In Uence of The Implant Drill Design and Sequence

Inuence of the Implant Drill Design
and Sequence on Temperature

Changes During Site Preparation
G i a n p a o l o S a n n i n o , P a o l o C a p p a r , E n r i c o F.
Gherlone,
Alberto Barlattani
THE INTERNATIONAL JOURNAL OF ORAL &

MAXILLOFACIAL IMPLANTS ;2015;30:351358.
Contents
Introduction
Materials and methods
Results
Discussion
Conclusions
References
Drilling procedures during dental

implant site preparation may cause
both mechanical and thermal
damage, which are critical
obstacles to primary healing.
The degree of thermal injury
increases exponentially with
increasing temperature and
exposure time.
regeneration: An experimental study in rabbit using the

bone growth chamber. J Oral Maxillofac Surg 1984;42:705
711.
Eriksson, Albrektsson, and colleagues demonstrated

that bone is more sensitive to heat
They established that the threshold level for bone
survival during implant site preparation ranged
between 44C and 47C
It is achieved by keeping drilling time exposure to less
than 1 minute; at 50C, the regenerative capacity of
the bone was practically nonexistent.
4
Multiple factors have been implicated in the generation of

heat during osteotomy preparation.
1. Drilling depth
2. Geometry and material of the drill
3. Sharpness of the cutting tool
4. Drilling speed
5. Pressure applied to the drill
6. Use of graduated versus one-step drilling
7. Irrigation and equipment used (motor, handpiece, power
of the handpiece)
5
MATERIALS AND METHODS

Two implant drill designs were
evaluated in this study.
First drill
Test drill (4.2 Zero 1 Drill) used
in the study.
This drill design has a diameter
of 4.2 mm and a cutting
surface length of 4 mm.
6
Second drill
Control drill (4.2 Twist
Standard Drill).
This standard drill design has
a diameter of 4.2 mm and a
cutting surface length of 16
mm.
The cutting edges of this drill were

designed to selectively increase the
diameter and not the depth of the
implant site during the drilling
sequence.
The drill material was surgical
stainless steel
ASTM F-183908 Standard Specication for Rigid Polyurethane Foam for

Use as a Standard Material for Testing Orthopedic Devices
and Instruments
A total of 60 articial bone cylinders (Sawbones;

12.5 40 mm; density, 0.64 g/cm3) were used to
mimic type 1 bone behavior.
The bone cylinders were placed into a

locking device.
In the side of the locking device, a
hole 2 mm in diameter was used as a
guide channel, through which a lateral
channel 1.7 mm in diameter was
drilled into the bone cylinder.
10
The thermocouple (80PK-1 Ktype, Fluke) was positioned

inside the lateral channel to
measure the temperature in the
vicinity of the head of the
channel.
Furthermore, a heat-transfer
compound (HTCP20S,
Electrolube) was inserted
between the probe and the
channel
11
A surgical micromotor (Chiropro 980, BienAir) and a contraangle handpiece (CA30121, BienAir) with a speed-reducing
factor of 30:1 were used in the drilling procedures.
The torque of the micromotor was set at the maximum
value, ie, without torque limitation.
12
Test apparatus
The Instron machine for
electrome-chanic testing was
used to apply a constant load
on the contra-angle
handpiece, the specimen and
the digital thermocouple
thermometer;
The implant motor and the
saline solution
13
14
Group A (control): traditional

implant site preparation; 2.2 Pilot
Drill, 2.8, 3.5, and 4.2 Twist
Standard Drill (standard sequence)
Group B1 (test): guided surgery;
2.35 Pilot Drill (Leone) and 4.2 Zero
1 drill (recommended sequence for
dense bone)
Group B2 (test): guided surgery;
4.2 Zero 1 drill (recommended
sequence for normal bone)
15
16
The comparison was made in each block (T group A to T

group B1; T group A to T group B2), analyzing a single
distribution of the results, ie, the average of the blocks through
the Student t test.
Statistical calculations were performed with the statistical
software SPSS 14 for Windows (SPSS)
To validate the choice about the signicance test, the
corresponding measures of skewness and kurtosis as well as
the Kolmogorov-Smirnov test and its associated P value
were reported
17
18
19
DISCUSSION
The 4.2 Zero 1 drill is equivalent to the 4.2 Twist
Standard drill in term of material, indications, and
diameter, but diers in the design principles.
The 4.2 Zero 1 drill has a cutting surface 4 mm in
length, which provides a reduction in the bone-drill
contact area during the osteotomy.
20
during implant site preparation: An in vitro

study. Int J Oral Maxillofac Implants
1997;12:186193.
The short cutting surface of the 4.2 Zero 1 drill may be
advantageous for several reasons.
Many bone chips are typically formed during the drilling
procedure.
The utes of the drill ensure that these chips are channeled,
clearing the cutting edge and maintaining the cutting
power.
21
Sener BC, Dergin G, Gursoy B, Kelesoglu E, Slih

I. Eects of irrigation temperature on heat
control in vitro at dierent drilling depths. Clin
Oral Implants Res 2009;20:294298.
Sener et al in their study found that the highest temperature
increases during drilling were in the supercial aspects of the
drilling cavity, owing to the eects of the compact and spongy
components of bone.
22
Oh HJ, Wikesjo UME, Kang HS, Ku Y, Eom TG, Koo

KT. Eect of implant drill characteristics on heat
generation in osteotomy sites: A pilot study. Clin
In the 4.2 Zero 1 drill, the presence of short utes due
to its reduced length might suggest that
(1) a smaller contact area with the bone chips could
cause less frictional resistance and production of heat.
(2) the removal of the debris could be facilitated,
avoiding the clogging of the utes.
23
Padro E, Hernan-dez-Alfaro F. Thermal changes and drill

wear in bovine bone during implant site preparation. A
comparative in vitro study: Twisted stainless steel and
ceramic drills. Clin Oral Implants Res 2011;23:963969.
Oliveira et al showed that drill design and material composition

(ceramic and stainless steel) had a statistically signicant
inuence on the overall recorded temperature increase when
employed with the same standardized drilling protocol.
24
In all three groups, the mean temperature increases

recorded during the osteotomies were always higher
than the baseline bone temperature and less than the
critical harmful threshold.
Therefore, the test sequences (groups B1 and B2) may
still provide equally safe methods of site preparation if
the recommendations of the manufacturers are
followed.
25
Critical analysis
Pros:
1. Every drill was used for just one drilling procedure.
2. Maintained a constant initial temperature during the
tests.
26
CONCLUSION
The preliminary step of a pilot drill is crucial for the
reduction of frictional heat generation, regardless of
the drill geometry.
In all the drill sequences evaluated, the temperatures
recorded during the osteotomies were always below
the critical harmful threshold for the bone, both without
and with irrigation.
Therefore, the tested drill sequences may be safe and
reliable methods in addition to the conventional
sequence.
27
REFERENCES
Eriksson RA, Adell R. Temperatures during drilling for the
placement of implants using the osseointegration technique.
J Oral Maxillofac Surg 1986;44:47.
Oliveira N, Alaejos-Algarra F, Mareque-Bueno J, Ferres-Padro
E, Hernan-dez-Alfaro F. Thermal changes and drill wear in
bovine bone during implant site preparation. A comparative
in vitro study: Twisted stainless steel and ceramic drills. Clin
Sener BC, Dergin G, Gursoy B, Kelesoglu E, Slih I. Eects of
irrigation temperature on heat control in vitro at dierent
drilling depths. Clin Oral Implants Res 2009;20:294298.
28
Oh HJ, Wikesjo UME, Kang HS, Ku Y, Eom TG, Koo KT. Eect
of implant drill characteristics on heat generation in
osteotomy sites: A pilot study. Clin Oral Implants Res
2011;22:722726
Cordioli G, Majzoub Z. Heat generation during implant site
preparation: An in vitro study. Int J Oral Maxillofac Implants
1997;12:186193.
29

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Inuence of the Implant Drill Design

and Sequence on Temperature

THE INTERNATIONAL JOURNAL OF ORAL &

Drilling procedures during dental

regeneration: An experimental study in rabbit using the

Eriksson, Albrektsson, and colleagues demonstrated

Multiple factors have been implicated in the generation of

MATERIALS AND METHODS

The cutting edges of this drill were

ASTM F-183908 Standard Specication for Rigid Polyurethane Foam for

A total of 60 articial bone cylinders (Sawbones;

The bone cylinders were placed into a

The thermocouple (80PK-1 Ktype, Fluke) was positioned

Group A (control): traditional

The comparison was made in each block (T group A to T

during implant site preparation: An in vitro

Sener BC, Dergin G, Gursoy B, Kelesoglu E, Slih

Oh HJ, Wikesjo UME, Kang HS, Ku Y, Eom TG, Koo

Padro E, Hernan-dez-Alfaro F. Thermal changes and drill

Oliveira et al showed that drill design and material composition

In all three groups, the mean temperature increases

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