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ORIGINAL ARTICLE
Year : 2022  |  Volume : 26  |  Issue : 1  |  Page : 32-36  

Thermal Effect of Operatory Room Temperature, Surgical Drill Diameter, and Temperature of Irrigants at Different Depths of Implant Site Preparation – Thermographic Analysis on Goat Mandible


Department of Periodontology, V.Y.W.S. Dental College and Hospital, Amravati, Maharashtra, India

Date of Submission21-Nov-2020
Date of Decision21-Mar-2021
Date of Acceptance02-Apr-2021
Date of Web Publication01-Jan-2022

Correspondence Address:
Nikita Bhagwandas Rathi
Department of Periodontology, V.Y.W.S Dental College and Hospital, Tapovan Wadali Road, Amravati - 444 602, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisp.jisp_791_20

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   Abstract 


Background: Drilling of the implant site results in transient rise in temperature of the surrounding bone disrupting the bone healing process and implant stability. Overproduction of heat due to various factors at osteotomy site needs to be controlled as it hampers the final outcome of the procedure. Purpose: The purpose of this study was to evaluate various factors related to implant drills responsible for heat generation and temperature rise during osteotomy. Materials and Methods: A total of 64 bone specimens with dimensions of 15 mm × 15 mm were obtained from goat mandibles and were equally divided into Groups A and B with operating room temperature maintained at 25°C and 30°C, respectively. Osteotomies were performed using drills with diameters (4.2 mm and 5.6 mm) at various drilling depths (10 mm and 13 mm) with external saline irrigation temperatures (4°C and 25°C). Temperature change was recorded by laser thermometer. Results: The surgical drill depths, diameters, and room temperatures made no differences in temperatures at implant drilling sites whereas the temperatures of the irrigants provide sufficient heat control during drilling. Conclusion: Cooled saline provides beneficial effects in controlling the temperatures of osteotomy sites as compared to saline used at room temperature during implant site preparation.

Keywords: Bone drilling, dental implants, irrigation, room temperature


How to cite this article:
Kapse PG, Thakare KS, Yeltiwar RK, Parwani SR, Ashtankar MA, Rathi NB. Thermal Effect of Operatory Room Temperature, Surgical Drill Diameter, and Temperature of Irrigants at Different Depths of Implant Site Preparation – Thermographic Analysis on Goat Mandible. J Indian Soc Periodontol 2022;26:32-6

How to cite this URL:
Kapse PG, Thakare KS, Yeltiwar RK, Parwani SR, Ashtankar MA, Rathi NB. Thermal Effect of Operatory Room Temperature, Surgical Drill Diameter, and Temperature of Irrigants at Different Depths of Implant Site Preparation – Thermographic Analysis on Goat Mandible. J Indian Soc Periodontol [serial online] 2022 [cited 2022 Aug 19];26:32-6. Available from: https://www.jisponline.com/text.asp?2022/26/1/32/334328




   Introduction Top


Implant dentistry has gained importance in the modern era of dentistry and is considered as reliable treatment modality. Implants have been considered to be the possible closest substitute to natural, healthy teeth. It is considered as a preferable esthetic alternative for treating partial and complete edentulism, thus preserving the overall structures of the mouth.

During drilling of implant sites, applied forces are converted into heat, resulting in temperature rise and further destruction and impairment of the healing of the adjacent bone.[1] The temperature attained due to frictional heat generated during drilling process affects the normal bone tissue response.[2] The temperature threshold of 47°C exceeding 1 min impairs implant–bone contact, causes bone tissue necrosis, inhibits bone microcirculation, and activates bone destructive mechanism, thus hampering the regenerative potential of the bone, and therefore, it is considered to be a factor of early implant failure.[3] To reduce the overheating during drilling at bone–drill interface, sterile saline is a central strategy.[4] It removes the heated bone chips from the surgical drilling site and reduces friction during drilling further minimizing the production of the frictional heat.[5]

Climatic conditions in certain regions of India, specifically during summer season cross threshold temperature (47°C) leading to thermal bone necrosis. The body temperatures habitually fall by 0.5°C to 1.5°C; proposed reasons for this finding were loss of body heat by radiation in cold operating rooms, decrease in cellular oxidation, cutaneous vasodilation, and reduced muscular activity.[6]

Operating rooms could be classified by their effect on patients' temperatures:[7]

  1. Rooms below 21°C – All patients became hypothermic
  2. 21°C–24°C – 70% of the patients remained normothermic and 30% became hypothermic
  3. 24°C–26°C – All patients remained normothermic.


As there is variation in room temperature in different areas of India in different seasons, we consider to investigate its effect, so that we can standardize operatory room temperature before implant surgeries.

The purpose of the present study was to investigate the effect of the operatory room temperatures, surgical drill diameters, and irrigant temperature at different depths of implant site preparation.


   Materials and Methods Top


This in vitro study approved by the institutional experimentation committee was carried on bone blocks, obtained from goat mandible which simulates human jaw bone regarding bone density, relationship between cortical and cancellous bones, and thermal conductivity. All specimens were collected from the butchery. Samples were cut into equal sections of 15 mm thickness × 15 mm height to ensure uniform experimental conditions. A total of 64 specimens were obtained and were divided into Groups A and B with 32 specimens in each group, and impressions of bone specimens were made using silicone material and plaster casts were prepared. To maintain the physical and chemical properties, specimens were not used for few hours according to the guidelines established by Sedlin and Hirsch,[8] i.e., the specimens were kept moist in saline solution and stored in plastic bags at 10°C.

Thermal changes during implant osteotomies were recorded by an infrared or laser thermometer. It consists of a lens to focus the infrared thermal radiation onto sensor, which converts the radiant energy to an electrical signal that can be displayed in units of temperature after being compensated for surrounding temperature. The added advantage of this system is that temperature can be measured from a distance without actual contact with the object to be measured.

Emissivity represents the measured thermal changes at the osteotomy site. Layer of graphite spray of 0.95 emissivity was sprayed directly over the surface of the bone to cover it in order to void the difference between the cortical and cancellous bone layers. By using the graphite spray, the error of temperature difference between cortical and cancellous bones is cut down and the measurement of accuracy is thus improved. A bottle of saline was kept during the entire experiment in the heat-resistant bag to maintain the temperature of the solution. The same operator performed all the drillings in order to avoid the bias related to operator-related factors. Conventional physiodispenser dental handpiece was used. Drilling speed of 800 rpm was maintained throughout the procedure by the surgical motor unit, according to the recommendations of the manufacturer for a standard and atraumatic surgical protocol. For

Group A, the operating room temperature was maintained at 25°C and implant site preparation was done till 10 mm depth using drill with a diameter of 4.2 mm with irrigant temperatures first with 4°C and later with 25°C, and subsequently, drilling was done with 5.6 mm drill diameter and with the same irrigant temperatures. For the next set, the drilling was done till 13 mm depth and all the procedures were repeated with 10 mm drilling depth. For Group B, operating room temperature was maintained at 30°C and the same procedure was repeated with drilling depth till 10 mm and 13 mm [Table 1] and [Table 2]. At all the steps, temperature measurement was done using laser thermometer. The outcome evaluator and the statistician were blinded to all allocations of the intervention.
Table 1: Descriptive distribution of bone specimen with implant site preparation done till 10 mm depth

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Table 2: Descriptive distribution of bone specimen with implant site preparation done till 13 mm depth

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Statistical analysis

Data were analyzed using Student's t test. P > 0.05 suggests that the difference observed is nonsignificant and P < 0.05 will be considered significant.


   Results Top


Temperature changes of 64 drilling osteotomies at two different room temperatures were evaluated. The mean bone specimen baseline temperature before each osteotomy was 20.24 ± 0.60°C. All real-time measurement sequences presented an increase in temperature in superficial cortical and deeper cancellous bone areas for all investigated methods of implant osteotomies.

For intragroup comparison within Group A, no statistically significant difference could be observed between mean temperatures at 10 mm (26.37 ± 2.95) and 13 mm (27.37 ± 3.11) drilling depths at osteotomy sites [Table 3].
Table 3: Descriptive statistics of temperature changes (°C) during drilling of the implant sites with regard to the drilling depth at operating room temperature of 25°C

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No statistically significant difference could be observed between mean temperatures at 10 and 13 mm drilling depths with conical implant drills of 4.2 mm (25.92 ± 2.29) and 5.6 mm (27.82 ± 3.38) diameters [Table 4].
Table 4: Descriptive statistics of temperature changes (°C) during drilling of the implant sites with regard to the drill diameter at operating room temperature of 25°C

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Irrigation of the surgical site with saline at 5°C (24.47 ± 0.78) temperature significantly reduced the bone temperature compared to saline at 25°C (29.27 ± 1.77) temperature regardless of the use of drill guide [Table 5].
Table 5: Descriptive statistics of temperature changes (°C) during drilling of the implant sites with regard to the temperature of the saline used as irrigants at operating room temperature of 25°C

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For intragroup comparison within Group B, at 10 mm (26.77 ± 3.05) and 13 mm (27.75 ± 3.11) drilling depths at osteotomy site, no statistically significant difference could be observed between mean temperature increases [Table 6].
Table 6: Descriptive statistics of temperature changes (°C) during drilling of the implant sites with regard to the drilling depth at operating room temperature of 30°C Depth (mm)

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Similarly, 4.2 mm (26.27 ± 2.29) and 5.6 mm (28.82 ± 3.46) drill diameter showed no statistically significant difference between mean temperature increases at osteotomy sites [Table 7].
Table 7: Descriptive statistics of temperature changes (°C) during drilling of the implant sites with regard to the drill diameter at operating room temperature of 30°C

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When drilling was performed under cooled saline, i.e., 5°C (24.82 ± 0.080), a significant decrease of bone temperature was observed compared to saline temperature of 25°C (29.7 ± 1.85) [Table 8].
Table 8: Descriptive statistics of temperature changes (°C) during drilling of the implant sites with regard to the temperature of the saline used as irrigants at operating room temperature of 30°C

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Bone thermal changes at the surgical site were significantly affected by temperature of the saline used as irrigants whereas surgical drill depths and diameters made no significant difference in temperatures at osteotomy sites.

Intergroup comparisons between Groups A and B revealed no statistically significant difference in temperature of the bone at the surgical sites, with respect to change in room temperature.


   Discussion Top


Preservation of healthy bone during bone osteotomies for implant site preparation by surgical drills is an important prerequisite.[9] The thermal injury due to temperature rise at surgical site during osteotomies is affected by various factors such as bone mass, the amount of cortical versus cancellous bone at the surgical site, rotational drill speed, drill diameter, sharpening condition, drilling depth, and the force of drill application.[10],[11],[12],[13] Regardless of the reason, this temperature increase can cause damage or necrosis of the bone, impairing the post-operative healing, affecting the osseointegration and finally hampering the retention of implant.[14]

For protecting the osteotomy site from thermal injury, saline irrigation with varied temperatures is routinely used. In the present study, the temperature change at the drilling site with saline at 5°C was 24.47 ± 0.78 and 24.82 ± 0.080 and at 25°C was 29.27 ± 1.77 and 29.7 ± 1.85 for Groups A and B, respectively. When drilling was performed under cooled saline, i.e., 5°C, a significant decrease of bone temperature was observed compared to saline temperature of 25°C regardless of the use of drill guide for both the groups. Adequate control of adjacent bone temperature might be possible by using irrigants cooled at 5°C during implant site drilling. Histological data have shown higher osteoblast activity and vigorous increase in bone marrow dynamics when osteotomy site is drilled under saline at 4°C compared to 25°C.[15] However, the effect of cooled saline on nerves, blood vessels, or other surrounding structures should also be considered when selecting a temperature of the irrigants in the clinical setting.[16]

In the literature, there are some studies which state that saline application has an effect on temperature rise of osteotomy site,[13] however, on the contrary, others indicate that application of saline solution to the rotational system at bone interface does not reduce the temperature during the osteotomy to any significant degree.[17],[18] In the present study, only external irrigation was used as contingent clogging and germ contamination can be seen with the use of internal irrigation. This finding is in favor of the study carried by Misir et al. where they documented higher jaw bone temperature at implant drilling site with combined irrigation when compared to external irrigation.[19]

In the present study, no significant difference was found in rise of temperature in relation to different drilling depths of 10 mm (26.37 ± 2.95 and 26.77 ± 3.05) and 13 mm (27.37 ± 3.11 and 27.75 ± 3.11) for Groups A and B, respectively, which is in accordance to the study carried by Reza Tabrizi et al.[20] The American Society of Heating, Refrigeration, and Air-Conditioning Engineers recommends that operating room temperatures be kept between 66°F and 68°F (18.8°C–20°C), with a humidity percentage of 70. The reason behind it is to reduce bacterial growth and comfort of patients and operators. In the author's knowledge, ours is the first study which focuses on the effect of the operating room temperature on the temperature of surgical site during osteotomies, where no significant difference could be found between the two given room temperatures (i.e., 25°C and 30°C) on bone temperature at surgical site. One of the limitations of the present study is that it is an in vitro study on nonvital bone where measurement of actual effect of heat on subsequent bone healing was not possible. Further studies are required with variable difference and more sample size to investigate these parameters before concluding its effect.


   Conclusion Top


This study concluded that room temperature difference did not have a statistically significant effect on temperature generated at osteotomy sites. Difference between other parameters, i.e., drill diameter and drilling depth, was also statistically not significant. Difference between only one parameter was statistically significant, i.e., irrigant temperature while drilling. Lowering the temperature of irrigants helps to reduce the temperature at osteotomy site avoiding bone necrosis, thus facilitating osseintegration and finally retention of the implant.

Acknowledgements

The authors would like to thank the teaching and nonteaching staff of the Department of Periodontology, VYWS Dental College and Hospital, for the help they rendered for completion of this project.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ercoli C, Funkenbusch PD, Lee HJ, Moss ME, Graser GN. The influence of drill wear on cutting efficiency and heat production during osteotomy preparation for dental implants: A study of drill durability. Int J Oral Maxillofac Implants 2004;19:335-49.  Back to cited text no. 1
    
2.
Abouzgia MB, James DF. Temperature rise during drilling through bone. Int J Oral Maxillofac Implants 1997;12:342-53.  Back to cited text no. 2
    
3.
Eriksson AR, Albrektsson T. Temperature threshold levels for heat-induced bone tissue injury: A vital-microscopic study in the rabbit. J Prosthet Dent 1983;50:101-7.  Back to cited text no. 3
    
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Mishra SK, Chowdhary R. Heat generated by dental implant drills during osteotomy – A review: Heat generated by dental implant drills. J Indian Prosthodont Soc 2014;14:131-43.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    
6.
Goldberg MJ, Roe CF. Temperature changes during anesthesia and operations. Arch Surg 1966;93:365-9.  Back to cited text no. 6
    
7.
Morris RH. Operating room temperature and the anesthetized, paralyzed patient. Arch Surg 1971;102:95-7.  Back to cited text no. 7
    
8.
Sedlin ED, Hirsch C. Factors affecting the determination of the physical properties of femoral cortical bone. Acta Orthop Scand 1966;37:29-48.  Back to cited text no. 8
    
9.
Albrektsson T, Brånemark PI, Hansson HA, Lindström J. Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man. Acta Orthop Scand 1981;52:155-70.  Back to cited text no. 9
    
10.
Brisman DL. The effect of speed, pressure, and time on bone temperature during the drilling of implant sites. Int J Oral Maxillofac Implants 1996;11:35-7.  Back to cited text no. 10
    
11.
Cordioli G, Majzoub Z. Heat generation during implant site preparation: An in vitro study. Int J Oral Maxillofac Implants 1997;12:186-93.  Back to cited text no. 11
    
12.
Hobkirk JA, Rusiniak K. Investigation of variable factors in drilling bone. J Oral Surg 1977;35:968-73.  Back to cited text no. 12
    
13.
Hall PB, Landsman A, Banks AS, Dalmia L. Thermal properties of first metatarsal osteotomies. J Foot Ankle Surg 2009;48:432-8.  Back to cited text no. 13
    
14.
Eriksson A, Albrektsson T, Grane B, McQueen D. Thermal injury to bone. A vital-microscopic description of heat effects. Int J Oral Surg 1982;11:115-21.  Back to cited text no. 14
    
15.
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.  Back to cited text no. 15
    
16.
Kondo S, Okada Y, Iseki H, Hori T, Takakura K, Kobayashi A, et al. Thermological study of drilling bone tissue with a high-speed drill. Neurosurgery 2000;46:1162-8.  Back to cited text no. 16
    
17.
Larsen ST, Ryd L. Temperature elevation during knee arthroplasty. Acta Orthop Scand 1989;60:439-42.  Back to cited text no. 17
    
18.
Toksvig-Larsen S, Ryd L, Lindstrand A. On the problem of heat generation in bone cutting. Studies on the effects on liquid cooling. J Bone Joint Surg Br 1991;73:13-5.  Back to cited text no. 18
    
19.
Misir AF, Sumer M, Yenisey M, Ergioglu E. Effect of surgical drill guide on heat generated from implant drilling. J Oral Maxillofac Surg 2009;67:2663-8.  Back to cited text no. 19
    
20.
Tabrizi R, Nazhvanai AD, Farahmand MM, Pourali SY, Hosseinpour S. Do increased drilling speed and depth affect bone viability at implant site? Dent Res J 2017;14:331-5.  Back to cited text no. 20
  [Full text]  



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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