Purpose: The aim of the study was to investigate the effectiveness of multi-step drill for heat production during preparation of implant sites.

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Abstract

Purpose: The aim of the study was to investigate the effectiveness of multi-step drill for heat production during preparation of implant sites.

Materials and Methods: Four drilling experiments were carried out in this study. Two experiments were conducted in conventional drilling sequence for the implant site of diameter 4.3 mm and 4.6 mm; and another 2 experiments were conducted in experimental drilling sequence for the implant site of diameter 4.3 mm and 4.6 mm. Conventional triflute drill and pilot drill were used in conventional drilling sequence and multi-step drill was used in experimental drilling sequence. Six points of bovine femur were selected to measure the temperature during implant drilling. Temperature changes were assessed with infrared thermal-vision camera in real time. Each drilling sequence was performed 20 times. Thermal image data of experiment was transmitted to and analyzed by personal computer.

Results: Mean value of maximum temperature during experimental drilling sequence was 44.10

^o

C in diameter 4.3 mm and 45.65

^o

C in diameter 4.6 mm. Temperature elevation between conventional and experimental drilling sequence in the critical drilling step were not significantly different (p<0.05). Outer part of the bone showed the highest temperature elevation during drilling.

Conclusion: Within the limitations of this study, multi-step drill shortened the drilling sequence by omitting the pilot drilling step.

Based on the study results, the conclusions were (1) there were no significant temperature differences between conventional and experimental drilling sequence. Mean maximum temperature during experimental sequence was below 47

^o

C. Thus, several steps of the drilling could be shortened by using the multi-step drill; and (2) multi-step drill is potentially a powerful and efficient tool that provides several benefits. Shortening the procedures of implant drilling by changing the shapes of fore-end of the drills would be more beneficial to not only clinicians, but also patients.

Key Words: bone heating, implant, multi-step drill

⳰⭑⹡⺤ㄦ⬚コ⵻⮔⪬⮒⪷⺫⺟

⺝ⴓ⻭⸳ㅙ⼇⵼ㅟⵑ⤇⤱ど

서울대학교 치의학대학원 치주과학교실, 치학연구소

A New Drill Design in Sequential Drilling of the Osteotomy Sites

Sung Jong Lee, Hyun Jun Oh, Hyong-Soon Shin, Ki-Tae Koo

Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea

Reprint requests: Ki-Tae Koo

Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: 82-2-2072-3858, Fax: 82-2-744-0051

E-mail: PerioKoo@snu.ac.kr

Received for publication: September 7, 2015 Revised for publication: September 11, 2015 Accepted for publication: September 12, 2015

교신저자: 구기태

(03080) 서울시 종로구 대학로 101

서울대학교 치의학대학원 치주과학교실, 치학연구소 Tel: 82-2-2072-3858, Fax: 82-2-744-0051 E-mail: PerioKoo@snu.ac.kr

원고접수일: 2015년 9월 7일 원고수정일: 2015년 9월 11일 게재확정일: 2015년 9월 12일

Copyright © 2015. The Korean Academy of Oral & Maxillofacial Implantology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits

unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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** Materials and Methods

1. Drill design

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Step width (h)

A B C D

D B A

C B

15 13 11.5 10 8.5 75 43

Fig. 1.

Schematic drawing representing the design of multi-step drill. (A) After initial drill, multi-step drill was used. (B) After multi-step drill, final drill was used. (C) Experimental multi-step drill, MD 2038 where ФA is 2.0 mm, ФB is 3.0 mm, and ФD is 3.8 mm. (D) Experimental multi-step drill, MD2043 where ФC is 3.8 mm, and ФD is 4.3 mm.

Sung Jong Lee et al. : A New Drill Design in Sequential

Drilling of the Osteotomy Sites. Implantology 2015

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2.0 Fig. 2.

Schematic drawing showing drilling sequence performed in this study for diameter 4.3 mm. (A) Conventional drilling sequence with conventional drill. (B) Experimental drilling sequence with multi-step drill. Ф: diameter (mm), PD: pilot drill.

Sung Jong Lee et al. : A New Drill Design in Sequential Drilling of the Osteotomy Sites. Implantology 2015

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Fig. 3.

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control box, drilling equipment, infrared thermo-vision camera, artificial bone block, implant drill and personal computer (PC) which analyzes the data.

Sung Jong Lee et al. : A New Drill Design in Sequential Drilling of the Osteotomy Sites. Implantology 2015

Fig. 4.

Temperature measurement scheme; the selected 6 points for measuring temperature during drilling.

Sung Jong Lee et al. : A New Drill Design in Sequential Drilling of the Osteotomy Sites. Implantology 2015 16 mm

1 2 3 4 5 6

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5. Experimental procedure

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Table 1. Drilling steps and c omparison of temp er atur e changes Step 1 2 3 4 5 6 7 8 9 10 Last drill prior to ev aluate Ф2.0 PD2030 Ф3.0 PD3038 Ф3.8 Ф4.3 Ф2.0 Ф2.0 MD2043 MD2038 Drill under ev aluation PD2030 Ф3.0 PD3038 Ф3.8 Ф4.3 Ф4.6 MD2043 MD2038 Ф4.6 Ф4.3

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Temp er atur e change ( C) 2.58±0.27 3.8 4±0.51 2.58±0.21 6.4 4±0.45 6.33±0.82 7.51±0.86 7.25±0.66 6.22±0.73 6.15±0.87 5.69±0.85 V alues ar e pr esente d as mean±standar d de viation. Ф: diameter (mm), PD: pilot drill, MD: multi-step drill. Sung Jong Lee et al. : A New Drill Design in Sequential Drilling of the Osteotomy Sites. Implantology 2015

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Fig. 5.

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Sung Jong Lee et al. : A New Drill Design in Sequential Drilling of the Osteotomy Sites. Implantology 2015

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*** Results

1. Mean maximum temperature in experimental drilling sequence

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Table 2.

List of experimental and conventional sequences with involved step

Experiment Sequence Involved step

1-A for Ф4.3 Ф2.0 → MD2038 → Ф4.3 Step 8, 10

1-B for Ф4.3 Ф2.0 → PD2030 → Ф3.0 → PD3038 → Ф3.8 → Ф4.3 Step 1, 2, 3, 4, 5

2-A for Ф4.6 Ф2.0 → MD2043 → Ф4.6 Step 7, 9

2-B for Ф4.6 Ф2.0 → PD2030 → Ф3.0 → PD3038 → Ф3.8 → Ф4.3 → Ф4.6 Step 1, 2, 3, 4, 5, 6 Ф: diameter (mm), PD: pilot drill, MD: multi-step drill.

Sung Jong Lee et al. : A New Drill Design in Sequential Drilling of the Osteotomy Sites. Implantology 2015

Table 3.

Mean maximum temperature in experimental drilling sequence

Sequence

1-A for Ф4.3 2-A for Ф4.6

Mean bone temperature before drilling (^oC) 32.19 32.25

Mean maximum temperature after drilling (^oC) 44.10 45.65

Temperature change (^oC) 11.91±0.83 13.40±1.08

Values are presented as number or mean±standard deviation.

Ф: diameter (mm).

Sung Jong Lee et al. : A New Drill Design in Sequential Drilling of the Osteotomy Sites. Implantology 2015

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2. The largest temperature rising drilling step in each experiment

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Sung Jong Lee et al. : A New Drill Design in Sequential Drilling of the Osteotomy

Sites. Implantology 2015

(9)

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Fig. 7.

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Sung Jong Lee et al. : A New Drill Design in Sequential Drilling of the Osteotomy Sites. Implantology 2015

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References

1. Cordioli G, Majzoub Z. Heat generation during implant site preparation:

an in vitro study. Int J Oral Maxillofac Implants. 1997; 12: 186-193.

2. Eriksson RA, Albrektsson T. The effect of heat on bone regeneration: an experimental study in the rabbit using the bone growth chamber. J Oral Maxillofac Surg. 1984; 42: 705-711.

3. Lundskog J. Heat and bone tissue. An experimental investigation of the thermal properties of bone and threshold levels for thermal injury. Scand J Plast Reconstr Surg. 1972; 9: 1-80.

4. Eriksson AR, Albrektsson T. Temperature threshold levels for heat- induced bone tissue injury: a vital-microscopic study in the rabbit. J Prosthet Dent. 1983; 50: 101-107.

5. Hobo S, Ichida E, Garcia LT. Osseointegration and occlusal rehabilitation. Tokyo, Chicago: Quintessence Publishing Co. Ltd.; 1989.

6. Oh HJ, Wikesjö UM, Kang HS, et al. Effect of implant drill characteristics on heat generation in osteotomy sites: a pilot study. Clin Oral Implants Res. 2011; 22: 722-726.

7. Albrektsson T. The healing of autologous bone grafts after varying degrees of surgical trauma. A microscopic and histochemical study in the rabbit. J Bone Joint Surg Br. 1980; 62: 403-410.

8. Albrektsson T, Eriksson A. Thermally induced bone necrosis in rabbits:

relation to implant failure in humans. Clin Orthop Relat Res. 1985;

(12)

(195): 311-312.

9. Eriksson A, Albrektsson T, Grane B, et al. Thermal injury to bone. A vital-microscopic description of heat effects. Int J Oral Surg. 1982; 11:

115-121.

10. Eriksson AR, Albrektsson T, Albrektsson B. Heat caused by drilling cortical bone. Temperature measured in vivo in patients and animals.

Acta Orthop Scand. 1984; 55: 629-631.

11. Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent. 1983; 50: 399-410.

12. Watanabe F, Tawada Y, Komatsu S, et al. Heat distribution in bone during preparation of implant sites: heat analysis by real-time

thermography. Int J Oral Maxillofac Implants. 1992; 7: 212-219.

13. Sener BC, Dergin G, Gursoy B, et al. Effects of irrigation temperature on heat control in vitro at different drilling depths. Clin Oral Implants Res. 2009; 20: 294-298.