Surgical Placement: Latch Reamers

Latch Reamers

During the preparation of an osteotomy, the latch reamers should be rotated at a maximum of 50 RPM without irrigation. The 400:1 handpiece will provide sufficient speed reduction and increased torque to appropriately prepare an osteotomy.

1. Using a surgical template, an 18:1 reduction handpiece, and a 2.0mm pilot drill, make the initial penetration into the ridge at approximately 1,100 RPM with external sterile irrigation. The pilot bur must completely penetrate the crestal cortex.
2. Place harvested autogenous bone, intermittently removed from the flutes of the reamer burs, into a silicone dappen dish for later use.
3. The reamers are used sequentially beginning with a 2.5mm diameter and ending with the diameter of the intended implant. The newest reamers have horizontal markings at 6.0, 8.0, 11, 14 and 17mm, whereas older reamers may have different markings. It is imperative that the depth indicators on the latch reamers are identified prior to surgery. No assumptions should be made about the height of the first marking on any latch reamer.
4. Drill to the depth that will allow the chosen implant to be seated below the bone. For aesthetic reasons the implant should be placed 5.0mm below the buccal gingiva.

Keys to Success

• To facilitate removal of the reamer from the osteotomy, continue rotating the reamer while it is being withdrawn.
• In very dense bone, it may be necessary to use the 2.5mm and 3.0mm latch reamers at a speed of approximately 1,100 RPM with external sterile irrigation to prepare an osteotomy.
• Avoid clogging the reamer flutes with bone shavings since the bony walls of the osteotomy may become overheated due to friction.
• Using latch reamer burs in excess of 50 RPM may result in overheated bone and the subsequent failure of the implant to osseointegrate.
• Irrigation is not recommended since it dilutes the blood in the socket and in the harvested autogenous bone, which may inhibit healing.
• It is not necessary to use all reamers in creating an osteotomy. One must only finish the osteotomy with the final reamer and a reamer that is 0.5mm smaller than the final reamer. For example, when drilling to a width of 5.0mm one must finish the osteotomy with 4.5mm and 5.0mm reamers.