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

The Effect of Dental Implant Drills Materials on Heat Generation in Osteotomy Sites: A Systematic Review

The aim of this review was to examine the impact of dental implant drill materials and wear profiles on heat generation in the osteotomy sites as reported in experimental studies and to critically appraise these studies. The research question was formulated based on predefined patient, intervention, comparison, and outcome (PICO) elements. A comprehensive electronic search was undertaken in Medline/PubMed Central, Science Direct, and Google Scholar, using predetermined keywords, followed by a manual search of the bibliography of the selected articles. The selection of the studies for the critical appraisal part of our study was based on the criteria used to assess the study designs such as study aims, outcome measure, clarity of method, sample selection, randomization, allocation concealment, sample attrition, bias, method of data analysis, and external validity. Increased heat generation was observed with both ceramic and metal drills; the heat generation was proportional to drills' wear. The literature was inconclusive regarding the association between drill material and heat generation. However, drill materials had a significant influence on the overall temperature increase during osteotomy. The noncoated drills showed a higher wear resistance, and it has been observed that using worn drills leads to more friction contact, reduced drill cutting efficiency, and increased heat generation. Eleven in vitro studies met the inclusion criteria, and showed a considerable methodological heterogeneity and confounding factors, including drill geometry, speed and load, depth and diameter, number of uses, irrigation protocol, study specimens, and the heat measuring device. Besides, most of the studies have a potential operator and assessor bias, and some have sponsorship bias. It is possible to conclude that the literature is not conclusive on the effect of drill materials on heat generation during osteotomy. Lack of standardization and uniformity in the study design, along with potential bias in the study methodology can be the reason for the heterogeneity of the results.

Steel drills versus zirconia drills on heat generation at the surgical site of dental implants: A systematic review and meta-analysis

Objective

The aim was to evaluate the difference in the heat generated between zirconia (Zr) and steel (SS) drills, during implant site preparation.

Material and methods

This systematic review followed the PRISMA methodology criteria and used the JBI Critical Assessment Guidelines for Quasi-Experimental Studies for quality assessment. The electronic search was conducted by using the PubMed/MEDLINE, Embase, and Cochrane Library databases to January 2023. The formulated population, intervention, comparison, outcome (PICO) question was "Do zirconia drills generate less heat than steel drills during implant site preparation?". The meta-analysis was based on an inverse variance (IV) method.

Results

This review included 10 studies in vitro that used zirconia drills compared to steel drills with or without coatings. The meta-analysis indicated a significant difference between Zr drills and SS drills, with a lower bone temperature variation with Zr drills.

Conclusions

Despite the limitations of this review, it was concluded that Zr drills had significantly less temperature variation than SS drills.

A Comparative Analysis Regarding the Osseointegration of Immediate Loaded Implants Using Two Different Implant Site Preparations: Erbium:Yttrium-Aluminum-Garnet Laser Versus Surgical Conventional Way-An In Vivo and Histological Animal Study

Objective: The aim of the study is to evaluate the possibility of preparing the implant site using the erbium:yttrium-aluminum-garnet (Er:YAG) laser scanner prototype and to reduce and/or eliminate time between primary (mechanical) stability and secondary (biological) stability, looking to the immediate occlusal loading in a single implant. Background: A prerequisite for successful osseointegration is the establishment of direct bone-to-implant contact without interposition of nonbone or connective tissue. In recent years, the use of laser radiation was presented as an alternative/adjunctive treatment for bone tissue ablation due to vaporization of the tissues in the absence of a smear layer. Methods: The experimental protocol included six minipigs, which underwent tooth extraction, followed (after 2 months) by implant bed preparation in two methods: using a conventional bur kit and using an Er:YAG laser scanner (X runner) protocol. Four implants were placed in positions 34, 37, 44, and 47 on each animal. The animals underwent the second surgical procedure for bone sample collection (including the implant) before their sacrifice at 45-60-90-120 days. The newly formed bone was evaluated on the bone samples using histological examination and quantitative evaluations of different histological parameters based on microscopical analysis. Results: The results that we obtained allow some interesting comparison in terms of different bone composition, depending on the method of implant site preparation and on healing periods. Moreover, it was possible to compare the bone composition, at different time stages, of implant sites prepared in the same way. Conclusions: Our research allowed us to demonstrate that the use of Er:YAG laser compared with traditional drill leads to the presence of a greater share of lamellar bone and a lower necrotic share in the implant site. We also showed the possibility of applying immediate occlusal loading on an in vivo animal model.

The effects of repeated usage of implant drills on cortical bone temperature, primary/secondary stability and bone healing: A preclinical in vivo micro-CT study

OBJECTIVE

The aims of the study were to evaluate the effects of new vs. used drills on cortical bone temperature, operation time, and primary/secondary stability and to assess bone healing by micro-CT.

MATERIALS AND METHODS

New, 50×-used and 100×-used drills at 800 rpm were used to place implants in the iliac crests of three male sheep in this experimental in vivo animal study. A total of 36 implants (12 in each group) were placed. The temperature of the cortical bone was recorded with an infrared thermometer, and the ISQ values at implant placement (primary stability) and at 4 weeks (secondary stability) were evaluated. The bone volume assessed by micro-CT was used to evaluate bone tissue healing. The results were statistically compared.

RESULTS

The results have shown that the operation time and the cortical bone temperature increased by the usage of the drills (p < .05) and the primary/secondary stability (ISQ values) decreased with the number of drill usage (p < .05) The highest 2- and 3-dimensional bone volume (assessed by micro-CT) were noted for new drills group followed by 50×-used drills and 100×-used drills (p < .05 at 4 weeks).

CONCLUSION

The number of drill usage seems to be directly affecting the osseointegration process in implant surgery. Therefore, replacing the drills at certain time intervals may increase the success of implant treatment.

Comparative Analysis of the Chemical Composition and Microstructure Conformation Between Different Dental Implant Bone Drills

Background: Hardness is considered an important parameter for evaluating the clinical performance of dental implant bone drills. It is connected to the chemical composition, microstructure conformation and manufacture of the surgical drills. Methods: Microstructure of five dental implant drills using scanning electronic microscopy (SEM) integrated with energy dispersive X-ray spectrometry. Vickers microhardness was measured using a CV 2000 microhardness tester with an indentation force of 500 g. Results: Composition of the implant drills was typical of martensitic stainless steel (MSS). The drills contained 13%–17% of Cr; Mo, Si and Mn were present as minor ligands. The examined bone drills showed different external surface conformation and hardness in relation to the different industrial production processes. A rougher external surface and a higher hardness value are characteristics of the surgical bone drills produced by hot forming; the implant drills produced by machining showed mailing lines on their external surface and a lower hardness. Conclusions: Different compositions and treatments were used by the manufacturers to improve the hardness of the external layer of the dental implant drills making them prone to a diverse heat generation during the implant site preparation.