The material, size and geometry of bone drills is adapted to the requirements of different indications. Sonic instruments are also an option in this context. Oral and maxillofacial surgeon Djuza Bulatovic tested various models from the range of Komet instruments and described his experience in an interview.

Dr Bulatovic, for which indications do you choose bone drills from your drawer?
Our dental clinic focuses on implantology, prosthetics, aesthetic dentistry, children’s dentistry, endodontics as well as plastic and aesthetic oral and maxillofacial surgery. We cover the entire range of applications in dentoalveolar surgery. Generally speaking, I use a bone cutter when I need space. For example, this might be necessary when it comes to removing impacted teeth, exposing teeth during the removal of root fragments from the extraction alveolus, or as part of special techniques for alveolar ridge extension or for bone window preparation during an external sinus lift. Depending on the indication, large or small-dimensioned drills are required.

Let us focus on fine bone drills. What effect do fine bone drills have?
A small/fine drill will naturally produce fine incisions. This can reduce trauma to such an extent that healing can take place quickly, without complications and with a good prognosis. The benefit of fine or small instruments is best explained in a bone structure where the bone bed must be preserved. In other words, my primary goal is to prevent damage to the vestibular lamella during the procedure and to preserve the width of the bone ridge. To illustrate this, let’s imagine the cross section of bone. Only if I manage to penetrate the area between the tooth and the bone with a fine/slender instrument, the outer bone wall can be preserved, and I can create optimal conditions for subsequent implant insertion. Likewise, I also perform a sinus lift or apicoectomy only with small- dimensioned bone drills in accordance with state-of-the-art requirements.

You tested the smallest bone drills from the Komet range, i.e., the H254E and the H255E. What was your impression?
The H254E is a small, tapered bone drill with a blue ring marking (length 6 mm, size 1.2 mm at full insertion depth). The penetration depth is only 3 mm and the working part has a diameter of only 0.9 mm. It penetrates the bone gap quickly under optimal control. I have the impression that, thanks to its tapered shape, it adapts to the tooth root more easily than the cylindrical H255E with with black ring. But the latter is also good: thanks to its cylindrical shape, the rotational speed at the tip is higher. The instrument is able to continuously remove 1.2 mm of bone substance, no matter how deep it works.

Dr. Bulatovic, please give your opinion regarding the aspect "view"
The advantage of bone drills with small dimensions is the fact that I do not necessarily have to open the operating field with a flap to ensure clear view. Let me explain this with the example of a tooth that has broken off at bone level and needs to be extracted. In such a case, no forceps will help me. With the H245E or H255E, however, I can carefully penetrate and enlarge the gap, palpate the tooth fragment easily and work precisely, even though I don't have an unobstructed view at that moment. Then I use a luxation elevator in the cavity I have created. The mucosa and the vestibular lamella will remain intact. This procedure fully complies with the requirements of minimally invasive surgery.

 How stable did you find the two bone drills H254E and H255E despite their small dimensions?
I was amazed at how stable both instruments are. Neither instrument broke during use. However, it has to be made sure that under no circumstances they are used as a lever.

Now let's talk about a medium-size model, the H162ST.
The H162ST (working length 9 mm, size 1.6 mm) impressed me very much due to its ST toothing. The special toothing geometry ensures smooth operation without vibrations. The bone drill has no tendency to “jump”. This allows me to work safely under optimal control, and the treatment is also much more comfortable for the patient who can keep calm.

Any vibration of the instrument would mean a highly unpleasant sound conduction for the patient. I use the H162ST when I'm working on hard bones, when I want to create space effectively and when I want to work quickly.

What influence do instruments with high cutting efficiency have on the handpieces and contraangles including the motor?
Instruments with high cutting efficiency are gentle on the handpieces and contra-angles and the motor. Therefore, the practitioner and the practice team are obliged to check the bone drills for damage/wear after reprocessing and, if necessary, replace them by new ones in due time.

All mentioned bone drills can be used in the handpiece as well as in the red or green contraangle. What does that mean for you in terms of practical use?
As a specialist in dental, oral and maxillofacial surgery, my background is in medicine. Therefore, I am used to working with the handpiece. Dentists, on the other hand, usually prefer working with the contra-angle. It is therefore good to have both options at hand.

Do you also have experience with sonic instruments in surgery?
Bone cuts with sonic instruments create incredibly thin bone cuts of only 0.25 mm, such as the sonic tip SFS100/101/102 from the range SonicLine developed by Dr. Ivo Agabiti (Komet Dental).

They are particularly gentle on the neighbouring structures due to their oscillating mode of operation. There is no risk of any soft tissue unintentionally wrapping itself around the instrument. They also do not make the typical drilling sound and are used without exerting contact pressure, which is particularly helpful for patients with dental anxiety. However, the treatment takes longer. I always have to consider which patients are eligible for this kind of treatment.

I would also like to point to the learning curve: The use of sonic instruments needs to be practiced! Given that sonic instruments used in surgery work better on angled structures than on straight structures, a combination of sonic instruments and bone cutters is probably the best option for chairside treatment!

Thank you very much for the interview.

Djuza Bulatovic

2000 State examination Dentistry at the Johann Wolfgang von Goethe Universität, Frankfurt
2006 State examination Medicine at the Johannes Gutenberg- Universität
2007-2012 Advanced training assistant at the central German army hospital, Koblenz
2012-2015 Senior physician at the central German army hospital, department of oral and maxillofacial surgery; further training in the field of plastic surgery
Responsible for hygiene, transfusion and DRG in the department of oral/maxillofacial surgery
Many years of activity in the training of oral surgical assistants in the field of implantology, dental alveolar surgery, traumatology and dysgnathia surgery
2015 Locum doctor at the Marienhausklinikum St. Elisabeth Neuwied and in different practices in the region of Koblenz
2015 Registered doctor in the joint practice Dr. Milinko Bulatovic and Djuza Bulatovic in Ebhausen
Since 1st January 2019 Registered doctor in the practice Dr. Dortmann & Bulatovic, Mühlheim-Kärlich

Article Published Sep - Nov 2024 Dental Solutions