Measurement of thermal conductivity of bovine cortical bone

Advancing atom probe tomography capabilities to understand bone microstructures at near-atomic scale

Bone structure is generally hierarchically organized into organic (collagen, proteins, ...), inorganic (hydroxyapatite (HAP)) components. However, many fundamental mechanisms of the biomineralization processes such as HAP formation, the influence of trace elements, the mineral-collagen arrangement, etc., are not clearly understood. This is partly due to the analytical challenge of simultaneously characterizing the three-dimensional (3D) structure and chemical composition of biominerals in general at the nanometer scale, which can, in principle be achieved by atom probe tomography (APT). Yet, the hierarchical structures of bone represent a critical hurdle for APT analysis in terms of sample yield and analytical resolution, particularly for trace elements, and organic components from the collagen appear to systematically get lost from the analysis. Here, we applied in-situ metallic coating of APT specimens within the focused ion beam (FIB) used for preparing specimens, and demonstrate that the sample yield and chemical sensitivity are tremendously improved, allowing the analysis of individual collagen fibrils and trace elements such as Mg and Na. We explored a range of measurement parameters with and without coating, in terms of analytical resolution performance and determined the best practice parameters for analyzing bone samples in APT. To decipher the complex mass spectra of the bone specimens, reference spectra from pure HAP and collagen were acquired to unambiguously identify the signals, allowing us to analyze entire collagen fibrils and interfaces at the near-atomic scale. Our results open new possibilities for understanding the hierarchical structure and chemical heterogeneity of bone structures at the near-atomic level and demonstrate the potential of this new method to provide new, unexplored insights into biomineralization processes in the future. STATEMENT OF SIGNIFICANCE: Atom probe tomography (APT) is a relatively new technique for the analysis of bones, teeth or biominerals in general. APT can characterize the microstructure of materials in 3D down to the near-atomic level, combined with a high elemental sensitivity, down to parts per million. APT application to study biomineralization phenomena is plagued by low sample yield and poorer analytical performance compared to metals. Here we have overcome these limitations by in-situ metal coating of APT specimens. This can unlock future APT analysis to gain insights into fundamental biomineralization processes, e.g. collagen/hydroxyapatite interaction, influence of trace elements and a better understanding of bone diseases or bone biomineralization in general.

Design and performance analysis of low damage anti-skid crescent drills for bone drilling

BACKGROUND

With orthopedic surgery increasing year on year, the main challenges in bone drilling are thermal damage, mechanical damage, and drill skid. The need for new orthopedic drills that improve the quality of surgery is becoming more and more urgent.

METHODS

Here, we report the skidding mechanism of drills at a wide range of inclination angle and propose two crescent drills (CDTI and CDTII). The anti-skid performance and drilling damage of the crescent drills were analyzed for the first time. Inclined bone drilling experiments were carried out with crescent drills and twist drills and real-time drilling forces and temperatures were collected.

RESULTS

The crescent drills are significantly better than the twist drill in terms of anti-skid, reducing skidding forces, thrust forces and temperature. The highest temperature is generated close to the upper surface of the workpiece rather than at the hole exit. Finally, the longer crescent edge with a small and negative polar angle increases the rake angle of the cutting edge and reduces thrust forces but increases skidding force and temperature. This study can promote the development of high-quality orthopedic surgery and the development of new bone drilling tools.

CONCLUSION

The crescent drills did not skid and caused little drilling damage. In comparison, the CDTI performs better in reducing the skidding force, while the CDTII performs better in reducing the thrust force.

Excessive Heat Generation by Power-Driven Craniotomy Tools: A Possible Cause of Autologous Bone Flap Resorption Observed in an Ex Vivo Simulation

BACKGROUND

Bone flap resorption is an issue after autologous cranioplasty. Critical temperatures above 50°C generated by power-driven craniotomy tools may lead to thermal osteonecrosis, a possible factor in resorption. This ex vivo study examined whether the tools produced excessive heat resulting in bone flap resorption.

METHODS

Using swine scapulae maintained at body temperature, burr holes, straight and curved cuts, and wire-pass holes were made with power-driven craniotomy tools. Drilling was at the conventional feed rate (FR) plus irrigation (FR-I+), at a high FR plus irrigation (hFR-I+), and at high FR without irrigation (hFR-I-). The temperature in each trial was recorded by an infrared thermographic camera.

RESULTS

With FR-I+, the maximum temperature at the burr holes, the cuts, and the wire-pass holes was 69.0°C, 56.7°C, and 46.2°C, respectively. With hFR-I+, these temperatures were 53.1°C, 52.1°C, and 46.0°C, with hFR-I- they were 56.0°C, 66.5°C, and 50.0°C; hFR-I- burr hole- and cutting procedures resulted in the highest incidence of bone temperatures above 50°C followed by FR-I+, and hFR-I+. At the site of wire-pass holes, only hFR-I- drilling produced this temperature.

CONCLUSIONS

Except during prolonged procedures in thick bones, most drilling with irrigation did not reach the critical temperature. Drilling without irrigation risked generating the critical temperature. Knowing those characteristics may be a help to perform craniotomy with less thermal bone damage.

Assessment of Thermal Osteonecrosis during Bone Drilling Using a Three-Dimensional Finite Element Model

Bone drilling is a common procedure used to create pilot holes for inserting screws to secure implants for fracture fixation. However, this process can increase bone temperature and the excessive heat can lead to cell death and thermal osteonecrosis, potentially causing early fixation failure or complications. We applied a three-dimensional dynamic elastoplastic finite element model to evaluate the propagation and distribution of heat during bone drilling and assess the thermally affected zone (TAZ) that may lead to thermal necrosis. This model investigates the parameters influencing bone temperature during bone drilling, including drill diameter, rotational speed, feed force, and predrilled hole. The results indicate that our FE model is sufficiently accurate in predicting the temperature rise effect during bone drilling. The maximum temperature decreases exponentially with radial distance. When the feed forces are 40 and 60 N, the maximum temperature does not exceed 45 °C. However, with feed forces of 10 and 20 N, both the maximum temperatures exceed 45 °C within a radial distance of 0.2 mm, indicating a high-risk zone for potential thermal osteonecrosis. With the two-stage drilling procedure, where a 2.5 mm pilot hole is predrilled, the maximum temperature can be reduced by 14 °C. This suggests that higher feed force and rotational speed and/or using a two-stage drilling process could mitigate bone temperature elevation and reduce the risk of thermal osteonecrosis during bone drilling.

On the thermal impact during drilling operations in guided dental surgery: An experimental and numerical investigation

In recent years, a major development in dental implantology has been the introduction of patient-specific 3D-printed surgical guides. The utilization of dental guides offers advantages such as enhanced accuracy in locating the implant sites, greater simplicity, and reliability in performing bone drilling operations. However, it is important to note that the presence of such guides may contribute to a rise in cutting temperature, hence increasing the potential hazards of thermal injury to the patient's bone. The aim of this study is to examine the drilling temperature evolution in two distinct methods for 3D-printed surgical dental guides, one utilizing an internal metal bushing system and the other using external metal reducers. Cutting tests are done on synthetic polyurethane bone jaw models using a lab-scale automated Computer Numeric Control (CNC) machine to find out the temperature reached by different drilling techniques and compare them to traditional free cutting configurations. Thermal imaging and thermocouples, as well as the development of numerical simulations using finite element modeling, are used for the aim. The temperature of the tools' shanks experienced an average rise of 2.4 °C and 4.8 °C, but the tooltips exhibited an average increase of around 17 °C and 24 °C during traditional and guided dental surgery, respectively. This finding provides confirmation that both guided technologies have the capability to maintain temperatures below the critical limit for potential harm to bone and tissue. Numerical models were employed to validate and corroborate the findings, which exhibited identical outcomes when applied to genuine bone samples with distinct thermal characteristics.

A Novel Irrigation System to Reduce Heat Generation during Guided Implantology: An In Vitro Study

The purpose of this in vitro study is to evaluate the effectiveness of incorporating a new irrigation system into a surgical guide and monitor its effect on heat generation during implant bed preparation. A total of 48 surgically guided osteotomies were performed on 12 bovine ribs divided into 4 groups, using different irrigation techniques: Group A (test) had entry and exit channels incorporated into the guide; Group B had a similar design with an entry channel only; Group C had conventional external irrigation; and Group D (control) had no irrigation. Heat generation during the osteotomies was measured using thermocouples placed at a depth of 2 mm and 6 mm. The lowest mean temperature was observed in Group A (22.1 °C at 2 mm and 21.4 °C at 6 mm), which was statistically significant when compared with Groups C and D (p < 0.001). Group A showed a lower mean temperature compared with Group B as well; however, it was statistically significant only at 6 mm depth (p < 0.05). In conclusion, the proposed surgical guide has significantly reduced heat generation during implant osteotomy compared to conventional external irrigation. The integration of an exit cooling channel can resolve limitations found in previously designed surgical guides such as debris blockage and can be easily incorporated into computer designing and 3D printing software.

The impact of surgical guide design and bone quality on heat generation during pilot implant site preparation: an in vitro study

BACKGROUND

Surgical guides restrict the flow of cooling agent to osteotomy site, which will lead to a temperature rise that provokes tissue injury. Few studies compared differences in the temperature changes between non-limiting 'conventional' and limiting 'guided' surgical guides during implant site preparation. The objective of this study was to investigate the difference in temperature changes during bone drilling for implant placement using non-limiting and limiting surgical guides at cortical and cancellous bone levels.

METHODS

Forty-four bovine rib samples were used for implant bed preparation in this study with a minimum thickness of 11 mm was chosen for the ribs. The bone was stored in a freezer at 10 °C until it was used. On the day of the study, the bone was defrosted and soaked in water at 21 °C for three hours before embarking on drilling to make sure each sample was at the same temperature when tested. Forty-four bone specimens were prepared and randomly allocated to receive either a limiting or a non-limiting surgical guides (22 for each group). The osteotomy site was prepared by one operator following the manufacturer's instructions, using limiting and non-limiting surgical guides. Temperature changes were recorded during implant bed preparation using thermocouples that fit into 7 mm-horizontal channels at two different depths (Coronally) and (Apically) at 1 mm distance from the osteotomy site. The data were tested for homogeneity of variances using Levene's test, then data were analyzed using an Independent sample t-test and the significance level was set at P ≤ 0.05.

RESULTS

The mean temperature rise for all samples was 0.55 °C. The mean temperature rises for the limiting and non-limiting surgical guides were 0.80 °C and 0.33 °C respectively. There was a statistically significant difference in temperature rise between the limiting and non-limiting surgical guides (P = 0.008). In relation to position of temperature recording (coronal vs. apical), there was no significant difference (P > 0.05). No significant difference was noted between the two groups at cancellous bone level (P = 0.68), but the difference was significant at cortical bone level (P = 0.036).

CONCLUSION

Limiting surgical guides showed higher readings than non-limiting. However, for both techniques, temperature rise was not significant clinically and within a safe range.

Analysis of the influence of surgical robot drilling parameters on the temperature of skull drilling based on Box-Behnken design

It is easy to cause thermal damage to the bone tissue when the surgical robot performs skull drilling to remove bone flaps, due to the large diameter of the drill bit, the large heat-generating area, and the long drilling time. Therefore, in order to reduce the thermal damage during the robot-assisted skull drilling process, the relationship between the drilling parameters and the drilling temperature during the skull drilling was studied in this paper. Firstly, a dynamic numerical simulation model of the skull drilling process was established by ABAQUS, and a temperature simulation plan for skull drilling was designed based on the Box-Behnken method. Then according to the simulation results, a quadratic regression model of drill diameter, feed rate, drill speed, and drilling temperature was established by using the multiple regression method. By analyzing the regression model, the influence of drilling parameters on the drilling temperature was clarified. Finally, the bone drilling experiment was carried out, and the error percentage was lower than 10.5% through the experiment to verify the reliability of the conclusion, and a safety strategy was proposed to ensure the safety of the surgical drilling process based on this experiment.

Thermal changes during implant site preparation with a digital surgical guide and slot design drill: an ex vivo study using a bovine rib model

PURPOSE

In this study, we aimed to evaluate the degree of heat generation when a novel drill design with an irrigation slot was used with metal sleeve-free (MF) and metal sleeve-incorporated (MI) surgical guides in an environment similar to that of the actual oral cavity.

METHODS

A typodont with a missing mandibular right first molar and 21 bovine rib blocks were used. Three-dimensional-printed MF and MI surgical guides, designed for the placement of internal tapered implant fixtures, were used with slot and non-slot drills. The following groups were compared: group 1, MI surgical guide with slot drill; group 2, MI surgical guide with a non-slot drill; and group 3, MF surgical guide with a slot drill. A constant-temperature water bath at 36°C was used. The drilling was performed in 6 stages, and the initial, highest, and lowest temperatures of the cortical bone were measured at each stage using a non-contact infrared thermometer.

RESULTS

There were no temperature increases above the initial temperature in any drilling procedure. The only significant difference between the non-slot and slot groups was observed with the use of the first drill in the MI group, with a higher temperature in the non-slot group (P=0.012). When the heat generation during the first and the second drilling was compared in the non-slot group, the heat generation during the first drilling was significantly higher (P<0.001), and there was no significant difference in heat generation between the drills in the slot group.

CONCLUSIONS

Within the limitations of this study, implant-site preparation with the surgical guide showed no critical increase in the temperature of the cortical bone, regardless of whether there was a slot in the drill. In particular, the slotted drill had a cooling effect during the initial drilling.

Computational analysis of cutting parameters based on gradient Voronoi model of cancellous bone

Bone cutting is a complicated surgical operation. It is very important to establish a kind of gradient porous bone model in vitro which is close to human bone for the research of bone cutting. Due to the existing bone cutting researches are based on solid bone model, which is quite different from human bone tissue structure. Therefore, Voronoi method was used to establish a gradient porous bone model similar to real bone tissue to simulate the process of bone drilling in this paper. High temperature and large cutting force during bone drilling can cause serious damage to bone tissue. Urgent research on bone drilling parameters is necessary to reduce cutting temperature and cutting force. The finite element analysis (FEA) of Voronoi bone models with different gradients is carried out, and a Voronoi model which is similar to real bone tissue is obtained and verified by combining the cutting experiment of pig bone. Then orthogonal experiments are designed to optimize the cutting parameters of Voronoi bone model. The range method is used to analyze the influence weights of cutting speed, feed speed and tip angle on cutting temperature and cutting force, and the least square method was used to predict the cutting temperature and cutting force, respectively. The gradient porous bone model constructed by Voronoi method was studied in detail in this paper. This study can provide theoretical guidance for clinical bone drilling surgery, and the prediction model of bone drilling has practical significance.

Non-Destructive Removal of Dental Implant by Using the Cryogenic Method

Background and Objectives: The gold standard for a successful prosthetic approach is the osseointegration of an implant. However, this integration can be a problem in cases where the implant needs to be removed. Removing the implant with minimal damage to the surrounding tissues is important. Osteocytes cannot survive below −2 °C, but epithelial cells, fibroblasts, and other surrounding tissue cells can. Remodeling can be triggered by cryotherapy at temperatures that specifically affect osteocyte necrosis. In this study, we aimed to develop a method for reversing the osseointegration mechanism and for protecting the surrounding tissues by bone remodeling induced by CO2 cryotherapy. Materials and Methods: In this study, eight 2.8 mm diameter, one-piece mini implants were used in New Zealand rabbit tibias. Two control and six implants were tested in this study. After 2 months of osseointegration, a reverse torque force method was used to remove all osseointegrated implants at 5, 10, 20, and 30 Ncm. The osseointegration of the implants was proven by periotest measurements. Changes in bone tissue were examined in histological sections stained with toluidine blue after rabbit sacrifice. The number of lacunae with osteocyte, empty lacunae, and lacunae greater than 5 µm and the osteon number in a 10,000 µm2 area were calculated. Cryotherapy was applied to the test implants for 1 min, 2 min, and 5 min. Three implants were subjected to cryotherapy at −40 °C, and the other implants were subjected to cryotherapy at −80 °C. Results: Empty lacunae, filled osteocytes, lacunae >5 µm, and the osteon count around the implant applied at −40 °C were not significantly different from the control implants. The application of −40 °C for 1 min was found to cause minimal damage to the bone cells. The implants, which were applied for 1 min and 2 min, were successfully explanted on the 2nd day with the 5 Ncm reverse torque method. Test implants, which were applied cold for 5 min, were explanted on day 1. Tissue damage was detected in all test groups at −80 °C. Conclusions: The method of removing implants with cryotherapy was found to be successful in −40 °C freeze−thaw cycles applied three times for 1 min. To prove implant removal with cryotherapy, more implant trials should be conducted.

Comparison of k-wire insertion using oscillatory and unidirectional drilling modes under constant thrust force

Heat generation during the Kirschner wire (K-wire) insertion process, under either unidirectional or oscillatory drilling mode, places bone at risk of thermal osteonecrosis which can lead to infection. There is a lack of quantitative understanding of the heat generation difference between the two drilling modes and knowledge of optimal thrust force level under each mode is missing. The goal of this study is to investigate the effects of drilling modes and thrust force levels on the bone drilling outcomes. Controlled machine-based constant thrust force K-wire insertion experiments were conducted with key process parameters monitored and compared quantitatively. Statistical analysis showed that the oscillatory mode consumed 2.6 times more electricity than the unidirectional mode but generated 53% less thermal energy and 23% lower peak temperature. However, the oscillation also led to 18% higher peak torque in the transient drilling stage and 23% shallower drilling depth. The optimal choice of the drilling mode depends on specific surgical needs to minimize bone damage (control of peak temperature vs. exposure time and torque control). Heat generation was dominated by the torque and corresponding rotational power under both modes. To minimize the bone temperature while keeping high drilling speed efficiency, a moderate thrust force is preferred under the unidirectional mode to balance between feed force and compressed debris resistance. For oscillatory mode, a small thrust force to keep the K-wire engaged with the bone is optimal.

Thermal Management of Bone Drilling Based on Rotating Heat Pipe

Bone drilling is a common surgical operation, which often causes an increase in bone temperature. A temperature above 47 °C for 60 s is the critical temperature that can be allowed in bone drilling because of thermal bone osteonecrosis. Therefore, thermal management in bone drilling by a rotating heat pipe was proposed in this study. A new rotating heat pipe drill was designed, and its heat transfer mechanism and thermal management performance was investigated at occasions with different input heat flux and rotational speed. Results show that boiling and convection heat transfer occurred in the evaporator and film condensation appears in the condenser. The thermal resistance decreases with the increase of the rotational speed at the range from 1200 to 2000 rpm and it decreases as the input heat flux rises from 5000 to 10,000 W/m2 and increases at 20,000 W/m2. The temperature on the drill tip was found to be 46.9 °C with an input heat flux of 8000 W/m2 and a rotational speed of 2000 rpm. The new designed rotating heat pipe drill showed a good prospect for application to bone drilling operations.

Thermal changes during drilling in human femur by rotary ultrasonic bone drilling machine: A histologic and ultrastructural study

Undue heat production in surgical bone drilling leads to osteonecrosis and can be an important cause of failure of osteosynthesis, impaired healing, and loosening of implants following orthopedic surgery. The present work aims to minimize heat production below the critical temperature for thermal osteonecrosis (i.e., 47°C) and obviate thermal bone damage due to drilling. A total of 20 samples from the shaft of the human femur were obtained at autopsies and drilling was performed at room temperature by an operation theater (OT) compatible rotary ultrasonic bone drilling (RUBD) machine. K-type thermocouples were used to measure the temperature rise during drilling and the physical changes of the bone samples were observed by infrared gama camera. Light microscopic and transmission electron microscopic studies were performed to evaluate the bone cell damage. The maximum temperature recorded in RUBD (40.6 ± 1.3°C) was much below the critical temperature for thermal osteonecrosis (p < .05) at the rotational speed of 2000 rpm. Light microscopic and ultrastructural studies also revealed that there was no appreciable damage to the bone cells. Conventional bone drilling (CD) on the other hand recorded much higher temperature (66.6 ± 3.2°C), tissue burn and bone cell necrosis. Hence, RUBD machine has a potentiality for its use in orthopedic surgery and may provide better results.

3D printed implant surgical guides with internally routed irrigation for temperature reduction during osteotomy preparation: A pilot study

OBJECTIVE

The purpose of this study was to test a novel through-the-guide means of irrigation in an in-vitro bovine bone model and to explore the method clinical applicability.

MATERIALS AND METHODS

Surgical guides were designed to fit over five fresh bovine samples. Control osteotomy sites were compared to experimental sites irrigated through a 3D printed surgical guide with customized channels that direct the coolant toward the interface of the alveolar crest and drill. Temperature was measured during surgery with thermocouples located at 3 and 6 mm from the crestal height of the bone, and with an infrared thermal camera taking direct temperature readings from a window cut into axial wall at 9 mm from the crestal height of the ridge.

RESULTS

Incorporation of routed irrigation significantly decreased heat generation, keeping temperature consistently below 47°C. A clinical case illustrates the method applicability using standard implant planning software, 3D printing technology, and regular implant armamentarium.

CONCLUSIONS

The in-vitro analysis shows that this method mitigates temperature increase caused by static surgical guide irrigation blockade at the osteotomy site. This technique can be incorporated in the surgical guide design using commercially available software and 3D printing technology and has immediate applications in practice.

CLINICAL SIGNIFICANCE

The in-vitro analysis shows that this method can significantly mitigate the temperature increase caused by static surgical guide irrigation blockade at the osteotomy site. This technique also has the advantage that it can be incorporated in the digital surgical guide design using commercially available software and 3D printing technology. The method has immediate applications in practice, and especially in the treatment of edentulism in esthetic zone where use of guided surgery for implant placement is crucial in obtaining consistent results.

Effect of different dental implant drilling template designs on heat generation during osteotomy - an in vitro study

OBJECTIVES

This in vitro study examined the effect of different implant drilling template designs on heat generation during osteotomy and on cooling fluid distribution.

MATERIAL AND METHODS

Five different template designs were investigated in a standardized setup against a control group and a negative control group: Occlusal-splint-design (OSD), OSD-covering, OSD-lateral opening, Bar design, and Orientation template. Pilot and one consecutive drill were run at 800 rpm with external irrigation and 2-kg load. Thermocouples recorded temperature changes at depths of 3, 6, and 9 mm in a bovine rib model. In the second experimental setup, the drill channel of one rib sample was perforated, and the irrigation volume passing through the drill channel was collected separately over time.

RESULTS

Following mean temperature rises occurred [in °C]: control, 4.9; negative control, 12; OSD, 5.6; OSD-covering, 4.7; OSD-lateral opening, 3.8; Bar design, 5.1; and Orientation template, 4.9. The highest temperature increases were found at a drilling depth of 6 mm (p < .006). The 2.2-mm drill resulted in a significantly higher temperature rise than the 2.8-mm drill (p < .001). The mean volume (ml/min) of irrigation through the drill channel was Control group-flow, 28.5; OSD, 4.1; OSD-covering, 2; OSD-lateral opening; 5.8; bar design, 4; and Orientation template, 24.1.

CONCLUSION

Within the limitations, it was shown that fully guided drilling templates reduce the amount of cooling liquid at the point of osteotomy. The template design had an influence on the effective volume of the cooling liquid. However, this did not seem to increase the intraosseous temperature significantly.

Heat and Sound Generation During Implant Osteotomy When Using Different Types of Drills in Artificial and Bovine Bone Blocks

The purpose of this study was to compare heat and sound generated during implant osteotomy when different types of drill were used in artificial bone and bovine bone blocks. A total of 80 implant osteotomies were formed using 4 implant drilling systems; N1 (OsseoShaper) (Nobel), NobelActive (Nobel), V3 (MIS) and BLX (Straumann) in both artificial bone and bovine bone blocks. Thermocouple probes were used to record temperature change at the depths of 5.0 mm and 13.0 mm of each implant osteotomy formed by the final drill. In addition, thermographic images, drilling sound, and drilling time were recorded and evaluated. Statistical analyses were performed at α = 0.05. The mean temperature changes as recorded by thermocouple probes and thermocamera were significantly lower in OsseoShaper than most other drill-bone combinations (p < .05). The mean drilling times and sound generation for OsseoShaper were significantly higher and lower than most other drill-bone combinations (p < .05), respectively. Minimal heat and sound generation can be expected when implant osteotomies are performed using Osseoshaper at a low rotational speed (50 rpm) even without irrigation. However, extended drilling time is required.

Heat impact during laser ablation extraction of mineralised tissue micropillars

The underlying constraint of ultrashort pulsed laser ablation in both the clinical and micromachining setting is the uncertainty regarding the impact on the composition of material surrounding the ablated region. A heat model representing the laser-tissue interaction was implemented into a finite element suite to assess the cumulative temperature response of bone during ultrashort pulsed laser ablation. As an example, we focus on the extraction of mineralised collagen fibre micropillars. Laser induced heating can cause denaturation of the collagen, resulting in ultrastructural loss which could affect mechanical testing results. Laser parameters were taken from a used micropillar extraction protocol. The laser scanning pattern consisted of 4085 pulses, with a final radial pass being 22 [Formula: see text] away from the micropillar. The micropillar temperature was elevated to 70.58 [Formula: see text], remaining 79.42 [Formula: see text] lower than that of which we interpret as an onset for denaturation. We verified the results by means of Raman microscopy and Energy Dispersive X-ray Microanalysis and found the laser-material interaction had no effect on the collagen molecules or mineral nanocrystals that constitute the micropillars. We, thus, show that ultrashort pulsed laser ablation is a safe and viable tool to fabricate bone specimens for mechanical testing at the micro- and nanoscale and we provide a computational model to efficiently assess this.

Effect of Guiding Sleeve Design on Intraosseous Heat Generation During Implant Site Preparation (In Vitro Study)

PURPOSE

To compare the effect of different designs of guiding sleeves on heat generation during implant surgery while using different cooling fluid temperatures.

MATERIAL AND METHODS

Temperature measurements were performed during guided implant site preparation in bovine rib samples using two K- type thermocouples at 2 mm and 8 mm depths. Three groups were tested according to guiding sleeve design: conventional cylindrical sleeve, open C-shaped sleeve, and modified cylindrical sleeve. Each group was irrigated with three fluid temperatures: 10°C, 15°C, and 20°C. The groups were compared using Kruskal Wallis test followed by post hoc comparisons with Bonferroni correction. The level of statistical significance was set at p = 0.05.

RESULTS

Surgical guides with conventional cylindrical sleeve design showed significantly higher heat generation during implant site preparation than guides with both the open C-shaped and the modified cylindrical sleeve designs at both 2mm and 8mm depths. The difference between C-shaped and modified cylindrical sleeves was not significant in any group. Using pre-cooled irrigation fluids (10°C and 15°C) reduced the generated heat; however, the differences within the same group were not statistically significant.

CONCLUSIONS

The use of a surgical guide with the conventional cylindrical sleeves led to higher heat generation than other sleeve designs, which might reach or near the critical threshold of bone thermal necrosis. Using surgical guides with open sleeves or modified cylindrical sleeves could be helpful in irrigation fluid delivery and decreasing the generated heat.

Finite element simulation and integration of CEM43 °C and Arrhenius Models for ultrasonic-assisted skull bone grinding: A thermal dose model

The aim of the study was to develop a novel automated setup for bone grinding to limit the temperature to below 43 °C. The feasibility of using ultrasonic actuation during bone osteotomy was explored with different machining variables, such as rotational speed, feed rate and ultrasonic frequency, in terms of the criterion variable (i.e., temperature). A thermal dose model based on the CEM43 °C and the Arrhenius model was developed for the prediction of tissue damage during bone grinding. CEM43 °C is a normalizing method to convert the time-temperature relationship into an equivalent number of minutes at 43 °C. For every degree rise in temperature above 43 °C, the cell viability significantly increased. The temperature generated during bone grinding was measured with an infrared thermography technique. The increase in temperature above threshold levels of 43 °C and 47 °C may harm the bone tissues and cause thermogenesis and osteonecrosis, respectively. A finite-element simulation was conducted to visualise the spatial and temporal distribution of temperature on the bone surface after bone grinding. Furthermore, simulation results were used to measure the depth of thermogenesis and osteonecrosis at the grinding site. Evaluation of the optimised set of bone grinding process parameters was supported with analysis of variance at the 95% confidence level.

Thermal exposure of implant osteotomies and its impact on osseointegration-A preclinical in vivo study

OBJECTIVES

Thermal and mechanical stresses during osteotomy preparation can impair implant osseointegration. This study investigated implant osseointegration following the measurement of temperature exposure during osteotomy drilling, varying drill design, sequence, and drill wear.

MATERIALS AND METHODS

36 tapered implants were placed in a mandibular minipig model after guided drilling of implant osteotomies using 4 different groups: (1) control drills with a conservative, sequential drilling sequence, (2) control drills using a shortened drill sequence (PF), (3) novel test drill displaying an optimized drill design and surface treatment, PF, and (4) aged test drill, PF. Intraosseous temperatures during drilling were measured using a temperature probe. BIC, fBIC, and tissue reactions were histomorphometrically derived after 2 and 8 weeks of healing.

RESULTS

Compared to control drills (1) or (2), test drills (3) resulted in significantly lower maximum temperatures ((35.4 (CI 30.2-40.5)°C vs. (46.5 (CI 41.0-52.0)°C, p = .0021)) and shorter drill times ((4.5 (CI 1.6-7.3)sec vs. 10.3 (7.3-13.4)sec). Lower osteotomy temperature values and shorter drill times corroborated with significantly higher BIC after 2 and 8 weeks healing for the test (3) compared to control groups (2) (2 weeks: (44.9 (CI 34.1-55. 7)% vs. (31.3 (CI 20.5-42.2)%, p = <.0001 and 8 weeks: (73.7 ( CI 64.2-83.2)% vs. (66.2 (CI 57.0-75.4)%, p = <.0455).

CONCLUSION

The improved osseointegration of implants placed after osteotomy preparation with novel test drills using a shortened drill sequence compared to standard drills and conventional drill protocols might be attributed to more favorable thermal profiles and less mechanical stress exerted on the bone surrounding the implant osteotomy.

Bone Temperature Variation Using a 3D-Printed Surgical Guide with Internal Irrigation

Bone overheating is a possible cause of implants early failure. When a surgical guide is used, the risk of heat injury is greater due to the reduced efficacy of the irrigation. The aim of this ex vivo study was to evaluate the effect of an additional built-in irrigation on bone temperature variation during implant osteotomy. Twelve bovine ribs were used. Cone beam computerized tomography (CBCT) was performed and a 3D-printed surgical guide with additional built-in irrigation tubes was produced for each rib. A total of 48 osteotomies were prepared, to compare the supplementary internal irrigation system (Group A) with external irrigation alone (Group B), no irrigation (Group C) and with free-hand surgery with external irrigation (Group D). Temperature was measured by three thermocouples placed at depths of 1.5, 7, and 12 mm. The largest temperature variation at each thermocouple showed median values of 3.0 °C, 1.9 °C, and 2.3 °C in Group 1; 2.3 °C, 1.7 °C, and 0.9 °C in Group 2; 3.2 °C, 1.6 °C, and 2.0 °C in Group 3; 2.0 °C, 2.0 °C, and 1.3 °C in Group 4, respectively. No differences were found among the four groups. In general, the highest temperature increase was observed with the use of the first drill (cortical perforator). Post-experimental CBCT revealed the presence of radiopaque material clogging the aperture of the internal irrigation channels. Additional internal irrigation was not found to significantly contribute to decrease bone temperature in this ex vivo setting.

Analysis of factors determining thermal changes at osteotomy site in dental implant placement - An in-vitro study

Background

Heat generation during osteotomy site preparation is a crucial factor that determines the success of dental implant placement. Among the factors that affect the heat generation, drilling speed, hand pressure and coolant temperature are independent variables. However, a relation between these three parameters and their optimal values required for the maximum outcome has not been studied so far. This study aims at finding out a relation between these factors in order to derive the optimum balance required, using an in vitro study.

Material and Methods

This in vitro experiment was performed on bovine femur. A total of 72 drillings were undertaken with the aid of a physiodispenser mounted on the test apparatus. Drill diameters of 2 mm and 2.8 mm, rotated at 1500, 2000 and 2500 rpm were included for the analysis. Hand pressures included for the comparison were 1.2 kgf and 2.4 kgf. Normal saline at room temperature, and that chilled to 00C were used for external irrigation. The temperature generated during drilling was recorded by infrared thermography using a Forward-Looking Infrared (FLIR) camera.

Results

The highest temperature during osteotomy was observed at 2000 rpm rotational speed, 1.2 kgf operator hand pressure and saline irrigant solution at room temperature. In contrast, the lowest temperature generated was using 2500 rpm rotational speed, 2.4 kgf operator hand pressure and chilled irrigant solution.

Conclusions

The results indicate that none of the three experimented parameters generated heat above the critical temperature for bone necrosis (47°C). Thus, a high drilling speed with high hand pressure and continuous irrigation with copious amounts of cooled saline may be the ideal combination for implant osteotomy site preparation.

Key words:Heat generation, dental implant drills, drilling speed, drilling pressure, irrigation, infrared thermography, thermal necrosis, osteotomy preparation.

Thermal effects of various drill materials during implant site preparation-Ceramic vs. stainless steel drills: A comparative in vitro study in a standardised bovine bone model

OBJECTIVES

The aim of this study was to evaluate thermal effects of ceramic and metal implant drills during implant site preparation using a standardised bovine model.

MATERIAL AND METHODS

A total of 320 automated intermittent osteotomies of 10- and 16-mm drilling depths were performed using zirconium dioxide-based and stainless steel drills. Various drill diameters (2.0/ 2.2, 2.8, 3.5, 4.2 mm ∅) and different cooling methods (without/ with external saline irrigation) were investigated at room temperature (21 ± 1°C). Temperature changes were recorded in real time using two custom-built multichannel thermoprobes in 1- and 2-mm distance to the osteotomy site. For comparisons, a linear mixed model was estimated.

RESULTS

Comparing thermal effects, significantly lower temperatures could be detected with steel-based drills in various drill diameters, regardless of drilling depth or irrigation method. Recorded temperatures for metal drills of all diameters and drilling depths using external irrigation were below the defined critical temperature threshold of 47°C, whereas ceramic drills of smaller diameters reached or exceeded the harmful temperature threshold at 16-mm drilling depths, regardless of whether irrigation was applied or not. The results of this study suggest that the highest temperature changes were not found at the deepest point of the osteotomy site but were observed at subcortical and deeper layers of bone, depending on drill material, drill diameter, drilling depth and irrigation method.

CONCLUSIONS

This standardised investigation revealed drill material and geometry to have a substantial impact on heat generation, as well as external irrigation, drilling depth and drill diameter.

Does vacuum mixing affect diameter shrinkage of a PMMA cement mantle during in vitro cemented acetabulum implantation?

Radiolucent lines on immediate postoperative cemented acetabular component radiographs between the PMMA bone cement mantle and bone are an indicator of an increased risk of early loosening. The cause of these lines has yet to be identified. Thermal and chemical necrosis, fluid interposition and cement shrinkage have all been suggested in the literature. The aim of the study reported here was to take an engineering approach - eliminating confounding variables present during surgery - to quantify the size of the interstice created by cement shrinkage when a 50 mm diameter flanged acetabular cup is implanted in a model acetabulum with a 52 mm hemispherical bore under controlled conditions using vacuum and non-vacuum mixed cement. Irrespective of the mixing method used, a significant interstice was created between the bone cement and the mock acetabulum. When the cement was mixed under vacuum the interstice created between the mock acetabulum and the cement mantle was 0.60 mm ± 0.09 mm; when the cement was mixed under non-vacuum conditions the interstice created was 0.39 mm ± 0.15 mm. Possible explanations for radiolucent lines are discussed.

Bone Healing Evaluation Following Different Osteotomic Techniques in Animal Models: A Suitable Method for Clinical Insights

Osteotomy is a common step in oncological, reconstructive, and trauma surgery. Drilling and elevated temperature during osteotomy produce thermal osteonecrosis. Heat and associated mechanical damage during osteotomy can impair bone healing, with consequent failure of fracture fixation or dental implants. Several ex vivo studies on animal bone were recently focused on heating production during osteotomy with conventional drill and piezoelectric devices, particularly in endosseous dental implant sites. The current literature on bone drilling and osteotomic surface analysis is here reviewed and the dynamics of bone healing after osteotomy with traditional and piezoelectric devices are discussed. Moreover, the methodologies involved in the experimental osteotomy and clinical studies are compared, focusing on ex vivo and in vivo findings.

Piezoelectric Implant Site Preparation: Influence of Handpiece Movements on Temperature Elevation

Piezoelectric devices are widely used in oral surgical procedures, including implant site preparation. However, little is known about the influence of working movement on temperature elevation in bone. The aim of this study was to assess the effects of two different working cycles on temperature elevation during piezoelectric implant site preparation. Sixty osteotomies at a depth of 10 mm were performed on bone blocks of bovine ribs using a piezoelectric tip with external irrigation (IM1s, Mectron Medical Technology, Carasco, Italy). A mechanical positioning device was used to guarantee reproducible working and measuring conditions. Two different working cycles, of 4 and 6 s, respectively, were tested, including both longitudinal and rotational movements. Temperature was recorded in real time with a fiber optic thermometer and applied pressure was maintained under 150 g. For each test, the highest recorded temperature (T_max) and the mean temperature recorded from 30 s before to 30 s after the highest recorded temperature (T_±30) were extrapolated. Tests duration was also recorded. Both T_max and T_±30 were significantly higher in the '6 s cycles' group than the '4 s cycles' group (42.44 ± 7.3 °C vs. 37.24 ± 4.6 °C, p = 0.002; 37.24 ± 4.6 °C vs. 33.30 ± 3.3 °C, p = 0.003). Test duration was also significantly higher using 6 s cycles compared to 4 s cycles (143.17 ± 29.4 s vs. 119.80 ± 36.4 s, p = 0.002). The results of this study indicate that working cycles of 4 s effectively reduce heat generation and working time during piezoelectric implant site preparation.

Surgical Drill Bit Design and Thermomechanical Damage in Bone Drilling: A Review

As drilling generates substantial bone thermomechanical damage due to inappropriate cutting tool selection, researchers have proposed various approaches to mitigate this problem. Among these, improving the drill bit design is one of the most feasible and economical solutions. The theory and applications in drill design have been progressing, and research has been published in various fields. However, pieces of information on drill design are dispersed, and no comprehensive review paper focusing on this topic. Systemizing this information is crucial and, therefore, the impetus of this review. Here, we review not only the state-of-the-art in drill bit designs-advances in surgical drill bit design-but also the influences of each drill bit geometries on bone damage. Also, this work provides future directions for this topic and guidelines for designing an improved surgical drill bit. The information in this paper would be useful as a one-stop document for clinicians, engineers, and researchers who require information related to the tool design in bone drilling surgery.

Analysis of machining process and thermal conditions during vibration-assisted cortical bone drilling based on generated bone chip morphologies

When the temperature during bone drilling exceeds the safety threshold, the bone tissue surrounding the drilling site can be irreversibly damaged. To investigate the influence of vibration-assisted drilling (VAD) methods on the temperature increase during bone drilling and the causes for temperature increase, drilling experiments were performed on fresh bovine femur samples. The morphology and granularity distribution of the generated bone chips were innovatively used to directly compare the machining processes and thermal conditions of conventional drilling (CD), low-frequency vibration-assisted drilling (LFVAD), and ultrasonic vibration-assisted drilling (UVAD). The experimental results indicated that LFVAD produced the lowest temperature increase of 31.4°C, whereas UVAD produced the highest temperature increase of 44.1°C with the same drilling parameters. Additionally, the morphologies and granularity distributions of the bone chips significantly differed among these methods. We concluded that the smaller temperature increase in LFVAD was mainly attributed to the improved thermal conditions resulting from the periodic cutting/separation motion and the reliable geometric chip-breaking mechanism. In contrast, the unfavourable thermal conditions of UVAD were caused by the higher applied frequency, which created a significantly larger amount of friction heat. This was the main cause for the highest observed temperature increase, resulting in bone crushing processes that generated additional heat.

Assessment of heat generation and risk of thermal necrosis during bone burring by means of three-dimensional dynamic elastoplastic finite element modelling

During bone burring, the heat generated due to friction at the bone-burr interface may cause thermal damage to the bone. Therefore, it is necessary to assess bone temperature distribution around a burring site and identify high-risk regions for thermal necrosis due to bone burring. In this study, a three-dimensional (3-D) dynamic elastoplastic finite element model for the burring process was developed and experimentally validated to investigate the influence of burring parameters (rotational speeds: 3,000, 10,000, 15,000 and 60,000 rpm; feed rates: 0.5, 0.9, 1.5 and 3.0 mm/s) on heat generation and evaluate the risk region for thermal necrosis. Calculated bone temperatures were compared with experimental values and found to be in good agreement with them. The analytical results demonstrated a linear relationship between the burring time and friction energy. In addition, the friction energy increased with the bone temperature. The high-risk thermal necrosis zone was measured from the edge of burring (y-direction) at feed rates of 0.5, 0.9, 1.5 and 3.0 mm/s and was found to be 7.8, 7.3, 6.6 and 5.5 mm, respectively. When the burr rotational speed increased from 3,000 to 60,000 rpm, the high-risk zone for thermal necrosis increased from 4.5 to 8.1 mm. We concluded that both the friction energy and the bone temperature increased in proportion with the burr rotational speed. Reducing burr rotational speeds and/or increasing feed rates may decrease the rise in bone temperature, thus decreasing the potential for thermal necrosis near the burring site. Our model can be used to select the optimal surgery parameters to minimise the risk of thermal necrosis due to bone burring and to assist in the design of optimal orthopaedic drill handpieces.

An in-vitro study of temperature rise during rotary ultrasonic bone drilling of human bone

Temperature rise in surgical bone drilling is an important factor that leads to death of the bone cells, known as Osteonecrosis, and results into poor osteosynthesis i.e. implant failure. The present work aims to study the temperature rise during bone drilling by a recently developed operation theatre (OT) compatible machine. The temperature during the drilling process was recorded from K-type thermocouple devices, which were embedded in the human tibial bone at four different positions (at 0.5 mm, 1.0 mm, 1.5 mm, and 2.0 mm) from the drilling site. Comparative study revealed that rotary ultrasonic bone drilling (RUBD) technique produced lesser temperature (40 - 50%) than conventional drilling on human tibia. Statistical model was developed to predict the temperature rise in RUBD process using response surface methodology (RSM), and the optimum parameters were determined using Genetic Algorithm. Analysis of variance (ANOVA) was carried out at a confidence interval of 95 percent (α = 0.05) to determine the influence of various drilling parameters such as rotational speed, feed rate, drill diameter and abrasive particle size on temperature rise. It was observed that the rotational speed was responsible for the maximum temperature rise (51.8%) followed by drill diameter (18.8%), and abrasive particle size (14.3%); whereas, the feed rate contributed minimal (4%) temperature rise.

In vitro comparison of conventional surgical and rotary ultrasonic bone drilling techniques

In orthopedic and trauma surgical operations, drilling of bone is one of the commonly used procedures performed in hospitals and is a clinical practice for fixing the fractured parts of human bones. Force, torque and temperature play a significant role during the bone drilling and decide the stability of the medical implants. Therefore, it is necessary to minimize force, torque and temperature while drilling to avoid the thermal necrosis and osteosynthesis. This study focused on studying the influence of various types of bone drilling parameters (rotational speed, feed rate, drill diameter and ultrasonic amplitude), tools (solid tool, hollow tool and conventional twist drill bit) and techniques (conventional surgical drilling, rotary ultrasonic bone drilling and rotary bone drilling) on force, torque, temperature and microcracks produced in the drilled surface of the bone. The experimental investigations were conducted on porcine bone samples to perform the comparative study. Results revealed that increasing the diameter of drill tool and feed rate results in the increase in force, torque and temperature, while low rotational speed (500 r/min) generated a low temperature, high cutting force and torque for all types of drilling processes and tools evaluated in this study. Experimental results also revealed that rotary ultrasonic bone drilling with hollow tool generated the lowest cutting force, torque, temperature (<47 °C) and microcracks in the drilled surface of the bone as compared to the other four types of drilling techniques evaluated in this study. Influence of external irrigation technique on temperature was also studied with respect to the rotary ultrasonic bone drilling with a hollow tool, which could eliminate the problem of thermal necrosis. In conclusion, this study revealed that the rotary ultrasonic bone drilling process with hollow tool produced lesser cutting force as compared to rotary bone drilling and conventional surgical drilling for hollow and solid tools. The study also revealed that rotary ultrasonic bone drilling process has the potential to minimize the cutting force, torque and temperature as compared to the conventional surgical drilling for orthopedic surgery.

A Thermal and Biological Analysis of Bone Drilling

With the introduction of high-speed cutting tools, clinicians have recognized the potential for thermal damage to the material being cut. Here, we developed a mathematical model of heat transfer caused by drilling bones of different densities and validated it with respect to experimentally measured temperatures in bone. We then coupled these computational results with a biological assessment of cell death following osteotomy site preparation. Parameters under clinical control, e.g., drill diameter, rotational speed, and irrigation, along with patient-specific variables such as bone density were evaluated in order to understand their contributions to thermal damage. Predictions from our models provide insights into temperatures and thresholds that cause osteocyte death and that can ultimately compromise stability of an implant.

The influence of the chosen in vitro bone simulation model on intraosseous temperatures and drilling times

There is no consensus about the most suitable in vitro simulating material investigating heat generation during bone preparation. The aim was to compare heat increases and drilling times of bone removals in different bone simulating materials and to compare them to fresh human cadaver bone. A cavity was drilled in the following samples: (1) bovine rib; (2) pig rib; (3) 20 PCF (lb/ft³) polyurethane (PU) block with 3 mm (50 PCF) cortical layer; (4) 20PCF PU without cortical; (5) 30 PCF PU with 2 mm (40 PCF) cortical; (6) 30 PCF PU with 1 mm (40 PCF) cortical; (7) 30PCF PU without cortical; (8) poly-methyl-methacrylate (PMMA); (9) fresh human cadaver rib. Data were analyzed with ANOVA followed by Tukey’s post hoc tests. P < 0.05 was considered significant. Highest heat increases and slowest drilling times were found in bovine ribs (p < 0.001). Regarding temperatures, human ribs were comparable to the pig rib and to PUs having cortical layers. Considering drilling times, the human rib was only comparable to the 20 PCF PU with 3 mm cortical and to 30 PCF PU without cortical. By the tested in vitro bone removals, only the 20 PCF PU with 3 mm cortical was able to simulate human ribs, considering both temperature increases and drilling times.

Intraosseous Temperature Change during Installation of Dental Implants with Two Different Surfaces and Different Drilling Protocols: An In Vivo Study in Sheep

Background: The intraosseous temperature during implant installation has never been evaluated in an in vivo controlled setup. The aims were to investigate the influence of a drilling protocol and implant surface on the intraosseous temperature during implant installation, to evaluate the influence of temperature increase on osseointegration and to calculate the heat distribution in cortical bone. Methods: Forty Brånemark implants were installed into the metatarsal bone of Finnish Dorset crossbred sheep according to two different drilling protocols (undersized/non-undersized) and two surfaces (moderately rough/turned). The intraosseous temperature was recorded, and Finite Element Model (FEM) was generated to understand the thermal behavior. Non-decalcified histology was carried out after five weeks of healing. The following osseointegration parameters were calculated: Bone-to-implant contact (BIC), Bone Area Fraction Occupancy (BAFO), and Bone Area Fraction Occupancy up to 1.5 mm (BA1.5). A multiple regression model was used to identify the influencing variables on the histomorphometric parameters. Results: The temperature was affected by the drilling protocol, while no influence was demonstrated by the implant surface. BIC was positively influenced by the undersized drilling protocol and rough surface, BAFO was negatively influenced by the temperature rise, and BA1.5 was negatively influenced by the undersized drilling protocol. FEM showed that the temperature at the implant interface might exceed the limit for bone necrosis. Conclusion: The intraosseous temperature is greatly increased by an undersized drilling protocol but not from the implant surface. The temperature increase negatively affects the bone healing in the proximity of the implant. The undersized drilling protocol for Brånemark implant systems increases the amount of bone at the interface, but it negatively impacts the bone far from the implant.

Infrared thermography of high-speed grinding of bone in skull base neurosurgery

For skull base tumor removal neurosurgery, skull bone grinding is required. During this process, temperature rise occurs, which may result in an irrecoverable thermal damage. In the present research, temperature variations during bone grinding have been studied. Experimental tests have been conducted in 27 states in terms of the parameters of rotational speed (three states), feed rate (three states), and cutting depth (three states) on bovine femur bone samples. Attempts have been made to determine optimal processing conditions for minimizing thermal damage during the surgery through infrared thermography and measuring thermal variations of the bone. The results indicated that the temperature rise of the bone has a direct relationship with the parameters of rotational speed, feed rate, and cutting depth. In other words, with elevation of each of these parameters, temperature rise was also intensified. Out of the cutting parameters, rotational speed had the maximum impact on temperature rise, followed by cutting depth and feed rate. Therefore, to reduce the extent of thermal damage incurred to the neural tissue, the minimum values for the cutting parameters are proposed as follows: rotational speed = 45000 r min−1, feed rate = 20–30 mm min−1 with depth of cut = 0.25 mm, and feed rate = 20 mm min−1 with cutting depth = 0.50 mm.

Intraosseous Heat Generation During Osteotomy Performed Freehand and Through Template With an Integrated Metal Guide Sleeve: An In Vitro Study

OBJECTIVE

To investigate drill wear and consequent intraosseous temperature elevation during freehand and guided bone drilling, with attention to the effect of metal-on-metal contact during guided drilling.

MATERIALS AND METHODS

Osteotomies were performed on bovine ribs, with 2.0 mm diameter stainless steel drill bits of the SMART Guide System, under 3 sterilization protocols, at 800, 1200, 1500, and 2000 rpm. Sterilization was performed after every 3 drilling. Temperature was measured after every 30 drilling.

RESULTS

The studied contributing factors had a cumulative effect, and each contributed significantly to temperature elevation. Whether guide use led to a near-necrotic (47°C) temperature increment depended largely on the applied sterilization protocol.

CONCLUSION

The metal sleeve is a significant contributing factor to heat generation during guided osteotomy, but its effect can be offset by keeping the other studied factors under control.

Analytical and experimental study of effective parameters on process temperature during cortical bone drilling

Bone drilling process is a prominent step of internal fixation in orthopedic surgeries. Process forces, leading to chip production, produce heat in the vicinity of the drilled bore and increase the probability of necrosis phenomenon. In this article, an analytical model to predict process temperature is presented based on Sui and Sugita model. This heat transfer model is the combination of a heat equilibrium equation for tool-chip system and a heat distribution equation for the bone itself where heat generation in tool's tip is due to cutting frictional forces. In an analytical model, it is possible to use material properties of the bone and geometry of the tool; therefore, the calibration test is not necessary. In order to validate analytical model, experiments were done using bovine bone. Using response surface method, a second-order linear regression mathematical model is derived using experimental results. The effect of each individual parameter as well as their interactions on the output of the process was investigated. Within the range of the parameters studied in this article, with an increase in rotational speed, process temperature boosts up. Effect of feed rate is complicated due to the tool-bone contact time issue. While higher temperature is achieved in lower feed rates because of higher tool-bone contact time but higher temperature is observed with high feed rates due to an increase in force and friction. Optimized combination of the parameters to minimize temperature of 35.6 °C is tool diameter of 2.5 mm, rotational speed of 500 r/min and feed rate of 30 mm/min. Good correlation was observed between analytical and experimental results.

Effect of the trabecular bone microstructure on measuring its thermal conductivity: A computer modeling-based study

The objective of this work is to quantify the relation between the value of the effective thermal conductivity of trabecular bone and its microstructure and marrow content. The thermal conductivity of twenty bovine trabecular bone samples was measured prior to and after defatting at 37, 47, and 57 °C. Computer models were built including the microstructure geometry and the gap between the tissue and measurement probe. The thermal conductivity (k) measured was 0.39 ± 0.06 W m^-1 K^-1 at 37 °C, with a temperature dependence of + 0.2%°C^-1. Replacing marrow by phosphate-buffered saline (defatting) increased both the computer simulations and measurement results by 0.04 W m^-1 K^-1. The computer simulations showed that k increases by 0.02-0.04 W m^-1 K^-1 when the model includes a gap filled by phosphate-buffered saline between the tissue and measurement probe. In the presence of microstructure and fatty red marrow, k varies by ± 0.01 W m^-1 K^-1 compared with the case considering matrix only, which suggests that there are no significant differences between cortical and trabecular bone in terms of k. The computer results showed that the presence of a gap filled by phosphate-buffered saline around the energy applicator changes maximum temperature by < 0.7 °C, while including the bone microstructure involved a variation of < 0.2 mm in the isotherm location. Future experimental studies on measuring the value of k involving the insertion of a probe into the bone through a drill hole should consider the bias found in the simulations. Thermal models based on a homogeneous geometry (i.e. ignoring the microstructure) could provide sufficient accuracy.

Investigation of cutting quality and surface roughness in abrasive water jet machining of bone

The abrasive water jet machining is known as a cold cutting process and can be effective for developing cut in the bone in orthopedic surgery to prevent thermal necrosis. This research examined surface roughness and cutting quality of bovine femur bone using abrasive water jet machining. Furthermore, the effect of three parameters was studied including water pressure, traverse speed, and the type of abrasive particles. The feed rate of the abrasive particles was considered 100 g/min, and the levels obtained from pure water jet cutting, bone powder abrasive water jet machining, and sugar abrasive water jet machining were compared with each other. Application of bone powder as an abrasive particle caused improved cutting quality, when compared with pure water jet, and in the best case, it resulted Ra and Rz values of 7.36 and 54.76 μm, respectively at the pressure of 3500 bar and traverse speed of 50 mm/min. The minimum surface roughness was obtained using sugar abrasive particles at the pressure of 3500 bar and traverse speed of 50 mm/min. The values of Ra and Rz parameters measured at the most desirable state were 3.87 and 19.72 μm, respectively. The results suggested that use of sugar as an abrasive material, in comparison with pure water jet and bone powder water jet, resulted in improved cutting quality. Furthermore, elevation of water pressure and reduction of traverse speed had a significant effect on improving surface roughness.

Improved Dental Implant Drill Durability and Performance Using Heat and Wear Resistant Protective Coatings

The dental implant drilling procedure is an essential step for implant surgery, and frictional heat in bone during drilling is a key factor affecting the success of an implant. The aim of this study was to increase the dental implant drill lifetime and performance by using heat- and wear-resistant protective coatings to decrease the alveolar bone temperature caused by the dental implant drilling procedure. Commercially obtained stainless steel drills were coated with titanium aluminum nitride, diamond-like carbon, titanium boron nitride, and boron nitride coatings via magnetron-sputter deposition. Drilling was performed on bovine femoral cortical bone under the conditions mimicking clinical practice. Tests were performed under water-assisted cooling and under the conditions when no cooling was applied. Coated drill performances and durabilities were compared with those of three commonly used commercial drills with surfaces made from zirconia, black diamond. and stainless steel. Protective coatings with boron nitride, titanium boron nitride, and diamond-like carbon have significantly improved drill performance and durability. In particular, boron nitride-coated drills have performed within safe bone temperature limits for 50 drillings even when no cooling is applied. Titanium aluminium nitride coated drills did not show any improvement over commercially obtained stainless steel drills. Surface modification using heat- and wear-resistant coatings is an easy and highly effective way to improve implant drill performance and durability, which can improve the surgical procedure and the postsurgical healing period. The noteworthy success of different types of coatings is novel and likely to be applicable to various other medical systems.

Parameters affecting mechanical and thermal responses in bone drilling: A review

Surgical bone drilling is performed variously to correct bone fractures, install prosthetics, or for therapeutic treatment. The primary concern in bone drilling is to extract donor bone sections and create receiving holes without damaging the bone tissue either mechanically or thermally. We review current results from experimental and theoretical studies to investigate the parameters related to such effects. This leads to a comprehensive understanding of the mechanical and thermal aspects of bone drilling to reduce their unwanted complications. This review examines the important bone-drilling parameters of bone structure, drill-bit geometry, operating conditions, and material evacuation, and considers the current techniques used in bone drilling. We then analyze the associated mechanical and thermal effects and their contributions to bone-drilling performance. In this review, we identify a favorable range for each parameter to reduce unwanted complications due to mechanical or thermal effects.

Assessment of thermal damage in total knee arthroplasty using an osteocyte injury model

Polymethylmethacrylate bone cement has been widely used for the anchorage of artificial implants in various orthopedic surgeries. Although it is one of the most successful biomaterials in use, excess heat generation intrinsically causes thermal damage to bone cells adjacent to the bone cement. To estimate a risk of thermal injury, a response of bone cells to cement polymerization must be elucidated because of the occurrence of thermal damage. Thermal damage is affected not only by maximal temperature but also by exposure time, temperature history, and cell type. This study aimed at quantifying the thermal tolerance of bone cells for the development of a thermal injury model, and applying this model for the estimation of thermal damage during cement polymerization in total knee arthroplasty. Osteocytes, osteoblasts, and fibroblasts were respectively subjected to steady supraphysiological temperatures ranging from 45 to 50°C. Survival curves of each cell and temperatures were used to formulate the Arrhenius model. A three-dimensional heat conduction analysis for total knee arthroplasty was conducted using the finite element model based on serial CT images of human knee. A maximal temperature rise of 50°C was observed at the interface between the 3-mm thick cement and the tissue immediately beneath the tibial tray of the prosthesis. The probability of thermal damage to the osteocyte, which was calculated using the Arrhenius model, was negligible at a distance of at least 1 mm away from the cement-bone interface. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2799-2807, 2017.

Experimental investigation of temperature rise in bone drilling with cooling: A comparison between modes of without cooling, internal gas cooling, and external liquid cooling

Bone fracture occurs due to accident, aging, and disease. For the treatment of bone fractures, it is essential that the bones are kept fixed in the right place. In complex fractures, internal fixation or external methods are used to fix the fracture position. In order to immobilize the fracture position and connect the holder equipment to it, bone drilling is required. During the drilling of the bone, the required forces to chip formation could cause an increase in the temperature. If the resulting temperature increases to 47 °C, it causes thermal necrosis of the bone. Thermal necrosis decreases bone strength in the hole and, subsequently, due to incomplete immobilization of bone, fracture repair is not performed correctly. In this study, attempts have been made to compare local temperature increases in different processes of bone drilling. This comparison has been done between drilling without cooling, drilling with gas cooling, and liquid cooling on bovine femur. Drilling tests with gas coolant using direct injection of CO2 and N2 gases were carried out by internal coolant drill bit. The results showed that with the use of gas coolant, the elevation of temperature has limited to 6 °C and the thermal necrosis is prevented. Maximum temperature rise reached in drilling without cooling was 56 °C, using gas and liquid coolant, a maximum temperature elevation of 43 °C and 42 °C have been obtained, respectively. This resulted in decreased possibility of thermal necrosis of bone in drilling with gas and liquid cooling. However, the results showed that the values obtained with the drilling method with direct gas cooling are independent of the rotational speed of drill.