Heat and speed of dental implant drilling

 ver the past few decades since the inception of implantology, implant system design and treatment concepts have come forward leaps and bounds. A vast choice of dental implants has evolved; however it may be surprising that some aspects have seen relatively little change. Based on biological research with a basic science approach, one such area is the effect of dental implant drilling protocols and implant site preparation. In this article, we unpack some of the biological response to conventional bone drilling and how Nobel Biocare is addressing the associated draw backs by introducing the OsseoShaper™ protocol.*

How do conventional, high-speed dental drills impact implant site viability?

Even with the most careful site preparation, it should be no surprise that inevitably, drilling into bone damages the bone tissue and the osteocytes – the cells that enable new bone formation and osseointegration – surrounding the osteotomy.1

A significant factor is the high speed that a conventional dental drill needs to operate effectively.2 The problem with high speed and friction is that they generate heat.4 This heat radiates from the cutting drill edge into surrounding tissue and kills bone cells, and bone cell death triggers bone resorption at the implant site.1,5,6,7

Ultimately, therefore, the heat generated by high-speed drilling can impede the much-coveted implant stability.5

This area of dead and dying osteocytes around the osteotomy has been termed the ‘Zone of Death’, and in triggering bone resorption, presents one of the challenges in achieving optimal site viability. What options might clinicians consider for minimizing causes of cell death?

For more: https://uniqa.dental/product/drills-with-external-internal-irrigation/

Could more irrigation help a viable implant site?

To counteract the effects of heat, saline irrigation is typically applied in the osteotomy at each step of the drill sequence, cooling the temperature. Should we, then, simply increase irrigation to reduce heat further?

Unfortunately, irrigation brings its own drawbacks. When drilling to create an osteotomy, autologous bone chips and osseous coagulum – a blend of blood, bone cells and growth factors – are created. Because of their osteogenic properties, when left in situ this valuable material can promote new bone formation.8

However, copious irrigation washes away bone chips and osseous coagulum. Once the bone chips are removed from the osteotomy, cells quickly begin to die, and so, even if retrieved, their osteogenic potential quickly deteriorates.9 To maximize the healing potential of bone chips, the cell death should be minimized while maintaining bone chips in situ.