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

Abstract

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.

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

“…During guided sequential drilling with a 4.2 mm final drill, the time over critical temperature (time with a temperature increase over 15°C for a 25°C polyurethane foam block) was more than 1 min and exceeded the threshold for causing morphological bone damage (Eriksson & Albrektsson, ). Our results do not correspond to the findings of other in vitro studies which documented that heat generation with GOP did not reach temperature levels critical to bone (Dos Santos et al, ; Liu et al, ; Markovic et al, ; Migliorati et al, ; Misir et al, ).…”

“…Higher temperature changes were observed in GOP compared to CA, and in sequential compared to single drilling. This is in line with several other studies that suggest the greater heat generation with guided procedures is caused by the surgical guide impairing the irrigation fluid from entering the drilling site (Dos Santos et al, ; Markovic et al, ; Migliorati et al, ; Misir et al, ). Drilling with a cooling channel in the guide has been shown to reduce the temperature increase by 1.9‐fold (Liu et al, ).…”

“…However, it underlines the importance of ensuring an appropriate intermittent drilling procedure that allows constant access for irrigation fluid, which avoids the clogging effect of bone chips on the cutting edge and drill flutes (Strbac et al, ). Furthermore, it can be hypothesized that the use of cooled saline might also reduce temperature development (Markovic et al, ).…”

“…Most experimental studies investigating temperature development have used thermocouples (Bulloch et al, ; Migliorati et al, ; Misir et al, ), which allow temperature measurements only at single points and provide limited data about the temperature distribution in the entire surgical field (Liu et al, ). Real‐time infrared thermography was used in the present study to generate an overall thermal profile, as previously described (Markovic et al, ). While Markovic et al used bovine ribs as drilling media, standardized polyurethane foam blocks were applied in the current study for various reasons: in a previous project (data not shown), reproducible heat measurements could not be generated in ribs and vertebrae derived from pigs because bone structures varied in density and grade of mineralization.…”

“…However, there is some concern that heat-induced bone necrosis may occur during GOP since the surgical guide impairs the irrigation fluid from entering the drilling site. Furthermore, the friction between the drill and the cylinder of the drill handle might also contribute to temperature increases (Markovic et al, 2016). In a review of the current literature, most studies that investigated the heat generation during GOP measured the temperature development at single depths by the use of thermocouples (Bulloch, Olsen, & Bulloch, 2012;Liu, Wu, Zhang, Peng, & Liao, 2016;Migliorati et al, 2013;Misir, Sumer, Yenisey, & Ergioglu, 2009).…”