Background:
Osteotomy preparation may result in a region of necrotic bone surrounding the inserted implant and the extent of this region is potentially influenced by the relationship between the drilling protocoll and heat generated at these sites. The amount of damage incurred to bone due to instrumentation, and subsequently its ability to heal around implants may depend on the drill material, drill design, irrigation and the rate which the drilling site diameter is incrementally increased (the number of iteration from initial drill and final drill diameter prior to implant placement). Some of the drilling protocols require many time-consuming steps. It is of great interest to investigate if reducing the number of drills used would provide comparable results to the conventional drilling sequence.
Aim/Hypothesis:
To test the hypothesis that there would be no differences in bone trauma by reducing the number of implant drills to only one multi-stepped drill for site preparation relative to conventional implant drilling sequence with multiple drills.
Material and Methods:
Three different drilling groups were compared: Control (2mm diameter pilot drill + 3.3mm 3-stepped drill + 4.1mm 3-stepped drill); Test A (3.3mm 3-stepped drill); Test B (4.1mm 3-stepped drill). Medentika® (Medentika GmbH, Hügelsheim, Germany) manufactured the newly designed 3-stepped drills from a special steel –1.4197. The implant bed preparaton was performed in artificial bone similes (BoneSim, Newaygo, MI, USA) resembling type II bone according to Lekholm and Zarb classification. The procedure was initiated by making the perforations for the thermocouples in the bone similes, using a small stainless-steel fissure bur of 0.5mm diameter x 10mm length (H254L Komet®, Lemgo, Germany); the cavities created were filled with a heat-transfer compound (HTCP20S 20 ml; Electrolube®, Leicestershire, UK) to ensure transfer from the bone to the sensors during drilling. Two needle microprobe thermocouples, T-Type MLT 1406 (ADInstruments Inc., Colorado Springs, USA) for real time data acquisition were inserted and sealed with bone wax to prevent any environmental effects during data registration. Three hundred random perforations (30 per disc) were made, a total of 100 perforations per group. Each drill was used no more than ten times before being replaced. Thermocouples were calibrated using the comparative method; a relative-humidity-temperature sensor (Sensirion, Staefa, Switzerland) was used for reference. Implant stability was measured with the Periotest® device (Siemens, Bensheim, Germany) and the insertion torque. The drilling procedure was performed by calibrated operators in order to reproduce a clinical situation. ANOVA followed by Bonferroni post-hoc analysis were used to identify mean differences between groups.
Results:
All the drills induced thermal changes. The first drill in the control group increased temperature (6.911±0.341) followed by increments of 3.698±0.467 for drill 1, and 3.118±0.662 for drill 2 reaching a max temperature (TMax) of 39.049-40.859°C. Test A: increased temperature from T0 30.102±0.736°C to TMax 38.872±0.921°C (range: 37.948-39.764°C; ΔT = 8.771±0.122; 95% CI: 8.525, 8.893) and Test B: increased the temperature from T0 30.542±0.591°C to TMax 40.124±0.872°C (range: 39.581-40.953°C; ΔT = 9.582±0.094; 95% CI: 9.432, 9.684) without significant differences between groups (p<0.05). The mean time to accomplish drilling was significantly longer in the control group (p<0.05); test groups took 10±0.3seconds less to reach the required drilling depth. PTV values were higher in test groups, compared with controls (p<0.05).
Conclusions and clinical implications:
The simplified drilling protocol presented comparable bone trauma in regards to temperature outcomes to the conventional protocol, which proved the initial hypothesis. The 3-stepped drills used for single-stage implant site preparation: - Increase temperature comparable to a conventional incremental protocol. - Reduce drilling time. - Increase implant stability two-fold compared with a conventional incremental protocol.
Background:
Osteotomy preparation may result in a region of necrotic bone surrounding the inserted implant and the extent of this region is potentially influenced by the relationship between the drilling protocoll and heat generated at these sites. The amount of damage incurred to bone due to instrumentation, and subsequently its ability to heal around implants may depend on the drill material, drill design, irrigation and the rate which the drilling site diameter is incrementally increased (the number of iteration from initial drill and final drill diameter prior to implant placement). Some of the drilling protocols require many time-consuming steps. It is of great interest to investigate if reducing the number of drills used would provide comparable results to the conventional drilling sequence.
Aim/Hypothesis:
To test the hypothesis that there would be no differences in bone trauma by reducing the number of implant drills to only one multi-stepped drill for site preparation relative to conventional implant drilling sequence with multiple drills.
Material and Methods:
Three different drilling groups were compared: Control (2mm diameter pilot drill + 3.3mm 3-stepped drill + 4.1mm 3-stepped drill); Test A (3.3mm 3-stepped drill); Test B (4.1mm 3-stepped drill). Medentika® (Medentika GmbH, Hügelsheim, Germany) manufactured the newly designed 3-stepped drills from a special steel –1.4197. The implant bed preparaton was performed in artificial bone similes (BoneSim, Newaygo, MI, USA) resembling type II bone according to Lekholm and Zarb classification. The procedure was initiated by making the perforations for the thermocouples in the bone similes, using a small stainless-steel fissure bur of 0.5mm diameter x 10mm length (H254L Komet®, Lemgo, Germany); the cavities created were filled with a heat-transfer compound (HTCP20S 20 ml; Electrolube®, Leicestershire, UK) to ensure transfer from the bone to the sensors during drilling. Two needle microprobe thermocouples, T-Type MLT 1406 (ADInstruments Inc., Colorado Springs, USA) for real time data acquisition were inserted and sealed with bone wax to prevent any environmental effects during data registration. Three hundred random perforations (30 per disc) were made, a total of 100 perforations per group. Each drill was used no more than ten times before being replaced. Thermocouples were calibrated using the comparative method; a relative-humidity-temperature sensor (Sensirion, Staefa, Switzerland) was used for reference. Implant stability was measured with the Periotest® device (Siemens, Bensheim, Germany) and the insertion torque. The drilling procedure was performed by calibrated operators in order to reproduce a clinical situation. ANOVA followed by Bonferroni post-hoc analysis were used to identify mean differences between groups.
Results:
All the drills induced thermal changes. The first drill in the control group increased temperature (6.911±0.341) followed by increments of 3.698±0.467 for drill 1, and 3.118±0.662 for drill 2 reaching a max temperature (TMax) of 39.049-40.859°C. Test A: increased temperature from T0 30.102±0.736°C to TMax 38.872±0.921°C (range: 37.948-39.764°C; ΔT = 8.771±0.122; 95% CI: 8.525, 8.893) and Test B: increased the temperature from T0 30.542±0.591°C to TMax 40.124±0.872°C (range: 39.581-40.953°C; ΔT = 9.582±0.094; 95% CI: 9.432, 9.684) without significant differences between groups (p<0.05). The mean time to accomplish drilling was significantly longer in the control group (p<0.05); test groups took 10±0.3seconds less to reach the required drilling depth. PTV values were higher in test groups, compared with controls (p<0.05).
Conclusions and clinical implications:
The simplified drilling protocol presented comparable bone trauma in regards to temperature outcomes to the conventional protocol, which proved the initial hypothesis. The 3-stepped drills used for single-stage implant site preparation: - Increase temperature comparable to a conventional incremental protocol. - Reduce drilling time. - Increase implant stability two-fold compared with a conventional incremental protocol.
Background:
Osteotomy preparation may result in a region of necrotic bone surrounding the inserted implant and the extent of this region is potentially influenced by the relationship between the drilling protocoll and heat generated at these sites. The amount of damage incurred to bone due to instrumentation, and subsequently its ability to heal around implants may depend on the drill material, drill design, irrigation and the rate which the drilling site diameter is incrementally increased (the number of iteration from initial drill and final drill diameter prior to implant placement). Some of the drilling protocols require many time-consuming steps. It is of great interest to investigate if reducing the number of drills used would provide comparable results to the conventional drilling sequence.
Aim/Hypothesis:
To test the hypothesis that there would be no differences in bone trauma by reducing the number of implant drills to only one multi-stepped drill for site preparation relative to conventional implant drilling sequence with multiple drills.
Material and Methods:
Three different drilling groups were compared: Control (2mm diameter pilot drill + 3.3mm 3-stepped drill + 4.1mm 3-stepped drill); Test A (3.3mm 3-stepped drill); Test B (4.1mm 3-stepped drill). Medentika® (Medentika GmbH, Hügelsheim, Germany) manufactured the newly designed 3-stepped drills from a special steel –1.4197. The implant bed preparaton was performed in artificial bone similes (BoneSim, Newaygo, MI, USA) resembling type II bone according to Lekholm and Zarb classification. The procedure was initiated by making the perforations for the thermocouples in the bone similes, using a small stainless-steel fissure bur of 0.5mm diameter x 10mm length (H254L Komet®, Lemgo, Germany); the cavities created were filled with a heat-transfer compound (HTCP20S 20 ml; Electrolube®, Leicestershire, UK) to ensure transfer from the bone to the sensors during drilling. Two needle microprobe thermocouples, T-Type MLT 1406 (ADInstruments Inc., Colorado Springs, USA) for real time data acquisition were inserted and sealed with bone wax to prevent any environmental effects during data registration. Three hundred random perforations (30 per disc) were made, a total of 100 perforations per group. Each drill was used no more than ten times before being replaced. Thermocouples were calibrated using the comparative method; a relative-humidity-temperature sensor (Sensirion, Staefa, Switzerland) was used for reference. Implant stability was measured with the Periotest® device (Siemens, Bensheim, Germany) and the insertion torque. The drilling procedure was performed by calibrated operators in order to reproduce a clinical situation. ANOVA followed by Bonferroni post-hoc analysis were used to identify mean differences between groups.
Results:
All the drills induced thermal changes. The first drill in the control group increased temperature (6.911±0.341) followed by increments of 3.698±0.467 for drill 1, and 3.118±0.662 for drill 2 reaching a max temperature (TMax) of 39.049-40.859°C. Test A: increased temperature from T0 30.102±0.736°C to TMax 38.872±0.921°C (range: 37.948-39.764°C; ΔT = 8.771±0.122; 95% CI: 8.525, 8.893) and Test B: increased the temperature from T0 30.542±0.591°C to TMax 40.124±0.872°C (range: 39.581-40.953°C; ΔT = 9.582±0.094; 95% CI: 9.432, 9.684) without significant differences between groups (p<0.05). The mean time to accomplish drilling was significantly longer in the control group (p<0.05); test groups took 10±0.3seconds less to reach the required drilling depth. PTV values were higher in test groups, compared with controls (p<0.05).
Conclusions and clinical implications:
The simplified drilling protocol presented comparable bone trauma in regards to temperature outcomes to the conventional protocol, which proved the initial hypothesis. The 3-stepped drills used for single-stage implant site preparation: - Increase temperature comparable to a conventional incremental protocol. - Reduce drilling time. - Increase implant stability two-fold compared with a conventional incremental protocol.
Background:
Osteotomy preparation may result in a region of necrotic bone surrounding the inserted implant and the extent of this region is potentially influenced by the relationship between the drilling protocoll and heat generated at these sites. The amount of damage incurred to bone due to instrumentation, and subsequently its ability to heal around implants may depend on the drill material, drill design, irrigation and the rate which the drilling site diameter is incrementally increased (the number of iteration from initial drill and final drill diameter prior to implant placement). Some of the drilling protocols require many time-consuming steps. It is of great interest to investigate if reducing the number of drills used would provide comparable results to the conventional drilling sequence.
Aim/Hypothesis:
To test the hypothesis that there would be no differences in bone trauma by reducing the number of implant drills to only one multi-stepped drill for site preparation relative to conventional implant drilling sequence with multiple drills.
Material and Methods:
Three different drilling groups were compared: Control (2mm diameter pilot drill + 3.3mm 3-stepped drill + 4.1mm 3-stepped drill); Test A (3.3mm 3-stepped drill); Test B (4.1mm 3-stepped drill). Medentika® (Medentika GmbH, Hügelsheim, Germany) manufactured the newly designed 3-stepped drills from a special steel –1.4197. The implant bed preparaton was performed in artificial bone similes (BoneSim, Newaygo, MI, USA) resembling type II bone according to Lekholm and Zarb classification. The procedure was initiated by making the perforations for the thermocouples in the bone similes, using a small stainless-steel fissure bur of 0.5mm diameter x 10mm length (H254L Komet®, Lemgo, Germany); the cavities created were filled with a heat-transfer compound (HTCP20S 20 ml; Electrolube®, Leicestershire, UK) to ensure transfer from the bone to the sensors during drilling. Two needle microprobe thermocouples, T-Type MLT 1406 (ADInstruments Inc., Colorado Springs, USA) for real time data acquisition were inserted and sealed with bone wax to prevent any environmental effects during data registration. Three hundred random perforations (30 per disc) were made, a total of 100 perforations per group. Each drill was used no more than ten times before being replaced. Thermocouples were calibrated using the comparative method; a relative-humidity-temperature sensor (Sensirion, Staefa, Switzerland) was used for reference. Implant stability was measured with the Periotest® device (Siemens, Bensheim, Germany) and the insertion torque. The drilling procedure was performed by calibrated operators in order to reproduce a clinical situation. ANOVA followed by Bonferroni post-hoc analysis were used to identify mean differences between groups.
Results:
All the drills induced thermal changes. The first drill in the control group increased temperature (6.911±0.341) followed by increments of 3.698±0.467 for drill 1, and 3.118±0.662 for drill 2 reaching a max temperature (TMax) of 39.049-40.859°C. Test A: increased temperature from T0 30.102±0.736°C to TMax 38.872±0.921°C (range: 37.948-39.764°C; ΔT = 8.771±0.122; 95% CI: 8.525, 8.893) and Test B: increased the temperature from T0 30.542±0.591°C to TMax 40.124±0.872°C (range: 39.581-40.953°C; ΔT = 9.582±0.094; 95% CI: 9.432, 9.684) without significant differences between groups (p<0.05). The mean time to accomplish drilling was significantly longer in the control group (p<0.05); test groups took 10±0.3seconds less to reach the required drilling depth. PTV values were higher in test groups, compared with controls (p<0.05).
Conclusions and clinical implications:
The simplified drilling protocol presented comparable bone trauma in regards to temperature outcomes to the conventional protocol, which proved the initial hypothesis. The 3-stepped drills used for single-stage implant site preparation: - Increase temperature comparable to a conventional incremental protocol. - Reduce drilling time. - Increase implant stability two-fold compared with a conventional incremental protocol.