The procedure is usually performed without flap elevation in order to contain the sub-periosteal bleeding, avoid bacterial contamination, and maintain the peripheral blood supply. One 3g dose of amoxicillin (flash) is given orally, followed 20 min. later by antisepsis of the operative field (2% chlorhexidine or 10% povidone-iodine).
A local anesthetic containing adrenaline (1:200,000) is slowly injected using a diameter 0.30 mm, silicone-coated, beveled-edge needle. Apply the anesthesia only to the surface of the impact zone. The needle must stop at the cortical plate. After muco-periosteal anesthesia, bone penetration by the Osteotensor® is painless.
Number of impacts: Excessive numbers of impacts must be avoided. One vertical impact at the crestal level (minimum depth 8 mm) suffices for incisors and canines; two are enough for premolars and molars. The distance between two intrabony impacts must be no less than 3 mm.
Disinfect the Osteotensor® after each impact (10% povidone-iodine).
MANUAL VS ROTARY OSTEOTENSOR
Always begin with a manuel Osteotensor®. In particular, in case of type I, II or III bone, do not use a rotary Osteotensor® until the bone has first been tested with a manual Osteotensor®. For type IV bone, use only a manual Osteotensor®.
As soon as hard, dense bone is encountered, Switch from the manual version to a rotary Osteotensor®:
- crest ≥ 8 mm wide: large ø rotary Osteotensor®
- crest ≤ 8 mm wide: small ø rotary Osteotensor®
Rotation speed for rotary Osteotensors® : use 1:1 handpieces at 20,000 rpm with abondant spray to avoid heating. Do not work at low speeds. Make only one impact per tooth (depth ≥ 3 mm).
Silicone stops (suitable for autoclave sterilization) and tip protectors
- remove the silicone tip protector before use
- placement of a stop on the Osteotensor® controls the depth of penetration
- Red 14 mm
- Blue 12 mm
- Yellow 9 mm
Diamond-like carbon tip, 16 mm
2 mm working tip
4 mm working tip
6 mm working tip
16 mm working tip
Rotary Osteotensors® for handpiece
Ø 0.8 / 1 mm Ø 1.20 / 1.40 mm
Total length : short 33 mm long 40 mm
Total tip length : 13 mm
INTERVAL BETWEEN OSTEOTENSOR® APPLICATION AND THERAPY
- When an increase in bone density is desired : wait 45 days, then recheck the bone density. If necessary, the procedure can be repeated up to three times at 45-day intervals.
- When « bone softening » is sought (type I bone): wait 21 days then perform the desired act (tooth removal or crest expansion for example)
- Orthodontics: there is no waiting period, but the orthodontic device must be in place before application of the Osteotensor®
CLEANING AND STERILIZATION
This fragile dental instrument must only be used for its intended purposes in order to maintain efficacy and durability. Inspect the instrument after each use to detect any pitting, wear, discoloration, etc. Any instrument presenting one of these defects or any other defects should be discarded.
Be careful when cleaning and sterilizing the instrument. In particular, be careful not to damage the diamond-like carbon tip of the instrument. Never brush or scrape the tip ; use an antiseptic wipe to clean the tip. Respect the concentration of chemical product recommended by the manufacturer.
Cleaning should be performed respecting standard dental protocols. Sterilization should be performed in an autoclave at 135° C (minimum time 18 minutes).
The silicone stops (yellow, blue, red) are reusable and can be sterilized in an autoclave. They must be decontaminated and cleaned before sterilization. Place the selected stop on the Osteotensor® tip before sterilization in the autoclave. Replace stops as soon as they show signs of wear. Stops can be shortened as required.
NUMBER OF USES
- Type IV bone: no limit so long as visual inspection does not reveal any damage to the tip or the diamond-like carbon surface
- Type I, II, III bone: number of uses limited by visual inspection and the operator’s sensation during bone penetration (the Osteotensor® must penetrate the bone easily, without heating)
The bone density should always first be checked using a manual Osteotensor®.
- if natural teeth remain, avoid penetrating the periodontal ligament (leave a safety margin of at least 1 mm), unless plans call for extraction ofthe tooth 21 days later
- the first impact should be made perpendicular to the vestibular alveolar wall, at least 2 mm beneath the bone crest
Example (2 mm minimum between impacts)