Interview: Rethinking Osteotomy Preparation: Dr Zvi Fudim

Over the past two decades, Dr Fudim has focused on developing technologies to improve implant surgery through greater precision, enhanced thermal control, and a more biologically respectful approach to bone preparation. His Crown Down Surgical Drilling System challenges the traditional sequential drilling protocol by prioritising cortical bone management and leveraging the material properties of solid tungsten carbide drills.

In this interview with Dental Tribune South Asia, Dr Fudim discusses the philosophy behind the Crown Down concept, the science of heat management during osteotomy preparation, the role of drill design in implant success and his vision for the future of implant surgery.

What is the novelty in the Crown Down method compared to the traditional method?

The novelty of the Crown Down method is that it changes the logic of implant osteotomy preparation. Traditional implant drilling usually follows a sequential protocol, where the dentist begins with a narrow drill and gradually increases the diameter until the final osteotomy is reached. The Crown Down approach begins by addressing the most critical and resistant part first: the cortical bone.

In our method, the first drill manages the cortical portion of the osteotomy and creates the correct coronal clearance. The second drill then completes the preparation to the required depth and diameter, according to the implant system and the bone quality. This makes the procedure more controlled, especially in dense cortical bone, where excessive compression and heat generation can become major clinical problems.

Another important difference is the material and design of the drills. The Crown Down drills are made from solid tungsten carbide, which is harder and more thermally conductive than conventional stainless steel. This allows the drill to cut efficiently, maintain sharpness, and evacuate heat more effectively. The goal is not simply to make drilling faster, but to make implant osteotomy preparation more predictable, less traumatic, and less dependent on repeated sequential drilling.

How does the Crown Down method benefit the implant success rate?

Implant success depends on several biological and mechanical factors. The Crown Down method is designed to help the clinician control some of the most important variables during osteotomy preparation: heat generation, cortical bone compression, drilling accuracy, and primary stability.

Excessive heat is a known risk during implant drilling because it can damage bone and interfere with osseointegration. Another important factor is cortical compression. If cortical bone is not managed properly, the implant may exert excessive pressure at the crest, which can lead to discomfort, bone remodelling, or failure.

The Crown Down protocol reduces these risks by preparing the cortical area first and by using efficient tungsten carbide drills at low speed. This helps create a controlled osteotomy while preserving the biological environment around the implant site. The objective is not to claim that one instrument alone guarantees success. Rather, the Crown Down kit is designed to reduce variability in a procedure where small differences in heat, pressure, and accuracy can influence the final outcome.

Is the Crown Down kit expensive?

At first glance, the Crown Down kit may appear more expensive than a conventional surgical drill set. However, the value should be evaluated differently. Many implant systems require repeated replacement of stainless steel drills because they lose sharpness, wear out, or become less efficient over time. A dull drill not only slows the procedure; it can also increase heat and trauma to the bone.

The Crown Down kit is made from solid tungsten carbide and is designed for long-term use. The purpose is to provide a durable, high-performance surgical instrument rather than a disposable or frequently replaceable drill set. When dentists consider durability, reduced drill replacement, procedural efficiency, and the potential clinical advantages of better heat control and cutting performance, the cost becomes more understandable.

In other words, it is not just a purchase of drills. It is an investment in a more controlled implant drilling system.

What do you think about the benefits or drawbacks of irrigation in dental drilling?

Irrigation has an important role in conventional implant drilling. It helps cool the surgical site and remove debris, and for many traditional protocols, it is considered necessary. However, irrigation also has limitations that are often underestimated.

First, irrigation does not always reach the cutting interface effectively, especially in guided surgery or in deep osteotomies. The fluid may cool the surface, but it may not fully cool the area where friction is actually being generated. Second, heavy irrigation can wash away autogenous bone particles that could otherwise be valuable for grafting. Third, it can dilute the natural blood environment, which normally provides lubrication during low-speed drilling.

The Crown Down approach was developed to work differently. Using sharp, thermally conductive tungsten carbide drills at low speed aims to reduce the need for aggressive irrigation while maintaining temperature control. This does not mean irrigation is always bad or should never be used. This means that the drilling system, drill material, speed, bone density, and surgical situation should all be considered together.

How long does it take for a dentist to master the Crown Down technique?

The Crown Down technique is not difficult to learn, especially for dentists who already place implants. The learning curve is mainly conceptual. The dentist needs to understand the sequence, the roles of the cortical drill and the final drill, and how to select the protocol based on implant size and bone quality.

In many cases, a clinician can understand the basic protocol after a short training session and a review of the drilling chart. With a few supervised or carefully planned cases, the technique becomes intuitive. The goal was to create a system that improves control without complicating the procedure.

As with any surgical method, proper training and case selection are important. Dentists should begin with straightforward cases, follow the recommended chart, and then expand their use as they gain confidence.

Where did the name Crown Down come from, and why did you choose it?

The name "Crown Down" describes the technique's direction and philosophy. In implant dentistry, we usually plan from the final prosthetic result. The crown determines the ideal implant position, and the implant position determines the osteotomy. Therefore, the treatment should be prosthetically driven from the crown downward.

At the surgical level, the name also reflects the method itself. We begin by managing the coronal and cortical part of the osteotomy before completing the deeper preparation. The name Crown Down, therefore, represents both the prosthetic logic and the drilling sequence.

Which implant systems are compatible with the Crown Down kit and method?

The Crown Down kit was designed to be a multi-compatible system. It is not limited to one implant company. The protocol can be adapted to different implant systems by using the appropriate drilling chart and selecting the correct drill combination according to implant diameter, length, and bone quality.

This is important because many clinicians work with multiple implant brands and need a drilling system that is practical in real clinical settings. The Crown Down method is intended to support a broad range of commonly used implant systems while giving the dentist a consistent drilling philosophy.

Where can dentists purchase the Crown Down kit and learn more about the technique?

Dentists can learn more about the Crown Down Surgical Drilling Kit through the official website: crowndownkit.com. The website includes information about the technique, the drilling concept, clinical rationale, and product details.

For dentists who want a deeper explanation, we recommend reviewing the drilling chart, user instructions, and educational materials before using the kit clinically. We are also available to provide guidance, answer technical questions, and support clinicians who want to understand how the method applies to their implant systems and surgical workflow.

What does the future hold for Stomatotech? Are there any new innovations or developments coming?

Stomatotech was created to improve implant dentistry through practical innovation. The Crown Down kit is one part of a broader vision: to make implant surgery more predictable, more biologically respectful, and more accessible to clinicians.

Our future developments are focused on guided surgery, improved drilling control, and digital support for implant placement. We are also continuing to study heat generation, drill wear, drilling efficiency, and the biological advantages of low-trauma osteotomy preparation.

The goal is not only to sell a surgical kit. The goal is to continue developing systems that help dentists perform implant surgery with greater confidence, better control, and greater respect for bone biology.

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