ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Placing Dental Implants Using a Simplified Drilling Protocol Produces Comparable Heat to Conventional Sequential Drilling Protocols
Clinical Question In a patient receiving dental implants, would using a simplified drilling protocol lead to more heat generation than the conventional drilling protocol?
Clinical Bottom Line For a patient receiving dental implants, a single drill technique (pilot drill and implant drill with or without cannulation) will not generate heat exceeding the upper threshold temperatures for bone survival. The single drill technique can provide comparable results, in terms of heat generation, to conventional sequential drilling protocols with a shorter time of surgery. However, the single drill technique should be performed with precision by an experienced surgeon to achieve the proper angle of insertion.
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) 23431303Giro/201318 Beagle dogs (~1.5 years old)Laboratory study
Key resultsWhile there was a significant increase in both bone area fraction occupancy (BAFO) and bone-to-implant contact (BIC) (P < 0.01 and P = 0.02, respectively) from week 1 to 3, there was no significant difference in BAFO or BIC (P = 0.85 and P = 0.82, respectively) from week 3 to 5 of implants placed by single drill technique in comparison to the conventional sequential drilling technique. The histology around the site of the implant placed by the two methods did not show any signs of inflammation or necrosis, suggesting that neither drilling technique exceeded the 47°C standard for bone survival.
#2) 23189297Bulloch/2012Bovine femoral boneLaboratory study
Key resultsThe use of a cannula provides the surgeon with an implantation guide, decreasing the opportunity for improper angulation during implant placement with a single drill. This study shows that the use of a cannulated single implant drill does not cause an increase in bone temperature greater than that seen with conventional sequential drilling with or without a surgical guide.
Evidence Search ("dental implants"[MeSH Terms] OR ("dental"[All Fields] AND "implants"[All Fields]) OR "dental implants"[All Fields] OR ("dental"[All Fields] AND "implant"[All Fields]) OR "dental implant"[All Fields]) AND ("mandrillus"[MeSH Terms] OR "mandrillus"[All Fields] OR "drill"[All Fields]) AND ("time"[MeSH Terms] OR "time"[All Fields])
Comments on
The Evidence
The articles’ results are restricted to randomized in vitro and animal experimental studies. Human studies have not been published. Both studies seemed to have adequate methods to measure temperature changes during drilling, although the Bulloch study does not address bone changes histologically. The Giro study conducted procedures at a constant 900 rpm with irrigation, while the Bulloch study did so at 2,100 rpm with irrigation. The Giro study did not state at which pressure the implants were placed, while the Bulloch study placed implants at constant 2-kg drilling pressure. It is important to further study the simplified drilling technique to identify the proper drilling speed and pressure, as these factors also affect heat generation.
Applicability Although no human studies have been carried out, the results from these studies suggest that both techniques would be appropriate for placing implants without causing unnecessary heat generation around the implant, which could lead to osteonecrosis. The main outcome gained from the single-drill technique is a shorter surgical time. This technique should only be performed by surgeons with extensive experience in the technique for precise placement of the implants, since a single drill allows little room for error.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords single drill implant, heat generation, simplified drill protocol
ID# 2896
Date of submission: 04/03/2015spacer
E-mail wongnc@livemail.uthscsa.edu
Author Nancy Carolina Wong
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Conception Barboza, DDS
Faculty mentor/Co-author e-mail barbozaargue@uthscsa.edu
Basic Science Rationale
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