Upper left #25 & #26 dry drilling with the Crown Down 2-drill protocol

Photo essay

The surgical sequence, step by step

Every step below shows Dr. Diederich's original clinical imagery paired with a short technical note on what the Crown Down protocol is doing at that moment.

1. STEP 01

   The Crown Down cortical drill

   The first drill in the Crown Down protocol is a solid tungsten carbide cortical drill with a titanium-nitride (TiN) coating, mounted on a low-speed surgical handpiece. This is the same first pass that would prepare either osteotomy on this case.

   

2. STEP 02

   Osteotomy at #25 - engaging the crest

   Intra-oral view of the Crown Down cortical drill breaching the crest at the upper left second premolar site. The tissue flap is retracted; the crest is visible around the entering drill. On this case the drill was run dry, at low speed - no external saline was directed onto the site during preparation.

   

   

   

3. STEP 03

   Autogenous bone captured on the drill flute

   On withdrawal the drill flute carries a compact mass of autogenous bone particles produced during the same drilling pass. Because the drilling was performed dry, the particles were not washed into the suction line - they remained on the flute and inside the osteotomy, available for chairside collection.

   

4. STEP 04

   Osteotomy at #26 - preparing the second site

   The identical 2-drill sequence is repeated at the adjacent upper left first molar site. Because there is no drill-tray change between adjacent sites, the surgical rhythm and tactile feedback stay consistent between osteotomies.

   

5. STEP 05

   Prepared alveolar bed

   Occlusal-adjacent view of the prepared alveolar bed at #25 and #26 with the tissue flap retracted. The two osteotomies are ready to receive their implants; the autogenous bone captured during preparation is available for peri-implant packing at seating.

   

6. STEP 06

   Implant selection

   The implant is loaded onto the delivery driver ready for seating into the prepared osteotomy. The delivery driver's hex adapter engages the implant's internal connection so the wrench torque during placement is transferred directly to the implant body.

   

7. STEP 07

   Implant seating at #25

   The implant is seated into the prepared osteotomy at the upper left second premolar site. The driver remains engaged through initial threading; on this case the autogenous bone chips captured during drilling are available for the peri-implant space.

   

   

8. STEP 08

   Cover screw at #26

   After the second implant is seated at #26 the cover screw is placed on top of the implant platform. The green anodized colour of the cover screw makes it visible against the peri-implant tissue.

   

   

9. STEP 09

   Both implants seated, cover screws in place

   Occlusal view of the completed placement: two adjacent implants at upper left #25 and #26, both with cover screws in position, ready for closure. The alveolar contour is preserved and both platforms sit at approximately the same crestal height.

   

10. STEP 10

    The two carbide drills that did the work

    The two Crown Down carbide drills after both osteotomies are complete: cortical drill on the left, trabecular drill on the right. Autogenous bone and blood remain on the flutes because the drilling was performed dry - the material that would ordinarily be washed off by saline irrigation stayed with the drill and inside the osteotomy for chairside collection.

    

Case questions and technique reference

Quick clinical answers dentists ask about this case and about the Crown Down 2-drill protocol it demonstrates.