Oral & Craniofacial Implants Study Day · Friday 7 August 2026

The afternoon.
Two stations,
fifty minutes each.

You have been on rungs 0–8 of the ladder all morning. From 14:00 you can only stand on two of them: native bone, and native bone plus a graft. That is not a limitation of the day. It is the honest limit of a jaw model, and it is where the hands go.

20registrars

3groups

50minutes per station

1faculty per bench

Before anyone picks up a handpiece

Three rules for the next three hours.

1

Eye protection stays on.

Bone chips and irrigant travel. Glasses on from the moment a bur is in a handpiece to the moment the last tray is cleared.

2

Nothing sharp is passed hand to hand.

Onto the tray, then picked up. Blades, drills, taps, trephines, chisels. A crowded bench is the exact geometry in which this goes wrong.

3

Irrigate as if it were a patient.

The model does not care about heat. You are here to build the habit, not to make a hole. If you would not do it in theatre, do not do it at this bench.

Industry supplies the kit, not the content. Sweden & Martina have provided the fixtures, drills, models and biomaterials. No commercial figure on any slide this afternoon is being taught as evidence — where a number comes from a catalogue it is flagged as such.

Where you are, and when

The rotation.

	14:00 – 14:50	14:55 – 15:45
A · Osteotomy	six — one per drill	a fresh six
B · The graft	everyone else	everyone else

14:50 swap — five minutes, benches reset by faculty not by you

15:45 models to the scan queue · break

17:00 debrief

Your model from Station A goes to the scan queue, not back in the box. Deviation is measured after the afternoon, in a batch, so the reveal at 17:00 is a moment rather than a trickle.

What is on your bench

One system, all afternoon.

Sweden & Martina Shelta Power — conical core, conical thread, rounded apex. Six instrument kits on the benches. The tray is colour-coded and numbered in the order you use it: if you are ever unsure what comes next, the tray tells you.

2	fixtures per trainee at the drill — ø 3.80 and ø 4.25, both 10.0 mm, placed adjacent	kit list
24	dummy fixtures: 12 × SH-ZT-PS380-100 and 12 × SH-ZT-PS425-100	kit list
10–70	Ncm range of the CRI5-KIT ratchet, individually calibrated at manufacture	S&M kit spec

Two diameters means two final drills and two cover screws. Everything before that is shared.

Shelta Power surgical tray, instruments numbered in sequence order — The tray is the protocol. **Green column is the ø 3.80, blue is the ø 4.25** — and the 10 mm row is the one you want in both. Sweden & Martina, *Shelta Power* product overview. Reproduced for kit familiarisation.

Diameter, length, and the core inside

Read the small number, not the big one.

Table of Shelta Power fixtures with outer diameter, length and apical core diameter — Every cell carries two diameters: the outer thread and, below it, the core. Sweden & Martina, *Shelta Power* product overview. Reproduced for kit familiarisation.

Your ø 3.80 apex is 2.20 mm. Your ø 4.25 apex is 2.55 mm. The conical drill is cut to that core, not to the thread — the thread is what cuts its own path into bone and generates the primary stability you are about to measure.

Observed: the catalogue gives both diameters for every fixture. Inferred, and the thing that actually matters: when you over-prepare, you remove the bone the thread was going to engage. The torque reading is the first place it shows.

Station A

The osteotomy.

Partially edentulous mandible, one posterior span, two adjacent sites. A ø 3.80 and a ø 4.25 Shelta Power, both 10 mm, with 3 mm of bone between them.

50minutes

2fixtures each

3 mmbetween them

→scan queue

The number the whole protocol is built around

47 °C for one minute.
Everything else is a consequence.

Graded drills, controlled speed, copious irrigation, sharp burs. Those are not four conventions. They are four defences against one threshold, and the bone does not warn you before it is crossed.

47 °C	one minute of exposure is enough to cause bone necrosis at the osteotomy wall	Eriksson & Albrektsson
0	sensory feedback you will get from the model, or from the patient, when you cross it	—

This is the only irreversible thing you can do at this bench that leaves no mark.

Graded drills — each step removes a thin annulus, not a bolus

Controlled speed — heat rises with rpm and with axial load

Copious irrigation — external, and internal where the drill allows

Sharp burs — a blunt drill burnishes; burnishing is friction

Pressure and persistence — the instinct when a drill stops cutting is to push. That is the failure mode.

Shelta Power · conical

Three shared drills,
then one each.

Shelta precision drill, pilot drill, 2.50 mm intermediate drill and the depth stops — Steps 1–3 and their stops, as the tray presents them. Sweden & Martina, *Shelta Power* product overview. Reproduced for kit familiarisation.

The sequence, and what each step is actually for

#		code
1	Precision drill — marks the point, breaks the cortex, sets nothing else	FS-230
2	Pilot drill — this is the drill that decides each axis	FPT3-200-LXS
3	Intermediate ø 2.50 — first widening, still correctable	SE-FK250
—	One stop for both of those, at 10 mm	CSR-STOP-2028-100
4a	Final conical for the ø 3.80 — green	SH-FK380-100 + SH-STOP4-FK380
4b	Final conical for the ø 4.25 — blue	SH-FK425-100 + SH-STOP4-FK425
5	Bone tap — dense bone only; in soft bone it costs you stability	SH-MS-380-CA · SH-MS-425-CA

Step 2 is the whole station. Everything after the pilot drill widens a hole you have already committed to. If an axis is wrong at 2.00 mm it is wrong at 4.25 mm, and no later drill will rescue it — and with two sites there are two of them to get wrong.

Station A · the osteotomy, step 1 of 9

Two fixtures, one ridge

SH-ZT-PS380-100 · SH-ZT-PS425-100Centre to centre is 1.90 + 3.00 + 2.13 = 7.03 mm. Mark that before anything turns.

Station A · the osteotomy, step 2 of 9

Mark both sites

FS-230Both marks before any pilot. Once you have widened one, the other is much harder to move.

Station A · the osteotomy, step 3 of 9

Pilot Ø 2.00 mm — both sites

FPT3-200-LXS + CSR-STOP-2028-100One stop serves both. The drill that decides each axis, and the last point either is cheap to move.

Station A · the osteotomy, step 4 of 9

Two pins, not one

PPTL-2-28Parallel to each other first, then to the neighbours. Converging pins are converging fixtures.

Station A · the osteotomy, step 5 of 9

Widen to Ø 2.50 mm — both

SE-FK250 + CSR-STOP-2028-100Follow each pilot hole. A second hole beside the first is two holes, and neither of them holds.

Station A · the osteotomy, step 6 of 9

Now the two sites diverge

SH-FK380-100 · SH-FK425-100Green column for the Ø 3.80, blue for the Ø 4.25. Say the code out loud before you pick it up.

Station A · the osteotomy, step 7 of 9

Tap — dense bone only

SH-MS-380-CA · SH-MS-425-CAShelta has a conical core and a conical thread. In D3 or D4 it condenses for you — skip the tap.

Station A · the osteotomy, step 8 of 9

Both fixtures, torque recorded

EASY4-EX230-EX · CRI5-KITTwo numbers per model. Read each at the moment it stops turning, and write it down at the bench.

Station A · the osteotomy, step 9 of 9

Cover screws, then close

SH-VT-380-VE (green) · SH-VT-425-BL (blue)One screw per diameter. Probe both fully home, then lift the instrument off the flap.

Where the two sites stop being the same operation

One tray, two columns.

Everything that differs between your two sites

#		code
ø 3.80	Final conical, green	SH-FK380-100 + SH-STOP4-FK380
ø 4.25	Final conical, blue	SH-FK425-100 + SH-STOP4-FK425
ø 3.80	Bone tap · cover screw, green	SH-MS-380-CA · SH-VT-380-VE
ø 4.25	Bone tap · cover screw, blue	SH-MS-425-CA · SH-VT-425-BL

Final conical drills, colour-coded per fixture diameter — Colour is the only thing standing between you and the wrong final drill. Sweden & Martina, *Shelta Power* product overview. Reproduced for kit familiarisation.

A conical fixture in a conical osteotomy self-centres and picks up torque fast. That is the selling point and it is also the trap: the last half-turn is where over-torque happens, and on a conical body you will feel it arrive suddenly rather than gradually. Twice, on this model.

Observed: every step up to ø 2.50 is shared between the two sites, and one stop covers both. Inferred: that the mistake this bench will actually produce is a ø 3.80 drill in the ø 4.25 site, at the one step where nothing is shared.

Final cylindrical drills, colour-coded per fixture diameter — Colour is the only thing standing between you and the wrong final drill. Sweden & Martina, *Shelta Power* product overview. Reproduced for kit familiarisation.

The drill always cuts deeper than the fixture is long

LL is what you read.
LS is what you forgot.

Diagram of drill working length LL and over-preparation length LS with depth notches at 7.0 to 18.0 mm — LL is the working length including the tip. LS is the over-preparation — the height of the tip itself. Sweden & Martina, *Shelta Power* product overview. Reproduced for kit familiarisation.

Set a stop for a 10.0 mm fixture and the hole is deeper than 10.0 mm by the height of the drill tip. In the posterior mandible that difference is measured against the inferior alveolar canal, and it is measured after you have already made it.

2 mm	the safety margin above the canal — a planning number	3D rules
+ LS	what the drill adds beyond the fixture length, every single time	S&M kit spec

Two millimetres of plan minus an unaccounted LS is not two millimetres.

Depth control, twice over

Notches you read. Stops you fit.

Laser-etched working-depth notches on bone taps and osteotomes at 7.00 to 18.00 mm — The same depth ladder is etched on taps and osteotomes: 7.00 · 8.50 · 10.00 · 11.50 · 13.00 · 15.00 · 18.00 mm. Sweden & Martina, *Shelta Power* product overview. Reproduced for kit familiarisation.

The conical stops are per diameter, not per depth

#		code
—	One stop for the pilot and the ø 2.50 — use the -100	CSR-STOP-2028-085 … -150
—	Stop for the ø 3.80 conical drill	SH-STOP4-FK380
—	Stop for the ø 4.25 conical drill	SH-STOP4-FK425
—	Depth gauge	PROF3

Observed: the pilot and intermediate stops carry the depth (-100 is your 10.0 mm), but the conical stops carry the diameter instead — the depth is already built into the drill. Two different naming schemes on one tray. Inferred: that is exactly where a tired operator picks up the wrong one.

A stop that is not fully seated fails silently and in one direction only: deeper. Nobody has ever been injured by a stop that was too proud.

The guided side — seat it, then verify it, then verify it again

A guide removes your variance.
It does not remove its own.

Guided kit — note that every drill code ends in its sleeve

#		code
1	Mucotome — punches the soft tissue through the sleeve	GS-MUC-415 · GS-MUC-550
2	Bone profiler — flattens the crest to a known plane	GS-LC-415 · GS-LC-550
3	Initial and progressive drills, sleeve-specific	GS-F200-415 · GS-F200-550
4	Depth-coded drills — diameter, depth, sleeve	GS-F<dia>-<depth>-<415\|550>
5	Countersink, per fixture diameter	GS-FCS-A380 / A425 / A500
6	Fixation pins and pin drill	GS-PIN · GS-FPN-148

Sweden and Martina guided surgery kit tray, showing the two sleeve diameters — Two sleeve diameters, ø 4.15 and ø 5.50. A drill for one will not behave in the other. Sweden & Martina, *Shelta Power* product overview. Reproduced for kit familiarisation.

This is 47 °C coming back, four hours later, in your hands

Irrigation cannot reach the bur
through a sleeve.

verified	sleeve-guided drilling impairs external irrigation and raises bone temperature	Ashry 2021 · Sannino & Gherlone 2018 · Orgev 2020
nuance	not every guided system and protocol behaves identically	Tur 2025

The guide protects your axis by putting a metal tube between your irrigant and your bur.

Pause. Intermittent drilling, not one continuous descent.

Withdraw and irrigate. Flood the sleeve between passes, not only at the start.

Do not chase the osteotomy. If the drill is not advancing, the answer is never more axial load. It is a sharper drill, or a step you skipped.

Observed: three independent studies measure a temperature rise with sleeves. Inferred: that the clinically relevant consequence is necrosis at the crest — which is where marginal bone loss is measured, and where you will never be able to prove it was you.

Freehand — and now there are two axes to hold

Depth by eye. Axis by feel.
Twice.

Two sites 7 mm apart, and the error that matters is not either axis on its own — it is the angle between them. What you have instead of a guide is two parallelism pins, the adjacent teeth, and the person opposite you sighting down the pair.

What replaces the guide

#		code
—	Parallelism pins — place after the pilot, then step back and look	PPTL-2-28
—	Depth gauge	PROF3
—	Torque ratchet, set before you start	CRI5-KIT

3.5°	mean angular deviation, static guided implant placement	Tahmaseb 2018
3.68°	mean angular deviation, dynamic navigation	Jorba-García 2021
4.02° vs 7.97°	dynamic navigation vs freehand, randomised, and dynamic cost +14 min	Jorba-García 2023

Roughly double the error, freehand. Now go and add your own dot to that chart.

Three distances, and they are not negotiable

Where the fixture goes.

1.5

mm from the adjacent tooth

Closer and you take the tooth's periodontal blood supply with you. The interproximal bone crest is shared, and it does not divide fairly.

3.0

mm between implants

Two saucerisation cones that overlap become one crater. The papilla between them has nothing left to sit on.

2.0

mm of buccal plate

Thinner than this and it is resorbing on a timetable you do not control. This is the number that decides whether Station B is needed at all.

Cawood & Howell I–VI is not just about how much bone is left. Resorption changes the direction the drill has to take. A class IV ridge will happily accept a fixture in exactly the wrong axis, and the model will not object either.

Insertion torque — record it, both sides

Primary stability is not
good placement.

Sweden and Martina CRI5-KIT torque control ratchet marked to 70 Ncm — CRI5-KIT — adjustable 10–70 Ncm, calibrated individually at manufacture. Sweden & Martina, *Shelta Power* product overview. Reproduced for kit familiarisation.

Manufacturer figure, not evidence. The 10–70 Ncm range and the individual calibration are the manufacturer's specification. Neither tells you what torque is right for your site.

You can reach 45 Ncm in exactly the wrong place and it will feel wonderful. Torque tells you the fixture is held. It says nothing about whether it is held somewhere a prosthesis can be built on.

Record card — one row per fixture

fixture	guided?	Ncm	tapped?	notes
ø 3.80 × 10
ø 4.25 × 10

Write the number down at the bench. Nobody has ever successfully reconstructed an insertion torque from memory at 17:00.

Mountless insertion

Then close it, tension-free.

Easy Insert driver seated in a Sweden and Martina fixture — Easy Insert: dodecagonal, mountless, with a hexagon on the shaft aligned to the connection so you can read the fixture's rotational position from outside the mouth. Sweden & Martina, *Shelta Power* product overview. Reproduced for kit familiarisation.

Finish the pair

1
Seat the fixture by hand until it engages, then to the ratchet. Read the torque at the moment it stops turning, not after you have pushed past it.
2
Note the rotational position — the shaft hexagon tells you where the internal connection sits without disassembling anything.
3
Cover screw — and check the colour. Green SH-VT-380-VE on the ø 3.80, blue SH-VT-425-BL on the ø 4.25. Hand-tight only.
4
Crestal closure, papilla-sparing, periosteal release until the flap sits without a suture holding it over both sites.
5
Record insertion torque for both fixtures.
6
Model to the scan queue — labelled, with your initials.

Station B

The graft.

Maxilla with a lateral ridge defect and a sinus. Guided bone regeneration, a lateral window, and one membrane you are going to perforate on purpose.

50minutes

PASSthe whole station

1deliberate perforation

0tension at closure

Run the whole station against four letters

Every GBR failure in the literature
is one of these four.

P

Primary closure

Tension-free, and tension-free means the flap stays where you put it before the first suture goes in. If the suture is holding it, it will dehisce.

A

Angiogenesis

The graft is dead material until something grows into it. Decorticate. Perforate the cortex. Blood is not a contaminant here, it is the point.

S

Space maintenance

The membrane must hold a volume, not drape over one. Tenting screws, a stiffer membrane, or a graft that resists collapse.

S

Stability

Fix the membrane. A graft that moves does not consolidate, and micromovement at the graft–host interface is fibrous tissue by another name.

When something fails at this bench — and it will — do not ask whose fault it was. Ask which of the four letters was broken. That question has an answer; the other one does not.

Every graft has a donor, and the donor sends a bill

Escalate only when forced.

Do nothing. A shortened arch is a legitimate treatment plan, not a failure of nerve.
Avoid the graft. Short implants, tilted implants, a different position entirely.
Particulate GBR. Where you are now. Cheapest biology, lowest morbidity.
Block graft. A second surgical site, and a second consent conversation.
Distraction. Slow, compliant patient, real complication rate.
Free tissue transfer. Rung 6 of the ladder. A different operation, a different team.

The rung you are on this afternoon is rung 3. Every rung above it buys bone with someone's morbidity, and the patient pays whether or not the graft takes.

Four categories, three properties

What is actually in the pot.

material	osteogenic	osteoinductive	osteoconductive	the catch
Autograft	yes	yes	yes	a donor site, and a bill
Allograft — DFDBA	no	yes	yes	demineralised: inductive but structurally weaker
Allograft — FDBA	no	limited	yes	mineralised: holds space better, resorbs slower
Xenograft	no	no	yes	barely resorbs — which is sometimes exactly what you want
Alloplast	no	no	yes	a scaffold and nothing more

Demineralisation is the trade. Take the mineral out and you expose the proteins that make it inductive — and you lose the stiffness that made it hold a space. That is the whole choice between DFDBA and FDBA, and it is why people mix them.

Cenobiologic — what is actually on this bench today

Particle size is a decision,
not a packaging detail.

form	particle	use it when
Powder	150–500 µm	fine defects, socket walls, thin dehiscences
Powder	150–1000 µm	the general-purpose GBR particle
Powder	500–1000 µm	larger volumes — bigger interparticle spaces
Chips	2–10 mm	sinus floor, large contained volumes
Crushed	2–5 mm	between the two
Putty / gel	150–2000 µm	handling only — still needs a membrane
Ring	ø 6 or 8 mm	simultaneous placement through the graft
Cube / strip	5–20 mm	structural, screw-fixed

Smaller particles pack denser and resorb faster. Larger particles keep bigger interparticle spaces for vessels to grow into and hold volume longer. That is the A and the S of PASS, decided at the moment you pick a jar.

Manufacturer figure, not evidence. Both FDBA and DFDBA are supplied in every form above, including putty and gel. The manufacturer is explicit that putty and gel are handling formats with the same indication as the powder — they do not remove the need for a barrier.

Cenobiologic Ltd, CenoBone / CenoMembrane catalogue. Reproduced for kit familiarisation.

Choosing a barrier

Thickness is the only dial you get.

thickness	sizes on the bench	behaviour
0.2–0.6 mm	10×10 → 40×40 mm	drapes easily, least space maintenance
0.6–0.9 mm	10×10 → 40×40 mm	the workhorse
1.0–1.4 mm	20×20 → 30×60 mm	stiffer, holds a contour
> 1.4 mm	20×20 → 40×40 mm	thickest; also used to replace gingiva

Manufacturer figure, not evidence. CenoMembrane is an acellular matrix from fascia lata or pericardium, stated as >95% collagen. The manufacturer states it rehydrates in 15–20 seconds, sutures well, and resorbs in 6 to 8 weeks. That last figure is a catalogue claim with no citation behind it — treat it as a starting assumption, not a resorption profile.

Thicker resorbs slower and holds space better. Thicker is also harder to adapt, harder to tuck, and more likely to sit proud under a flap you have not released enough.

The membrane you can see is a membrane that has failed. Exposure converts a barrier into a bacterial scaffold. Everything about your closure exists to prevent this one thing.

Observed: four thicknesses, one material. Inferred: that your real choice is between space maintenance and closure risk — and the thicker you go, the more periosteal release you owe.

Cenobiologic Ltd, CenoBone / CenoMembrane catalogue. Reproduced for kit familiarisation.

Lateral window — round bur and piezo, both

Feel the difference
before anyone tells you about it.

The window, step by step

1
Outline the window with a round bur. Note how much of your attention goes to not going through.
2
Now the same outline with piezo. Slower. And you can feel the membrane change the note before you reach it.
3
Elevate the Schneiderian membrane — blunt, from the bony margin inward, all round before you lift anywhere.
4
Perforate one deliberately. Small, controlled, where you can see it.
5
Repair it with a collagen membrane laid over the defect and tucked under the bony margin.
6
Graft. Chips for the sinus floor. Place a fixture simultaneously only if residual height gives you stability — and be able to say why.

≤ 1 week

graft particles displaced into a healthy sinus clear by mucociliary transport

Park

Proportionality. Not every perforation is a disaster, and treating it as one leads to worse decisions than the perforation.

The ridge defect — particulate, membrane, fixation

Then the part everyone rushes.

Horizontal GBR

1
Decorticate. Perforate the cortex until it bleeds. This is the A in PASS and it takes ten seconds.
2
Tenting screws first, before any graft goes in — they define the volume you are about to fill.
3
Graft to the contour you want, slightly over rather than under, without packing it to a solid.
4
Membrane, fixed. Tacks or screws on the buccal, tucked palatally. A membrane held by graft alone is not fixed.
5
Periosteal releasing incision. Score the periosteum only. Then test: the flap should sit passively over the graft with no instrument holding it.
6
Close — horizontal mattress to take tension, interrupted to appose the edges.

Observed: you can close almost any flap if you pull hard enough. Inferred, and the reason this station exists: the flap that needed pulling is the flap that dehisces on day five, and by then the membrane is a bacterial scaffold.

17:00 — do not let this get squeezed

The debrief.

The deviation reveal. Your dots, guided against freehand, with the published benchmarks and the 2 mm line drawn across. If guided did not beat freehand in this room, that is the better conversation — guide fit, seating, model fixation, n.
Post-test. Same twenty questions as this morning.
Three take-homes. Say them, then stop. Do not add a fourth.
Portfolio clinic. Simulated DOPS and CBDs signed while everyone is still in the room. This is the bit that always gets dropped and the bit trainees actually value.
Feedback. Before anyone leaves.

Three things, and then we stop

The prosthesis leads. Survival is not success. You control five of the six.

Everything this afternoon was one of those three, in your hands. The drill sequence is the prosthesis leading. The torque reading is survival that is not success. The 47 degrees, the irrigation, the release, the fixation — those are the five you control.

The afternoon.Two stations,fifty minutes each.