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The surface morphology of machined screw-shaped titanium dental implants was modified by pulsed irradiation with an Nd glass laser. This method supplied very different surface elements in nanometer and micrometer ranges identified with scanning electron microscopy and atomic force microscopy as well. The surface composition was unchanged during these treatments. A rabbit experiment was carried out to investigate the direct bone contact (osseointegration) which was characterized by the removal torque of the implants. The 50 nm and 10-50 µm sized droplike elements were formed from the machined flat surface by the laser irradiation depending on the laser intensity. The osseointegration was enhanced by the increase of the density of nanosized elements and by the size of the microsized elements, showing the importance of this surface morphology in the direct bone-implant contact.

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.

The use of irrigation fluid being cooled to 10°C combined with low-speed drilling (800 rpm) seems to be a safe method for implant site preparation and drilling through a drilling guide in terms of temperature control.

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