Maintaining primary stability and accelerating secondary stability are essential for AnyTime Loading, allowing implants to be placed and loaded without the usual delays caused by a stability dip. In our previous discussions, we questioned traditional loading times and explored immediate and early loading options, highlighting how careful management of stability is key to successful outcomes.

‘No Stability Dip’ theory and Neobiotech’s innovative implant designs were introduced as groundbreaking approaches that help maintain implant stability throughout the critical healing phase.

Now, we shift our focus to the ‘Drilling and Placement Protocol’ specifically designed for AnyTime Loading. This protocol aims to maximize bone-implant contact (BIC) and maintain stability across different bone conditions, ensuring optimal fixation even in challenging environments. By understanding these advanced techniques, clinicians can minimize bone loss, enhance primary stability, and ultimately provide faster and more predictable results for their patients.

The Need to Minimize Bone Trauma

Minimizing bone trauma, especially in dense cortical bone, is essential for achieving the optimal primary stability. So, how can we ensure the stability required for AnyTime Loading while avoiding the risks of over-compression or bone damage?

To achieve this, we need fixation 1) from every part of the implant and 2) across all bone densities. We need to consider whether the traditional drilling protocols and implant systems are truly capable of achieving optimal stability.

Understanding Bone Density and the Challenges in Implant Placement

Usually, bone density is divided into three types: soft bone, moderate bone, and hard bone. This classification is well known among dental professionals. However, in real clinical settings, implants rarely encounter just one type of bone density. Instead, implants are often surrounded by a combination of bone densities, varying in different parts of the implant site. For instance, while a case classified as soft bone may have a denser crestal area of hard bone.

The Limitations of General Drilling Protocols

Let’s take a closer look at the general protocols used for drilling and implant placement in clinical practice. In mixed-density scenarios, where a site classified as soft bone actually has a hard bone crestal area, we need to examine the stability and potential outcomes of using general protocols.

Protocol for Soft Bone

For soft bone, the standard practice is to use undersized drilling, also known as “1 less step drilling.” Clinicians assess the bone density and proceed with undersized drilling. The implant is then placed through self-compression and self-tapping, which helps achieve a stable fit in less dense bone. However, this approach can sometimes lead to over-compression in the coronal area of the crestal bone, compromising the implant’s stability.

Protocol for Hard Bone

When dealing with hard bone, the full diameter drilling is performed, following every step of the drilling protocol. This may involve widening the crestal area or using countersink techniques. However, this can result in excessive widening, leaving only the tips of the implant threads in contact with the bone, which compromises fixation. While this limited engagement may suffice for conventional loading, it falls short of the primary stability needed for AnyTime Loading.

Optimal stability for AnyTime Loading requires fixation from the entire implant body, not just the threads (Maximum BIC). Excessive crestal widening can concentrate stress in narrow contact areas, leading to bone resorption and even peri-implantitis, ultimately compromising implant stability. Thus, standard protocols, while providing adequate torque, may not ensure the robust stability required for immediate or early loading scenarios.

The Solution: CMI Implant and Drilling Protocol

As a result, these single-density protocols do not always provide the optimal stability required for AnyTime Loading in cases where bone density varies. It is important to understand that implants often encounter a combination of different bone densities within a single site. Recognizing this complexity, we must follow protocols designed to achieve maximum bone-to-implant contact (BIC) across all bone types. This is why Neobiotech has developed not only the CMI Implant but also the CMI Drilling Protocol to address these challenges effectively.

Summary & Next Step

As we've discussed, traditional implant drilling protocols often fall short in providing the comprehensive stability needed for AnyTime Loading, particularly in complex bone conditions. This highlights the need for advanced solutions that directly tackle these challenges.

In the next post, we will introduce the CMI fixation, a revolutionary method designed to enhance fixation and stability across all bone types. This innovative approach promises to overcome the obstacles presented by conventional techniques—stay tuned to learn how it can redefine your implant practices.