Bone Milling: Perfect Harmony of Function and Feel

Interview with Dr. Adriano Azaripour By Dorothee Holsten

For Dr. Adriano Azaripour, instruments play an essential role in his surgical and periodontal work at the University of Mainz and in his practice in Bad Soden. Function and feel must form a unified whole. Using a patient case, he describes his high standards for his bur portfolio.

Dr. Azaripour, what role does bone surgery play in your practice?

I bring an interesting mix to the table due to my dental background - I'm originally a periodontist and endodontist. Today, I cover all indications of modern hard and soft tissue surgery in my practice. However, periodontology is always present.

I firmly believe that one specialty cannot exist without the other. If we ignored the red aesthetics, for example during implantations, the results would be short-lived and aesthetically unsatisfactory. I specialized in microsurgical and plastic periodontal surgery during my training in my second home, Italy. This brings another layer to the mix: I combine knowledge and skills from both German and Italian dental education.

Why does nationality make a difference? Can you explain using instruments as an example?

Both Italian and German dentists strive for precision. However, Germans tend to be more pragmatic - tools should be quick, functional, and economical. Italians, on the other hand, love working with microscopes and are more detail-oriented. Treatment time becomes secondary. That’s why Italian dentists are big fans of sonic instruments. So, the path to aesthetic results differs slightly between the two countries.

What do you expect from a bone mill?

High cutting performance with maximum preservation of the bone. Only fracture-free blades can meet this requirement, enabling effective, gentle, and precise cuts. Bone mills must allow for exact preparation, which requires good control of the instrument. Patient comfort is also crucial - they can feel how smoothly an instrument runs. For tooth extractions, my favorite is the extremely fine Lindemann bur H254LE (Komet Dental).

Figure 3: Condition after extraction and preservation of the buccal root portion

Figure 4: Condition after implantation

Figure 5: Condition after bone augmentation.

Clinical Case Example

A 26-year-old female patient was referred to my practice. Tooth 35 was deemed non-restorable. A CBCT scan showed the buccal bone plate was missing. Especially in aesthetic zones, we aim to reduce tissue collapse post-extraction (up to 50%). We considered various ridge preservation techniques to minimize this risk.

Surgical Approach

Figure 6: Postoperative X-ray image of region 34, condition after immediate implantation.

I chose the Socket Shield Technique, a minimally invasive method to reduce tissue shrinkage and achieve better long-term aesthetic outcomes. The technique requires healthy periodontal tissue and an intact root, both of which were present. The tooth is partially extracted, leaving the buccal root portion to support the soft tissue. This maintains the buccal periodontal attachment, allowing the tissue to behave as if the tooth were still in place. Hürzeler et al. introduced this technique in 2010 to reduce tissue shrinkage during immediate implantation.

Instruments Used

The Socket Shield Technique is not easy to perform. High-quality instruments are essential. Cuts must be fine and precise with minimal pressure. For this case, I used the H254LE 314 012 bone mill (Komet Dental) with a cross-cut design (right-right fluting), which runs smoothly and cuts efficiently. Its thin cut and controlled use in a red contra-angle handpiece make it ideal. I used it to section the tooth and shape the root remnant. Then, I refined the root with instruments 8831L, 831LEF, and ZR8801L (Komet Dental) - all of which allow fingertip control and effective cutting.

After osteotomy, I placed a 3.75 mm diameter implant, filled the gap between implant and root surface with allogenic bone substitute, inserted a provisional, and later restored with an aesthetic ceramic crown.

Figures 7 and 8: Clinical situation after 6 months
Figure 9: Clinical image after prosthetic restoration	Figure 10: X-ray image after prosthetic restoration.

Outcome

After six months, the soft tissue remained stable, and the papillae were well-formed. The case met all expectations for “pink-white aesthetics.” I was very satisfied with both the surgical and prosthetic results.

Reference: Hürzeler MB, Zuhr O, Schupbach P, Rebele SF, Emmanouilidis N, Fickl S. The socket-shield technique: A proof-of-principle report. J Clin Periodontol 2010;37:855–862.

More about Dr. Adriano Azaripour

Latest Blog Articles

Failure To Replace: Who Pays The Ultimate Price?

What criteria do you utilize when deciding to replace a scaler? The condition of the working end? Broken blades? Your curettes have become sickles from an incorrect sharpening technique or the knowledge of the physical and often irreversible effects on your body when using a scaler that is past its ‘use by’ date? What about the consequences of using a compromised scaler on a patient? Do these facts affect your decision on when to replace?

5 Reasons Dental Practices Are Making the Switch to Nitrile

Let’s face it: gloves may not be the most exciting item on your clinic supply list, but they’re among the most critical. As infection control remains a top priority in every dental practice, more and more clinics are re-evaluating what they put on their hands every day. The result? A noticeable shift away from latex gloves and toward nitrile.

The New Kavo MASTERmatic LUX M45L High-Speed Contra-Angle

KaVo is expanding its family of red high-speed contra-angles with the new MASTERmatic LUX M45 L. KaVo completes the successful portfolio of its red high-speed contra-angles, and these precision instruments marked with a red ring are the power players in everyday practice: they reach the highest speeds and reliably withstand extreme loads - both during use and subsequent reprocessing.