Use Of The Surgical Motor By Shatkin F.I.R.S.T.

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

Good morning and welcome to this Monday morning minute. I’m Dr. Todd Shatkin and I want to talk to you today about the use of the surgical motor from Shatkin. First, it’s manufactured for us, private, labeled by aseptico. It’s a great motor. It’s our workhorse. We use it every day in our office. I’ve got about five of them in my office. I go from room to room doing mini implants. And this machine has been a godsend for our practice. And what’s great about it is aseptico has pre programmed the motor for the Shatkin F.I.R.S.T.® Technique.

The first setting at number one is called the pilot drill setting. The pilot drill is placed in the bone at 2000 RPMs. 55 newton centimeters with 30% water flow. Now if you have a motor, one of these motors and it’s not preprogrammed, we can send you a little card, an SD card that you can put in the back of it and program it for the shack and first technique in case for some reason the program got lost or unprogrammed. Now once you place your pilot hole, the next step you need to do is what we call the torque test.

Start implant torque test. And the torque test measures the amount of torque, the newton centimeter torque that the implant is going into the bone. Now if you came to one of our shack and first seminars, you may recall that the minimum torque that we need to restore a mini implant the same day to load it the same day is 30 newton centimeters of torque. Now this motor is set to 30 newton centimeters of torque at 35 RPMs.

So you’re going to go ahead and place the implant through that pilot hole with the motor until you hear the beeping sound of 30 newton centimeters of torque. Once you get to 30 newton centimeters of torque, you know you’ve got enough torque resistance to load that implant immediately. That means you can pick up the housings or you can cement a crown or multiple crowns on multiple implants. Now once you get to 30 newton centimeters of torque, you go to setting number three. Now keep in mind all of these controls can be controlled by the foot pedal. You don’t need to touch this keypad to control that. But I’m touching the keypad now to show you.

Now setting number three is our final implant placement setting. This setting is set to 60 newton centimeters of torque. Now, 60 newton centimeters is at the upper range of the torque resistance we want to have. The maximum torque resistance we want is 70 newton centimeters of torque. Beyond 70, a couple things can happen. Number one, the bone can be compressed too much and you can end up having osteonecrosis and you’ll lose the implant.

Number two, if you get too high, you can break the implant because the implants break around 80 newton centimeters of torque. So 70 newton centimeters of torque is the maximum we want. We have this set to 60 because that gives you a really good idea of where you’re at. It’s very rare that you get to 60 newton centimeters of torque and you can’t place the implant the whole way. If that happens, you can increase the torque by pushing the torque up button here up to 70. We do not recommend you going past 70 torque on the mini implants.

If you get to 60 and the implant is only about halfway in back, the implant out, drill deeper and sometimes even go up to a wider diameter drill, like a 1.5 drill, to make it a little wider and deeper so that you can go back in and put that implant all the way in without going past 60 newton centimeters of torque.

Okay, so just to recap that, you’ve got your pilot hole, you’ve got your torque test, and you’ve got your final placement of the implant. Now, what happens if you don’t get to 30 newton centimeters of torque on your initial torque test? That’s a great question. What do you do if you don’t get to 30 newton centimeters of torque? Well, if you have multiple implants, let’s say you’re doing eight to ten implants for a roundhouse, and nine out of ten get to 30 newton centimeters, but one of them doesn’t. I’m not too worried about that because the other ones will take up the slack, and you can still load that restoration with either a denture or a roundhouse temporary or whatever it is you’re putting in.

If you have, say, four implants and three out of four reach over, 31 doesn’t, but it still seems solid when you tap on it with your mirror handle, you’re okay to cement your final bridge on that. Okay, if it’s a single tooth and you don’t get the 30 newton centimeters of torque, do not put a crown on it. Okay, two options you have. One, which I usually do, is I’ll take that implant out and go to a wider diameter immediately.

So if I’m doing a 2.0 or 2.5 and I don’t get the torque I want, I’ll take it out, I’ll go up to a 3.0 or a 3.75 right in the same hole, and 99% of time will reach that 30 newton centimeters of torque with a wider diameter implant. So that’s your first option. Second option is if you feel like the implant is really solid, just didn’t quite get to 30, you can leave it without loading it. So how do you do that? Well, if it’s a crown or bridge, put a temporary healing cap on it. Leave it out of occlusion and don’t touch it for about four weeks. You can also splint it to the adjacent teeth with a temporary restoration, but keep it out of occlusion. That’s another option.

If it’s in a denture. What do you do? Well, in a denture, what I would do is I wouldn’t put the housing on. I would probably put a healing cap on it, cut the healing cap down so it’s not touching the denture at all, and hollow out the denture so it just seats over without any resistance and it just passively fits over that particular implant.

You always want to put something on the implant to keep that soft tissue from swelling up around the neck of the implant. But if you don’t reach 30 newton centimeters at torque, my first choice is take that implant out, put a bigger one in, and you’ll probably get to that 30 newton centimeters of torque. I hope this Monday Morning Minute was helpful to you and I look forward to seeing you on the next Monday Morning Minute.