Effect of surgical drill guide and irrigans temperature on thermal bone changes during drilling implant sites – Thermographic analysis on bovine ribs

Aleksa Marković; Zoran Lazić; Tijana Mišić; Miodrag Šćepanović; Aleksandar Todorović; Kaustubh Thakare; Bojan Janjić; Zoran Vlahovic; Mirko Glišić

doi:10.2298/VSP141208041M

Aleksa Marković Clinic of Oral Surgery, University of Belgrade, Belgrade, Serbia
Zoran Lazić Clinic of Dentistry, Military Medical Academy, Belgrade, Serbia, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Tijana Mišić Clinic of Oral Surgery, University of Belgrade, Belgrade, Serbia
Miodrag Šćepanović Clinic of Oral Surgery, Faculty of Dentistry, University of Priština/Kosovska Mitrovica, Kosovska Mitrovica, Serbia
Aleksandar Todorović Clinic of Oral Surgery, Faculty of Dentistry, University of Priština/Kosovska Mitrovica, Kosovska Mitrovica, Serbia
Kaustubh Thakare Clinic of Oral Surgery, University of Belgrade, Belgrade, Serbia
Bojan Janjić Clinic of Oral Surgery, University of Belgrade, Belgrade, Serbia
Zoran Vlahovic Clinic of Oral Surgery, Faculty of Dentistry Pristina , Kosovska Mitrovic, Serbia
Mirko Glišić Clinic of Oral Surgery, Faculty of Dentistry Pristina , Kosovska Mitrovic, Serbia

DOI: https://doi.org/10.2298/VSP141208041M

Keywords: dental implants, irrigation, temperature, bone and bones, stents,

Abstract

Background/Aim. During drilling implant sites, mechanical energy is converted into thermal one resulting in transient rise in temperature of surrounding bone. The temperature of 47°C exeeding one minute impairs osseointegration, compromises mechanical properties of the local bone and could cause early implant failure. This in vitro study aimed to assess the effect of surgical drill guide and temperature of irrigans on thermal changes of the local bone during drilling implant sites, and to test the influence of irrigans temperature on the temperature of surgical drill guide. Methods. A total of 48 specimens obtained from bovine ribs were randomly allocated to four experimental conditions according to the 2 ´ 2 factorial design: drill guide (with or without) and saline (at 25°C or 5°C). Real-time infrared thermography was used as a method for temperature measurement. The primary outcome was bone temperature change during drilling implant sites measured at 3 osteotomy depths, whereas the second one was change in the temperature of the drill guide. Data were analyzed by Brunner and Langer nonparametric analysis and Wilcoxon test. Results. The effect of drill guide on the changes of bone temperature was significant at the entrance of osteotomy, whereas the effect of saline temperature was significant at all osteotomy levels (p < 0.001). No significant interaction was found (p > 0.05). Guided surgery and irrigation with saline at 25°C were associated with the highest bone temperature increase. Increase in drill guide temperature was significantly higher when saline at 25°C was used (p < 0.001). Conclusion. Guided implant site preparation generates higher temperature of the local bone than conventional drilling, not exceeding the threshold for thermal bone necrosis. Although saline at room temperature provides sufficient heat control during drilling, cooled saline is more effective regardless the use of surgical drill guide.

References

Ercoli C, Funkenbusch PD, Lee H, Moss ME, Graser GN. The in-fluence of drill wear on cutting efficiency and heat production during osteotomy preparation for dental implants: a study of drill durability. Int J Oral Maxillofac Implants 2004; 19(3): 335−49.

Abouzgia MB, James DF. Temperature rise during drilling through bone. Int J Oral Maxillofac Implants 1997; 12(3): 342−53.

Eriksson AR, Albrektsson T. Temperature threshold levels for heat-induced bone tissue injury: a vital-microscopic study in the rabbit. J Prosthet Dent 1983; 50(1): 101−7.

Borchers RE, Gibson LJ, Burchardt H, Hayes WC. Effects of se-lected thermal variables on the mechanical properties of trabe-cular bone. Biomaterials 1995; 16(7): 545−51.

Jo K, Yoon K, Park K, Bae J, You K, Han J, Cheong J. Thermally induced bone necrosis during implant surgery: 3 case reports. J Korean Assoc Oral Maxillofac Surg 2011; 37(5): 406−14.

Piattelli A, Piattelli M, Mangano C, Scarano A. A histologic evalu-ation of eight cases of failed dental implants: is bone overheat-ing the most probable cause. Biomaterials 1998; 19(7−9): 683−90.

Ganz SD. Presurgical planning with CT-derived fabrication of surgical guides. J Oral Maxillofac Surg 2005; 63(9 Suppl 2): 59−71.

Misir A, Sumer M, Yenisey M, Ergioglu E. Effect of surgical drill guide on heat generated from implant drilling. J Oral Maxillo-fac Surg 2009; 67(12): 2663−8.

Migliorati M, Amorfini L, Signori A, Barberis F, Biavati AS, Benedi-centi S. Internal Bone Temperature Change During Guided Surgery Preparations for Dental Implants: An In Vitro Study. Int J Oral Maxillofac Implants 2013; 28(6): 1464−9.

dos Santos PL, Queiroz TP, Margonar R, de Souza CA, Betoni W, Rezende RR, et al. Evaluation of bone heating, drill deformation, and drill roughness after implant osteotomy: guided surgery and classic drilling procedure. Int J Oral Maxillofac Implants 2014; 29(1): 51−8.

Bulloch SE, Olsen RG, Bulloch B. Comparison of heat generation between internally guided (cannulated) single drill and tradi-tional sequential drilling with and without a drill guide for den-tal implants. Int J Oral Maxillofac Implants 2012; 27(6): 1456−60.

Mishra SK, Chowdhary R. Heat generated by dental implant drills during osteotomy-a review: heat generated by dental implant drills. J Indian Prosthodont Soc 2014; 14(2): 131−43.

Lundskog J. Heat and bone tissue. An experimental investiga-tion of the thermal properties of bone and threshold levels for thermal injury. Scand J Plast Reconstr Surg 1972; 9: 1−80.

Al-Dabag AN. Effect of Cooling an Irrigation Solution During Preparation of Implant Site on Heat Generation Using Elite System for implant. (Experimental Study). Al-Rafidain Dent J 2010; 10(2): 260−4.

Sener BC, Dergin G, Gursoy B, Kelesoglu E, Slih I. Effects of irriga-tion temperature on heat control in vitro at different drilling depths. Clin Oral Implants Res 2009; 20(3): 294−8.

Marković A, Mišić T, Miličić B, Calvo-Guirado JL, Aleksić Z, Ðinić A. Heat generation during implant placement in low-density bone: effect of surgical technique, insertion torque and implant macro design. Clin Oral Implants Res 2013; 24(7): 798−805.

Sedlin ED, Hirsch C. Factors affecting the determination of the physical properties of femoral cortical bone. Acta Orthop Scand 1966; 37(1): 29−48.

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 2014; 25(8): 910−8.

Matthews LS, Hirsch C. Temperatures measured in human cor-tical bone when drilling. J Bone Joint Surg Am 1972; 54(2): 297−308.

Kondo S, Okada Y, Iseki H, Hori T, Takakura K, Kobayashi A, et al. Thermological study of drilling bone tissue with a high-speed drill. Neurosurgery 2000; 46(5): 1162−8.

Isler SC, Cansiz E, Tanyel C, Soluk M, Selvi F, Cebi Z. The effect of irrigation temperature on bone healing. Int J Med Sci 2011; 8(8): 704−8.

Tehemar SH. Factors affecting heat generation during implant site preparation: a review of biologic observations and future considerations. Int J Oral Maxillofac Implants 1999; 14(1): 127−36.