The effect of guided flapless implant procedure on heat generation from implant drilling
Introduction
In the recent years, there has been some interest in developing techniques that can provide function, aesthetics and comfort with a minimally invasive surgical approach. To fulfill this requirement, flapless implant surgery has been advocated by many clinicians. A flapless surgical approach is advantageous compared to conventional surgical procedures (Jeong et al., 2007, Jeong et al., 2011, Kim et al., 2009, You et al., 2009). According to some reports, flapless surgery is a low pain procedure with less postoperative bleeding, less discomfort for the patient, shorter surgery time, and reduced healing time (Rocci et al., 2003a, Rocci et al., 2003b). Some have suggested that flapless implant surgery can preserve the soft tissue profiles, including the gingival margins of the adjacent teeth and interdental papillae (Widmann and Bale, 2006). Despite the many benefits, flapless implant surgery is generally perceived as a blind procedure because of the difficulty in evaluating the alveolar bone contours and angulations. More recently, this concept has been revised dramatically based on a new methodology, guided flapless implant surgery. Using 3D image-based surgical drill guides, the surgeon can correctly place implants through a small mucosa hole made by a soft tissue punch, without observing the bone surface (Nickenig and Eitner, 2007, Nickenig and Eitner, 2010, Nickenig et al., 2010a, Nickenig et al., 2010b; Oh et al., 2007, Siessegger et al., 2001, Wat et al., 2002). It has been reported that more bone loss and higher rates of implant failure occurred in the implants placed with flapless implant surgery than in implants placed with flap implant surgery (Malo and Nobre, 2008, De Bruyn et al., 2011). There is some concern that heat-induced necrosis can occur during the guided flapless drilling, because the osteotomy is performed below the soft tissue and the surgical drill guide. In a review of the current literature, there are no published reports on the effect of guided flapless implant procedure on heat generation from implant drilling. Therefore, the purpose of this study was to evaluate heat generation in vitro during the flapless drilling procedure using surgical drill guides.
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Materials and methods
This in vitro study was designed to simulate the clinical conditions involved in implant site preparation. A total of ten resin mandible models that had bilateral edentulous spaces in the first and second molar regions were used in this study (Fig. 1). The edentulous regions were covered with a silicone lining mimicking the soft tissues and a wood block mimicking the hard tissues. The silicone lining had a thickness of 2 mm. The wood block had D1 bone density, using the Hounsfield units (HU)
Results
Twenty drilling procedures were undertaken with the use of surgical drill guides on each side of the mandible. Data from two drilling sites on each side were excluded from this study as the wall between the drill preparations and the thermocouple canals did not remain intact. The mean maximum temperatures at the drilling sites with guided flapless procedures were 29.5 °C (range 25.4 °C–34.5 °C) and 32.6 °C (range 27.5 °C–36.6 °C) at the depths of 3 and 6 mm, respectively, whereas for flap
Discussion
Preparation of hard tissues for insertion of dental implants is usually performed with drills at a high speed. The surgical trauma resulting from the bone overheating during such procedures will generally give rise to a zone of devitalized bone around the bur holes or osteotomies. The heat generated during an implant site preparation is related to the presence and temperature of irrigation (Eriksson et al., 1984), the amount of bone being prepared (Eriksson and Adell, 1986), drill sharpness and
Conclusion
These findings suggest that drilling with external irrigation in an up-and-down pumping motion may not lead to a significant increase in bone temperature during a flapless procedure using surgical drill guides.
Conflict of interest
No authors of this paper have any conflict of interest pertinent to this study.
Acknowledgments
This study was supported by a grant of the Korea Health technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A100054).
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These authors contributed equally to this work.