A comparative study to evaluate the heat generated during osteotomy with conventional drill, trephine and alveolar expander

Abstract

Purpose : Excessively produced heat could lead to clinical failure of osseointegration. This study was done to compare the heat generated during osteotomy with the conventional drill, trephine, and alveolar expander Material and methods: This in vitro study was performed on ten bovine femoral bones. In each femoral bone, three osteotomy sites were prepared at a distance of 1.5cm using the conventional drill, trephine, and alveolar expander. During osteotomy, the site was irrigated with a copius amount of normal saline. Osteotomy sites of 3.6 mm in diameter and 11.5 mm in length were prepared using the conventional drill and bone trephines. The alveolar expander used for preparing the osteotomy site was 3.5mm, the nearest dimensions available. The temperature rise was measured using a thermocouple thermometer. Repeated measures ANOVA and Fisher’s least significant difference pairwise comparison test was done for statistical analysis. Results: Repeated measures ANOVA revealed a significant difference in the heat generation with the conventional drill, trephine, and alveolar expander (P< 0.001). The mean heat generated was maximum with the trephine (28.26±0.246) followed by the conventional drill (27.27±0.297) and least with alveolar expander (25.64±0.142). Pairwise comparison showed a significant difference in heat generated during osteotomy with conventional drill compared to trephine (P=0.023), conventional drill compared to alveolar expander (P=0.014), and trephine compared to alveolar expander (P< 0.001). Conclusion: The heat generated with trephine was maximum compared to the alveolar expander and conventional drills. If in case trephine is to be used, both internal and external irrigation must be used. Less heat generation during osteotomy by alveolar expander seems very promising and advantageous for better osseointegration.

Keywords

• alveolar expander
• dental implant
• heat generation
• osteotomy
• trephine

References

1. Reference 1. Ogle OE. Implant surface material, design, and osseointegration. Dent Clin North Am 2015;59:505-20.
2. Reference 2. Guglielmotti MB, Olmedo DG, Cabrini RL. Research on implants and osseointegration. Periodontol 2000.2019;79:178-89.
3. Reference 3. Möhlhenrich SC, Modabber A, Steiner T, Mitchell DA, Hölzle F. Heat generation and drill wear during dental implant site preparation: systematic review. Br J Oral Maxillofac Surg 2015;53:679-89.
4. Reference 4.Tehemar SH. Factors affecting heat generation during implant site preparation: a review of biologic observations and future considerations. Int J Oral Maxillofac Implants 1999;14:127-36.
5. Reference 5. Kuster M, Mukaddam K, Zitzmann NU, Filippi A, Kühl S. Influence of a Novel Drill Design on Heat Generation During Conventional and Guided Implant Osteotomy. Int J Oral Maxillofac Implants 2021;36:e31-41.
6. Reference 6. Eriksson R, Adell R. Temperatures during drilling for the placement of implants using the osteointegration technique. J Oral Maxillofac Surg 1986;36:968-73.
7. Reference 7.Flanagan D. Heat generated during seating of dental implant fixtures. J Oral Implantol 2014;40:174-81.
8. Reference 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;8:704-8.

9. Reference 9. Gupta S, Gupta AS, Chandu GS, Jain S. Infrared thermographic evaluation of rise in temperature with conventional versus trephine drills. J Indian Prosthodont Soc 2021;21:45-9.
10. Reference 10. Bhargava D, Thomas S, Pandey A, Deshpande A, Mishra SK. Comparative study to evaluate bone loss during osteotomy using standard drill, bone trephine, and alveolar expanders for implant placement. J Indian Prosthodont Soc 2018;18:226-30.
11. Reference 11. Tribst JP, de Morais DC, Alonso AA, Piva AM, Borges AL. Comparative three‑dimensional finite element analysis of implant‑supported fixed complete arch mandibular prostheses in two materials. J Indian Prosthodont Soc 2017;17:255‑60.
12. Reference 12. Elakkiya S, Ramesh AS, Prabhu K. Systematic analysis on the efficacy of bone enhancement methods used for success in dental implants. J Indian Prosthodont Soc 2017;17:219‑25.
13. Reference 13. Scarano A, Piattelli A, Assenza B, Carinci F, Di Donato L, Romani GL, et al. Infrared thermographic evaluation of temperature modifications induced during implant site preparation with cylindrical versus conical drills. Clin Implant Dent Relat Res 2011;13:319-23.
14. Reference 14. Mishra SK, Chowdhary R. Heat Generated by Dental Implant Drills During Osteotomy-A Review. J Indian Prosthodont Soc 2014;14:131-43.
15. Reference 15. Albrektsson T, Eriksson A. Thermally induced bone necrosis in rabbits: Relation to implant failure in humans. Clin Orthop Relat Res 1985;195:311-2.
16. Reference 16. Eriksson RA, Adell R. Temperatures during drilling for the placement of implants using the osseointegration technique. J Oral Maxillofac Surg 1986;44:4-7.
17. Reference 17. Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent 1983;50:399-410.
18. Reference 18. Mohamed JB, Alam MN, Singh G, Chandrasekaran SN. Alveolar bone expansion for implant placement in compromised aesthetic zone-Case series. J Clin Diagn Res 2014;8:237‑8.
19. Reference 19. Cortes AR, Cortes DN. Nontraumatic bone expansion for immediate dental implant placement: An analysis of 21 cases. Implant Dent 2010;19:92-7.
20. Reference 20. Lee EA, Anitua E. Atraumatic ridge expansion and implant site preparation with motorized bone expanders. Pract Proced Aesthet Dent 2006;18:17‑22.