SURGICAL PROTOCOL

Continuous moderate longitudinal pressure during implant insertion

With copious irrigation, perforate the alveolar crest.
With copious irrigation, drill a pilot hole in a speed of 800–1200 RPM, to the appropriate depth marking on the drill.
Depending on implant diameter and the density of bone at the osteotomy site, it may be necessary to utilize one or more of the Surgical Drills to widen the osteotomy.
Apply firm pressure and begin slowly rotating the implant in a C.W direction with a max. speed of 15 RPM.

Recommended insertion torque: 35-60 Ncm.
Procedure recommended by SMART cannot replace the judgment and professional experience of the surgeon.
Drilling with the marking drill should stop upon penetration of the cortical bone.

NARROW RIDGE PROTOCOL

A buccal and lingual wall thickness of >1.5 mm is recommended at the time of implant placement.
Once the implant site has been determined, mark it with the marking drill at 1200 – 1500 RPM for penetrating the cortical bone. Use copious irrigation with sterile water or saline solution to prevent overheating of the bone.
Proceed with 2 mm drill diameter at the same conditions.
Insert the implant in a low speed and moderate longitudinal force concurrently for splitting the ridge during implant insertion.

Notes:

During implant insertion It is recommended to stop every 2mm for letting the peri – implant to adapt.

Bone type D1 is counterindication for such application.

Recommended insertion torque: 35-60 Ncm.
Procedure recommended by SMART cannot replace the judgment and professional experience of the surgeon.
Drilling with the marking drill should stop upon penetration of the cortical bone.

Assessment of the thickness of the sinus floor by x-ray imaging.
Use of a 1.5 drill in 800 RPM with irrigation till reaching the sinus floor.
Use a moderate vertical force with the same 1.5 drill in non-rotational mode to assess sinus floor hardness. If according to the x-ray and the feedback from the drill is of thin flexible wall, insert the by a rotational and vertical force simultaneously, if the feedback is of a hard sinus floor, keep going deeper with the same drill for having thinnest floor to facilitate SMART insertion.
Insert the implant gently in a C.W direction till reaches the sinus floor.
Note: make as much turns and move slow before reaching the floor to collect and move as much bone to the apex of the implant.
Apply rotational and mild vertical force concurrently for bumping up the sinus floor.
Note: make sure that the sinus floor yield to the vertical force.
Keep moving the implant to the desire position till reaching a maximum torque level.
Note: The sinus floor is playing a crucial role during floor elevation. As long as it not too thick and not too hard, it must be intact or with smallest hole diameter than the 2.4 mm apex diameter to assure optimal results.

Surgical Manual-7.5.5.00.10