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

Thermal optimization of robotic piezoelectric osteotomy motion in porcine trabecular bone

BACKGROUND

Piezoelectric osteotomy represents a potentially viable alternative to conventional techniques for preparing pilot holes for bone screws. However, piezoelectric osteotomes have demonstrated the potential to heat bone beyond 47 °C, which induces necrosis that could contribute to screw loosening, resulting in osteosynthetic material failure and pseudarthrosis. Thus, we sought to determine the working movements of a piezoelectric drill that resulted in the lowest maximum bone temperatures while ensuring that this optimal drilling motion resulted in temperatures below 47 °C.

METHODS

Vertebrae samples were obtained fresh from a local abattoir. A robot was used to drill 15 mm holes through the vertebrae bodies parallel to a sectioned viewing surface, observed with a thermal camera. We tested three significant aspects of the osteotome's movement: the feed rate, retraction speed and working cycle to see which combination resulted in the lowest maximum temperatures. Each factor combination was tested three times for a total of 24 trials.

FINDINGS

A feed rate of 2 mm/s, a retraction speed of 2 mm/s and a novel working cycle termed "multi-pass" were found to generate the lowest maximum temperatures (41.5 °C, σ = 1.91 °C). The factors of retraction speed and working cycle demonstrated statistical significance through analysis of variance, with ordinary least squares regression indicating their optimal settings resulted in reductions in maximum temperatures of 4.95 °C and 5.63 °C, respectively.

INTERPRETATION

Robotic piezoelectric osteotomy appears to represent a safe method of pedicle screw pilot hole preparation from a thermal perspective when using the optimal methods found in this study.

Soft material drilling: A thermo-mechanical analysis of polyurethane foam for biomimetic bone scaffolds and optimization of process parameters using Taguchi method

Drilling is a widely employed technique in machining processes, crucial for efficient material removal. However, when applied to living tissues, its invasiveness must be carefully considered. This study investigates drilling processes on polyurethane foam blocks mimicking human bone mechanical properties. Various drill bit types (118° twist, 135° twist, spherical, and conical), drilling speeds (1000-1600 rpm), and feed rates (20-80 mm/min) were examined to assess temperature elevation during drilling. The Taguchi method facilitated systematic experiment design and optimization. Signal-to-noise (S/N) ratio and analysis of variance (ANOVA) identified significant drilling parameters affecting temperature rise. Validation was conducted through confirmation testing. Results indicate that standard twist drill bits with smaller point angles, lower drilling speeds, and higher feed rates effectively minimize temperature elevation during drilling.

Correlation Between Implant Stability Quotient and Percussion Sound Frequency

OBJECTIVES

To determine the correlation between the primary implant stability quotient and the implant percussion sound frequency.

MATERIALS AND METHODS

A total of 14 pigs' ribs were scanned using a dental cone beam computed tomography (CBCT) scanner to classify the bone specimens into three distinct bone density Hounsfield units (HU) value categories: D1 bone: >1250 HU; D2: 850-1250 HU; D3: <850 HU. Then, 96 implants were inserted: 32 implants in D1 bone, 32 implants in D2 bone, and 32 implants in D3 bone. The primary implant stability quotient (ISQ) was analyzed, and percussion sound was recorded using a wireless microphone connected and analyzed with frequency analysis software.

RESULTS

Statistically significant positive correlations were found between the primary ISQ and the bone density HU value (r = 0.719; p < 0.001), and statistically significant positive correlations between the primary ISQ and the percussion sound frequency (r = 0.606; p < 0.001). Furthermore, significant differences in primary ISQ values and percussion sound frequency were found between D1 and D2 bone, as well as between D1 and D3 bone. However, no significant differences were found in primary ISQ values and percussion sound frequency between D2 and D3 bone.

CONCLUSION

The primary ISQ value and the percussion sound frequency are positively correlated.

Thermographic analysis of perforations in polyurethane blocks performed with experimental conical drill bit in comparison to conventional orthopedic drill bit: a preliminary study

OBJECTIVE

Conical orthopedic drill bits may have the potential to improve the stabilization of orthopedic screws. During perforations, heat energy is released, and elevated temperatures could be related to thermal osteonecrosis. This study was designed to evaluate the thermal behavior of an experimental conical drill bit, when compared to the conventional cylindrical drill, using polyurethane blocks perforations.

RESULTS

The sample was divided into two groups, according to the method of drilling, including 25 polyurethane blocks in each: In Group 1, perforations were performed with a conventional orthopedic cylindrical drill; while in Group 2, an experimental conical drill was used. No statistically significant difference was observed in relation to the maximum temperature (MT) during the entire drilling in the groups, however the perforation time (PT) was slightly longer in Group 2. Each drill bit perforated five times and number of perforations was not correlated with a temperature increase, when evaluated universally or isolated by groups. The PT had no correlation with an increase in temperature when evaluating the perforations universally (n = 50) and in Group 1 alone; however, Group 2 showed an inversely proportional correlation for these variables, indicating that, for the conical drill bit, drillings with longer PT had lower MT.

A Study on the Biofilm Removal Efficacy of a Bioelectric Toothbrush

Effective oral care is a critical requirement to maintain a high quality of life. Most oral diseases are caused by plaque (oral biofilm), which is also correlated with systemic diseases. A common method to remove biofilm is brushing teeth with toothpaste. However, 3.5 billion people in the world have oral diseases, meaning that more efficient methods of removing biofilms are needed. We have developed a toothbrush that applies a bioelectric effect (BE) utilizing an electric force for biofilm removal. It demonstrated significantly higher biofilm removal efficiency than non-BE manual toothbrushes. Tests were performed in saline and toothpaste conditions using various pressures. Results showed that the BE toothbrush had a significantly higher biofilm removal efficiency in saline (0.5 N: 215.43 ± 89.92%, 2.5 N: 116.77 ± 47.02%) and in a toothpaste slurry (0.5 N: 104.96 ± 98.93%, 2.5 N: 96.23 ± 35.16%) than non-BE manual toothbrushes. Results also showed that BE toothbrushes were less dependent on toothpaste. This study suggests that the application of BE can be a new solution to plaque problems in oral care.

Heat Accumulation in Implant Inter-Osteotomy Areas-An Experimental In Vitro Study

To examine the influence of the distance between adjacent implant osteotomies on heat accumulation in the inter-osteotomy area, two experimental groups with 15 pairs of osteotomies in Type II polyurethane blocks were compared: 7 mm inter-osteotomy separations (Group A, n = 15) and 14 mm inter-osteotomy separations (Group B, n = 15). An infrared thermographic analysis of thermal changes in the inter-osteotomy area was completed. A one-way analysis of variance (ANOVA) and Fisher post-test were used to determine group differences. Higher temperatures were recorded in Group A at the coronal and middle levels compared to the apical level in both groups. The temperature reached max temperatures at T80s and T100s. In Group A, the threshold for thermal necrosis was exceeded. Meanwhile, Group B did not reach the threshold for thermal necrosis. Preparing adjacent implant osteotomies in dense bone with a 7 mm separation between their centers increases the temperature in the inter-osteotomy area, exceeding the threshold for bone thermal necrosis; meanwhile, increasing the distance between osteotomies reduces the thermal accumulation and the risk for thermal necrosis.

Heat Generation During Initial Osteotomy for Implant Site Preparation: An In Vitro Measurement Study

Introduction

Controlling temperature generation during implant site preparation is important to prevent implant early failure.

Aim

The present in vitro study aimed at measuring temperature variation generated during the initial osteotomy using both rotatory and piezo-surgical inserts.

Methods

Nine groups were defined according to drill and insert type, cooling volume (mL/min) and cooling temperature. A total of 315 implant site preparations were performed in an artificial bone sample and the temperature was measured using an infrared camera. Drills’ wear was assessed using scanning electron microscopy at baseline and after 10 and 35 utilizations.

Results

Piezo-surgical insert groups determined a temperature increase that was significantly higher than the one generated by rotatory drills groups (p < 0.001). When considering rotatory drills groups a temperature ≥ 40 °C was never recorded.

Conclusion

Lower saline temperature implied a significant temperature decrease (p < 0.001), while the increase in cooling volume did not imply a temperature decrease. The scanning electron microscopy analysis of the drills demonstrated that little drill wear occurred up to 35 utilization times.

Screw-Type Collar vs. Non-Screw-Type Collar Implants—Comparison of Initial Stability, Soft Tissue Adaptation, and Early Marginal Bone Loss—A Preclinical Study in the Dog

Simple Summary

Implant neck characteristics may affect initial implant stability, soft tissue healing, and early marginal bone loss (EMBL) at second-stage surgery. Screw-type rough-surface collar implants had statistically significant poorer soft tissue healing and increased marginal bone loss compared to non-screw type implants at the time of 2nd-stage surgery. The significance of the novel implant design results in preventing EMBL awaits further research.

Abstract

Background: Implant neck characteristics may affect initial implant stability, soft tissue healing, and early marginal bone loss (EMBL) at second-stage surgery. The null hypothesis was that, following two-stage implant insertion, rough surface, non-screw-type collar implants will present lower EMBL at 2nd-stage surgery than rough-surface, screw-type collar implants. Methods: The study comprised seven male beagle dogs (mean weight 10.57 ± 2.8 kg; range 9–17 kg). A novel implant design was developed, composed of 2 parts: an apical part resembling a regular threaded implant, and a coronal non-screw-type collar, 4.2 mm long, served as the study group, whereas standard threaded implants served as control. Twenty-eight implants were placed: two on each side of the mandible. All implants were sand-blasted/acid-etched and of similar dimensions. Each dog received four implants. To assess location (anterior vs. posterior) impact on the outcomes, implants were placed as follows: group I—posterior mandible right—non-screw-type collar implants; group II—anterior mandible right—similar non-screw-type collar implants. To assess the collar-design effect on the outcomes, implants were placed as follows—Group III—anterior mandible left—control group, screw-type collar implants; Group IV—study group, posterior mandible left—non-screw-type collar implants. The following parameters were measured and recorded: insertion torque, soft tissue healing, early implant failure, and EMBL at 2nd-stage surgery. Results: No statistically significant differences were noted between groups I and II regarding all outcome parameters. At the same time, although insertion torque (55 N/cm) and early implant failure (0) were similar between groups III and IV, group III presented significantly poorer soft tissue healing (1.43 vs. 0.14) and increased marginal bone loss (0.86 vs. 0 mm). Conclusions: When a two-stage implant protocol was used, rough-surface non-screw-type collar implants led to superior outcomes at 2nd-stage surgery. Implant location did not affect the results. The significance of this result in preventing EMBL awaits further research.

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.

Autonomous Robotic Point-of-Care Ultrasound Imaging for Monitoring of COVID-19-Induced Pulmonary Diseases

The COVID-19 pandemic has emerged as a serious global health crisis, with the predominant morbidity and mortality linked to pulmonary involvement. Point-of-Care ultrasound (POCUS) scanning, becoming one of the primary determinative methods for its diagnosis and staging, requires, however, close contact of healthcare workers with patients, therefore increasing the risk of infection. This work thus proposes an autonomous robotic solution that enables POCUS scanning of COVID-19 patients’ lungs for diagnosis and staging. An algorithm was developed for approximating the optimal position of an ultrasound probe on a patient from prior CT scans to reach predefined lung infiltrates. In the absence of prior CT scans, a deep learning method was developed for predicting 3D landmark positions of a human ribcage given a torso surface model. The landmarks, combined with the surface model, are subsequently used for estimating optimal ultrasound probe position on the patient for imaging infiltrates. These algorithms, combined with a force–displacement profile collection methodology, enabled the system to successfully image all points of interest in a simulated experimental setup with an average accuracy of 20.6 ± 14.7 mm using prior CT scans, and 19.8 ± 16.9 mm using only ribcage landmark estimation. A study on a full torso ultrasound phantom showed that autonomously acquired ultrasound images were 100% interpretable when using force feedback with prior CT and 88% with landmark estimation, compared to 75 and 58% without force feedback, respectively. This demonstrates the preliminary feasibility of the system, and its potential for offering a solution to help mitigate the spread of COVID-19 in vulnerable environments.

Developments in data science solutions for carnivore tooth pit classification

Competition for resources is a key question in the study of our early human evolution. From the first hominin groups, carnivores have played a fundamental role in the ecosystem. From this perspective, understanding the trophic pressure between hominins and carnivores can provide valuable insights into the context in which humans survived, interacted with their surroundings, and consequently evolved. While numerous techniques already exist for the detection of carnivore activity in archaeological and palaeontological sites, many of these techniques present important limitations. The present study builds on a number of advanced data science techniques to confront these issues, defining methods for the identification of the precise agents involved in carcass consumption and manipulation. For the purpose of this study, a large sample of 620 carnivore tooth pits is presented, including samples from bears, hyenas, jaguars, leopards, lions, wolves, foxes and African wild dogs. Using 3D modelling, geometric morphometrics, robust data modelling, and artificial intelligence algorithms, the present study obtains between 88 and 98% accuracy, with balanced overall evaluation metrics across all datasets. From this perspective, and when combined with other sources of taphonomic evidence, these results show that advanced data science techniques can be considered a valuable addition to the taphonomist’s toolkit for the identification of precise carnivore agents via tooth pit morphology.

Degree of conversion and in vitro temperature rise of pulp chamber during polymerization of flowable and sculptable conventional, bulk-fill and short-fibre reinforced resin composites

OBJECTIVE

Determine the degree of conversion (DC) and in vitro pulpal temperature (PT) rise of low-viscosity (LV) and high-viscosity (HV) conventional resin-based composites (RBC), bulk-fill and short-fibre reinforced composites (SFRC).

METHODS

The occlusal surface of a mandibular molar was removed to obtain dentine thickness of 2 mm above the roof of the pulp chamber. LV and HV conventional (2 mm), bulk-fill RBCs (2-4 mm) and SFRCs (2-4 mm) were applied in a mold (6 mm inner diameter) placed on the occlusal surface. PT changes during the photo-polymerization were recorded with a thermocouple positioned in the pulp chamber. The DC at the top and bottom of the samples was measured with micro-Raman spectroscopy. ANOVA and Tukey's post-hoc test, multivariate analysis and partial eta-squared statistics were used to analyze the data (p < 0.05).

RESULTS

The PT changes ranged between 5.5-11.2 °C. All LV and 4 mm RBCs exhibited higher temperature changes. Higher DC were measured at the top (63-76%) of the samples as compared to the bottom (52-72.6%) in the 2 mm HV conventional and bulk-fill RBCs and in each 4 mm LV and HV materials. The SFRCs showed higher temperature changes and DC% as compared to the other investigated RBCs. The temperature and DC were influenced by the composition of the material followed by the thickness.

SIGNIFICANCE

Exothermic temperature rise and DC are mainly material dependent. Higher DC values are associated with a significant increase in PT. LV RBCs, 4 mm bulk-fills and SFRCs exhibited higher PTs. Bulk-fills and SFRCs applied in 4 mm showed lower DCs at the bottom.

Biomechanical properties of the bone during implant placement

Background

In this research the biomechanical properties of a bone model was examined. Porcine ribs are used as experimental model. The objective of this research was to investigate and compare the biomechanical properties of the bone model before and after implant placement.

Methods

The bone samples were divided in three groups, Group 1 where ALL-ON-FOUR protocol was used during pre-drilling and placing the implants, Group 2 where ALL-ON-FOUR protocol was used during pre-drilling, and implants were not placed, and Group 3 consisting of intact bones served as a control group. Static and dynamic loading was applied for examining the model samples. Kruskal–Wallis statistical test and as a post-hoc test Mann–Whitney U test was performed to analyze experimental results.

Results

According to the results of the static loading, there was no significant difference between the implanted and original ribs, however, the toughness values of the bones decreased largely on account of predrilling the bones. The analysis of dynamic fatigue measurements by Kruskal–Wallis test showed significant differences between the intact and predrilled bones.

Conclusion

The pre-drilled bone was much weaker in both static and dynamic tests than the natural or implanted specimens. According to the results of the dynamic tests and after a certain loading cycle the implanted samples behaved the same way as the control samples, which suggests that implantation have stabilized the skeletal bone structure.

JOHNSON–COOK MODEL COMBINED WITH COWPER–SYMONDS MODEL FOR BONE CUTTING SIMULATION WITH EXPERIMENTAL VALIDATION

Constitutive models are widely used to predict the mechanical behavior of different kinds of materials. Although the Johnson–Cook model for bovine bone and Cowper–Symonds model for human thoracic rib and tibia was developed, the predictability of these models was found good only at particular strain rates. This study addresses this lack of information by investigating the Cowper–Symonds model, Johnson–Cook model, and Johnson–Cook model combined with Cowper–Symonds model at different strain rates to utilize in the bone cutting simulation. Specimens prepared using two rear femurs harvested from a 3.50-year-old bovine were investigated at different strain rates (0.00001–1/s). A comparative study made among the stresses predicted from these models showed 29.41%, 10.91%, and 11.11% mean absolute percentage errors using Cowper–Symonds model, and 2.03%, 7.19%, and 3.62% mean absolute percentage errors using Johnson–Cook model, respectively, at 0.0001, 0.001 and 1/s strain rates. However, the Johnson–Cook model combined with the Cowper–Symonds model predicted the stress with a maximum of only 2.03% mean absolute percentage error. The potential of each model to utilize in the orthogonal bone cutting was also evaluated using Ansys® and found that the combined model predicted the cutting force close to experimental cutting force with minimal error (5.20%). The outcomes of this study can be used in the surgical practice and osteotomy procedure before commencing actual surgery.

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.

Influence of bone density, screw size and surgical procedure on orthodontic mini-implant placement - part A: temperature development

The aim of this in vitro study was to determine the influence of bone density, orthodontic mini-implant (OMI) size, and the surgical procedure on temperature increase during implant site osteotomy and placement. OMIs of different sizes (2.0×7, 2.3×7, 2.0×11, and 2.3×11mm) were placed in artificial bone blocks of different densities (D1-D4). Optionally, the drilling and insertion angle was 90° or 60° to the bone surface. A total of 640 OMIs were inserted, and predrilling was performed in 320 cases. All insertions were done without irrigation with an axial load of 20N, which resulted in 64 groups. Temperature measurements were performed during implant site preparation and placement using Type-K-thermocouples. Mean temperature increase differed for OMI osteotomy between 1.38°C and 8.75°C and placement between 3.8°C and 18.74°C, respectively. Critical thermal increase was especially reached during placement using long implants. Increasing bone density and implant size (diameter <length) correlated with thermal increase. Predrilling and angulated implant placement resulted in less heat development. Critical temperature behaviour in high-density bone could be partially responsible for the high failure rates of OMI placement in the lower jaw. The influence of the implant size on temperature development should be considered when selecting an OMI.

Primary Stability of Dental Implants in Low-Density (10 and 20 pcf) Polyurethane Foam Blocks: Conical vs Cylindrical Implants

Background: The aim of the present study was to compare, in low-density polyurethane blocks, the primary implant stability values (micromobility) and removal torque values of three different implant geometries in two different bone densities representing the structure of the human posterior jaws. Methods: A total of 60 implants were used in the present investigation: twenty implants for each of three groups (group A, group B, and group C), in both polyurethane 10 pcf and 20 pcf densities. The insertion torque, pull-out torque, and implant stability quotient (ISQ) values were obtained. Results: No differences were found in the values of Group A and Group B implants. In both these groups, the insertion torques were quite low in the 10 pcf blocks. Better results were found in the 20 pcf blocks, which showed very good stability of the implants. The pull-out values were slightly lower than the insertion torque values. High ISQ values were found in Group A and B implants. Lower values were present in Group C implants. Conclusions: The present investigation evaluated implants with different geometries that are available on the market, and not experimental implants specifically created for the study. The authors aimed to simulate real clinical conditions (poor-density bone or immediate post-extraction implants) in which knowledge of dental implant features, which may be useful in increasing the primary stability, may help the oral surgeon during the surgery planning.

Comparative Analysis of Bone Tissue Temperature during Implant Preparation with Variable Drilling Parameters: In Vitro Study

Purpose. The aim of this work was to compare the temperature fluctuations that occur during the development of the implant bed using three different implant systems and the impact on their value of cooling method and rotational speed of drill. Material and Methods. As a model of the human jaw due to the analogy of bone structure and hardness, pig ribs were used. Drills from three different implant systems were used in the study: Straumann® (Straumann GmbH, Basel, Switzerland), AnyRidge® (Megagen Implant Co., Ltd., Daegu, South Korea), and Osstem (OSSTEM IMPLANT CO., LTD., Seoul, South Korea). The sequence of three successive drills was given—from pilot drill to final drill. For each system, a group with two water cooling methods, without cooling, and three different speed ranges, 800, 1200, and 1500 rpm, and their effect on temperature fluctuations was evaluated. The temperature was measured by thermography. Results. The highest temperature increases were noted during preparation with pilot drills. The maximum temperature (50.8°C) was noted for the AnyRidge pilot drill at 1500 rpm without cooling. When cooling with physiological saline, none of the applied drills exceeded 28°C. Significant differences between lack of cooling and cooling with saline at 20°C and 3°C have been demonstrated. During preparation with cooling, the difference between the times of the maximum temperature achievement was observed between AnyRidge® and Osstem (2.6 vs. 1.6 s, p=0.004). Conclusion. The experiment showed that the drills of the tested implant systems differed in the amount of heat generated during operation. The temperature of the cooling solution and the rotational speed applied have an influence on its amount.