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Koutiech T, Ahmad Heshmeh O, Alkerdi K, Toumi J, Al Sabek L. Comparison of Maximum Heat Generation during Implant Site Preparation between Single and Gradual Drilling Protocols in Artificial D1 Bone Blocks: An In Vitro Study. Int J Dent 2022; 2022:9370395. [PMID: 35761968 DOI: 10.1155/2022/9370395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Aim Two protocols for implant site preparation have been demonstrated in the literature: conventional gradual drilling and single drilling. Objectives The purpose of this study is to assess the maximum temperature changes reached during and after implant site preparation of 4.2 implant diameter using the gradual drilling protocol and single drilling protocol. Material and Methods. The artificial bone block samples (#1522-23; Sawbones, Malmö, Sweden) with the density of d1 were divided into two groups. Twelve implant site preparations were performed with the use of only one drill in group A, and the same number of preparations was performed using five gradual drills in group B. The drilling speed was set for each group at 1500 rpm with the use of external irrigation with a constant of 50 ml/min at room temperature (25 ± 1°C). The maximum temperature changes were measured using an infrared camera (Fluke Ti55, USA). The data were gathered and analyzed using Student's t-test for independent samples. Results With the 95% confidence intervals (CIs) for the means of ∆T between groups A and B, group B showed a statistically significant higher temperature change (∆T) than group A. Conclusions The current outcomes propose that the single drilling protocol, while preparing a bed for a 4.25 mm dental implant in d1 artificial bone blocks, generates less heat than the conventional gradual drilling protocol.
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Abstract
Implant site preparation is a critical stage of implant surgery that may underpin various complications related to implant surgery. This review discusses the latest available scientific information on risk factors related to implant site preparation. The role of the drilling process in relation to the density of the available alveolar bone, the effects of insertion torque on peri-implant osseous healing, and implant-related variables such as macrodesign and implant-abutment connection are all factors that can influence implant success. Novel information that links osteotomy characteristics (including methods to improve implant initial stability, the impact of drilling speed, and increase of the implant insertion torque modifying the bone-implant interface) with the appropriate instrumentation techniques will be discussed, as well as interactions at the bone-biomaterial interface that may lead to biologic complications mediated by implant dissolution products.
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Affiliation(s)
| | - Georgios E Romanos
- Department of Periodontology, School of Dental Medicine, Stony Brook, New York, USA.,Department of Oral Surgery and Implant Dentistry, Dental School, Johann Wolfgang Goethe University, Frankfurt, Germany
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Teich S, Bocklet M, Evans Z, Gutmacher Z, Renne W. 3D printed implant surgical guides with internally routed irrigation for temperature reduction during osteotomy preparation: A pilot study. J ESTHET RESTOR DENT 2021; 34:796-803. [PMID: 34837657 DOI: 10.1111/jerd.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to test a novel through-the-guide means of irrigation in an in-vitro bovine bone model and to explore the method clinical applicability. MATERIALS AND METHODS Surgical guides were designed to fit over five fresh bovine samples. Control osteotomy sites were compared to experimental sites irrigated through a 3D printed surgical guide with customized channels that direct the coolant toward the interface of the alveolar crest and drill. Temperature was measured during surgery with thermocouples located at 3 and 6 mm from the crestal height of the bone, and with an infrared thermal camera taking direct temperature readings from a window cut into axial wall at 9 mm from the crestal height of the ridge. RESULTS Incorporation of routed irrigation significantly decreased heat generation, keeping temperature consistently below 47°C. A clinical case illustrates the method applicability using standard implant planning software, 3D printing technology, and regular implant armamentarium. CONCLUSIONS The in-vitro analysis shows that this method mitigates temperature increase caused by static surgical guide irrigation blockade at the osteotomy site. This technique can be incorporated in the surgical guide design using commercially available software and 3D printing technology and has immediate applications in practice. CLINICAL SIGNIFICANCE The in-vitro analysis shows that this method can significantly mitigate the temperature increase caused by static surgical guide irrigation blockade at the osteotomy site. This technique also has the advantage that it can be incorporated in the digital surgical guide design using commercially available software and 3D printing technology. The method has immediate applications in practice, and especially in the treatment of edentulism in esthetic zone where use of guided surgery for implant placement is crucial in obtaining consistent results.
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Affiliation(s)
- Sorin Teich
- Department of Oral Rehabilitation, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael Bocklet
- College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary Evans
- Department of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zvi Gutmacher
- Department of Maxillofacial Rehabilitation and Temporomandibular Joint Disease Unit, Rambam Medical Center, Haifa, Israel
| | - Walter Renne
- Department of Oral Rehabilitation, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Paul B, Frank A, Raschke MJ, Wähnert D. Local heat generation during screw insertion into diaphyseal bone: a biomechanical study on different conditions (e.g. screw type, material, mode of insertion). BMC Musculoskelet Disord 2021; 22:841. [PMID: 34592967 PMCID: PMC8485562 DOI: 10.1186/s12891-021-04723-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background The implantation of screws is a standard procedure in musculoskeletal surgery. Heat can induce thermal osteonecrosis, damage the bone and lead to secondary problems like implant loosening and secondary fractures. The aim of this study was to investigate whether screw insertion generates temperatures that can cause osteonecrosis. Methods We measured the temperature of twenty human femur diaphysis in a total of 120 measurements, while screws of different material (stainless steel and titanium alloy) and different design (locking and cortex screw) were inserted in three different screwing modes (manual vs. machine screwing at full and reduced rotational speed) with 6 thermocouples (3 cis and 3 trans cortex). Each was placed at a depth of 2 mm with a distance of 1.5 mm from the outer surface of the screw. Results The screw design (cortical > locking), the site of measurement (trans-cortex > cis-cortex) and the type of screw insertion (hand insertion > machine insertion) have an influence on the increase in bone temperature. The screw material (steel > titanium), the site of measurement (trans-cortex > cis-cortex) and the type of screw insertion (machine insertion > hand insertion) have an influence on the time needed to cool below critical temperature values. The combination of the two parameters (maximum temperature and cooling time), which is particularly critical for osteonecrosis, is found only at the trans-cortex. Conclusion Inserting a screw hast the potential to increase the temperature of the surrounding bone tissue above critical values and therefore can induce osteonecrosis. The trans-cortex is the critical area for the development of temperatures above the osteonecrosis threshold, making effective cooling by irrigation difficult. It would be conceivable to cool the borehole with cold saline solution before inserting the screw or to cool the screw in cold saline solution. If possible, insertion by hand should be considered.
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Affiliation(s)
- Berit Paul
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Andre Frank
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany.
| | - Dirk Wähnert
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany. .,Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Germany.
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Gabrić D, Aumiler D, Vuletić M, Gjorgievska E, Blašković M, Mladenov M, Pavlić V. Thermal Evaluation by Infrared Thermography Measurement of Osteotomies Performed with Er:YAG Laser, Piezosurgery and Surgical Drill-An Animal Study. Materials (Basel) 2021; 14:ma14113051. [PMID: 34205094 PMCID: PMC8199930 DOI: 10.3390/ma14113051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022]
Abstract
The bone healing process following osteotomy may vary according to the type of surgical instrumentation. The aim of the present in vivo study was to determine thermal changes of the bone tissue following osteotomies performed by Er:YAG laser ablation in contact and non-contact modes, piezoelectric surgery, and surgical drill using an infrared thermographic camera. For each measurement, the temperature before the osteotomy-baseline (Tbase) and the maximal temperature measured during osteotomy (Tmax) were determined. Mean temperature (ΔT) values were calculated for each osteotomy technique. The significance of the difference of the registered temperature between groups was assessed by the ANOVA test for repeated measures. Mean baseline temperature (Tbase) was 27.9 ± 0.3 °C for contact Er:YAG laser, 29.9 ± 0.3 °C for non-contact Er:YAG laser, 29.4 ± 0.3 °C for piezosurgery, and 28.3 ± 0.3 °C for surgical drill. Mean maximum temperature (Tmax) was 29.9 ± 0.5 °C (ΔT = 1.9 ± 0.3 °C) for contact Er:YAG laser, 79.1 ± 4.6 °C (ΔT = 49.1 ± 4.4 °C) for non-contact Er:YAG laser, 29.1 ± 0.2 °C (ΔT = −0.2 ± 0.3 °C) for piezosurgery, and 27.3 ± 0.4 °C (ΔT = −0.9 ± 0.4 °C) for surgical drill. Statistically significant temperature changes were observed for the non-contact laser. The results of the study showed beneficial effects of the osteotomy performed by the Er:YAG laser used in the contact mode of working as well as for piezosurgery, reducing the potential overheating of the bone tissue as determined by means of infrared thermography.
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Affiliation(s)
- Dragana Gabrić
- Department of Oral Surgery, School of Dental Medicine, University Hospital Center, University of Zagreb, 10000 Zagreb, Croatia;
| | | | - Marko Vuletić
- Department of Oral Surgery, School of Dental Medicine, University Hospital Center, University of Zagreb, 10000 Zagreb, Croatia;
- Correspondence:
| | - Elizabeta Gjorgievska
- Department of Pediatric and Preventive Dentistry, Faculty of Dental Medicine, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia;
| | - Marko Blašković
- Department of Oral Surgery, Faculty of Dental Medicine, University Hospital Center, University of Rijeka, 51000 Rijeka, Croatia;
| | - Mitko Mladenov
- Faculty of Natural Sciences and Mathematics, Institute of Biology, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia;
| | - Verica Pavlić
- Department of Periodontology and Oral Medicine, Medical Faculty, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
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Heuzeroth R, Pippenger BE, Sandgren R, Bellón B, Kühl S. Thermal exposure of implant osteotomies and its impact on osseointegration-A preclinical in vivo study. Clin Oral Implants Res 2021; 32:672-683. [PMID: 33629437 DOI: 10.1111/clr.13729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Thermal and mechanical stresses during osteotomy preparation can impair implant osseointegration. This study investigated implant osseointegration following the measurement of temperature exposure during osteotomy drilling, varying drill design, sequence, and drill wear. MATERIALS AND METHODS 36 tapered implants were placed in a mandibular minipig model after guided drilling of implant osteotomies using 4 different groups: (1) control drills with a conservative, sequential drilling sequence, (2) control drills using a shortened drill sequence (PF), (3) novel test drill displaying an optimized drill design and surface treatment, PF, and (4) aged test drill, PF. Intraosseous temperatures during drilling were measured using a temperature probe. BIC, fBIC, and tissue reactions were histomorphometrically derived after 2 and 8 weeks of healing. RESULTS Compared to control drills (1) or (2), test drills (3) resulted in significantly lower maximum temperatures ((35.4 (CI 30.2-40.5)°C vs. (46.5 (CI 41.0-52.0)°C, p = .0021)) and shorter drill times ((4.5 (CI 1.6-7.3)sec vs. 10.3 (7.3-13.4)sec). Lower osteotomy temperature values and shorter drill times corroborated with significantly higher BIC after 2 and 8 weeks healing for the test (3) compared to control groups (2) (2 weeks: (44.9 (CI 34.1-55. 7)% vs. (31.3 (CI 20.5-42.2)%, p = <.0001 and 8 weeks: (73.7 ( CI 64.2-83.2)% vs. (66.2 (CI 57.0-75.4)%, p = <.0455). CONCLUSION The improved osseointegration of implants placed after osteotomy preparation with novel test drills using a shortened drill sequence compared to standard drills and conventional drill protocols might be attributed to more favorable thermal profiles and less mechanical stress exerted on the bone surrounding the implant osteotomy.
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Affiliation(s)
- Raphael Heuzeroth
- Department of Oral Surgery, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Benjamin E Pippenger
- Department of Preclinical and Translational Research, Institut Straumann AG, Basel, Switzerland.,Department of Periodontology, Faculty of Dentistry, University of Zurich, Zurich, Switzerland
| | - Rebecca Sandgren
- Biomedical Center, Faculty of Medicine, Lund University, Lund, Sweden
| | - Benjamin Bellón
- Department of Preclinical and Translational Research, Institut Straumann AG, Basel, Switzerland.,Department of Periodontology, Faculty of Dentistry, University of Zurich, Zurich, Switzerland
| | - Sebastian Kühl
- Department of Oral Surgery, University Center for Dental Medicine, University of Basel, Basel, Switzerland
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Tur D, Giannis K, Unger E, Mittlböck M, Rausch-Fan X, Strbac GD. Thermal effects of various drill materials during implant site preparation-Ceramic vs. stainless steel drills: A comparative in vitro study in a standardised bovine bone model. Clin Oral Implants Res 2020; 32:154-166. [PMID: 33220104 PMCID: PMC7898889 DOI: 10.1111/clr.13685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/19/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate thermal effects of ceramic and metal implant drills during implant site preparation using a standardised bovine model. MATERIAL AND METHODS A total of 320 automated intermittent osteotomies of 10- and 16-mm drilling depths were performed using zirconium dioxide-based and stainless steel drills. Various drill diameters (2.0/ 2.2, 2.8, 3.5, 4.2 mm ∅) and different cooling methods (without/ with external saline irrigation) were investigated at room temperature (21 ± 1°C). Temperature changes were recorded in real time using two custom-built multichannel thermoprobes in 1- and 2-mm distance to the osteotomy site. For comparisons, a linear mixed model was estimated. RESULTS Comparing thermal effects, significantly lower temperatures could be detected with steel-based drills in various drill diameters, regardless of drilling depth or irrigation method. Recorded temperatures for metal drills of all diameters and drilling depths using external irrigation were below the defined critical temperature threshold of 47°C, whereas ceramic drills of smaller diameters reached or exceeded the harmful temperature threshold at 16-mm drilling depths, regardless of whether irrigation was applied or not. The results of this study suggest that the highest temperature changes were not found at the deepest point of the osteotomy site but were observed at subcortical and deeper layers of bone, depending on drill material, drill diameter, drilling depth and irrigation method. CONCLUSIONS This standardised investigation revealed drill material and geometry to have a substantial impact on heat generation, as well as external irrigation, drilling depth and drill diameter.
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Affiliation(s)
- Dino Tur
- Clinical Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Katharina Giannis
- Clinical Division Unit-Dentistry Training, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Ewald Unger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, AKH Vienna, Vienna, Austria
| | - Martina Mittlböck
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Xiaohui Rausch-Fan
- Clinical Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Georg D Strbac
- Clinical Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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Akhbar MFA, Sulong AW. Surgical Drill Bit Design and Thermomechanical Damage in Bone Drilling: A Review. Ann Biomed Eng 2021; 49:29-56. [PMID: 32860111 DOI: 10.1007/s10439-020-02600-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022]
Abstract
As drilling generates substantial bone thermomechanical damage due to inappropriate cutting tool selection, researchers have proposed various approaches to mitigate this problem. Among these, improving the drill bit design is one of the most feasible and economical solutions. The theory and applications in drill design have been progressing, and research has been published in various fields. However, pieces of information on drill design are dispersed, and no comprehensive review paper focusing on this topic. Systemizing this information is crucial and, therefore, the impetus of this review. Here, we review not only the state-of-the-art in drill bit designs-advances in surgical drill bit design-but also the influences of each drill bit geometries on bone damage. Also, this work provides future directions for this topic and guidelines for designing an improved surgical drill bit. The information in this paper would be useful as a one-stop document for clinicians, engineers, and researchers who require information related to the tool design in bone drilling surgery.
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Bacci C, Lucchiari N, Frigo AC, Stecco C, Zanette G, Dotto V, Sivolella S. Temperatures generated during implant site preparation with conventional drilling versus single-drill method: an ex-vivo human mandible study. Minerva Stomatol 2020; 68:277-284. [PMID: 32052615 DOI: 10.23736/s0026-4970.19.04142-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Bone overheating during osteotomy is a potential cause of necrosis and consequent failure of dental implant osseointegration. The aim of this study is to identify any differences between conventional osteotomy with drills of increasing size and the use of a single drill in terms of the temperature increase in the bone during implant site preparation. METHODS Thirty-eight implant sites were prepared in ex vivo human mandibles, 19 using the conventional method with drills of increasing diameter (group A) and 19 using a single-drill method (group B), with no irrigation in either procedure. An infrared thermometer was used to measure the temperature difference (T°) induced by the drills at each site. Student's t-test (with P<0.05) was used to compare the temperature increase induced by the last drill in group A, and by the single drill in group B. RESULTS The mean ΔT° in group A was 0.64 °C, while in group B it was 1.47 °C. The difference between the temperatures obtained in the two groups was statistically significant (P=0.0073). CONCLUSIONS In statistical terms, the two methods differ significantly in the temperature increase induced by the drilling procedure, but this difference is clinically irrelevant.
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Affiliation(s)
- Christian Bacci
- Unit of Oral Surgery, Section of Clinical Dentistry, Department of Neurosciences, University of Padua, Padua, Italy -
| | - Nicola Lucchiari
- Unit of Oral Surgery, Section of Clinical Dentistry, Department of Neurosciences, University of Padua, Padua, Italy
| | - Anna C Frigo
- Section of Biostatistics, Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Carla Stecco
- Section of Human Anatomy, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Gastone Zanette
- Unit of Oral Surgery, Section of Clinical Dentistry, Department of Neurosciences, University of Padua, Padua, Italy
| | - Virginia Dotto
- Unit of Oral Surgery, Section of Clinical Dentistry, Department of Neurosciences, University of Padua, Padua, Italy
| | - Stefano Sivolella
- Unit of Oral Surgery, Section of Clinical Dentistry, Department of Neurosciences, University of Padua, Padua, Italy
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Chargui M, Dhouib A, Esposito F, Spyropoulou V, Steiger C, Dayer R, Ceroni D. Osteonecrosis After Contralateral in Situ Prophylactic Pinning for a Slipped Capital Femoral Epiphysis: A Case Report. JBJS Case Connect 2019; 8:e60. [PMID: 30095469 DOI: 10.2106/jbjs.cc.17.00200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
CASE We report the case of an 11-year-old girl who developed osteonecrosis of the femoral head in the radiographically normal, asymptomatic left hip that had been fixed prophylactically in the context of a slipped capital femoral epiphysis (SCFE) that had been detected on the contralateral hip. The etiology of the osteonecrosis remains unknown. CONCLUSION This case report demonstrates that prophylactic fixation of a radiographically normal, asymptomatic hip in the context of an SCFE on the contralateral side has the potential for substantial complications. Therefore, the risk of osteonecrosis in the prophylactically pinned hip should be carefully considered because this complication may have devastating functional consequences.
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Affiliation(s)
- Moez Chargui
- Orthopedic Service, Regional Hospital of Neuchâtel, Neuchâtel, Switzerland
| | - Amira Dhouib
- Department of Radiology (A.D.), Pediatric Emergency Service (F.E. and V.S.), and Pediatric Orthopaedic Service (C.S., R.D., and D.C.), University Hospital of Geneva, Geneva, Switzerland
| | - Fabiana Esposito
- Department of Radiology (A.D.), Pediatric Emergency Service (F.E. and V.S.), and Pediatric Orthopaedic Service (C.S., R.D., and D.C.), University Hospital of Geneva, Geneva, Switzerland
| | - Vasiliki Spyropoulou
- Department of Radiology (A.D.), Pediatric Emergency Service (F.E. and V.S.), and Pediatric Orthopaedic Service (C.S., R.D., and D.C.), University Hospital of Geneva, Geneva, Switzerland
| | - Christina Steiger
- Department of Radiology (A.D.), Pediatric Emergency Service (F.E. and V.S.), and Pediatric Orthopaedic Service (C.S., R.D., and D.C.), University Hospital of Geneva, Geneva, Switzerland
| | - Romain Dayer
- Department of Radiology (A.D.), Pediatric Emergency Service (F.E. and V.S.), and Pediatric Orthopaedic Service (C.S., R.D., and D.C.), University Hospital of Geneva, Geneva, Switzerland
| | - Dimitri Ceroni
- Department of Radiology (A.D.), Pediatric Emergency Service (F.E. and V.S.), and Pediatric Orthopaedic Service (C.S., R.D., and D.C.), University Hospital of Geneva, Geneva, Switzerland
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11
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Barrak I, Joób-Fancsaly Á, Braunitzer G, Varga E Jr, Boa K, Piffkó J. Intraosseous Heat Generation During Osteotomy Performed Freehand and Through Template With an Integrated Metal Guide Sleeve: An In Vitro Study. IMPLANT DENT 2018; 27:342-50. [PMID: 29762185 DOI: 10.1097/ID.0000000000000763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate drill wear and consequent intraosseous temperature elevation during freehand and guided bone drilling, with attention to the effect of metal-on-metal contact during guided drilling. MATERIALS AND METHODS Osteotomies were performed on bovine ribs, with 2.0 mm diameter stainless steel drill bits of the SMART Guide System, under 3 sterilization protocols, at 800, 1200, 1500, and 2000 rpm. Sterilization was performed after every 3 drilling. Temperature was measured after every 30 drilling. RESULTS The studied contributing factors had a cumulative effect, and each contributed significantly to temperature elevation. Whether guide use led to a near-necrotic (47°C) temperature increment depended largely on the applied sterilization protocol. CONCLUSION The metal sleeve is a significant contributing factor to heat generation during guided osteotomy, but its effect can be offset by keeping the other studied factors under control.
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12
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Gehrke SA, Bettach R, Aramburú Júnior JS, Prados-Frutos JC, Del Fabbro M, Shibli JA. Peri-Implant Bone Behavior after Single Drill versus Multiple Sequence for Osteotomy Drill. Biomed Res Int 2018; 2018:9756043. [PMID: 29850594 DOI: 10.1155/2018/9756043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 02/07/2018] [Indexed: 11/26/2022]
Abstract
Objectives The present study aims to compare the drilling protocol effect on osseointegration event in three commercially available titanium dental implants with different drill protocol using a rabbit tibia model. Materials and Methods Three different drilling sequences were compared as follows: drilling sequence using a single unique drill of 4.2 mm conical implant (Group 1), drilling sequence using 3 consecutive cylindrical drills for a 4.1 mm cylindrical implant (Group 2), and drilling sequence using 3 consecutive conical drills for a 4.3 mm conical implant (Group 3). For each group, 18 drilling procedures and implant placements were performed, totalizing 54 commercially available titanium dental implants. The samples were removed 6 weeks after implantation. Resonance frequency analyses (RFA) were performed immediately after the implantation, and at 6 weeks removal torque test (RTt) and histological analysis were performed. Results The RFA measured showed statistical difference between the groups in time 1 and no significant statistical differences in time 2 (p > 0.05). In the RTt no significant difference was found between the 3 groups tested. Histomorphometric analysis showed no significant difference between groups in the bone-to-implant contact% (p > 0.05). Conclusion In the present preclinical study, osteotomy using a single bur did not show differences regarding the proposed and evaluated tests parameters for assessing the peri-implant behavior.
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13
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Lee J, Chavez CL, Park J. Parameters affecting mechanical and thermal responses in bone drilling: A review. J Biomech 2018; 71:4-21. [PMID: 29559242 DOI: 10.1016/j.jbiomech.2018.02.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/01/2018] [Accepted: 02/17/2018] [Indexed: 10/17/2022]
Abstract
Surgical bone drilling is performed variously to correct bone fractures, install prosthetics, or for therapeutic treatment. The primary concern in bone drilling is to extract donor bone sections and create receiving holes without damaging the bone tissue either mechanically or thermally. We review current results from experimental and theoretical studies to investigate the parameters related to such effects. This leads to a comprehensive understanding of the mechanical and thermal aspects of bone drilling to reduce their unwanted complications. This review examines the important bone-drilling parameters of bone structure, drill-bit geometry, operating conditions, and material evacuation, and considers the current techniques used in bone drilling. We then analyze the associated mechanical and thermal effects and their contributions to bone-drilling performance. In this review, we identify a favorable range for each parameter to reduce unwanted complications due to mechanical or thermal effects.
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Affiliation(s)
- JuEun Lee
- Department of Mechanical Engineering, School of Engineering and Computer Science, University of the Pacific, Stockton, CA 95211, USA.
| | - Craig L Chavez
- Department of Mechanical Engineering, School of Engineering and Computer Science, University of the Pacific, Stockton, CA 95211, USA
| | - Joorok Park
- Department of Orthodontics, Arthur. A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA 94103, USA
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Katic Z, Jukic T, Stubljar D. Effects of Osteotomy Lengths on the Temperature Rise of the Crestal Bone During Implant Site Preparation. IMPLANT DENT 2018; 27:213-20. [PMID: 29443816 DOI: 10.1097/ID.0000000000000732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To compare temperatures of the crestal bone during implant site preparation for different osteotomy lengths and implant systems. METHODS Bovine ribs were used to simulate the cortical bone of the human mandible. Three different implant systems were tested: Astra Tech, Ankylos, and XiVE. Six drills per system were performed, meaning each drilling set was used for 2 drills per 3 osteotomy lengths (8, 12, and 16 mm). Drilling force, drilling speed, drilling length, and temperature were recorded. RESULTS Differences in the maximum temperature of the crestal bone during the first drilling for various osteotomy lengths (P = 0.021) and all implant systems (P = 0.013) were observed. A similar result was showed during the second drilling; osteotomy lengths (P = 0.014) and drilling systems (P = 0.003). Second drillings showed lower temperatures of the crestal bone with statistical differences on all measurements (P < 0.001). Astra Tech and Ankylos implant systems showed similar performance; XiVE had lower temperature and higher temperature differences between osteotomy lengths. CONCLUSIONS Different drilling lengths contributed to the variation in temperature regardless of the implant system. Longer drills and osteotomies induced higher temperatures on the crestal bone. The maximum temperature difference between the shortest and the longest osteotomy was under 1°C. Temperature above 47°C that could cause bone necrosis was not recorded at any time. The XiVE system showed the best performance.
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Di Fiore A, Sivolella S, Stocco E, Favero V, Stellini E. Experimental Analysis of Temperature Differences During Implant Site Preparation: Continuous Drilling Technique Versus Intermittent Drilling Technique. J ORAL IMPLANTOL 2018; 44:46-50. [DOI: 10.1563/aaid-joi-d-17-00077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Implant site preparation through drilling procedures may cause bone thermonecrosis. The aim of this in vitro study was to evaluate, using a thermal probe, overheating at implant sites during osteotomies through 2 different drilling methods (continuous drilling technique versus intermittent drilling technique) using irrigation at different temperatures. Five implant sites 13 mm in length were performed on 16 blocks (fresh bovine ribs), for a total of 80 implant sites. The PT-100 thermal probe was positioned 5 mm from each site. Two physiological refrigerant solutions were used: one at 23.7°C and one at 6.0°C. Four experimental groups were considered: group A (continuous drilling with physiological solution at 23.7°C), group B (intermittent drilling with physiological solution at 23.7°C), group C (continuous drilling with physiological solution at 6.0°C), and group D (intermittent drilling with physiological solution at 6.0°C). The Wilcoxon rank-sum test (2-tailed) was used to compare groups. While there was no difference between group A and group B (W = 86; P = .45), statistically significant differences were observed between experimental groups A and C (W = 0; P =.0001), B and D (W = 45; P =.0005), and C and D (W = 41; P = .003). Implant site preparation did not affect the overheating of the bone. Statistically significant differences were found with the refrigerant solutions. Using both irrigating solutions, bone temperature did not exceed 47°C.
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Affiliation(s)
- Adolfo Di Fiore
- Department of Neurosciences, Section of Dentistry, University of Padua, Italy
| | - Stefano Sivolella
- Department of Neurosciences, Section of Dentistry, University of Padua, Italy
| | - Elena Stocco
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Italy
| | - Vittorio Favero
- Department of Surgery, Section of Maxillo-Facial Surgery and Dentistry, University of Verona, Italy
| | - Edoardo Stellini
- Department of Neurosciences, Section of Dentistry, University of Padua, Italy
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Abstract
PURPOSE This study evaluated the effect of drilling speed on early bone healing in the mandible of dogs. MATERIAL AND METHODS Six dogs were selected, and mandibular premolars and molars were extracted. After 2 months, 3 hydroxyapatite-surfaced fixtures were implanted with drilling speeds of 50, 800, and 1200 rpm on the right side first and then on the left side after 2 weeks. Implant stability quotient (ISQ) was measured on insertion, after 2 and 4 weeks. RESULTS Based on the ISQ measurement, the 1200-rpm group showed a higher value than the 50-rpm group at 2 weeks and 4 weeks (P < 0.05). New bone formation around the implant was highest for the 800-rpm group at 2 weeks and the 1200-rpm group at 4 weeks. The bone-implant contact of the superior half of the alveolar bone was highest for the 800-rpm group at 2 weeks and the 1200-rpm group at 4 weeks. There was no statistically significant difference. CONCLUSION This study suggests that 50, 800, and 1200 rpm are drilling speeds which can expect favorable outcome, yet, higher drilling speed presented overall the best biological responses.
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Affiliation(s)
- Dong-Uk Seo
- Graduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Su-Gwan Kim
- Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Ji-Su Oh
- Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Sung-Chul Lim
- Professor, Department of Pathology, School of Medicine, Chosun University, Gwangju, Korea
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Trisi P, Berardini M, Falco A, Vulpiani MP. Effect of temperature on the dental implant osseointegration development in low-density bone: an in vivo histological evaluation. IMPLANT DENT 2015; 24:96-100. [PMID: 25621555 DOI: 10.1097/ID.0000000000000204] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To make an in vivo evaluation of the effects of 2 different bone temperatures, on the development of implant osseointegration, in low-density bone. MATERIALS AND METHODS Fifteen implant osteotomic sites were prepared in the iliac crests of sheep. Before the implant insertion, 5 sites were heated to 50°C for 1 minute, 5 sites to 60°C for 1 minute, and 5 sites were not overheated. Fifteen titanium dental implants (Cortex, Israel) were inserted. After a healing period of 2 months, the histomorphometric parameters calculated for each implant were the Bone-Implant Contact percentage (%BIC) and the infrabony pocket depth. Unpaired t test was applied to find statistical differences between groups. RESULTS No implants failed. Statistical significant differences in %BIC and periimplant bone loss were found between the 60°C group and control group. No significant differences were found between the 50°C group and control group, although bone suffering signs were present. CONCLUSION An osteotomic site overheating up to 60°C for 1 minute in low-density bone, before implant insertion, did not lead to implant failure, but it induced significant crestal bone loss during healing and lower %BIC.
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Chen YC, Hsiao CK, Ciou JS, Tsai YJ, Tu YK. Effects of implant drilling parameters for pilot and twist drills on temperature rise in bone analog and alveolar bones. Med Eng Phys 2016; 38:1314-1321. [DOI: 10.1016/j.medengphy.2016.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 06/13/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
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Singh TS, Yusoff AH, Chian YK. How Safe Is High-Speed Burring in Spine Surgery? An In Vitro Study on the Effect of Rotational Speed and Heat Generation in the Bovine Spine. Spine (Phila Pa 1976) 2015; 40:E866-72. [PMID: 25996539 DOI: 10.1097/BRS.0000000000000985] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vitro animal cadaveric study. OBJECTIVE To identify the appropriate rotational speed and safe bone distance from neural tissue during bone burring in spinal surgery. SUMMARY OF BACKGROUND DATA Bone burring is a common step in spinal surgery. Unwanted frictional heat produced during bone burring may result in thermal injury to the bone and adjacent neural structure. One of the important parameters influencing the bone temperature rise during bone burring is rotational speed. METHODS This laboratory-based animal study used bovine spine bones, and the tests were conducted using a steel round burr. The bone temperature was measured simultaneously with thermocouple at the distances of 1 mm, 3 mm, and 5 mm from the burring site during the burring process. The bone burring was done with 4 different rotational speeds of 35,000 revolutions per minute (rpm), 45,000 rpm, 65,000 rpm, and 75,000 rpm. RESULTS This study showed that increasing the rotational speed significantly elevated bone temperature. The threshold temperature of 47°C was reached when bone was burred for 10 seconds, with a rotational speed of 45,000 rpm. The mean bone temperature measured at a distance 1 mm from the burring site for all 4 rotational speeds was always higher than that measured at a distance of 3 mm and 5 mm and this difference was statistically significant (P < 0.001). There was no significant difference between the mean bone temperature measured at a distance of 3 mm and 5 mm (P > 0.05). CONCLUSION Taking 47°C as the threshold temperature for causing significant impairment to the regenerative capacity of bone, a rotational speed of lower than 45,000 rpm is preferable so as to minimize thermal injury to bone tissue. We also concluded that a 3-mm distance between the site of burring and the neural tissue is a safe distance. LEVEL OF EVIDENCE N/A.
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Trisi P, Berardini M, Falco A, Vulpiani MP, Masciotra L. Effect of 50 to 60°C Heating on Osseointegration of Dental Implants in Dense Bone: An In Vivo Histological Study. IMPLANT DENT 2014; 23:516-21. [DOI: 10.1097/id.0000000000000162] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Calvo-Guirado JL, Delgado-Peña J, Maté-Sánchez JE, Mareque Bueno J, Delgado-Ruiz RA, Romanos GE. Novel hybrid drilling protocol: evaluation for the implant healing--thermal changes, crestal bone loss, and bone-to-implant contact. Clin Oral Implants Res 2014; 26:753-60. [PMID: 24502654 DOI: 10.1111/clr.12341] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate a new hybrid drilling protocol, by the analysis of thermal changes in vitro, and their effects in the crestal bone loss and bone-to-implant contact in vivo. MATERIALS AND METHODS Temperature changes during simulated osteotomies with a hybrid drilling technique (biologic plus simplified) (test) versus an incremental drilling technique (control) were investigated. One hundred and twenty random osteotomies were performed (60 by group) in pig ribs up to 3.75-mm-diameter drill to a depth of 10 mm. Thermal changes and time were recorded by paired thermocouples. In a parallel experiment, bilateral mandibular premolars P2, P3, P4, and first molar M1 were extracted from six dogs. After 2-month healing, implant sites were randomly prepared using either of the drilling techniques. Forty eight implants of 3.75 mm diameter and 10 mm length were inserted. The dogs were euthanized at 30 and 90 days, and crestal bone loss (CBL) and bone-to-implant contact (BIC) were evaluated. RESULTS The control group showed maximum temperatures of 35.3 °C ± 1.8 °C, ΔT of 10.4 °C, and a mean time of 100 s/procedure; meanwhile, the test group showed maximum temperatures of 36.7 °C ± 1.2 °C, ΔT of 8.1 °C, and a mean time of 240 s/procedure. After 30 days, CBL values for both groups (test: 1.168 ± 0.194 mm; control: 1.181 ± 0.113 mm) and BIC values (test: 43 ± 2.8%; control: 45 ± 1.3%) were similar, without significant differences (P > 0.05). After 90 days, CBL (test: 1.173 ± 0.187 mm; control: 1.205 ± 0.122 mm) and BIC (test: 64 ± 3.3%; control: 64 ± 2.4%) values were similar, without significant differences (P > 0.05). The BIC values were increased at 90 days in both groups compared with the 30-day period (P < 0.05). CONCLUSIONS Within the limitations of this study, the new hybrid protocol for the preparation of the implant bed without irrigation, increase the temperature similarly to the incremental conventional protocol, and requires twice the time for the completion of the drilling procedure in vitro. Crestal bone loss and bone-to-implant contact in the hybrid drilling protocol are comparable with the conventional drilling protocol and do not affect the osseointegration process in vivo.
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Gehrke SA, Pazetto MK, de Oliveira S, Corbella S, Taschieri S, Mardegan FEC. Study of temperature variation in cortical bone during osteotomies with trephine drills. Clin Oral Investig 2014; 18:1749-55. [PMID: 24398970 DOI: 10.1007/s00784-013-1163-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/05/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare temperature variation during osteotomies with trephine drills under different irrigation conditions: without irrigation, external irrigation, and double irrigation. MATERIALS AND METHODS Synthetic blocks of bone (type I density) were used for drilling procedures with an experimental computed machine, which measured the maximum temperature in the cortical bone during osteotomy with a bone cut that was 5 mm in both diameter and depth. Three groups were formed depending on the irrigation conditions: no irrigation (G1), external irrigation (G2), and double irrigation (G3). Fifty drillings were performed for each group. RESULTS The average thermal increase in the groups was 21.7 ± 1.52 °C in G1, 14.2 ± 0.70 °C in G2, and 12.4 ± 0.75 °C in G3. The results presented statistically significant differences among all groups (α = 0.05). CONCLUSION The double irrigation technique resulted in a smaller increase in temperature in the cortical bone model, demonstrating a greater efficiency, which may be beneficial when compared to external irrigation alone. CLINICAL RELEVANCE The trephine has been widely used in removing small blocks for bone graft, especially the posterior mandible, where the possibility of heating may be higher due to the density of cortical bone in this area. So it is important that the professionals select instruments that can reduce the risks of complications in the proposed treatment.
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Jeong SM, Yoo JH, Fang Y, Choi BH, Son JS, Oh JH. The effect of guided flapless implant procedure on heat generation from implant drilling. J Craniomaxillofac Surg 2013; 42:725-9. [PMID: 24332815 DOI: 10.1016/j.jcms.2013.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 08/02/2013] [Accepted: 11/04/2013] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to evaluate the heat generation in vitro during the flapless drilling procedure using surgical drill guides. Ten resin models with bilateral edentulous tooth spaces in the first and second molars in the mandible were used in this study. On one side of the mandible, drilling was performed with a flapless approach using a surgical drill guide. On the other side of the mandible, drilling was performed with a flap approach. The temperature changes were measured during final drilling by thermocouples. The mean maximum temperatures during drilling with guided flapless procedures were 29.5 °C and 32.6 °C at the depths of 3 and 6 mm, respectively, whereas for flap procedures they were 29.4 °C and 31.3 °C. There was no statistically significant difference between the groups. These findings suggest that drilling with external irrigation in an up-and-down pumping motion may not lead to a significant increase the bone temperature during a flapless procedure using surgical drill guides.
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Affiliation(s)
- Seung-Mi Jeong
- Department of Dentistry, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Je-Hyeon Yoo
- Department of Dentistry, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Yiqin Fang
- Department of Dentistry, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Byung-Ho Choi
- Department of Dentistry, Yonsei University Wonju College of Medicine, Wonju, South Korea.
| | - Jeong-Seog Son
- Department of Dentistry, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Ji-Hyeon Oh
- Department of Dentistry, Yonsei University Wonju College of Medicine, Wonju, South Korea
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Gehrke SA, Bettach R, Taschieri S, Boukhris G, Corbella S, Del Fabbro M. Temperature Changes in Cortical Bone after Implant Site Preparation Using a Single Bur versus Multiple Drilling Steps: An In Vitro Investigation. Clin Implant Dent Relat Res 2013; 17:700-7. [PMID: 24215668 DOI: 10.1111/cid.12172] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The study aims to test the hypothesis of no differences in temperature variation by using a single bur for implant site preparation as compared with conventional drilling sequence using multiple burs with incremental diameter. MATERIALS AND METHODS Synthetic blocks of bone (type I density) were used for drilling procedures. THREE GROUPS WERE EVALUATED Group 1 and Group 2 - drilling with three consecutive burs for a 4.1 mm cylindrical implant and for a 4.3 mm conical implant, respectively; Group 3 - drilling with a single bur for a 4.2 mm conical implant. For each group, 20 drilling procedures were performed without irrigation and 20 with external irrigation. The temperature in the cortical bone during osteotomy for implant site preparation was measured through a thermocouple. RESULTS The mean temperatures and standard deviations for the drilling without irrigation were: 25.5 ± 1.24°C for Group 1; 28.1 ± 1.76°C for Group 2; 26.5 ± 1.79°C for Group 3. Considering the drilling with irrigation, the mean values and standard deviations were: 20.4 ± 1.17°C for Group 1; 22.2 ± 1.38°C for Group 2; 20.2 ± 0.83°C for Group 3. Groups 1 and 3 yielded similar results, while Group 2 displayed significantly higher temperature increase than the other two groups. CONCLUSIONS The single bur drilling protocol did not produce greater bone heating than the conventional protocol and may be considered a safe procedure.
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Affiliation(s)
- Sergio Alexandre Gehrke
- Biotecnos Research Center, Santa Maria, Brazil.,Catholic University of Uruguay, Montevideo, Uruguay
| | - Raphaél Bettach
- New York University, New York, NY, USA.,private practice, Gretz-Armainvilliers, France
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,Section of Endodontics and Implant Surgery, Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Stefano Corbella
- Università degli Studi di Milano, Department of Biomedical, Surgical and Dental Sciences, Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Massimo Del Fabbro
- Research Center in Oral Health, Department of Biomedical, Surgical and Dental Sciences, IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milan, Italy
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Jimbo R, Janal MN, Marin C, Giro G, Tovar N, Coelho PG. The effect of implant diameter on osseointegration utilizing simplified drilling protocols. Clin Oral Implants Res 2013; 25:1295-1300. [PMID: 25040139 DOI: 10.1111/clr.12268] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To observe and to compare histologically and histomorphometrically, the combined effect of drilling sequence and implant diameter in vivo. MATERIAL AND METHODS A total of 72 alumina-blasted and acid-etched Ti-6Al-4V implants with three different diameters (3.75, 4.2, and 5 mm, n = 24 for each group) were placed in the right and left tibiae of 12 beagle dogs. Within the same diameter group, half of the implants were inserted after a simplified drilling procedure (pilot drill + final diameter drill) on one tibia and the other half were placed using the conventional drilling procedure on the other tibia. After 1 week, half of the animals (n = 6) were sacrificed, and the other half was sacrificed after 5 weeks (n = 6). The retrieved bone-implant samples were subjected to non-decalcified histologic sectioning, and the bone-to-implant contact (BIC) and the bone area fraction occupancy (BAFO) were analyzed. Primary statistical analysis used a mixed model analysis of variance with significance level set at P < 0.05. RESULTS Histologic observation showed that at 1 week, immature woven bone formed in vicinity of the implant, whereas at 5 weeks, the woven bone was replaced by lamellar bone, which formed in proximity with the implant. Histomorphometrically, the simplified technique was associated with significantly greater BIC and BAFO after 1 week. Differences between techniques were not longer apparent after 5 weeks, but BAFO was inversely and significantly associated with implant diameter at that time. CONCLUSIONS The simplified technique did not impair either early or late bone formation for any tested implant diameter; however, wider diameters were associated with less bone formation at longer healing times for both techniques.
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Affiliation(s)
- Ryo Jimbo
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Malvin N Janal
- Department of Epidemiology and Health Promotion, New York University, New York, NY, USA
| | - Charles Marin
- Department of Dentistry, Division of Oral and Maxillofacial Surgery, Universidade Federal de Santa Catarina, Brazil
| | - Gabriela Giro
- Department of Biomaterials and Biomimetics, New York University, New York, NY, USA
| | - Nick Tovar
- Department of Biomaterials and Biomimetics, New York University, New York, NY, USA
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, New York University, New York, NY, USA
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Marković A, Mišić T, Mančić D, Jovanović I, Šćepanović M, Jezdić Z. Real-time thermographic analysis of low-density bone during implant placement: a randomized parallel-group clinical study comparing lateral condensation with bone drilling surgical technique. Clin Oral Implants Res 2013; 25:910-8. [PMID: 23710900 DOI: 10.1111/clr.12191] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare the effect of two surgical techniques, lateral condensation and bone drilling, on changes in temperature of the adjacent low-density bone during implant placement into posterior maxilla and to investigate the influence of the host factors - age, gender, region of implantation, bone density, and thickness of the cortical bone at the recipient sites. MATERIAL AND METHODS Local bone temperature was measured thermographically during implant placement into posterior maxilla following lateral bone condensing (test group) or bone drilling (controls). The main study outcomes were baseline bone temperature prior to implantation and maximum bone temperature recorded during implantation. Early implant success was evaluated after 6 months of healing. RESULTS A total of 40 implants were randomly allocated to test and control groups and placed into maxillary premolar and/or molar region of 18 participants of both genders and average age of 51.74 years. All recorded bone temperatures were below the threshold for thermal necrosis. Although both groups showed significant increase in bone temperature during implant placement procedure (P ≤ 0.0005), it was significantly higher for bone condensing compared with drilling (P ≤ 0.0005; 3.79 ± 1.54°C; 1.91 ± 0.70°C respectively). No host factor was singled out as a significant predictor of bone temperature changes, although trend of higher increase was observed in young patients, regardless of gender, during implant placement procedure into maxillary first premolar region with bone density type 3 and cortical layer thicker than 1 mm. Early implant success rate after 6 months follow-up was 100%. CONCLUSION Although both surgical techniques, bone condensing and bone drilling, can be considered safe regarding their thermal effect on the bone of posterior maxilla, bone drilling is associated with fewer local bone heating during implantation. Host factors do not affect the bone thermal changes significantly.
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Affiliation(s)
- Aleksa Marković
- Clinic of Oral Surgery, School of Dentistry, University of Belgrade, Belgrade, Serbia
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27
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Trisi P, Berardini M, Falco A, Podaliri Vulpiani M, Perfetti G. Insufficient irrigation induces peri-implant bone resorption: anin vivohistologic analysis in sheep. Clin Oral Implants Res 2013; 25:696-701. [DOI: 10.1111/clr.12127] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Paolo Trisi
- Biomaterial Clinical Research Association; Private Practice; Pescara Italy
| | | | | | | | - Giorgio Perfetti
- Head Department of Oral Surgery; University of Chieti-Pescara; Chieti Italy
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Lee J, Ozdoganlar OB, Rabin Y. An experimental investigation on thermal exposure during bone drilling. Med Eng Phys 2012; 34:1510-20. [DOI: 10.1016/j.medengphy.2012.03.002] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 12/27/2011] [Accepted: 03/05/2012] [Indexed: 01/12/2023]
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Stelzle F, Frenkel C, Riemann M, Knipfer C, Stockmann P, Nkenke E. The effect of load on heat production, thermal effects and expenditure of time during implant site preparation - an experimental ex vivo comparison between piezosurgery and conventional drilling. Clin Oral Implants Res 2012. [PMID: 23186531 DOI: 10.1111/clr.12077] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Piezoelectric surgery (PS) is meant to be a gentle osteotomy method. The aim of this study was to compare piezosurgical vs. conventional drilling methods for implant site preparation (ISP) - focusing on load-dependent thermal effect on hard tissue and the expenditure of ISP time. MATERIALS AND METHODS Three hundred and sixty ISP were performed on ex vivo pig heads using piezosurgery, spiral burs (SB) and trephine burs (TB). The load applied was increased from 0 to 1000 g in 100-g intervals. Temperature within the bone was measured with a thermocouple, and duration was recorded with a stop watch. Thermal effects were histomorphometrically analysed. Twelve ISPs per technique were performed at the lateral wall of the maxillary sinus. RESULTS PS yields the highest mean temperatures (48.6 ± 3.4°C) and thermal effects (200.7 ± 44.4 μm), both at 900-1000 g. Duration is reduced with a plus of load and significantly longer in either case for PS (P < 0.05). There is a correlation of the applied load with all other examined factors for PS and TB. Temperature and histological effects decrease for SB beyond 500 g. CONCLUSIONS PS yields significantly higher temperatures and thermal tissue alterations on load levels higher than 500 g and is significantly slower for ISP compared to SB and TB. For ISP with PS, a maximum load of 400 g should be maintained.
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Affiliation(s)
- Florian Stelzle
- Department of Oral and Maxillofacial Surgery, Erlangen University Hospital, Erlangen, Germany
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Lahiri BB, Bagavathiappan S, Jayakumar T, Philip J. Medical applications of infrared thermography: A review. Infrared Phys Technol 2012; 55:221-235. [PMID: 32288544 PMCID: PMC7110787 DOI: 10.1016/j.infrared.2012.03.007] [Citation(s) in RCA: 397] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Indexed: 05/02/2023]
Abstract
Abnormal body temperature is a natural indicator of illness. Infrared thermography (IRT) is a fast, passive, non-contact and non-invasive alternative to conventional clinical thermometers for monitoring body temperature. Besides, IRT can also map body surface temperature remotely. Last five decades witnessed a steady increase in the utility of thermal imaging cameras to obtain correlations between the thermal physiology and skin temperature. IRT has been successfully used in diagnosis of breast cancer, diabetes neuropathy and peripheral vascular disorders. It has also been used to detect problems associated with gynecology, kidney transplantation, dermatology, heart, neonatal physiology, fever screening and brain imaging. With the advent of modern infrared cameras, data acquisition and processing techniques, it is now possible to have real time high resolution thermographic images, which is likely to surge further research in this field. The present efforts are focused on automatic analysis of temperature distribution of regions of interest and their statistical analysis for detection of abnormalities. This critical review focuses on advances in the area of medical IRT. The basics of IRT, essential theoretical background, the procedures adopted for various measurements and applications of IRT in various medical fields are discussed in this review. Besides background information is provided for beginners for better understanding of the subject.
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Affiliation(s)
- B B Lahiri
- Smart Materials and Radiation Techniques Section, Non-Destructive Evaluation Division, Metallurgy and Materials Group, Indira Gandhi Centre for Atomic Research, Kalpakkam 603 102, Tamil Nadu, India
| | - S Bagavathiappan
- Smart Materials and Radiation Techniques Section, Non-Destructive Evaluation Division, Metallurgy and Materials Group, Indira Gandhi Centre for Atomic Research, Kalpakkam 603 102, Tamil Nadu, India
| | - T Jayakumar
- Smart Materials and Radiation Techniques Section, Non-Destructive Evaluation Division, Metallurgy and Materials Group, Indira Gandhi Centre for Atomic Research, Kalpakkam 603 102, Tamil Nadu, India
| | - John Philip
- Smart Materials and Radiation Techniques Section, Non-Destructive Evaluation Division, Metallurgy and Materials Group, Indira Gandhi Centre for Atomic Research, Kalpakkam 603 102, Tamil Nadu, India
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Christensen J, Matzen LH, Vaeth M, Schou S, Wenzel A. Thermography as a quantitative imaging method for assessing postoperative inflammation. Dentomaxillofac Radiol 2012; 41:494-9. [PMID: 22752326 DOI: 10.1259/dmfr/98447974] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess differences in skin temperature between the operated and control side of the face after mandibular third molar surgery using thermography. METHODS 127 patients had 1 mandibular third molar removed. Before the surgery, standardized thermograms were taken of both sides of the patient's face using a Flir ThermaCam™ E320 (Precisions Teknik AB, Halmstad, Sweden). The imaging procedure was repeated 2 days and 7 days after surgery. A region of interest including the third molar region was marked on each image. The mean temperature within each region of interest was calculated. The difference between sides and over time were assessed using paired t-tests. RESULTS No significant difference was found between the operated side and the control side either before or 7 days after surgery (p > 0.3). The temperature of the operated side (mean: 32.39 °C, range: 28.9-35.3 °C) was higher than that of the control side (mean: 32.06 °C, range: 28.5-35.0 °C) 2 days after surgery [0.33 °C, 95% confidence interval (CI): 0.22-0.44 °C, p < 0.001]. No significant difference was found between the pre-operative and the 7-day post-operative temperature (p > 0.1). After 2 days, the operated side was not significantly different from the temperature pre-operatively (p = 0.12), whereas the control side had a lower temperature (0.57 °C, 95% CI: 0.29-0.86 °C, p < 0.001). CONCLUSIONS Thermography seems useful for quantitative assessment of inflammation between the intervention side and the control side after surgical removal of mandibular third molars. However, thermography cannot be used to assess absolute temperature changes due to normal variations in skin temperature over time.
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Affiliation(s)
- J Christensen
- Department of Oral Radiology, Aarhus School of Dentistry, Aarhus University, Denmark.
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Abstract
OBJECTIVE To determine changes in drill bit performance attributable to application of a triaxially resilient, hard-carbon thin film. STUDY DESIGN In vitro mechanical study. METHODS Five matched pairs of control bits and bits with a carbon nanofilm applied were tested in equine cortical bone and a synthetic bone substrate. Thirty sequential holes were drilled with each bit. Drilling time was recorded for all holes. Maximum substrate temperature was measured with infrared thermography for holes 1, 15, and 30. Drilling time, prolongation of drilling time over successive uses, and maximum substrate temperature were compared between control and test bits in each substrate. RESULTS Drilling time was significantly reduced with test bits in both substrates. Drilling time over successive osteotomies increased more slowly with test bits than with control bits. Test bits generated significantly lower substrate temperatures during drilling. CONCLUSIONS Bits with the carbon nanofilm completed osteotomy faster and generated less heat than control bits. Test bits also had less degradation of drilling performance with repeated use.
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Affiliation(s)
- Janik C Gasiorowski
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
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Oliveira N, Alaejos-Algarra F, Mareque-Bueno J, Ferrés-Padró E, Hernández-Alfaro F. Thermal changes and drill wear in bovine bone during implant site preparation. A comparative in vitro study: twisted stainless steel and ceramic drills. Clin Oral Implants Res 2011; 23:963-9. [PMID: 21806686 DOI: 10.1111/j.1600-0501.2011.02248.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose was to assess thermal changes and drill wear in bovine bone tissue with the use of twisted stainless steel and zirconia-based drills, during implant site preparation. METHODS A total of 100 implant site preparations were performed on bovine ribs using a surgical unit linked to a testing device, in order to standardize/simulate implant drilling procedures. Bone temperature variations and drilling force were recorded when drilling at a depth of 8 and 10 mm. A constant irrigation of 50 ml/min. (21±1°C) and drilling speed of 800 r.p.m. were used. Scanning electron microscopy analysis was preformed prior and after drilling. RESULTS Mean temperature increase with both drills at 8 mm was 0.9°C and at 10 mm was 2°C (P<0.0001). Statistical significant higher bone temperatures were obtained with stainless steel drill (1.6°C), when comparing with the ceramic drill (1.3°C) (P<0.05). Temperature increase was correlated with higher number of perforations (P<0.05) and drilling load applied. There was no significant association between drilling force applied and temperature increase by either drill or at either depth. No severe signs of wear of either drill were detected after 50 uses. CONCLUSIONS Drill material and design, number of uses, depth and drilling load applied appear to influence bone temperature variations during implant site preparation. Drilling depth was a predominant factor in bone temperature increase. Both drills can be used up to 50 times without producing harmful temperatures to bone tissue or severe signs of wear and deformation.
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Affiliation(s)
- Natália Oliveira
- International Program in Implant Dentistry, Surgery and Prosthodontics, Faculty of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain.
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Kim SJ, Yoo J, Kim YS, Shin SW. Temperature change in pig rib bone during implant site preparation by low-speed drilling. J Appl Oral Sci 2011; 18:522-7. [PMID: 21085811 PMCID: PMC4246386 DOI: 10.1590/s1678-77572010000500016] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Accepted: 02/16/2010] [Indexed: 11/22/2022] Open
Abstract
Objectives The purpose of this study was to evaluate the temperature change during lowspeed
drilling using infrared thermography. Material and Methods Pig ribs were used to provide cortical bone of a similar quality to human
mandible. Heat production by three implant drill systems (two conventional
drilling systems and one low-speed drilling system) was evaluated by measuring the
bone temperature using infrared thermography. Each system had two different bur
sizes. The drill systems used were twist drill (2.0 mm/2.5 mm), which establishes
the direction of the implant, and finally a 3.0 mm-pilot drill. Thermal images
were recorded using the IRI1001 system (Infrared Integrated Systems Ltd.).
Baseline temperature was 31±1ºC. Measurements were repeated 10
times, and a static load of 10 kg was applied while drilling. Data were analyzed
using descriptive statistics. Statistical analysis was conducted with two-way
ANOVA. Results and Conclusions Mean values (n=10 drill sequences) for maximum recorded temperature (Max
TºC), change in temperature (∆TºC) from baseline were as
follows. The changes in temperature (∆TºC) were 1.57ºC and
2.46ºC for the lowest and the highest values, respectively. Drilling at 50
rpm without irrigation did not produce overheating. There was no significant
difference in heat production between the 3 implant drill systems (p>0.05). No
implant drill system produced heat exceeding 47ºC, which is the critical
temperature for bone necrosis during low-speed drilling. Low-speed drilling
without irrigation could be used during implant site preparation.
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Affiliation(s)
- Sun-Jong Kim
- Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Seoul, Korea.
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Matsuoka M, Motoyoshi M, Sakaguchi M, Shinohara A, Shigeede T, Saito Y, Matsuda M, Shimizu N. Friction heat during self-drilling of an orthodontic miniscrew. Int J Oral Maxillofac Surg 2011; 40:191-4. [DOI: 10.1016/j.ijom.2010.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
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Martins GL, Puricelli E, Baraldi CE, Ponzoni D. Bone healing after bur and Er:YAG laser ostectomies. J Oral Maxillofac Surg 2010; 69:1214-20. [PMID: 20674121 DOI: 10.1016/j.joms.2010.02.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 10/07/2009] [Accepted: 02/12/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Ostectomies, performed by different methods, are often necessary in oral and maxillofacial surgery. Rotatory and reciprocating devices are most frequently used but have disadvantages, such as noise, vibration, and the potential for inducing thermal damage. Laser systems are interesting alternatives to these procedures. We analyzed bone healing in a rat model after mandibular ostectomy with a surgical bur or noncontact erbium:yttrium-aluminum-garnet laser using different energy levels. MATERIALS AND METHODS Four groups of 5 rats each underwent ostectomy of the bone cortical of the mandibular body, with irrigation, using a surgical bur or erbium:yttrium-aluminum-garnet laser with different energy parameters. A metal plate was used for morphologic standardization of the cavities. The samples collected after 7, 14, 45, 60, and 90 days were analyzed by optical microscopy. RESULTS The ostectomies performed with surgical burs resulted in bone healing from the cortical endosteum and remaining trabecular bone. The cortical endosteum was repaired after 45 days, followed by bone remodeling. After laser irradiation, healing involved bone neoformation from the external cortical surface and endosteum. Surface regions with thermal damage were observed after laser treatment in the 3 conditions used up to day 60, followed by bone remodeling. CONCLUSIONS Laser ostectomies resulted in a thin layer of thermal damage. Bone healing was faster when surgical burs were used, with similar results reached after 90 days.
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Abstract
The aim of this study was to evaluate the effect of water irrigation on heat dissipation kinetics following abutment preparation of 1-piece dental implants. UNO 1-piece dental implants were mounted on Plexiglas apparatus clamping the implant at the collar. T-type thermocouple was attached to the first thread of the implant and recorded thermal changes at 100 millisecond intervals. Implants were prepared using highspeed dental turbine at 400,000 RPM with a coarse diamond bur. Once temperature reached 47 degrees C, abutment preparation was discontinued. Thirty implants were divided into 2 groups. Group A: Passive cooling without water irrigation. Group B: Cooling with turbine's water spray adjacent to the implant (30 mL/min). The following parameters were measured: T47 (time from peak temperature to 47 degrees C), T50%, T75% (time until the temperature amplitude decayed by 50% and 75%, respectively), dTemp50%/dt decay, and dTemp75%/dt decay (cooling rate measured at 50% and 75% of amplitude decay, respectively). Water spray irrigation significantly reduced T47 (1.37+/-0.29 seconds vs 19.97+/-3.06 seconds, P<0.0001), T50% (3.04+/-0.34 seconds vs 27.37+/-2.56 seconds, P<0.0001), and T75% (5.71+/-0.57 seconds vs 57.61+/-5.47 seconds, P<0.0001). Water spray irrigation also increased cooling capacity ninefold: dTemp50%/dt decay (4.14+/-0.61 degrees C/s vs 0.48+/-0.06 degrees C/s, P<0.0001), and dTemp50%/dt decay (1.70+/-0.29 degrees C/s vs 0.19+/-0.03 degrees C/s, P<0.0001). The continuous use of water spray adjacent to the abutment following the cessation of implant preparation might prove beneficial for rapid cooling of the implant.
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Affiliation(s)
- Omer Cohen
- Department of Periodontology, Rambam Health Care Campus, and Faculty of Medicine-Technion, Haifa, Israel.
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Misir AF, Sumer M, Yenisey M, Ergioglu E. Effect of Surgical Drill Guide on Heat Generated From Implant Drilling. J Oral Maxillofac Surg 2009; 67:2663-8. [DOI: 10.1016/j.joms.2009.07.056] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 05/21/2009] [Accepted: 07/31/2009] [Indexed: 11/23/2022]
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Sener BC, Dergin G, Gursoy B, Kelesoglu E, Slih I. Effects of irrigation temperature on heat control in vitro at different drilling depths. Clin Oral Implants Res 2009; 20:294-8. [PMID: 19397641 DOI: 10.1111/j.1600-0501.2008.01643.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Thermal injury during implant bed preparation has a major influence on implant osseointegration and survival. This study investigated the effectiveness of the temperature of the saline solution used for heat control during drilling. MATERIAL AND METHODS Fresh frozen edentulous segments of bovine mandibles were sectioned into 12 x 6 cm pieces. Thermoresistors were placed 0.5 mm from the drilling cavity walls, at depths of 3, 7, and 12 mm. Signals from the three thermoresistors were analyzed using ORIGIN 5.0 software. RESULTS The maximum temperatures during drilling without irrigation were 50.9, 47.4, and 38.1 degrees C at depths of 3, 7, and 12 mm, respectively. With irrigation using saline at 25 and 10 degrees C, the maximum temperatures at a depth of 12 mm were 37.4 and 36.3 degrees C, respectively. All other measurements with both 25 and 10 degrees C saline were below body temperature. DISCUSSION AND CONCLUSION This experimental in vitro study showed that more heat was generated in the superficial part of the drilling cavity than at the bottom. Therefore, external irrigation at room temperature can provide sufficient cooling during drilling. Lower temperature saline was more effective in cooling the bone, and irrigation of the site should be continued between the drilling steps.
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Affiliation(s)
- Bedrettin Cem Sener
- Department of Oral and Maxillofacial Surgery, Marmara University, School of Dentistry, Istanbul, Turkey.
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Augustin G, Davila S, Udiljak T, Vedrina DS, Bagatin D. Determination of spatial distribution of increase in bone temperature during drilling by infrared thermography: preliminary report. Arch Orthop Trauma Surg 2009; 129:703-9. [PMID: 18421465 DOI: 10.1007/s00402-008-0630-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION During the drilling of the bone, the temperature could increase above 47 degrees C and cause irreversible osteonecrosis. The spatial distribution of increase in bone temperature could only be presumed using several thermocouples around the drilling site. The aim of this study was to use infrared thermographic camera for determination of spatial distribution of increase in bone temperature during drilling. MATERIALS AND METHODS One combination of drill parameters was used (drill diameter 4.5 mm; drill speed 1,820 rpm; feed-rate 84 mm/min; drill point angle 100 degrees) without external irrigation on room temperature of 26 degrees C. The increase in bone temperature during drilling was analyzed with infrared thermographic camera in two perpendicular planes. Thermographic pictures were taken before drilling, during drilling with measurement of maximal temperature values and after extraction of the drill from the bone. RESULTS The thermographic picture shows that the increase in bone temperature has irregular shape with maximal increase along cortical bone, which is the most compact component of the bone. The width of this area with the temperature above critical level is three times broader than the width of cortical bone. From the front, the distribution of increase in bone temperature follows the form of the cortical bone (segment of a ring), which is the most compact part and causes the highest resistance to drilling and subsequent friction. CONCLUSIONS Thermography showed that increase in bone temperature spreads through cortical bone, which is the most compact and dense part, and generates highest frictional heat during drilling. The medullar cavity, because of its gelatinous structure, contributes only to thermal dissipation.
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Affiliation(s)
- Goran Augustin
- Department of Surgery, University Hospital Center Zagreb, Kispatićeva 12, 10000 Zagreb, Croatia.
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Ormianer Z, Feuerstein O, Assad R, Samet N, Weiss EI. In Vivo Changes in Dental Implant Temperatures During Hot Beverage Intake: A Pilot Study. IMPLANT DENT 2009; 18:38-45. [DOI: 10.1097/id.0b013e318192e143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Feuerstein O, Zeichner K, Imbari C, Ormianer Z, Samet N, Weiss EI. Temperature changes in dental implants following exposure to hot substances in an ex vivo model. Clin Oral Implants Res 2008; 19:629-33. [DOI: 10.1111/j.1600-0501.2007.01502.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
INTRODUCTION During the drilling of the bone, the temperature could increase above 47 degrees C and cause irreversible osteonecrosis. The result is weakened contact of implants with bone and possible loss of rigid fixation. The aim of this study was to find an optimal condition where the increase in bone temperature during bone drilling process would be minimal. MATERIALS AND METHODS Influence of different drill parameters was evaluated on the increase of bone temperature. Drill diameters were 2.5, 3.2 and 4.5 mm; drill speed 188, 462, 1,140 and 1,820 rpm; feed-rate 24, 56, 84 and 196 mm/min; drill point angle 80 degrees , 100 degrees and 120 degrees and external irrigation with water of 26 degrees C. RESULTS Combinations of drill speed and drill diameter with the use of external irrigation produced temperatures far below critical. Without external irrigation, temperature values for the same combination of parameters ranged 31.4-55.5 degrees C. Temperatures above critical were recorded using 4.5 mm drill with higher drill speeds (1,140 and 1,820 rpm). There was no statistical significance of different drill point angles on the increase or decrease of bone temperature. The higher the feed-rate the lower the increase of bone temperature. CONCLUSIONS The external irrigation is the most important cooling factor. With all combinations of parameters used, external irrigation maintained the bone temperature below 47 degrees C. The increase in drill diameter and drill speed caused increase in bone temperature. The changes in drill point angle did not show significant influence in the increase of the bone temperature. With the increase in feed-rate, increase in bone temperature is lower.
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Affiliation(s)
- Goran Augustin
- Department of Surgery, University Hospital Center Zagreb, Kispatićeva 12, 10000 Zagreb, Croatia.
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Draenert FG, Mathys R, Ehrenfeld M, Draenert Y, Draenert K. Histological examination of drill sites in bovine rib bone after grinding in vitro with eight different devices. Br J Oral Maxillofac Surg 2007; 45:548-52. [PMID: 17287057 DOI: 10.1016/j.bjoms.2006.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2006] [Indexed: 10/23/2022]
Abstract
The way in which bone is processed may affect the quality of the specimen and how much information may be gleaned on histological examination. We investigated eight widely used rasps and drills and compared the results. All large chip cutters damaged the bed and marrow of the bone. The tool that caused the least damage was the wet grinding diamond tool.
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Affiliation(s)
- F G Draenert
- Clinic for Craniomaxillofacial Surgery, University of Munich, Lindwurmstr. 2a, 80336 Munich, Germany.
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45
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Lamey PJ, Biagioni PA, Al-Hashimi I. The feasibility of using infrared thermography to evaluate minor salivary gland function in euhydrated, dehydrated and rehydrated subjects. J Oral Pathol Med 2007; 36:127-31. [PMID: 17305632 DOI: 10.1111/j.1600-0714.2006.00484.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Infrared thermography technique (IRT) is utilized by a growing number of disciplines within medicine and dentistry. However, IRT has not been employed in the evaluation of salivary gland dysfunction. The purpose of this study was to examine the feasibility of using thermographic imaging in the evaluation of minor labial salivary gland function in subjects during euhydration, dehydration, and rehydration states. METHODS Ten subjects were studied. Upper labial minor salivary gland secretion was quantified whilst simultaneously visualizing lower minor salivary gland output thermographically during each state. RESULTS A significant difference was observed in the minor labial salivary flow among euhydrated, dehydrated and rehydrated, states. Despite the lack of statistical difference in the thermographic findings, IRT images reflected noticeable differences among the three hydration states. CONCLUSION The overall results of this study suggest that IRT could potentially provide a valuable non-invasive tool for evaluating the relationship between minor labial salivary gland function and hydration status.
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Affiliation(s)
- P-J Lamey
- Oral Science Research Centre, School of Dentistry, Queen's University Belfast, BT12 6BP, UK.
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46
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Abstract
In the preparation of osseointegrated dental implant sites, the use of bone drilling with conventional external irrigation has been shown to be thermally non-injurious to bovine bone, when employed as a model for dental implantology. The use of internal irrigation drilling systems is promoted on the basis of improved delivery of coolant to the bone/drill interface, which should subsequently improve local debridement and cooling, and therefore reduce thermal insults to the bone. The aim of this bovine model study was to compare the temperatures that were generated with external and internal irrigation systems during bone preparation for dental implants. A constant drill load of 1.7 kg was applied throughout the drilling procedures via a drilling rig. The burs that were used for both irrigation methods were a 2 mm twist drill for cutting the channel and a 3.25 mm drill for trephining this channel. The principal recorded parameter was the change in temperature generated via the drilling procedure. The 2 mm twist drills produced a maximum change in temperature of only 3.0 degrees C and 3.1 degrees C for the internal and external irrigation systems, respectively. Maximum changes for the 3.25 mm drills were 1.34 degrees C and 1.62 degrees C, respectively. Using the t-test, no statistical benefit was observed for one irrigant delivery system over the other. The clinical benefit of using the more expensive internal irrigation systems is therefore deemed unjustifiable, on the grounds that these systems do not appear to reduce the thermal challenge to the bone over and above that of simple flood irrigation.
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Affiliation(s)
- Ian C Benington
- Division of Restorative Dentistry, School of Dentistry, Queen's University, Belfast, Belfast, Northern Ireland
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47
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Abstract
Damage to bone tissue due to heat shock is one of the main causes of the failure of osseointegration at the bone-implant interface. To investigate the effect of heat shock on regeneration of bone tissue, osteoblasts were exposed to heat shock for 10 minutes at 42, 45, or 48 degrees C or kept at 37 degrees C as a control. After 10 minutes of heat shock, disruption of actin filaments was seen in the cells and the degree of disruption increased with the temperature. The cytoskeleton reassembled after a 12-hour incubation at 37 degrees C in the cells treated at 42 or 45 degrees C, but this reversible recovery did not occur in the cells treated at 48 degrees C. Flow cytometric analysis showed that heat shock at 48 degrees C increased the number of necrotic cells to 15-20% within minutes (p < 0.05 compared with 37 degrees C). Apoptosis, evidenced by annexin V staining, DNA laddering, and caspase 3 activation, started after 6-8 hours of incubation, reached a peak at 12 hours, and gradually declined (p<0.05). Pretreatment with the antioxidant N-acetyl-L-cysteine reduced the necrosis induced at 48 degrees C of heat shock by one-half (p<0.05) but had no significant effect on caspase 3 activation induced by heat shock, suggesting that reactive oxygen species were critical in heat shock-induced necrosis but not in apoptosis. Heat shock at 48 degrees C induced a sustained translocation of p53 into the nucleus and a sustained activation of c-jun N-terminal kinase, whereas that at 42 and 45 degrees C induced only transient p53 translocation and c-jun N-terminal kinase activation. These results suggest that the sustained activation of p53 and c-jun N-terminal kinase pathways may contribute to heat shock-induced apoptosis. On the other hand, heat shock protein 70 increased dramatically in the cells treated at 45 or 48 degrees C, suggesting that the protecting mechanism in the cells was also activated. Such protection was able to prevent apoptosis in cells treated at 45 degrees C but not in those treated at 48 degrees C.
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Affiliation(s)
- S Li
- Department of Bioengineering and The Whitaker Institute of Biomedical Engineering, University of California, San Diego, La Jolla 92093-0427, USA
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48
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Abstract
OBJECTIVE This in-vitro study aimed to examine the change in surface temperature induced by the actions of drills for the placement of dentine pins. METHODS Ten decoronated extracted premolar teeth were embedded by the apical tip of their roots in orthoresin. They were held in a bench vice and allowed to reach the ambient temperature of 24 degrees C. A thermal imaging camera, Agema Thermovision 900 series, was positioned 0.05 m perpendicular to the decoronated surface. Sequential recording of a series of images was stored at a rate of three per second during each stage of the pin placement procedure. This included a pilot drill, a channel cutting drill and the pin placement. All pins were 0.675 mm diameter x 2 mm in length and were placed 1 mm from the amelo-dentinal junction using a Kavo handpiece rotating at 4000 rpm. RESULTS The mean baseline temperature for the thermally stabilized teeth was 23.9 degrees C. The action of the round pilot drill changed the temperature from baseline by 25 degrees C. The action of the channel drill generated the greatest heat, with a mean maximum temperature recorded during these procedures of 94 degrees C +/- 9 degrees C. The pilot drill produced a mean change from baseline of 31.3 degrees C +/- 17.7 degrees C during pin placement. CONCLUSIONS The placement of dentine pins produced a high temperature increase on the surface of the dentine. All stages of pin placement gave rise to an increased temperature, but this was maximal with the channel drill. Further studies are required to determine whether these surfaces temperatures are transferred to the pulpal chamber.
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Affiliation(s)
- P A Biagioni
- Division of Oral Medicine, School of Clinical Dentistry, Queen's University of Belfast, Royal Victoria Hospital, UK
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