Comparison of heat generation between guided and conventional implant surgery for single and sequential drilling protocols—An in vitro study

Abstract

Objectives The aim of this in vitro study was to compare the heat generation during guided osteotomy preparation (GOP) with that of a conventional approach (CA) for a single and sequential drilling protocol. Methods Temperature measurements were performed during standardized osteotomy preparations in polyurethane foam blocks with an infrared camera. The four groups included single and sequential drilling with and without the use of a surgical guide. In the first group (single CA) and the second group (single GOP), only the final drills diameters were applied once. In the third group (sequential CA) and the fourth group (sequential GOP), two to four drills with increasing diameters were applied. Guided and conventional as well as single and sequential drilling were compared using a one‐way ANOVA with Tukey post hoc test. The level of statistical significance was set at α = 0.05. Results Guided osteotomy preparation showed statistically significant higher temperatures than CA for the 2.2 mm, the 3.5 mm, and the 4.2 mm drill (p = 0.032, p = 0.005 and p < 0.001, respectively). Sequential drilling led to higher heat generation and longer duration of latent heat than single drilling. For all drilling procedures, the duration of heat exposure over critical temperature was less than 1 min, except for the sequential GOP drilling protocol with the 4.2 mm drill (76 s). Conclusions Guided drilling requires specific attention to heat development. When guided implant surgery is performed, a single drilling procedure could alleviate heat production compared to a sequential procedure.

The accuracy of computer‐guided implant surgery with tooth‐supported, digitally designed drill guides based on CBCT and intraoral scanning. A prospective cohort study

“…Next to the prosthetic outcome, a key factor in treatment evaluation is the overall survival of implants. Despite the potential increased heat generated associated with guided drilling protocols (Frosch, Mukaddam, Filippi, Zitzmann, & Kuhl, ), the current study demonstrated promising survival rates on a short term. These survival rates could be attributed to ideal prosthetic placement with benefits for proper oral hygiene and well‐planned inter‐implant distances.…”

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

“…The purpose of this investigation was to examine metal and ceramic implant twist drills with identical or similar diameters during automated and reproducible drilling osteotomies by using a TA B L E 2 Location of maximum temperature increase: median sensor channel location [ch (minimum-maximum)] (sensor channel depths: 2, 4, 8, 10 mm for 10-mm drilling sequence and additionally 11, 13, 16 for 16-mm drilling sequence) in 1-and 2-mm measuring distance (MD = measuring distance, CER = ceramic, MET = metal) highly sensitive real-time multichannel temperature measurement system and a standardised bovine bone model, previously introduced for temperature testing of surgical instruments (Abboud et al, 2015;Delgado-Ruiz et al, 2016Strbac et al, 2015;Strbac, Giannis, et al, 2014). Infrared thermography poses a valid alternative to thermocouple technology and has been successfully used in temperature investigations in the past (Augustin et al, 2012;Benington et al, 2002;Frösch et al, 2019). Doubts concerning its accuracy when recording temperatures at irrigated preparation sites (Benington et al, 1996;Tehemar, 1999) led to further development of real-time multichannel thermoprobes by the authors in the past (Strbac et al, 2015;Strbac, Giannis, et al, 2014;.…”

“…Eriksson & Albrektsson identified the temperature threshold for bone survival to be between 44 and 47°C with an exposure time of less than 1 min (Eriksson & Albrektsson, 1983, 1984); however, an exact threshold for osteonecrosis remains still unclear (Augustin et al., 2012; Oliveira et al., 2012; Yoshida et al., 2009). Numerous factors have been reported to influence heat generation during implant bed preparation, such as drill diameter (Strbac, Giannis, et al., 2014; Strbac, Unger, et al., 2014), drill design and geometry (Cordioli & Majzoub, 1997; Oh et al., 2011; Sannino et al., 2015), drill load (Abouzgia & James, 1997), sharpness and drill wear (Salimov et al., 2020; Scarano et al., 2007), surgical technique used (Frösch et al., 2019; Lajolo et al., 2018; Lucchiari et al., 2016), irrigation (Gehrke et al., 2018; Harder et al., 2013; Strbac et al., 2015) and bone density (Yacker & Klein, 1996). Moreover, drill material has been suggested to affect temperature increase during osteotomy (Hochscheidt et al., 2017; Oliveira et al., 2012; Scarano et al., 2020; Sumer et al., 2011).…”

Thermal exposure of implant osteotomies and its impact on osseointegration—A preclinical in vivo study

“…The herein used model further applied guided drilling under irrigation. Studies conducted by Misir et al and Froesch et al suggest that guided drilling might induce higher temperatures compared to non-guided setups due to the friction of drills and the interference of drill guides with external irrigation or removal of bone chips from the osteotomy (Frösch et al, 2019;Misir et al, 2009). This possible limitation in the model was taken into account to allow for a highly standardized osteotomy preparation minimizing potential positional and angular deviations of drills between experiments and thereby reducing their effect on temperature evolution and histomorphometric parameters related to implant osseointegration as much as possible (Tahmaseb et al, 2014).…”

“…Intracrestal temperature was monitored in situ during osteotomy preparation using a temperature probe (Type T, Ø 1 mm, Transmetra) that was positioned in a specifically prepared drill cavity parallel to the implant osteotomy at a distance of 0.5 mm from the drill osteotomy wall. The subcrestal depth of the drill cavity for the thermocouple was set to 5 mm based on a previous laboratory study with a comparable guided drill setup that identified this depth to display maximum temperatures during osteotomy preparation (Frösch et al, 2019…”