Effect of Densah Bur Versus Magnetic Mallet Device on Osseodensification of Narrow Alveolar Ridge for Implant Placement
Phase: NA
Conditions: Alveolar Bone Loss
Sponsor: Al-Azhar University

Protocol Cover Page
Official Study Title:
Effect of Densah Bur versus Magnetic Mallet Device
on Osseodensification of Narrow Alveolar Ridge for
Implant Placement
NCT Number: P-SU-22-02
Document Type: Study Protocol
Document Date: April 1, 2022
Submitted to:
Faculty of Dental Medicine for Girls, Al-Azhar University
In Partial Fulfillment of the Requirements for Doctor
Degree
In Oral & Maxillofacial Surgery
By:
Reham Abdelrahman Abdelsalam
Assistant Lecturer of Oral and Maxillofacial Surgery,
Faculty of Dentistry, Deraya University
Faculty of Dental Medicine for Girls, Al-Azhar University
2022 G

Effect of Densah Bur versus Magnetic Mallet Device
on Osseodensification of Narrow Alveolar Ridge for
Implant Placement
A proposal
Submitted to the Faculty of Dental Medicine for Girls, Al-Azhar University
In Partial Fulfillment of the Requirement for Doctor Degree 
In
Oral & Maxillofacial Surgery
By
Reham Abdelrahman Abdelsalam
B.D.S (2011) El-Minya University
M.Sc. (2019) Al-Azhar University
Assistant Lecturer of Oral and Maxillofacial Surgery,
Faculty of Dentistry, Deraya University
Faculty of Dental Medicine for Girls
Al-Azhar University
1443 H-2022 G
Code
OR SUR-108-1-K

Supervisors 
Dr. Fatma Ibrahim Mohamed 
Professor of Oral and Maxillofacial Surgery, 
Faulty of Dental Medicine for Girls 
AL- Azhar University 
Dr. Hanan Mohamed Reda 
Lecturer of Oral and Maxillof acial surgery 
Faculty of Dental Medicine for Girls 
Al Azhar University 

Introduction
Implant therapy has become an integral part of clinical dentistry,
with ever-increasing numbers of patients seeking such treatment. Several
factors contribute to implant success and can be objectively evaluated.
These include the patient’s healing capabilities, the level and condition of
the existing soft and hard tissues, and the provisional and final
restorations. In particular, hard tissue defects may lead to functional,
structural, or esthetic compromises in the final prosthesis (1).
Alveolar bone resorption after tooth extraction or avulsion occurs
more rapidly during the first years. The loss is predicted to be 40-60% for
the first 3 years then decreases to 0.25-0.5% gross annual loss thereafter.
Extraction of maxillary teeth usually results in a progressive loss of bone
mainly from the labial side. Furthermore, the presence of bone
fenestration or dehiscence during extraction may accelerate the post-
extraction alveolar remodeling, leading to more severe buccal concavity
after healing (2).
Many techniques have been suggested for ridge widening,
including guided bone regeneration (GBR), autogenous bone graft,
alveolar ridge splitting and alveolar ridge expansion (3,4). It was observed
that alveolar ridge augmentation procedures may be more technique-and
operator-experience sensitive, whereas implant survival may be a affected
by the residual bone supporting the dental implant rather than the grafted
bone (5).
As a result, assessment of the jawbone quality provides crucial
information to assisst clinician in choosing the most appropriate implant
planning. According to macroscopic cortical and trabecular bone
characteristics, as well as tactile analogues, bone density of the
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edentulous regions of the jaws was classified into four categories (D1-
D4). Recently, these data were used to compare with anatomical location
and radiographic images (6).
Nowadays, bone density according to this classification can be
measured using CBCT cross sectional views. D3 and D4 bone is
frequently found in the anterior maxilla and posterior regions of both
maxilla and mandible. This type of bone is weaker than D2 type.
Moreover, the bone-implant contact is also less favorable and increases
the risk of implant failure (6, 7).
Ridge expansion techniques allow implant placement in narrow
alveolar ridges (bone types 3 and 4). By increasing bone volume using
the native bone. This technique has shown to be a safe and effective
procedure, with high percentage of survival rate following implant
placement (8, 9). However, limitations of this technique include surgical
trauma and unintentional fracture or displacement of bone, which affect
implant insertion stability (9).
A new concept for osteotomy called Osseodensification (OD),
technique, was which has been developed in 2013. This relatively new
concept uses universally compatible drills, Densah Burs, (10-12) to provide
better osteotomy site preparation and bone expansion at different sites of
varying bone densities. These burs combine advantages of osteotomes
with the speed and tactile control of the drilling procedures. Densah burs
can create a densified layer of surrounding bone through compaction
autografting, while simultaneously expanding the bony ridge, thus
increasing the peri-implant bone density, and the implant mechanical
stability (12).The autografting occurs along the entire length of the
osteotomy through a hydrodynamic process with copious irrigation. As a
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result, the osteotomy is uniformly cylindrical and densified. This
technique seems to be promising in cases where the autologous bone is
poor in quality and quantity (12, 13).
The magnetic mallet (MM) is a novel instrument that can be used
to provide osseo-densification in case of soft bone (D3 and D4), the bone
socket can be formed exclusively by MM, no rotary tools are required. In
a significant number of cases there is no bone loss at all, and in a lesser
rate, there is minimal bone loss, which is just a small part of that
compared to the bone loss made by traditional drills (15, 16). Therefore, it is
considered a minimally invasive technique capable of providing a safe,
predictable, and comfortable surgical procedure that does not result in
bone injury or overheating. Furthermore, it provides better visibility and
maximal bone preservation, which significantly contributes to a reduction
or absence of postoperative complaints (15(.
Therefore, this study will be implemented to compare between the
effect of Densah bur and MM Device on Osseodensification and
expansion of type 3 and type 4 narrow alveolar ridges.
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Aim of the study
The present study will be performed to assess clinically and
radiographically the efficacy of Densah bur and Magnetic Mallet on
osseodensification and expansion of narrow alveolar ridge for implant
placement.
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Subjects and Methods
The present study will be conducted on 12 implants that will be
inserted in type 3 and type 4 narrow edentulous alveolar ridges. The
patients which will be selected from the outpatient clinic of the oral and
maxillofacial surgery department in Faculty of Dental Medicine for Girls,
Al-Azhar University and Deraya University.
All patients will be properly selected according to defined
inclusion and exclusion criteria as follows:
Inclusion Criteria (8):
1- Patients with partial edentulous alveolar ridges with adequate
alveolar bone height and deficient width and density.
2- Patients with good state of health and free from systemic or local
pathosis that may influence the outcome of the therapy.
3- Good oral hygiene.
4- Age above 18 years.
5- Agreement to participate in the study and also have to be able to
attend postoperative clinical and radiological follow-up schedule.
Exclusion Criteria (8):
1- Patients with para-functional habits such as bruxism and clenching
or abnormal occlusal relationship that may complicate the future
restoration.
2- Patients with bad oral hygiene or smokers.
3- Patients with uncontrolled systemic disease.
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