Bibliographic reviews

IMPLANTOLOGY, Dental Press Thematic Magazine

Magnetic Mallet (MM) is a new technique all over the world, having been developed since 2012, in which shaping the bone is possible by replaceable osteotomes, chisels, implant bed shapers, bent pieces placed in the handpieces of bone-modelling equipment controlled electromagnetically.

Conclusions
Magnetic mallet in bone-shaping, implantology.
• MM is an instrument applied in a wide range of oral surgical and implantological interventions.
• In the case of risk patients and lesser bone mass, it is possible to prepare implant sockets
by splitting and expanding the bone with minimal bone loss.
• The application of MM, with implants of favourable properties on their surfaces (e.g. Straumann SLActiv), increases the chance of success, even in high-risk cases.
• It can be well combined with other surgical techniques.
• Its application allows bone preservation even at the removal of teeth and roots.
• Based on our one and a half years’ favourable experience, it can be recommended for every-day praxis, especially in implant socket preparation, removal of teeth and roots and bone-splitting. It is indispensible in the case of little bone mass and in high risk patients.

Lekholm & Zarb 1985 Patient selection and preparation. In tissue-integrated prosthesis: Osseointegration in clinical dentistry. Chicago: Quintessence Publ Co. 1985; 199-209

In this report, the clinical experiences on the pre-clinical and clinical use of the magnetic mallet for osteotomies and tooth extractions is described after having introduced this clinical procedures in 2016.

In conclusion, the introduction of the magnetic mallet device in our training and clinical setting has broadened the field of minimal invasive indications, increased the safety of the described techniques, reduced the patient´s discomfort so far without any substantial adverse effects.

International Education & Research Journal, 2016, 2:9-10

Implant dentistry has become a revolutionary branch nowadays. The use of magnetic mallet has provided us with some clinical advantages during the surgical procedure over the traditional method of osteotomy using hand mallet and chisel. The present clinical report stated the procedure of surgical placement of an implant in the mandible using an innovative device known as Electrical Magnetic Mallet with great precision.

Int J Med Res Rev 2016;4 (6):1046-1048.doi: 10.17511/ijmrr.2016.i06.31

Dental extractions sounds scary to the patients due to complications like dry socket, delayed healing,paresthesia, bleeding from site etc. This case reportintroduces a novel and innovative magneto-dynamical patented device Magnetic Malletused for extraction of the tooth followed by immediate implant placement. This method is least traumatic to patient and produces no post extraction complications with good quality bone healing.

Clin Implant Dent Relat Res. 2016 Sep 30. Doi: 10.1111/cid.12454. [Epub ahead of print]

This interesting study, as the one that follows, shows how delayed implants placed in post-extraction sockets without the removal of the reactive soft tissue achieved a significant increase of peri-implant bone tissue at three years.

Clinical Implant Dentistry and Related Research, Early View, First Published online on 2012, August, 15th

138 implants were inserted in 50 patients in the maxilla with bone type D3 or D4. Osteotomes with a hand mallet were used in the Control Group, the Magnetic Mallet in the Test Group. At 24 months the implant survival in the Control Group was 92.75%, in the Test Group 97.10%. The bone gain obtained in all patients remained stable at 24 months in both groups. The patients who underwent operation with the Magnetic Mallet did not report any complications linked to benign paroxysmal positional vertigo, which instead was encountered in two patients operated with osteotomes with a hand mallet.

The International Journal of Oral & Maxillofacial Implants 2013;28:869-874

70 Outlink² implants inserted in 32 patients with a bone expansion protocol performed with the Magnetic Mallet presented a survival of 98.57% and an average bone increase of 4.08 ±1.25 mm at 24 months. Patients reported no dizziness, nausea or vomiting after procedures, due to optimization of the transmission of the percussive force applied by the Magnetic Mallet in comparison to conventional mallets.

The Journal of Craniofacial Surgery, 2014;25,793-795

The Magnetic Mallet was used in an atraumatic conservative procedure for the extraction of 427 teeth in 156 patients. Healing produced no inflammation, and closure of the soft tissues by secondary intention was always completed in two weeks without bone exposure. Given the importance of the extraction procedure for subsequent implant insertion, and in particular in the case of immediate post-extraction insertions, the Magnetic Mallet showed itself to be a reliable and predictable instrument.

Numeri Uno, 2013,16:22-23

SPLIT-CREST PROCEDURE ON A VERY THIN CREST USING THE MAGNETIC MALLET

Although it permits the insertion of thin and/or extremely inclined implants, the presence of a moderately thin crest in the premaxilla area certainly compromises the final aesthetic result of rehabilitation with implant prostheses, making it therefore advisable to use surgical regeneration procedures.
If instead the crest is very thin (< 3 mm), implant insertion is impossible without using regenerative surgery.
Essentially, there are three surgical techniques to increase the thickness of thin crests available to implantologists:

• Block grafts with vestibular fixing;
• GBR with non-resorbable membranes or titanium mesh;
• Split-crest techniques.

Our therapeutic choice, whenever possible, is for a split-crest technique, which in our experience has the following advantages in comparison to other techniques:

• no bone harvesting necessary (reduction of morbidity post-operative);
• very predictable bone healing, as the volume to be regenerated is located between two viable bone walls;
• improved quantity and quality of the keratinized peri-implant gingiva;
• possibility of inserting implants at the same time (reduction of number of operations and total time).

The split-crest technique applied to particularly thin crests has always been a difficult task, even for the most experienced surgeons, especially when the classic instruments are used (hammer and chisels).
The introduction of the Magnetic Mallet has without doubt made split-crest procedures simpler, quicker and more precise. In fact, among the countless clinical advantages of this instrument, what makes it so decisive in a split-crest procedure is the great two-handed control over blade inserts and osteotomes that it gives, at a level unachievable with the standard hammer technique. The cutting precision offered by this instrument is, in our opinion, of great assistance for less-experienced practitioners of split-crest techniques, and even gives experts great advantages.
With the ample photographic documentation accompanying this case report involving a very thin crest, we hope to be able to share our split-crest protocol, used for many years in numerous clinical cases of varying levels of complexity.
In a later article we intend to discuss the contraindications for split-crest procedures (crests consisting entirely in cortical bone, crests thinner that 2.5 mm, grade IV crests), alternative techniques for these cases, and the management of intra-operative complications (rescue techniques in case of vestibular cortex fractures).

The International Journal of Oral & Maxillofacial Implants, 2012; 27: 1144-50

120 implants were inserted in 80 patients while at the same time sinus floor elevation was performed in the Control Group using osteotomes with a manual mallet and in the Test Group with the Magnetic Mallet. The total implant survival at 24 months was 98.33%, the bone gain was on average about 4 mm, without any significant differences in the two groups, and this gain, found after the first 6 months, was stable at 24 months. 3 patients treated using osteotomes with a manual mallet complained of benign paroxysmal positional vertigo, whereas the use of the Magnetic Mallet did not give rise to complications.