Drilling Sequence For Placing Mini Implants & Mono Implants

Good morning and welcome to the Shatkin F.I.R.S.T.® Monday morning minute.

Hi, I’m Dr. Todd Shatkin, and welcome to this Monday morning Minute. We’ve had a lot of questions about the drilling sequence for placing mini implants in modern mono implants and what size pilot drills to use, how deep should we drill the pilot holes? And so I thought I would do a little refresher on pilot holes for the mini and mono implants today. So let’s go over that a little bit here.

So, as you know, we use our 1.2 millimeter spdl the single patient pilot drill long. That’s what the L stands for. We usually use the Spdl. The Long Single Patient Pilot drill. And it’s a 1.2 millimeter pilot drill, and they come in an individual package, and you use it for one patient. That’s why it’s called a single patient. And why is it that we use it for a single patient? It’s because these pilot drills are very, very thin. And if you start autoclaving them, they can become very brittle, and they could possibly break off in the patient’s jaw. And you don’t want that to happen. These are titanium pilot drills, but if they break off in the patient’s jaw, you’re going to have to go retrieve it, and that can be difficult.

So that’s why we recommend using a brand new one for each patient. I know for a fact some of you don’t do that, and I’m a little concerned about that because you will potentially, if you autoclave it one or two times, they will get brittle, and it could break in the patient’s jaw. So please use a brand new one. It’s not that cost difference that it’s worth taking that risk. Okay?

The next thing you need to know is if you’re using a surgical guide stent, which we highly recommend for your cases, and you use the surgical stent with a pilot drill guide, which is how you should use it. The pilot drill will be self limiting. You’ll drill your pilot hole all the way down till it touches the surgical guide. The drill guide, okay, the pilot drill guide. So you don’t have to worry about the depth of drilling when you’re using a stent, because it’s already been predetermined to the right measurement that you’re going to drill. You’re going to drill all the way down until the drill hits the drill guide. Then you’re going to take it out, take the drill guide out, and screw your implant right through the surgical guide stent.

Okay? So that’s something to remember. You don’t have to be that concerned about how far to drill your hole when you’re using the drill guide. Now, if you’re not using a drill guide, if you’re free handing the implant, or if you’re doing a case with immediate extractions, then you have to think about, how deep should I drill the pilot hole? The 1.2 millimeter pilot drill you’re going to drill it about 50% for type three bone, about 60% for type two bone and about 80% for type one bone.

Now, I’m talking about the length of the implant. You’re going to drill about 80% of the overall length of the implant for a type one bone. So, for example, if we’re using a 15 millimeter 2.0 implant in type one mandibular bone, you’re going to drill about 80% of that, which would be about roughly 12 mm. Okay? Now, if you’re going to go into type two bone, you would drill 60%, which would be approximately 10 mm if you’re using a 15 millimeter implant. And if you’re going to go into type three bone, you’ll drill about half of the length of the 15 millimeter implants, or about seven and a half millimeters.

Does that all make sense? So you understand 50, 60 and 80 for type three, two and one. The denser the bone, the deeper you’re going to drill the pilot hole. Now, the other thing to remember is in very dense bone like that in the anterior mandible, you want to use a 2.0 implant the narrower diameter, because it’s very difficult to screw a 2.5 or a three millimeter implant into very dense bone. So we recommend using a narrow implant in denser bone and in softer bone like the maxilla or the posterior mandible, you can bump up the diameter of the implant to a 25, a 30, a three seven, or whatever you prefer.

Okay, now let’s talk a little bit about the larger implants. Because the 1.2 millimeter pilot drill is used for the 20 and 25 implants only. If you’re going up to a bigger implant like a 30 or 37 or four two, you need to use a bigger pilot drill. So for the 3.0 millimeter mylo O-ball implants, we’re going to go ahead and start with a 1.2. Then we’re going to go to A 1.5 and sometimes to a 2.0. It depends on the density of the bone.

If it’s denser bone, you’ll go to a larger diameter pilot drill. So if you’re doing this typically in the maxilla or posterior mandible and using a 30 mylo implant, you are either going to use up to A 1.5 and sometimes to a 2.0 pilot drill. All right. Now let’s talk about the mono mini implants, the new mono implants. We typically use the 1.5 gold pilot drill as our go-to pilot drill, and we use that for the 30 and the three three mono implants. You don’t need a bigger pilot drill, usually for the 30 or the three three implants. In most cases, a 1.5 will do the trick.

The reason for that is the implant itself comes to a very sharp point, and you can really thread that implant into the bone very nicely. It goes in very smoothly and very nicely in denser bone. You might need to go up to a 2.0 pilot drill for the 33. And if you’re going up to a 3.75 implant, you might use a 2.5 pilot drill. So you’ll have a sequence of 1.5, 2.0, then 2.5. And if you’re even going bigger to a 4.2 mono implant, then you would jump it up to a larger size, even like a two eight or a three two pilot drill.

But rarely do you have to go to those. Usually the 25 is big enough even for the 3.7 mono implant. And if you go to a 42, you might want to use a 2.8. So those are the drilling sequences for the mono implants, the mini dental implants, and the mylo implants. If you have any more questions about the drilling sequence, you certainly can call me or Dr. Powers, and we’ll help talk you through the drilling sequence. And I will see you on the next Monday morning minute. Thanks for listening.