ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title More Heat is Produced with Guided Dental Implant Surgery
Clinical Question Is more heat generated during guided dental implant osteotomy preparations as compared to non-guided?
Clinical Bottom Line More heat is produced with guided dental implant surgery. This is supported by three in vitro studies in which a statistically significant increase of temperature was reported when utilizing surgical guides as compared to conventional drilling without a guide. Although significant, the maximum temperatures did not reach critical levels for bone necrosis. Clinical research needs to be conducted to determine when temperature rise using surgical guides in-vivo is clinically relevant.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24451853dos Santos/201420 rabbit tibias, 40 osteotomy sitesLaboratory study
Key results20 rabbit tibias were used to evaluate and compare bone heating, drill deformation, and drill roughness after 40 osteotomy preparations using the guided surgery and the conventional drilling techniques. The guided group generated significantly higher temperatures than the conventional control group. Increase in temperature was directly proportional to the number of times drills were used; however, neither guided nor conventional techniques generated critical necrosis-inducing temperatures.
#2) 24278913Migliorati/201310 Porcine rib samples for each groupLaboratory study
Key resultsThis study utilized pig ribs, with mean cortical thickness of 1.90 mm, to evaluate significance of temperature rise during osteotomy preparation when utilizing surgical guides and also flap procedures. Temperature changes were recorded at a distance of 0.5 mm from the final osteotomy using 2 thermocouples at depths of 1.5 and 12 mm. A statistically significant increase of temperature was reported at only the 1.5 mm depth for both guided groups (flapless and open flap). Osteotomy preparation with surgical guides generated higher bone temperature than conventional drilling. However, this heat generation did not reach temperature levels critical for bone necrosis.
#3) 19925988Misir/200920 bovine femoral cortical bone samples for each groupLaboratory study
Key resultsThis study evaluated the generation of heat in bone using external or external and internal irrigation with and without the use of surgical drill guides. Thermocouples were placed at a 1-mm distance from the bovine femoral cortical osteotomy sites at depths of 3, 6, and 9 mm. Heat measurements were recorded out to 50 uses. A statistically significant difference was found at all measured depths between the surgical guide and conventional drilling procedures. More heat was generated with the surgical guides at all three depths regardless of the irrigation method; however, mean maximum temperatures did not reach the critical bone necrosis level.
Evidence Search ((("hot temperature"[MeSH Terms] OR ("hot"[All Fields] AND "temperature"[All Fields]) OR "hot temperature"[All Fields]) AND ("osteotomy"[MeSH Terms] OR "osteotomy"[All Fields])) AND ("dental implants"[MeSH Terms] OR ("dental"[All Fields] AND "implants"[All Fields]) OR "dental implants"[All Fields])) AND (("bone and bones"[MeSH Terms] OR ("bone"[All Fields] AND "bones"[All Fields]) OR "bone and bones"[All Fields] OR "bone"[All Fields]) AND ("surgery"[Subheading] OR "surgery"[All Fields] OR "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgery"[All Fields] OR "general surgery"[MeSH Terms] OR ("general"[All Fields] AND "surgery"[All Fields]) OR "general surgery"[All Fields]))
Comments on
The Evidence
Validity: The strongest available evidence for this topic are bench top studies, with no clinical studies reported in the literature. Clinical trials need to be developed for stronger evidence. Perspective: The available evidence concurs that greater temperatures are produced when utilizing a surgical guide; however, these temperatures do not exceed the 47° C threshold level. In addition to using a surgical guide, the reasons for heat production are multifactorial including drill size, drill sharpness, mode of drilling, bone type, irrigation, etc. and must be considered when evaluating heat production in osteotomy preparation studies.
Applicability Surgical guides help transfer pre-operative treatment planning information to the surgical site while assisting the operator to place the dental implant in the planned position and angulation, with regards to the final prosthesis. When using a surgical guide for dental implant osteotomy preparations, careful attention to surgical protocol should be implemented to minimize additional heat generation that occurs when using a guide.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords dental implant, osteotomy, surgical guide
ID# 2785
Date of submission: 11/25/2014spacer
E-mail hugharta@uthscsa.edu
Author Amanda G. Hughart, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ronald G. Verrett, DDS, MS
Faculty mentor/Co-author e-mail Verrett@uthscsa.edu
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