exciting about that?

Dr. Bergmann: The fact that in this way you can monitor the stability at subsequent stages and not just during the insertion. For example, if the primary stability of the implant is low, because it had to be inserted simultaneously to the bone augmentation, it is checked again after three or six months to ensure that the primary stability really is sufficient for the subsequent restoration. This is particularly significant in immediate restorations. The Osstell ISQ module is the only possibility available for measuring the osseointegration again at a later point in time. This can be integrated in a follow-up and is of enormous help when determining the best time for loading.

Are re-adjustments possible if the osseointegration isn’t all that great after a number of years?

Dr. Bergmann: The operator has the option, for example, when considering the superstructure or a peri-implantitis treatment, if there is still an infection present. These considerations are of course based not only on the Osstell ISQ value, but also on clinical examinations and x-rays.