1. Case Selection and Pre-Surgical Considerations

Use the MED in implant cases where enhanced early healing, improved osseo-integration, soft-tissue support, or modulation of inflammation may be beneficial:

Standard implant placement
Compromised bone quality (osteoporosis, diabetes, smoking)
Post-extraction implants
Inflammatory environments where additional biologic support is desirable (without claiming disease treatment)

Contraindications:

Submerged-healing protocols
Situations requiring immediate loading
Patient cannot maintain soft-tissue access to the device

2. Implant Placement

Position the implant crestal or slightly supra-crestal. The MED cannot be covered by soft tissue.
Achieve primary stability as per normal surgical protocol.
Irrigate thoroughly to remove bone fragments and debris from the implant chamber.
Confirm no sharp edges or interference that would prevent MED seating.

3. MED Activation (Outside the Mouth)

Remove the MED vial from the sterile tray.
Place the vial into the activation socket.
Press the activation button:
- Blue blinking for ~3 seconds = activation
- Blue solid light = ready for use (10 seconds)
Once activated, remove the MED and transfer directly using a 1.25 mm hex driver.

4. MED Placement

Ensure implant chamber is dry and clean.
Seat the MED with the 1.25 mm hex driver, keeping alignment with implant long axis.
Tighten by hand only until passive seating.
Apply restorative torque up to 10 Ncm. Do not exceed torque to avoid damaging electronics.
Reposition soft tissue around the MED and suture as preferred.
Confirm no occlusal contact with opposing dentition.

5. Immediate Post-Op Instructions

The MED is active for 30 days.
The device can remain in place until restoration.
Avoid electric toothbrushes during the first 30 days, but encourage gentle brushing around the MED to maintain soft tissue health.
If a provisional denture is used, ensure a relief space around the device.

6. Follow-Up Protocol

At 2 weeks:

Inspect tissue maturation, early keratinization, and absence of inflammation.
Verify device is fully seated.

At 4 weeks (30 days):

Replace the MED if extended biologic support is desired.
Take a baseline radiograph for early bone remodeling evaluation.
A 2nd MED may be recommended in moderate to severe inflammatory cases, or when clinical findings at 30 days indicate that extended support would be beneficial. This is an optional step and should be determined according to the initial severity and the tissue response following the first MED. If a 2nd MED is used, repeat the procedures described in Sections 4 and 5 accordingly.

SurgicalWorkflow.followUp.optionalNote

At 8–12 weeks:

Assess implant stability (ISQ recommended).
Proceed with restorative phase if healing trajectory is satisfactory.
Radiographic comparison to confirm bone density improvements.

7. Biological Rationale (from Periodontology 2000)

This section is optional for clinicians but useful to justify the protocol.

The Periodontology 2000 review highlights emerging host-modulating approaches that target:

Chronic inflammatory cycles
macrophage dysregulation
tissue breakdown and osteoclast activity

PEMF aligns with this category by:

modulating cytokines (↓ TNF-α, ↓ IL-1, ↑ IL-10)
supporting resolution of inflammation
encouraging bone formation through osteoblast activation
influencing pathogenic biofilm behavior

These mechanisms justify MED use as an adjunct to conventional implant surgery, not as a stand-alone disease therapy.

Surgical Workflow