Is osseo-densification associated with higher risk of pain and swelling?

Recently had a patient with narrow ridge, and I used Densah drills to expand the ridge. My first use of osseo-densification technique. The surgery to place 15 (FDI) went fine but patient reported pain and swelling one day after surgery, and the pain and swelling (minor) has subsided slightly when I saw her two days after surgery. I placed fixture using cutting drills to replace 24 (FDI) for this patient 3 years ago, and there was no post-surgery pain or swelling.

I use cutting drills and pain and swelling is rare, even with ridge splits. Will appreciate response from those who have more experience to make the comparison.

Timothy Carter comments:

I wish I could provide some feedback based on experience but I have never used the Densah protocol for this reason. I have always thought that it seemed rather counterproductive from a biological perspective as I still can't grasp why we are so ate up with the concept of primary stability from an insertion torque standpoint. Most experienced surgeons I have talked to will agree that most of our failures have come with fixtures placed at high insertion torque... whatever that critical value is remains controversial and is dependent on the implant system being used. The Densah protocol appears to be designed to maximize insertion torque under the false pretense of primary stability and IMHO can easily lead to overheating of the bone.

Matt Helm DDS comments:

Agreed on this one 100%. Overheating and vascular compression go hand in hand with so-called "osseodensification". And primary stability is over-hyped and overrated, specially considering that, in a proper world, one still has to wait the requisite 3-4 months in the madible and 6 months in the maxilla prior to proceeding with restoration. Your surgeons agree with mine: most failures are caused by overheating, often generated by excessively high final insertion torque.


I totally agree.

Gil Garalnick comments:

I have placed around 30 implants using osseodensification to widen the ridge. Unfortunately in the mandible I had several failures always associated with a lot if pain I will generally only use Densah drills in the maxilla unless the bone is particularly soft in the mandible, which is rarely the case It seems to me that the densification of the bone causes compression of the blood vessels and creates a "dry socket" unless used in very soft bone

Alex comments:

Salah Huwais, inventor of Densah burs, said " densify only if you have something to densify" - showing CBVTs of mandibles rich with trabecular bone. Not every slim ridge is amenable for densah protocols. Trick is to learn when to use Densah drils and greater trick to learn to "feel" them.

Dennis FlanaganDDSMSc comments:

Ridge split requires primary closure and antibiotics

Timothy Carter comments:

How and why are you so sure about this statement which has absolutely nothing to do with the original post???

Sean Hunt comments:

Thank you for the replies.