Intraosseous Heat Generation During Osteotomy Performed Freehand and Through Template With an Integrated Metal Guide Sleeve

Barrak, Ibrahim Ádám; Joób-Fancsaly, Árpád; Braunitzer, Gábor; Barootchi, Shayan; Boa, Kristóf; Piffkò, József

doi:10.1097/id.0000000000000763

Cited by 19 publications

(18 citation statements)

References 25 publications

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“…14 Worn drill bits will generate higher bone temperature due to reduce of cutting efficiency. 15,16 The directly proportional relationship between bone temperature and drilling speed, [17][18][19] drilling depth 20,21 and drill bit diameter 19,22,23 has been identified. Increasing feed rate was found to reduce bone temperature due to shorter drilling time.…”

Section: Introductionmentioning

confidence: 99%

Drilling of bone: Effect of drill bit geometries on thermal osteonecrosis risk regions

Akhbar

Yusoff

2018

Proc Inst Mech Eng H

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Bone-drilling operation necessitates an accurate and efficient surgical drill bit to minimize thermal damage to the bone. This article provides a methodology for predicting the bone temperature elevation during surgical bone drilling and to gain a better understanding on the influences of the point angle, helix angle and web thickness of the drill bit. The proposed approach utilized the normalized Cockroft-Latham damage criterion to predict material cracking in the drilling process. Drilling simulation software DEFORM-3D is used to approximate the bone temperature elevation corresponding to different drill bit geometries. To validate the simulation results, bone temperature elevations were evaluated by comparison with ex vivo bone-drilling process using bovine femurs. The computational results fit well with the ex vivo experiments with respect to different drill geometries. All the investigated drill bit geometries significantly affect bone temperature rise. It is discovered that the thermal osteonecrosis risk regions could be reduced with a point angle of 110°to 140°, a helix angle of 5°to 30°and a web thickness of 5% to 40%. The drilling simulation could accurately estimate the maximum bone temperature elevation for various surgical drill bit point angles, web thickness and helix angles. Looking into the future, this work will lead to the research and redesign of the optimum surgical drill bit to minimize thermal insult during bone-drilling surgeries.

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Section: Introductionmentioning

confidence: 99%

Drilling of bone: Effect of drill bit geometries on thermal osteonecrosis risk regions

Akhbar

Yusoff

2018

Proc Inst Mech Eng H

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“…Irrigation has been shown to prevent nerve damage in facial surgery 6 during drilling as it might prevent tissue heating to 47°C, which appears to be a critical temperature leading to tissue damage. 7 As higher rotation speeds, greater applied pressures, and greater surface contact area increase cutting burr thermogenesis, high-torque low-speed systems 8 are currently employed in foot surgery. Increase of either speed or load while drilling bovine cortical bone causes an increase in temperature.…”

Section: Levels Of Evidence: Level Ii: Comparative Prospectively Collmentioning

confidence: 99%

“…Apparently proper cooling with saline solution irrigation should be performed during drilling as it might prevent tissue heating to 47°C, which appears to be a critical temperature leading to tissue damage. 7…”

mentioning

confidence: 99%

Comparing the Temperature Effect of Dedicated Minimally Invasive Motor System to the Discontinuous Use of Rotatory Burrs in the Correction of Hallux Valgus

Robinson

Heller

Yassin

2019

Foot & Ankle Specialist

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The purpose of this study was to compare 2 motor systems for percutaneous osteotomy. The study consisted of 2 stages. In the first stage, bone temperatures during osteotomy using burrs or saw was measured using a thermal camera. In the second stage, the tissue and burr temperature elevation during surgery in 80 consecutive patients (96 feet) with hallux valgus undergoing distal first metatarsal and phalangeal osteotomies (hallux and in 61/96 feet lesser digits) were measured. The burr osteotomy procedure included the use of irrigated 2- or 4.1 mm rotary wedge burrs in discontinuous cutting bursts of less than 20 seconds. Tissue surface temperature was measured with a thermal camera. The temperature generated during the procedure was found to be significantly associated with the burr diameter used but was not affected by the type of motor. At the 6-week visit, thickness of the soft tissues over the first metatarsal head was similar in both groups. Temperature control using a noninvasive thermal camera is recommended to prevent tissue damage associated with heat generated during the use of rotary burrs. A dedicated low-speed high-torque system does not seem to be necessary and standard orthopaedic equipment can be used. Levels of Evidence: Level II: Comparative prospectively collected series

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“…There is no standard model for the observations into the preparation of implant sites. A variety of different osseous models have been used based on bone blocks from pig rib (22), pig mandible and maxilla (27), sheep tibia (28), bovine cortical/medullary bone (29)(30)(31)(32)(33)(34)(35)(36)(37), rabbit tibia (38) and rabbit mandible (39,40). There were studies which used synthetic blocks or resin models (41)(42)(43)(44).…”

Section: I31 Study Modelsmentioning

confidence: 99%

Intraosseous heat generation during guided osteotomy for dental implantological purposes

Barrak¹

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Prosthodontically driven implant surgery has been subject of interest to dental professionals for the past decade. The correct positioning of implants has a number of obvious advantages, such as favourable functional and aesthetic outcomes, better occlusion and less chance of implant overload, to mention just a few. A well-positioned implant can also make it easier for the patient to maintain good oral hygiene, once the superstructure has been inserted. Thermal osteonecrosis, thermal damage As the application of metal implants has become routine in musculoskeletal trauma surgery, orthopaedic surgery, spine surgery, cranio-maxillofacial surgery, dentistry and oral implantology, drilling of bone has also become one of the most common basic surgical steps. As for the healing of the osseous structure, this can be influenced by several factors including implant design, chemical composition, the material and shape of the implant, the physiological characteristics of the host bone bed, loading conditions, the topography of the implant surface, the healing potential of the host bone, the use of adjuvant treatments, pharmacological agents and also heat generation during osteotomy. The bone tissue is very vulnerable to thermal injury, and the temperature threshold for tissue survival during osteotomy is 47˚C when drilling is maintained for more than 1 minute. Therefore, it is critical for successful osseointegration to keep heat generation under control during osteotomy. Excess heating above this limit can lead to the primary failure to of osseointegration. In the last few years a rapid development could be observed in the field of computer-assisted implant placement. Increased beneficial use of computers was made possible through the recent advances in computer technology, which allowed the planning and the execution of various steps involved in dental reconstructions during the placement of dental implants. The above mentioned novel possibilities include computer assistance for the planning of surgical interventions, for the implementation of the surgical steps, for capturing intraoral situation and also for designing temporary and final prosthetic solutions or even for the manufacturing of prosthetic components. Combining the cone-beam computed tomography (CBCT) images with an implant planning software has made it possible to virtually plan the optimal implant positions, in regard of the future prosthetic needs and the vital anatomical structures. This information can be used to fabricate a drill guide, which ultimately results in the transfer of the planned implant position from the computer to the patient, with the guide directing both the osteotomy and the insertion of the implant. The present thesis sought to find answers to the following questions: 1. How does the effect of the combination of low-speed drilling and cooled irrigation fluid influence intraosseous temperature elevation during guided and freehand implant surgery? Our hypothesis was that with the combination of low-speed and cooled irrigation fluid we can control the temperature increment in such a way that with any of the drilling procedures it will be avoidable to do thermal damage to the bony structure. 2. How does drill wear and consequent intraosseous temperature elevation during freehand and guided bone drilling change, with special attention to the effect of metal-on metal contact during guided drilling? We hypothesized that the metal-on-metal contact would damage the surface of the drilling bits, and therefore it would be associated with significantly higher temperatures during the drilling procedures. In the present thesis, we sought, first of all, to examine the effect of several factors that we believed would significantly contribute to heat generation during osteotomy: the presence of the metal sleeve in the surgical template and the combination of different drilling speed with different temperature irrigation fluids. The effect of metal to metal contact was compared with freehand osteotomy, and 3 further factors, sterilization, drilling speed, and drill wear, were also considered. To summarize the findings, at 800rpm, the intraosseous temperature never reached the necrotic threshold in any of the examined conditions during the total of 210 osteotomies. At higher drilling speeds, 90 osteotomies could be safely (i.e., without approaching 47°C) performed regardless of the applied sterilization protocol and whether the drilling was performed freehand or through a metal guide. The results also show that whether guide use led to a near-necrotic temperature increment depended largely on the applied sterilization protocol. In general, our hypothesis regarding the significant and cumulative effect of each studied factor during the experiments regarding the drill wear has been confirmed. It has been proven that the metal guide sleeve contributes significantly to heat generation during osteotomy, but this does not mean a safety risk if a soft sterilization protocol is used. As for temperature elevations in guided osteotomy our results suggest that the use of a low drilling speed of 800 rpm combined with the external irrigation fluid being cooled to 10°C can result in a mean cortical intraosseous temperature change being below 1.0°C, regardless of drill diameter or drilling method (freehand surgery or guided surgery). All in all, the literature almost unequivocally suggests that guided osteotomy (with a metal sleeve) does not pose an extra safety risk in terms of temperature elevation, which is in agreement with our results. Based on the results of the investigations that provide the basis of the present work, a low drilling speed with cooled irrigation are recommended when performing osteotomy through a surgical guide. 800 rpm and 10°C proved to be optimal in our experiments. Furthermore, drills that are used for guided osteotomy should be taken care of with extra precaution regarding the cleaning and the sterilization protocols and their use (the drill bits) should be maximized at a level of 90 osteotomies.

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Intraosseous Heat Generation During Osteotomy Performed Freehand and Through Template With an Integrated Metal Guide Sleeve

Abstract: 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.

Cited by 19 publications

References 25 publications

Drilling of bone: Effect of drill bit geometries on thermal osteonecrosis risk regions

Drilling of bone: Effect of drill bit geometries on thermal osteonecrosis risk regions

Comparing the Temperature Effect of Dedicated Minimally Invasive Motor System to the Discontinuous Use of Rotatory Burrs in the Correction of Hallux Valgus

Intraosseous heat generation during guided osteotomy for dental implantological purposes

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