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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., (© 2021 Wiley Periodicals LLC.)

Background: Osseointegration is fundamental to achieving successful implant therapy in dentistry. However, the heat generated during implant placement emerges as a critical factor predisposing to implant failure. Objective: This study aimed to analyze the different factors related to heat generation during implant placement, offering insights to clinicians in their daily clinical practice. Methods: Utilizing the PubMed, Web of Science, and Embase databases, we conducted an electronic search for articles published between January 2013 and December 2023. The analysis focused on several factors including bone type, drill shape, drill speed, drill material, drilling force, osteotomy depth, drill load, drilling technique (intermittent or continuous), presence of a surgical guide, irrigation methods, drill wear, and preparation tools available. Results: Initially, 2525 records were identified. After applying the inclusion and exclusion criteria and full-text assessment, 93 articles were included in this scoping review. Additionally, some articles published before 2013 were incorporated in the bibliography to ensure completeness of the review. Conclusions: Heat generation during implant placement arises from a complex interplay of multiple factors. While irrigation and bone hardness appear to be crucial determinants of heat generation during the osteotomy phase, the involvement of other factors remains less clear. Further studies are needed to better understand the precise contribution of these factors towards increasing temperature at the implant site. [ABSTRACT FROM AUTHOR]

The aim of this in vitro study was to evaluate the temperature development of a novel, electropolished drill design during conventional and guided implant osteotomy in comparison to conventional drills under standardized conditions. Materials and Methods: Single and sequential 12-mm-deep drilling protocols (guided and unguided) with a conventional (control groups) and novel drill (test groups) were performed in artificial bone blocks under external irrigation. Each drilling protocol was repeated 30 times with drill diameters of 2.2, 2.8, 3.5, and 4.2 mm. Temperature changes were recorded by an infrared camera, and the accumulated thermal energy was calculated. For group comparison, a one-way analysis of variance (ANOVA) and Tukey post hoc test were used with a level of significance set to = .05. Results: The highest temperatures were measured up to 77.9°C for small-diameter drills in the control and test groups. The 3.5-mm and 4.2-mm novel drills showed significantly lower heat generation during guided and unguided osteotomy preparation for single and sequential drilling. The accumulated thermal energy during guided osteotomy preparation was significantly lower with the electropolished drills. Conclusion: The drill design has an important impact on heat development during osteotomy, which was most pronounced for guided osteotomy with conventional drills and for small-diameter osteotomies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of our study was to evaluate the impact of different irrigation fluid temperatures on intraosseous temperature increment during guided and freehand implant site preparation.Materials and Methods: Bovine rib segments were used. Temperature was detected using K-type thermocouples. The studied groups were defined as combinations of the following: drilling speed (1500, 2000 RPM), drill diameter (2.0, 2.5, 3.0, 3.5 mm), surgical method (guided, freehand), and irrigation fluid temperature (10°C, 15°C, 20°C). The data were analysed with Kruskal-Wallis analysis of variance (ANOVA) and ANOVA, as appropriate.Results: At 1500 RPM, guided drilling with 20°C irrigation fluid yielded temperature values exceeding the necrotic threshold (47°C) when performed with bits of 3.0 and 3.5 mm diameters. Meanwhile, 15°C irrigation managed to keep the mean increment below 8.0°C at the diameter of 3.5 mm for both guided and freehand surgery. However, 10°C irrigation cancelled every statistically significant difference between guided and freehand groups. At 2000 RPM and with 20°C irrigation, mean peak temperatures exceeded the necrotic threshold at the diameters 3.0 and 3.5 mm (guided) and 3.5 mm (freehand). When applying 10°C irrigation, though, all measurements indicated peak temperatures in the safe zone.Conclusion: Drillings at 1500 and 2000 RPM, in a guided setting, cause temperature elevations that exceed the necrotic threshold. A speed of 2000 RPM drilling may produce potentially harmful temperatures also in a freehand setting. 10°C and 15°C irrigation kept temperature increments in the safe zone at 2000 RPM and 1500 RPM, respectively. [ABSTRACT FROM AUTHOR]

Background: Surgical guides restrict the flow of cooling agent to osteotomy site, which will lead to a temperature rise that provokes tissue injury. Few studies compared differences in the temperature changes between non-limiting 'conventional' and limiting 'guided' surgical guides during implant site preparation. The objective of this study was to investigate the difference in temperature changes during bone drilling for implant placement using non-limiting and limiting surgical guides at cortical and cancellous bone levels. Methods: Forty-four bovine rib samples were used for implant bed preparation in this study with a minimum thickness of 11 mm was chosen for the ribs. The bone was stored in a freezer at 10 °C until it was used. On the day of the study, the bone was defrosted and soaked in water at 21 °C for three hours before embarking on drilling to make sure each sample was at the same temperature when tested. Forty-four bone specimens were prepared and randomly allocated to receive either a limiting or a non-limiting surgical guides (22 for each group). The osteotomy site was prepared by one operator following the manufacturer's instructions, using limiting and non-limiting surgical guides. Temperature changes were recorded during implant bed preparation using thermocouples that fit into 7 mm-horizontal channels at two different depths (Coronally) and (Apically) at 1 mm distance from the osteotomy site. The data were tested for homogeneity of variances using Levene's test, then data were analyzed using an Independent sample t-test and the significance level was set at P ≤ 0.05. Results: The mean temperature rise for all samples was 0.55 °C. The mean temperature rises for the limiting and non-limiting surgical guides were 0.80 °C and 0.33 °C respectively. There was a statistically significant difference in temperature rise between the limiting and non-limiting surgical guides (P = 0.008). In relation to position of temperature recording (coronal vs. apical), there was no significant difference (P > 0.05). No significant difference was noted between the two groups at cancellous bone level (P = 0.68), but the difference was significant at cortical bone level (P = 0.036). Conclusion: Limiting surgical guides showed higher readings than non-limiting. However, for both techniques, temperature rise was not significant clinically and within a safe range. [ABSTRACT FROM AUTHOR]

Purpose: To compare intrabony thermal changes induced by two different protocols for guided implant surgery during the whole drilling procedure. Materials and Methods: Two protocols for guided implant placement were evaluated in vitro using artificial bone cylinders. The control protocol provided traditional metal sleeves and a standard drilling sequence composed of four cylindrical triflute drills (cutting surface length = 16 mm). The test protocol provided a three-slot polyurethane sleeve and two cylindrical drills (second drill cutting surface length = 4 mm). Forty automated intermittent and graduated osteotomies (depth = 14 mm) were performed under external irrigation. Temperatures were measured in real time by three sensors at different depths (2, 8, and 13 mm). The temperature changes generated by the final drill of each protocol during the shearing and withdrawing processes were recorded as experimental results and subjected to the Student t test. Results: Maximum temperature increases were recorded during the process of withdrawing in both protocols. In the control group, the mean thermal changes were 10.18°C, 8.61°C, and 5.78°C at depths of 2, 8, and 13 mm, respectively. In the test group, the mean thermal changes were 1.44°C, 4.46°C, and 3.58°C at depths of 2, 8, and 13 mm, respectively. The control group revealed statistically significantly (P < .0001) higher thermal changes than the test group, both in the superficial and deeper bone areas. Conclusion: An appropriate irrigation system could be crucial for thermal lowering during a guided implant osteotomy mainly in the coronal and middle third of the implant site. Copious irrigation should be provided during the withdrawing process since greater thermal increases could be expected. Lower temperature increases could be achieved, reducing drill-to-bone contact, ie, cutting surface length, due to short frictional force exposure. [ABSTRACT FROM AUTHOR]

Objective : To study the early phases of osseointegration at implants installed in sites prepared with either high rotational speed with irrigation or low rotational speed without irrigation. Material and methods: After 3 months from tooth extraction, two implants were installed in one side of the mandible of twelve dogs. The osteotomies were prepared either at 60 rpm without irrigation or at 750 rpm with refrigeration. Biopsies were obtained after 4 and 8 weeks of healing, six animals each period for histological analyses. Results: After 4 weeks of healing, new bone percentage in contact with the implant surface (BIC%) was 46.6 ± 7.3% and 43.1 ± 6.8% at the low- and high-speed sites, respectively (p = 0.345). After 8 weeks of healing, the fractions increased to 60.0 ± 11.1% and 60.2 ± 6.2%, respectively (p = 0.753). Conclusions: Implants installed in sites prepared using either low-rotational drilling without irrigation or high speed with irrigation presented similar amounts of osseointegration. [ABSTRACT FROM AUTHOR]

Background: The thermal effect correlated with implant osteotomy could produce significant effects on the healing process and fixture osseointegration. The aim of the present investigation was to assess the heat generation and surface wearing of dental implant drills and manual tappers during simulated osteotomies on animal ribs. Methods: Steel drills (20 units per type) and tappers (20 units per type) were evaluated for a total of 30 osteotomies. The infrared thermal analysis was performed at the first and thirtieth osteotomy. The surface alteration and wearing was assessed by energy dispersive spectroscopy–scanning electron microscopy (EDS-SEM) prior to and after use. Conclusions: The drill material produced a non-significant temperature change during bone osteotomy. Lower heating was reported for manual tappers in favor of a manual osteotomy instead rotary instruments. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated whether simplified drilling protocols would provide comparable histologic and histomorphometric results to conventional drilling protocols at a low rotational speed. Materials and Methods: A total of 48 alumina-blasted and acid-etched Ti-6Al-4V implants with two diameters (3.75 and 4.2 mm, n = 24 per group) were bilaterally placed in the tibiae of 12 dogs, under a low-speed protocol (400 rpm). Within the same diameter group, half of the implants were inserted after a simplified drilling procedure (pilot drill + final diameter drill), and the other half were placed using the conventional drilling procedure. After 3 and 5 weeks, the animals were euthanized, and the retrieved bone-implant samples were subjected to nondecalcified histologic sectioning. Histomorphology, bone-to-implant contact (BIC), and bone area fraction occupancy (BAFO) analysis were performed. Results: Histology showed that new bone was formed around implants, and inflammation or bone resorption was not evident for both groups. Histomorphometrically, when all independent variables were collapsed over drilling technique, no differences were detected for BIC and BAFO; when drilling technique was analyzed as a function of time, the conventional groups reached statistically higher BIC and BAFO at 3 weeks, but comparable values between techniques were observed at 5 weeks; 4.2-mm implants obtained statistically higher BAFO relative to 3.75-mm implants. Conclusion: Based on the present methodology, the conventional technique improved bone formation at 3 weeks, and narrower implants were associated with less bone formation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the influence of implant and drill diameters on the stability of implant and bone response. Materials and Methods: An implant (GS II, Osstem Implant) with a 3.5-mm diameter and drills with three different diameters, differentiating the volume of bone compacted by the implant, were used in this study. Measurement of the insertion torque and observation of bone compression patterns were done during implant site preparation in minipigs. Also, analysis of resonance frequency, histomorphology, marginal bone resorption, and new bone formation were performed. Results: Microstrains and microcracks occurred in cortical bone around the thread when a drill with a smaller diameter than that of the thread was used. Higher implant stability was shown and maintained when a small-diameter drill was used. When using a drill with a smaller diameter than the root diameter of the implant thread, the bone-to-implant contact/bone area (BIC/BA) was higher than the wider drill during the whole test period. However, the use of a wide drill was the most rapid in increasing the BIC/BA value by new bone formation. In the cancellous bone, the speed of new bone formation was not different in each test group. However, the formation of new bone was faster when a large-diameter drill was used in the cortical bone. There was no significant difference in marginal bone loss (MBL) according to drill diameters, but the speed of MBL was fast when using a drill that was smaller than the root diameter of the implant thread. Conclusion: Implant stability, BIC, and BA were high when using a final drill that was smaller than the root diameter of the implant thread compared with a wide final drill. However, the speed of new bone formation was relatively slow and the speed of MBL was relatively fast if the final drill was excessively smaller. [ABSTRACT FROM AUTHOR]

The aim of this study was to measure the effect of drilling speed on heat generation in the cortical bone, on primary and secondary implant stability of implants and on early and late bone healing with micro-computerized tomography (micro-CT). Sixty implants were placed in the iliac crest of 6 sheep in order to form 5 different drilling protocols: 50 rpm without saline cooling, and 400, 800, 1200, and 2000 rpm with saline cooling. Simultaneous cortical bone temperature and primary stability at the time of placement; secondary stability and the ratio between relative bone and tissue volume (BV/TV) in 2D and 3D in micro-CT analysis were evaluated after 4 and 8 weeks. The 50-rpm group had the highest cortical bone temperature and the longest operation duration with the highest primary stability. Slightly higher values of secondary stability (T2) and subsequent 2D and 3D BV/TV values were found in 1200 rpm with irrigation at 8 weeks. All groups had sufficient ISQ values at 8 weeks for loading although the micro-CT analysis showed varying percentages of bone tissue around implants. The influence of drill speed for implant osteotomy and its irrigation is minimal when it comes to changes in temperature of the cortical bone, primary and secondary implant stability, and BV/TV. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effect of different designs of guiding sleeves on heat generation during implant surgery while using different cooling fluid temperatures. Material and Methods: Temperature measurements were performed during guided implant site preparation in bovine rib samples using two K‐ type thermocouples at 2 mm and 8 mm depths. Three groups were tested according to guiding sleeve design: conventional cylindrical sleeve, open C‐shaped sleeve, and modified cylindrical sleeve. Each group was irrigated with three fluid temperatures: 10°C, 15°C, and 20°C. The groups were compared using Kruskal Wallis test followed by post hoc comparisons with Bonferroni correction. The level of statistical significance was set at p = 0.05. Results: Surgical guides with conventional cylindrical sleeve design showed significantly higher heat generation during implant site preparation than guides with both the open C‐shaped and the modified cylindrical sleeve designs at both 2mm and 8mm depths. The difference between C‐shaped and modified cylindrical sleeves was not significant in any group. Using pre‐cooled irrigation fluids (10°C and 15°C) reduced the generated heat; however, the differences within the same group were not statistically significant. Conclusions: The use of a surgical guide with the conventional cylindrical sleeves led to higher heat generation than other sleeve designs, which might reach or near the critical threshold of bone thermal necrosis. Using surgical guides with open sleeves or modified cylindrical sleeves could be helpful in irrigation fluid delivery and decreasing the generated heat. [ABSTRACT FROM AUTHOR]

Purpose: To establish a method for measuring the heat generated when preparing an osteotomy site, and to assess for correlations of rotational speed, proceeding speed, loading value of the drill (contact pressure), motion pattern, and bone density with temperature increases. Materials and Methods: A thermocouple was placed in the internal irrigation hole of a 2.0-mm-diameter twist drill used for measuring osteotomy site temperature. In the artificial blocks, two different densities were used to drill under varying conditions including drill proceeding, rotating speed, and motion pattern. The drilling procedure was repeated five times for each combination, and the data collected were statistically analyzed using multiple regression analysis. Results: Strong positive correlations were found among bone density, drill motion pattern, and maximum temperature, and a positive correlation was found in proceeding speed (P < .001). Rotation speed and maximum temperature were not correlated (P < .001). Conversely, loading values of the drill increased with the lower rotation speed and higher proceeding speed, which were effective in controlling the temperature rise. Conclusion: When preparing a simulated bone for an osteotomy with a thermocouple inserted into a twist drill with internal irrigation, the drilling motion pattern, bone density, drill speed, and proceeding rate affected bone temperature, in descending order. It was also observed that bone temperature correlated positively with speed and negatively with proceeding speed, independent of density. This indicates that lower drill speed and higher proceeding speed without excessive loading values minimize the bone temperature heat. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare bone temperature changes during implant drilling with two drill designs employed in three different drilling sequences. Materials and Methods: Two implant drill designs and three drilling sequences were evaluated in vitro using artificial bone cylinders. The evaluated drills were different only in the cutting-surface length (control, 16 mm; test, 4 mm). Three drilling sequences (control A, test B1, and test B2) were evaluated with and without irrigation. Temperatures were measured with thermocouple technology. The temperature changes generated by the final drill of each sequence were recorded as the experimental results and were subjected to the Student t test. Results: There were statistically significant differences in temperature changes when comparing the control group A with the test groups B1 (P = .001) and B2 (P = .01) during drilling without coolant. The mean temperature changes were 12.4°C, 6.5°C, and 13.7°C for groups A, B1, and B2, respectively. The Student t test showed statistically significant differences between temperature changes of the control group A and the test groups B1 (P < .01) and B2 (P < .05) during drilling with coolant. The mean temperature changes were 0.9°C, 0.7°C, and 1.9°C for groups A, B1, and B2, respectively. Conclusion: Reduction in length of the cutting surface of the drill may limit frictional heat. Drills with the same length of cutting surface may induce lower bone temperature changes, when considering a preliminary drilling step with a pilot drill. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The apical portion of the implant osteotomy receives less irrigation and cooling during surgical preparation. High bone temperature, above the critical 10°C threshold, may impair osseointegration, particularly around dense cortical bone. The aim of this study was to evaluate the apical cortical plate temperature increase with two different devices and pressure loads in a porcine rib ex vivo model.Methods: A total of 24 implant sites were prepared on porcine ribs, divided into 4 groups of 6 samples each, according to the device used (conventional drill system or piezosurgery) and pressure load applied (1,000 g or 1,500 g). A rubber dam was used to isolate the apical cortical plate from the cooling effect of irrigation. Temperature variation measurements were taken using an infrared thermometer.Results: The piezosurgery unit was two times more likely to increase the osteotomy temperature by 10°C (OR = 2; 95% CI 1.136, 3.522; P < 0.05). The average temperature increase was 0.07°C (SD = 0.10) for group 1 (drill system 1,000 g); 0.22°C (SD = 0.26) for group 2 (drill system 1,500 g); 9.18°C (SD = 4.51) for group 3 (piezosurgery 1,000 g); and 8.17°C (SD = 6.12) for group 4 (piezosurgery 1,500 g). The piezosurgery site preparation had significantly higher temperature increase than did the conventional drill site preparation (P < 0.05). There was no statistically significant difference in temperature change between the two pressure loads applied (P = 0.78). Temperature increases exceeded the critical 10°C threshold in half of the samples prepared with the piezoelectric device.Conclusions: Bone overheating using a piezosurgery unit is a potential risk during implant site preparation. The piezosurgical device resulted in significantly higher temperatures than did conventional drilling at the apical cortical portion of the osteotomy. The temperature increase was often higher than the critical 10°C threshold. [ABSTRACT FROM AUTHOR]

Abstract: Background: The use of a piezoelectric device (PED) for implant site preparation (ISP) has been introduced to overcome the limitations of using conventional drills (CDs). With little and inconsistent information in the literature regarding their efficiency for preparing implant osteotomies, the objective of this systematic review was to compare the use of CDs to PEDs for ISP with regard to implant stability values, marginal bone level changes, operating time, and dental implant failure rate. Methods: The systematic review was prepared according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). The literature was searched for studies that assessed the use of CDs and PEDs for ISP. The Cochrane Collaboration risk of bias tool was used to evaluate the selected studies and meta‐analyses were performed using statistical software. Results: A total of 755 citations were identified. Of these, 4 studies with 178 implant osteotomies in 80 participants were included. The pooled estimates for the implant stability showed significant differences between the 2 surgical techniques in favor of PEDs at baseline, 8 and 12 weeks. A statistically significant difference in the operating time was also shown between the 2 techniques with more time required using PED. The differences in marginal bone level changes or implant failure rate were not statistically significant. Conclusions: With the limitations of this review in mind, PEDs appear to be a viable alternative to traditional drilling techniques for ISP. With the exception of prolonged operating time associated with the use of PEDs, both techniques were comparable in terms of the marginal bone level changes and the risk of implant failure. The favorable influence of the implant stability pattern related to the use of PEDs on the predictability of immediate and early loading protocols need to be confirmed in future studies. [ABSTRACT FROM AUTHOR]

Background: As implant site preparation and bone are critical precursors to primary healing, thermal and mechanical damage to the bone must be minimized during the preparation of the implant site. Moreover, excessively traumatic surgery can adversely affect the maturation of bone tissue at the bone/implant interface and consequently diminish the predictability of osseointegration. So, this study was carried out to evaluate the various biological and mechanical factors responsible for heat generation during osteotomy site preparation to reduce the same for successful osseointegration of dental implants.Study Design: A broad search of the dental literature in PubMed added by manual search was performed for articles published between 1992 and December 2015. Various bio-mechanical factors related to dental implant osteotomy preparation such as dental implant drill designs/material/wear, drilling methods, type of irrigation, and bone quality were reviewed. Titles and abstracts were screened and articles which fulfilled the inclusion criteria were selected for a full-text reading.Results: The initial database search yielded 123 titles, of which 59 titles were discarded after reading the titles and abstracts, 30 articles were again excluded based on inclusion and exclusion criteria, and finally 34 articles were selected for data extraction. Many biological and mechanical factors responsible for heat generation were found.Conclusion: Literatures of this review study have indicated that there are various bio-mechanical reasons, which affect the temperature rise during osteotomy and suggest that the amount of heat generation is a multifactorial in nature and it should be minimized for better primary healing of the implant site. [ABSTRACT FROM AUTHOR]

Purpose To assess in vitro, using an infrared ( IR) thermometer, temperature changes generated at implant sites by osteotomies involving two different drilling methods (with multiple drills versus only one) and to measure the influence of irrigation on the temperature variation. Materials and Methods Forty bone samples (from bovine rib) were divided into two groups of 20. Osteotomies were performed in group A with four drills, using the standard method (Leone Dental Implant System, final diameter 3.5 mm), and in group B with a single drill (Zero1 Drill, Leone Dental Implant System 3.5 mm diameter). In each group, half of the osteotomies were performed with irrigation (subgroups A1 and B1) and the other half without irrigation (subgroups A2 and B2). Two osteotomies were performed on each sample, using four different-sized drills according to the standard technique on one side and using a single drill on the other side. The starting temperature ( T0) and the maximum temperature ( Tmax) reached in the bone were measured. Comparisons of Δ T were drawn between subgroups A1 and B1 and between subgroups A2 and B2. The data were analyzed using Student's t-test (with 95% confidence interval). Results The mean difference identified between the temperature produced with the last drill used in the traditional technique and that produced with the single drill was 0.3150 ± 1.0194° C when irrigation was used (group A1 vs group B1; not statistically significant). The mean difference between the temperature produced with the last drill of the traditional technique and that produced with the single drill was −0.3526 ± 0.5232° C when irrigation was not used (group A2 vs group B2; statistically significant). Conclusions The single-drill method induced a significantly greater variation in temperature than the traditional method, but only when irrigation was used; without any irrigation, the difference in the temperature variation generated by the two methods was not statistically significant. In any case, bone heating during the osteotomy never exceeded 2° C and was clinically irrelevant, as thermal damage to bone has only been reported in the literature for temperatures beyond 47° C persisting for more than one minute. [ABSTRACT FROM AUTHOR]

Purpose To evaluate an experimental multistepped drill for single-stage implant site preparation by means of real-time analysis of thermal variations during and postdrilling, and by implant stability evaluation. Materials and Methods Temperature and time were recorded in real time by paired microprobe thermocouples during simulated osteotomy in type 2 bone similes at the cortical and cancellous zones. Three different drilling groups with a new multistepped drill design were compared: Control (2-mm diameter pilot drill + 3.3-mm three-stepped drill + 4.1-mm three-stepped drill); Test A (3.3-mm three-stepped drill); and Test B (4.1-mm three-stepped drill). Implants were inserted, and implant stability was evaluated with the Perio Test Value (PTV). Two-way anova was used to test the independent effects of osteotomy and implant diameter on temperature and stability. Results All the drills induced thermal changes without significant differences between groups ( p > .05). Drilling in cortical bone produced significant increase of the temperatures in a range of 1.8 ± 0.9°C compared with drilling in cancellous bone ( p < .05). Δ T temperatures were significantly higher for test groups in cortical and cancellous bone ( p < .05); Δ T10 for all groups showed a reduction of the temperature in a range of 1.7 ± 0.3°C without significant differences between groups ( p > .05); the mean time to accomplish drilling was significantly longer in the control group ( p < .05); test groups took 10 ± 0.3 seconds less to reach the required drilling depth. PTV values were higher in test groups compared with controls ( p < .05). Conclusions The multistepped drills used for single-stage implant site preparation Increase temperature as in comparison with a conventional incremental protocol;, Induce the temperature increment in cortical bone compared with the cancellous bone;, Reduce drilling time when a multistepped drill is used alone; and, Increase implant stability twofold compared with a conventional incremental protocol. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective To compare peri-implant tissue healing at implants installed in sites prepared with conventional drills or a sonic device. Material and methods In six Beagle dogs, the mandibular premolars and first molars were extracted bilaterally. After 3 months, full-thickness muco-periosteal flaps were elevated and recipient sites were prepared in both sides of the mandible. In the right side (control), the osteotomies were prepared using conventional drills, while, at the left side (test), a sonic device (Sonosurgery®) was used. Two implants were installed in each side of the mandible. After 8 weeks of non-submerged healing, biopsies were harvested and ground sections prepared for histological evaluation. Results The time consumed for the osteotomies at the test was more than double compared to the conventional control sites. No statistically significant differences were found for any of the histological variables evaluated for hard and soft tissue dimensions. Although not statistically significant, slightly higher mineralized bone-to-implant contact was found at the test (65.4%) compared to the control (58.1) sites. Conclusions Similar healing characteristics in osseointegration and marginal hard tissue remodeling resulted at implants installed into osteotomies prepared with conventional drills or with the sonic instrument (Sonosurgery®). [ABSTRACT FROM AUTHOR]

Background Intrabony temperature increase is not only dependent on shearing energy and mechanical friction between bone and surgical drill but is also related to heat capacity and thermal conductivity of the surrounding bone and the applied surgical instrument. Thus time of occurrence of the highest temperature rise can be expected after the shearing process of the osteotomy, potentially affecting the process of osseointegration. Purpose The aim of this study was to evaluate temperature changes during the shearing and withdrawing processes during osteotomies. Materials and Methods An overall 160 automated intermittent osteotomies (10/16 mm drilling depth) with 2 mm diameter twist drills and 3.5 mm diameter conical drills and different irrigation methods (without/external/internal/combined) were performed on standardized bone specimens. The drilling cycles were operated by a computer-controlled surgical system, while a linear motion potentiometer and multichannel temperature sensors in various intrabony levels ensured the real-time documentation of temperature changes during the shearing and withdrawing processes. Results The highest temperature changes were invariably recorded during the process of withdrawal. Significantly lower temperature changes ( p < .02) could be recorded at maximum drilling depths during the shearing process regardless of drilling depth, diameter or irrigation method. During coolant supply, 2 mm diameter twist drills showed higher temperatures (10 mm, p < .01/16 mm, p < .03) compared with 3.5 mm diameter conical implant drills. Internal (10 mm, p < .01) or combined irrigation (16 mm, p < .01) was associated with significantly lower temperatures compared with external irrigation by the use of conical implant drills. Conclusions Considering that heat generation during osteotomies is a multifactorial scenario, this study could demonstrate that the highest temperature rise during implant osteotomies occurs during the withdrawing process and that the time of occurrence is influenced by predominant factors such as osteotomy depth and mode of irrigation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Statement of problem: Osseointegration is the more stable situation and results in a high success rate of dental implants. Heat generation during rotary cutting is one of the important factors influencing the development of osseointegration. Purpose: To assess the various factors related to implant drills responsible for heat generation during osteotomy. Materials and Methods: To identify suitable literature, an electronic search was performed using Medline and Pubmed database. Articles published in between 1960 to February 2013 were searched. The search is focused on heat generated by dental implant drills during osteotomy. Various factors related to implant drill such effect of number of blades; drill design, drill fatigue, drill speed and force applied during osteotomies which were responsible for heat generation were reviewed. Titles and abstracts were screened, and literature that fulfilled the inclusion criteria was selected for a full-text reading. Results: The initial literature search resulted in 299 articles out of which only 70 articles fulfils the inclusion criteria and were included in this systematic review. Many factors related to implant drill responsible for heat generation were found. Successful preparation of an implant cavity with minimal damage to the surrounding bone depends on the avoidance of excessive temperature generation during surgical drilling. Conclusion: The relationship between heat generated and implant drilling osteotomy is multifactorial in nature and its complexity has not been fully studied. Lack of scientific knowledge regarding this issue still exists. Further studies should be conducted to determine the various factors which generate less heat while osteotomy such as ideal ratio of force and speed in vivo, exact time to replace a drill, ideal drill design, irrigation system, drill-bone contact area. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this study was to evaluate the temperature changes during implant osteotomies with a combined irrigation system as compared to the commonly used external and internal irrigation under standardized conditions. Material and methods Drilling procedures were performed on VII bovine ribs using a computer-aided surgical system that ensured automated intermittent drilling cycles to simulate clinical conditions. A total of 320 drilling osteotomies were performed with twist (2 mm) and conical implant drills (3.5/4.3/5 mm) at various drilling depths (10/16 mm) and with different saline irrigation (50 ml/min) methods (without/external/internal/combined). Temperature changes were recorded in real time by two custom-built thermoprobes with 14 temperature sensors (7 sensors/thermoprobe) at defined measuring depths. Results The highest temperature increase during osteotomies was observed without any coolant irrigation (median, 8.01°C), followed by commonly used external saline irrigation (median, 2.60°C), combined irrigation (median, 1.51°C) and ultimately with internal saline irrigation (median, 1.48°C). Temperature increase with different drill diameters showed significant differences ( P < 0.05) regarding drill depth, confirming drill depth and time of drilling as influencing factors of heat generation. Internal saline irrigation showed a significantly smaller temperature increase ( P < 0.05) compared with combined and external irrigation. A combined irrigation procedure appears to be preferable ( P < 0.05) to an external irrigation method primarily with higher osteotomy depths. Conclusions Combined irrigation provides sufficient reduction in temperature changes during drilling, and it may be more beneficial in deeper site osteotomies. Further studies to optimize the effects of a combined irrigation are needed. [ABSTRACT FROM AUTHOR]

Objectives Based on a novel standardized bovine specimen, the aim of this study was to investigate thermal effects of different irrigation methods during intermittent and graduated drilling. Material and methods Temperature changes during implant osteotomies ( n = 320) of 10 and 16 mm drilling depths with various irrigation methods were investigated on manufactured uniform bone samples providing homogenous cortical and cancellous areas and analogous thermal conductivity comparable to human bone. Automated sequences were performed with surgical twist drills of 2 mm ∅ and conical drills of 3.5, 4.3 and 5 mm ∅. Real-time recording of temperature increase was done using two custom-built multichannel thermoprobes with 14 temperature sensors at a predefined distance of 1 and 2 mm to the final osteotomy. The effects of drilling depth, drilling diameter and irrigation methods on temperature changes were investigated by a linear mixed model. Results Using this uniform bone specimen, the greatest temperature rise was observed without any coolant supply with 29.87°C, followed by external with 28.47°C and then internal with 25.86°C and combined irrigation with 25.68°C. Significant differences ( P ≤ 0.0156) between drill depths of 10 vs. 16 mm could be observed with all irrigation methods evaluated. With each of the irrigation methods, significantly higher temperature changes ( P < 0.0001) during osteotomies could be observed between twist drills of 2 mm ∅ and conical drills of 3.5, 4.3 and 5 mm ∅. During 10 and 16 mm drilling osteotomies, external irrigation showed significantly higher temperatures ( P < 0.05) for all conical drills compared with internal or combined irrigation, respectively. Significantly lower temperatures ( P < 0.05) could be detected with internal or combined irrigation for the use of conical drills with various diameters and drilling depths. Conclusions This fully standardized bone model provides optimized comparability for the evaluation of bone osteotomies and resulting temperature changes. As regards the efficiency of the various irrigation methods, it could be demonstrated that internal and combined irrigation appears to be more beneficial than external irrigation. [ABSTRACT FROM AUTHOR]

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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. [ABSTRACT FROM AUTHOR]

Background: To date, some experimental studies have addressed the effect of bone drilling technique and sequence on dental implant osseointegration. In the present study, the authors hypothesize that there would be no differences in osseointegration when reducing the number of drills for osteotomy compared to the conventional drilling protocols. Methods: Seventy-two implants (diameters 3.75 mm and 4.2 mm; n = 36 for each diameter) were bilaterally placed in the tibia of 18 beagles for 1, 3, and 5 weeks. Half of the implants of each diameter were placed using a simplified drilling procedure (pilot and final drill), and the other half were placed using a conventional drilling procedure (all drills in sequence). The retrieved samples were subjected to histologic and histomorphometric evaluation. Results: Histology showed that new bone formed around the implant, and inflammation or bone resorption was not evident for both groups. Histomorphometrically, the simplified group presented significantly higher bone-to-implant contact and bone area fraction occupancy compared to the conventional group after 1 week; however, no differences were detected at 3 and 5 weeks. Conclusion: Bone responses to the implant with the simplified protocol can be comparable to the conventional protocol. [ABSTRACT FROM AUTHOR]

Objectives The study aimed to investigate the effect of surgical technique, implant macrodesign and insertion torque on bone temperature changes during implant placement. Material and methods In the in vitro study, 144 self-tapping (blue SKY® 4 × 10 mm; Bredent) and 144 non-self-tapping ( Standard implant® 4.1 × 10 mm; Straumann) were placed in osteotomies prepared in pig ribs by lateral bone condensing or bone drilling techniques. The maximum insertion torque values of 30, 35 and 40 Ncm were used. Real-time bone temperature measurement during implant placement was performed by three thermocouples positioned vertically, in tripod configuration around every osteotomy, at a distance of 5 mm from it and at depths of 1, 5 and 10 mm. Data were analysed using Kruskal- Wallis, Mann- Whitney U-tests and Regression analysis. Results Significant predictor of bone temperature at the osteotomy depth of 1 mm was insertion torque ( P = 0.003) and at the depth of 10-mm implant macrodesign ( P = 0.029), while no significant predictor at depth of 5 mm was identified ( P > 0.05). Higher insertion torque values as well as non-self-tapping implant macrodesign were related to higher temperatures. Implant placement in sites prepared by bone drilling induced significantly higher temperature increase ( P = 0.021) compared with bone condensing sites at the depth of 5 mm, while no significant difference was recorded at other depths. Compared with 30 Ncm, insertion torque values of 35 and 40 Ncm produced significantly higher temperature increase ( P = 0.005; P = 0.003, respectively) at the depth of 1 mm. There was no significant difference in temperature change induced by 35 and 40 Ncm, neither by implant macrodesign at all investigated depths ( P > 0.05). Conclusions Placement of self-tapping implants with low insertion torque into sites prepared by lateral bone condensing technique might be advantageous in terms of thermal effect on bone. [ABSTRACT FROM AUTHOR]

Heat generated during implant osteotomy might lead to osteonecrosis and delayed bone repair, thus resulting in impaired early osseointegration and fixation of bone-anchoring devices. In this study, we proposed to overcome heat-induced injury to bone by fabricating core-shell polymeric biodegradable microspheres encapsulating a mitogenic factor, platelet-derived growth factor (PDGF), and a differentiation factor, simvastatin, in a simultaneous or sequential release profile. Microspheres encapsulating bovine serum albumin (BSA), PDGF, simvastatin, PDGF-in-core with simvastatin-in-shell, and simvastatin-in-core with PDGF-in-shell were delivered to fill standardized osteotomy sites on edentulous ridges of rat maxillae under irrigated or non-irrigated conditions. In the absence of irrigation, significant reduction of cell viability and increase in inflammation and sequestrum formation without evidence of osteogenesis were observed. Both PDGF and simvastatin deliveries facilitated cell viability and reduced osteonecrosis. Localized osteogenesis was seen under simvastatin treatment, while generalized but primitive osteogenesis was noted in PDGF-treated osteotomy sites. In addition, sequential PDGF-simvastatin delivery further augmented osteogenesis and promoted bone maturation. The results suggested that sequential PDGF-simvastatin delivery was an effective modality to prevent heat-induced complications and facilitate bone apposition after implant osteotomy, potentially favoring the early fixation of bone-anchoring devices and oral implant osseointegration. [ABSTRACT FROM PUBLISHER]

Objectives: The purpose of this study was to evaluate the intraosseous temperature changes during ultrasonic and conventional implant site preparation in vitro with respect to the effect of load and irrigation volume. Material and methods: Implant sites were prepared using two different ultrasonic devices (Piezosurgery, Mectron Medical Technology and VarioSurg, NSK) and one conventional device (Straumann) at loads of 5, 8, 15 and 20 N and with irrigation volumes of 20, 50 and 80 ml/min. During implant site preparation, temperatures were measured in fresh, equally tempered bovine ribs using two thermocouples placed at a distance of 1.5 mm around the drilling site in cortical and cancellous bone. The preparation time was recorded. Results: The heat production and time required for implant site preparation using both ultrasonic devices were significantly higher than those for conventional drilling ( P<0.01). Increased loading had no effect on heat production. A higher irrigation volume was associated with a diminished temperature increase in the cortical bone for ultrasonic but not for conventional drilling, which resulted in significantly lower temperatures in cortical as compared with cancellous bone during ultrasonic implant site preparation. Conclusions: Ultrasonic implant site preparation is more time consuming and generates higher bone temperatures than conventional drilling. However, with the levels of irrigation, ultrasonic implant site preparation can be an equally safe method. To cite this article: Rashad A, Kaiser A, Prochnow N, Schmitz I, Hoffmann E, Maurer P. Heat production during different ultrasonic and conventional osteotomy preparations for dental implants. Clin. Oral Impl. Res. xx, 2011; 000-000. doi: 10.1111/j.1600-0501.2010.02126.x [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the effect of drill-bone contact area on bone temperature during osteotomy preparation. Conventional triflute Ø3.6 mm drills were modified with the intent to reduce frictional heat induction. The peripheral dimensions of the drill were reduced 0.15, 0.35 and 0.5 mm to evaluate the effect of surface area on induction of frictional heat between the drill and bone/cutting debris (parameter A). Also, the lateral cutting surface of the drill was set to 0.1, 2 and 7.5 mm to estimate heat induced by direct function of the drill (parameter B). A non-modified triflute drill (parameter A: 0 mm; parameter B: 15 mm) served as control. Thus, nine drills with different A/B combinations vs. one control were tested in artificial bone. Real-time temperature changes (during drilling and withdrawing) were assessed using an infrared thermal imager. Each drilling procedure was performed up to 20 times. Thermal image data were transferred to a PC for simultaneous analysis. Mean temperature changes for all modified drill combinations were smaller than for the control ( P<0.001). The effects of parameters A and B were statistically significant ( P<0.001). There was a significant interaction effect between the two parameters ( P<0.001) showing that the effect of parameter A on the mean temperature changes is different depending on the values of parameter B. As the dimensions of parameter B decreased, the temperature change during drilling also decreased. However, a tendency for the temperature to increase or decrease by parameter A was not observed. Within the limitations of this pilot study, the observations herein suggest that reduction in contact area between the drill and bone reduces heat induction. Further studies to optimize drill/bone contact dimensions are needed. Oh HJ, Wikesjö UME, Kang H-S, Ku Y, Eom T-G, Koo K-T. Effect of implant drill characteristics on heat generation in osteotomy sites: a pilot study. Clin. Oral Impl. Res. , 2011; 722-726 doi: 10.1111/j.1600-0501.2010.02051.x [ABSTRACT FROM AUTHOR]

The aim of this comparative study is to analyze the influence of drilling technique on the radiographic, thermographic, and geomorphometric effects of dental implant drills and osteotomy site preparations. One hundred and twenty osteotomy site preparations were performed on sixty epoxy resin samples using three unused dental implant drill systems and four drilling techniques performed with a random distribution into the following study groups: Group A: drilling technique performed at 800 rpm with irrigation (n = 30); Group B: drilling technique performed at 45 rpm without irrigation (n = 30); Group C: drilling technique performed at 45 rpm with irrigation (n = 30); and Group D: drilling technique performed at 800 rpm without irrigation (n = 30). The osteotomy site preparation morphologies performed by the 4.1 mm diameter dental implant drills from each study group were analyzed and compared using a cone beam computed tomography (CBCT) scan. The termographic effects generated by the 4.1 mm diameter dental implant drills from each study group were registered using a termographic digital camera and the unused and 4.1 mm diameter dental implant drills that were used 30 times from each study group were exposed to a micro computed tomography (micro-CT) analysis to obtain a Standard Tessellation Language (STL) digital files that determined the wear comparison by geomorphometry. Statistically significant differences were observed between the thermographic and radiographic results of the study groups (p < 0.001). The effect of cooling significatively reduced the heat generation during osteotomy site preparation during high-speed drilling; furthermore, osteotomy site preparation was not affected by the wear of the dental implant drills after 30 uses, regardless of the drilling technique. [ABSTRACT FROM AUTHOR]

The present in vitro study evaluated a new drill design to improve the temperature control during the osteotomies for dental implant installation, comparing with two drill designs that use conventional external irrigation. Three blocks of synthetic cortical bone were used for osteotomy procedures. Three groups were created: control group 1 (Con1), where a conical multiple drill system with a conventional external irrigation system was used; control group 2 (Con2), where a single bur with a conventional external irrigation system was used; and, test group (Test), where the new single bur (turbo drill) with a new irrigation system was used. Twenty osteotomies were made without irrigation and with intense irrigation, for each group. A thermocouple was used to measure the temperature produced during the osteotomies. The measured temperature were: 28.9 ± 1.68 °C for group Con1; 27.5 ± 1.32 °C for group Con2; 26.3 ± 1.28 °C for group Test. Whereas, the measured temperatures with irrigation were: 23.1 ± 1.27 °C for group Con1; 21.7 ± 1.36 °C for group Con2; 19.4 ± 1.29 °C for group Test. The single drill with a new design for improving the irrigation and temperature control, in comparison with the drill designs with conventional external irrigation. [ABSTRACT FROM AUTHOR]

The article discusses a study on the effectiveness of irrigation temperature control in lessening excessive thermal changes during osteotomy procedures on alveolar thermal trauma. It references the study "Effects of Irrigation Temperature on Heat Control In Vitro at Different Drilling Depths," by B. C. Sener in the 2009 issue of the "Clinical Oral Implants Research." According to the results of the study, one of the major factors influencing heat generation during osteotomy preparation was bone friction coefficient.