Intraosseous Heat Generation During Osteotomy Performed Freehand and Through Template With an Integrated Metal Guide Sleeve: An In Vitro Study

A Comparative In Vitro Study on Heat Generation with Static Guided and Conventional Implant Bed Preparation Using Stainless Steel Twist Drills and a Standardized Bovine Model

The aim of this in vitro study was to evaluate the differences in heat generation across the drilling techniques, depths, and irrigation conditions of static computer-assisted implant surgery (S-CAIS) and conventional implant preparation (CIP) using a standardized bone model for comparative investigation. A total of 240 automated intermittent experimental procedures of 10 and 12 mm drilling depths were performed during S-CAIS and CIP using stainless steel twist drills of three drill diameters (2.2, 2.8, and 3.5 mm) and two irrigation modes (without/external cooling) at room temperature. Temperature changes were recorded in real time using multiple temperature sensors in two distances to the osteotomy site. For comparison, a linear mixed model was fitted. The level of statistical significance was set at α = 0.05. Comparing the two surgical techniques, significant temperature differences could be observed using 3.5 mm drills: CIP yielded statistically higher temperatures during 10 and 12 mm drilling without irrigation (p = 0.0115 and p = 0.0253, respectively), while statistically higher temperatures were observed with S-CAIS and external irrigation at a 12 mm drilling depth (p = 0.0101). This standardized in vitro investigation demonstrated the impact of surgical technique, drilling depth, and irrigation mode on heat generation, indicating differences especially in drills of larger diameter.

Effect of Guided Implant Drilling on Bone Temperature Changes During Implant Osteotomy: A Comprehensive Systematic Review

The preparation of the implant site and the quality of the bone are crucial factors for preliminary healing following implant surgery. Therefore, any thermal or mechanical damage to the bone must be minimized during osteotomy preparation. The use of guided implant drilling is now widely employed for the precise placement of implants. Although guided implants are accurate, they are said to generate more heat compared to non-guided osteotomy. This systematic review was conducted to evaluate the heat generation that occurs during osteotomy with both guided and non-guided drilling. A comprehensive search of dental literature in PubMed, EBSCOhost, and Google Scholar was performed for articles published from 2010 to 2024. The search strategy incorporated MeSH terms and Boolean operators. The initial search across all three databases yielded a total of 548 articles. Of these, 477 were discarded after reviewing the titles and abstracts, 26 were removed as duplicates, 15 studies were excluded due to unavailable full texts, and 19 were excluded for not meeting the study design criteria set for the systematic review. Eleven articles were ultimately selected for review and data extraction. After analyzing and collating the results from all the studies, it can be concluded that using surgical guides does cause significant heat generation in the bone at the osteotomy site. However, this rise in temperature generally remains below the threshold that could cause bone necrosis. Additionally, other factors, such as irrigation temperature, drill length, drill diameter, and drilling speed, also influence heat generation during osteotomy in guided drilling.

Temperature Changes (ΔT) in Correlation with Number of Implant Osteotomy Preparations in Human Cadaver Tibiae, Comparing Osseodensification (OD) Burs in Clockwise (CW) versus Counterclockwise (CCW) Mode

(1) Background: OD burs are used in two different modes: (i) CW and (ii) CCW. The purpose of the study was to evaluate the ΔT during the preparation of implant osteotomies in a four-way interaction. (2) Methods: Three hundred and sixty osteotomies were prepared at 12 mm depth in human cadaver tibiae. The ΔT values were calculated similarly to the method used in two previous studies carried out by our group. Four different variables were evaluated for their effect on ΔT. (3) Results: A four-way interaction was observed in the CCW mode, allowing for 1000 RPM to have the least effect in both modes. However, in the CCW mode the use of 3.0 and 4.0 burs after 23 osteotomies showed a statistically significant increase in ΔT, and significant chatter, compared to the CW mode. In the CCW mode, the ΔT was increased significantly as the diameter of the burs increased in 800 and 1200 RPM. (4) Conclusions: The synergistic effect of drills' diameter, CCW mode, 800 and 1200 RPM, and bur usage (over 23 times) had a significant effect on ΔT, which exceeded 47 °C. One thousand (1000) RPM had the least effect in both modes. The 3.0 and 4.0 burs in the CCW mode drastically increased the temperature and produced significant chatter.

Robotic dental implant placement workflow for edentulous jaws

Yakebot, the first autonomous robotic dental implant system, provides a 1-stop solution for implant design, robot operation, real-time navigation, and precision analysis. This report describes the composition, principles, and implant operation procedures of the Yakebot dental implant robotic system in a patient for whom the robotic workflow procedure was used to place implants in the edentulous maxilla. The results showed that this workflow was more precise and predictable than traditional methods.

Analysis of implant precision in guided surgery: comparison of two methods

BACKGROUND

Implantology represents the therapy of choice for the rehabilitation of a partially or totally edentulous jaw in a healthy patient. Nowadays, it is possible to exploit of modern preoperative planning software, increasingly precise radiographic examinations (CBCT) and CAD/CAM technologies that allow designing devices directly on the computer to be sent to a milling center which produces the desired product, such as stereolithographic templates.

METHODS

The prospective clinical study in question aims to evaluate the accuracy between two different surgical guides using peek and metal guide bushings. Twenty-nine implants were placed: for the control group, 17 3i, T3 implants were used, while for the test group, 12 Xive S plus implants were used.

RESULTS

The result obtained shows that the deviations in the distribution of the control group and the test group are the same in the apical-coronal, vestibulo-palatal and mesio-distal direction. For the control group, the mean deviation was 1.394±0.644923 at the entry point of the implants and 1.85655±1.0765 at the most apical point of the implants. For the test group the mean deviation was 1.10157±0.312721 at the entry point of the implants and 1.54514±0.572100 at the most apical point of the implants.

CONCLUSIONS

The peek guide bushings have the same deviation as the metal ones. There is no difference in the method used, but precision must be sought in other elements, such as the patient's anatomy and maximum precision in the guide production phase.

Effect of Er:YAG Laser Exposure on the Amorphous Smear Layer in the Marginal Zone of the Osteotomy Site for Placement of Dental Screw Implants: A Histomorphological Study

The placement of dental screw implants typically involves the use of rotary techniques and drills to create a bone bed. This study explores the potential benefits of combining this method with an Er:YAG laser. Split osteotomies were performed on 10 jaws of euthanized domestic pigs (Sus scrofa domestica), with 12 mandibular implant osteotomies in each jaw, divided into 4 groups. In order to make a comprehensive assessment of the effect of Er:YAG lasers, histomorphological techniques were used to measure the reduction in amorphous layer thickness after Er:YAG laser treatment, both with and without the placement of dental screw implants from different manufacturers. Following bone decalcification and staining, the thickness of the amorphous layer was measured in four groups: Group A-osteotomy performed without Er:YAG laser treatment-had amorphous layer thicknesses ranging from 21.813 to 222.13 µm; Group B-osteotomy performed with Er:YAG laser treatment-had amorphous layer thicknesses ranging from 6.08 to 64.64 µm; Group C-an implant placed in the bone without laser treatment-had amorphous layer thicknesses of 5.90 to 54.52 µm; and Group D-an implant placed after bone treatment with Er:YAG laser-had amorphous layer thicknesses of 1.29 to 7.98 µm. The examination and photomicrodocumentation was performed using a LEICA DM1000 LED microscope (Germany) and LAS V 4.8 software (Leica Application Suite V4, Leica Microsystems, Germany). When comparing group A to group B and group C to D, statistically significant differences were indicated (p-value = 0.000, p < 0.05). The study demonstrates the synergistic effects and the possibility of integrating lasers into the conventional implantation protocol. By applying our own method of biomodification, the smear layer formed during rotary osteotomy can be reduced using Er:YAG lasers. This reduction leads to a narrower peri-implant space and improved bone-to-implant contact, facilitating accelerated osseointegration.

A Novel Irrigation System to Reduce Heat Generation during Guided Implantology: An In Vitro Study

The purpose of this in vitro study is to evaluate the effectiveness of incorporating a new irrigation system into a surgical guide and monitor its effect on heat generation during implant bed preparation. A total of 48 surgically guided osteotomies were performed on 12 bovine ribs divided into 4 groups, using different irrigation techniques: Group A (test) had entry and exit channels incorporated into the guide; Group B had a similar design with an entry channel only; Group C had conventional external irrigation; and Group D (control) had no irrigation. Heat generation during the osteotomies was measured using thermocouples placed at a depth of 2 mm and 6 mm. The lowest mean temperature was observed in Group A (22.1 °C at 2 mm and 21.4 °C at 6 mm), which was statistically significant when compared with Groups C and D (p < 0.001). Group A showed a lower mean temperature compared with Group B as well; however, it was statistically significant only at 6 mm depth (p < 0.05). In conclusion, the proposed surgical guide has significantly reduced heat generation during implant osteotomy compared to conventional external irrigation. The integration of an exit cooling channel can resolve limitations found in previously designed surgical guides such as debris blockage and can be easily incorporated into computer designing and 3D printing software.

Temperature Changes during Implant Osteotomy Preparations in Human Cadaver Tibiae Comparing MIS® Straight Drills with Densah® Burs

(1) Background: Several studies showed a sustained temperature of 47 °C or 50 °C for one minute resulted in vascular stasis and bone resorption with only limited bone regrowth over a 3-4-week healing period. The purpose of the present study was to evaluate the temperature changes (ΔΤ) that occur during the preparation of dental implant osteotomies using MIS^® straight drills versus Densah^® burs in a clockwise (cutting) drilling protocol. (2) Methods: Two hundred forty (240) osteotomies of two different systems' drills were prepared at 6 mm depth at 800, 1000, and 1200 revolutions per minute (RPM), in fresh, unembalmed tibiae, obtained by a female cadaver. ΔΤ was calculated by subtracting the baseline temperature on the tibial surface, from the maximum temperature-inside the osteotomy (ΔT = T_max - T_base). The variables were evaluated both for their individual and for their synergistic effect on ΔΤ with the use of one-, two-, three- and four-way interactions; (3) Results: An independent and a three-way interaction (drill design, drill width, and RPM) was found in all three RPM for the Densah^® burs and at 1000 RPM for the MIS^® straight drills. As Densah^® burs diameter increased, ΔΤ decreased. The aforementioned pattern was seen only at 1000 RPM for the MIS^® straight drills. The usage of drills 20 times more than the implant manufacturers' recommendation did not significantly affect the ΔΤ. A stereoscopic examination of the specimens confirmed the findings. (4) Conclusions: The independent and synergistic effect of drills' diameter, design and RPM had a significant effect on ΔΤ in human tibiae, which never exceeded the critical threshold of 47 °C.

Ridge augmentation-The new field of computerized guided surgery: A technical note for minimal-invasive bone splitting

Different instrumentation procedures of the alveolar ridge expansion technique (ARST) with or without Guided Bone Regeneration have proven to be effective for successful implant placement in cases of alveolar bone width between 3mm and 6mm. Conventional bone splitting techniques require flap arising. This technical note demonstrates a method for flapless guided bone splitting. For this purpose, a newly developed surgical guide with internal irrigation channels was used. Using CAD-CAM additive technology, a narrow slot along the field of interest and a pin of a cooling pipe was designed and implemented in a surgical guide template. The bone split was performed flapless through the surgical guide while the cooling pipe was connected to it. During surgery, the piezo-driven instrument was moved within that slot, and the irrigation solution was directly rinsing it at point of entry through the irrigation channel. This procedure was performed on a 3.3 mm wide alveolar ridge achieving over 3 mm of bone gain. The described method combines several positive aspects. The micro-invasive flapless surgical procedure might improve postoperative healing. Additionally, sufficient cooling of the bone might lead to less thermal affection of bone cells and less resorption of the cortical bone. However, systematic studies are needed to confirm the observations of the presented case report.

Bone Temperature Variation Using a 3D-Printed Surgical Guide with Internal Irrigation

Bone overheating is a possible cause of implants early failure. When a surgical guide is used, the risk of heat injury is greater due to the reduced efficacy of the irrigation. The aim of this ex vivo study was to evaluate the effect of an additional built-in irrigation on bone temperature variation during implant osteotomy. Twelve bovine ribs were used. Cone beam computerized tomography (CBCT) was performed and a 3D-printed surgical guide with additional built-in irrigation tubes was produced for each rib. A total of 48 osteotomies were prepared, to compare the supplementary internal irrigation system (Group A) with external irrigation alone (Group B), no irrigation (Group C) and with free-hand surgery with external irrigation (Group D). Temperature was measured by three thermocouples placed at depths of 1.5, 7, and 12 mm. The largest temperature variation at each thermocouple showed median values of 3.0 °C, 1.9 °C, and 2.3 °C in Group 1; 2.3 °C, 1.7 °C, and 0.9 °C in Group 2; 3.2 °C, 1.6 °C, and 2.0 °C in Group 3; 2.0 °C, 2.0 °C, and 1.3 °C in Group 4, respectively. No differences were found among the four groups. In general, the highest temperature increase was observed with the use of the first drill (cortical perforator). Post-experimental CBCT revealed the presence of radiopaque material clogging the aperture of the internal irrigation channels. Additional internal irrigation was not found to significantly contribute to decrease bone temperature in this ex vivo setting.

Comparing the Temperature Effect of Dedicated Minimally Invasive Motor System to the Discontinuous Use of Rotatory Burrs in the Correction of Hallux Valgus

The purpose of this study was to compare 2 motor systems for percutaneous osteotomy. The study consisted of 2 stages. In the first stage, bone temperatures during osteotomy using burrs or saw was measured using a thermal camera. In the second stage, the tissue and burr temperature elevation during surgery in 80 consecutive patients (96 feet) with hallux valgus undergoing distal first metatarsal and phalangeal osteotomies (hallux and in 61/96 feet lesser digits) were measured. The burr osteotomy procedure included the use of irrigated 2- or 4.1 mm rotary wedge burrs in discontinuous cutting bursts of less than 20 seconds. Tissue surface temperature was measured with a thermal camera. The temperature generated during the procedure was found to be significantly associated with the burr diameter used but was not affected by the type of motor. At the 6-week visit, thickness of the soft tissues over the first metatarsal head was similar in both groups. Temperature control using a noninvasive thermal camera is recommended to prevent tissue damage associated with heat generated during the use of rotary burrs. A dedicated low-speed high-torque system does not seem to be necessary and standard orthopaedic equipment can be used.Levels of Evidence: Level II: Comparative prospectively collected series.

Guided Implant Placement Using an Internally Cooling Surgical Template: A Technical Note

Cooling irrigation during implant bed preparation is mandatory to avoid overheating. Due to the surgical guide design, external cooling systems do not reach the point of entry of the implant burr. Here, a new technique for irrigation during guided implant surgery for direct rinse of the burr is described. Using computer-aided design/computer-aided manufacturing additive technology, a pin of a cooling pipe was designed and implemented in a surgical guide template. The implant bed preparation was performed while the cooling pipe was connected to the surgical guide. During surgery, the irrigation solution was directly rinsing the burr at the point of entry through the irrigation channel. The use of a cooling surgical guide seems to improve the cooling of the bone during implant bed preparation. This might lead to less thermal effect of bone cells. However, systematic studies are needed to confirm the observations of the presented case report.

Digitally planned root end surgery with static guide and custom trephine burs: A case report

INTRODUCTION

Apicoectomy is an endodontic surgical intervention that requires high precision. The computer-assisted static guided approach has proven to increase the precision of dental implantation in a significant manner. The authors sought to transfer this precision to root-end resection with the use of custom designed trephine burs manufactured specifically for use in targeted endodontic microsurgery.

METHODS

A set of custom bone trephines were designed and manufactured, then their digital models were integrated into an already existing implant surgical planning software, in cooperation with the software developer. Apicoectomy was performed in an actual case with the help of the new system.

RESULTS

It has become possible to plan root end removal in the virtual space and to manufacture 3D printed static surgical guides to help the execution of the surgery. A patient with persistent periapical lesion was successfully treated without complication. The 6-month follow-up found uneventful healing.

CONCLUSION

The presented system is a step toward a standardized digital system and workflow dedicated to guided endodontic surgery.

Drilling of bone: Effect of drill bit geometries on thermal osteonecrosis risk regions

Bone-drilling operation necessitates an accurate and efficient surgical drill bit to minimize thermal damage to the bone. This article provides a methodology for predicting the bone temperature elevation during surgical bone drilling and to gain a better understanding on the influences of the point angle, helix angle and web thickness of the drill bit. The proposed approach utilized the normalized Cockroft-Latham damage criterion to predict material cracking in the drilling process. Drilling simulation software DEFORM-3D is used to approximate the bone temperature elevation corresponding to different drill bit geometries. To validate the simulation results, bone temperature elevations were evaluated by comparison with ex vivo bone-drilling process using bovine femurs. The computational results fit well with the ex vivo experiments with respect to different drill geometries. All the investigated drill bit geometries significantly affect bone temperature rise. It is discovered that the thermal osteonecrosis risk regions could be reduced with a point angle of 110° to 140°, a helix angle of 5° to 30° and a web thickness of 5% to 40%. The drilling simulation could accurately estimate the maximum bone temperature elevation for various surgical drill bit point angles, web thickness and helix angles. Looking into the future, this work will lead to the research and redesign of the optimum surgical drill bit to minimize thermal insult during bone-drilling surgeries.