The aim of this study was to develop and evaluate a dental implant surgery simulator that allows learners to experience the drilling forces necessary to perform an osteotomy in the posterior mandibular bone. The simulator contains a force-sensing device that receives input and counteracts this force, which is felt as resistance by the user. The device consists of an actuator, a load cell, and a control unit. A mandibular bone model was fabricated in which the predicted forces necessary to drill the cortical and trabecular bone were determined via micro CT image-based 3D inite element analysis. The simulator was evaluated by ive dentists from the Department of Implantology at Tokyo Dental College. The ability of the evaluators to distinguish the drilling resistance through different regions of the mandibular bone was investigated. Of the ive dentists, four sensed the change in resistance when the drill perforated the upper cortical bone. All ive dentists were able to detect when the drill made contact with lingual cortical bone and when the lingual bone was perforated. This project successfully developed a dental implant surgery simulator that allows users to experience the forces necessary to drill through types of bone encountered during osteotomy. Furthermore, the researchers were able to build a device by which excessive drilling simulates a situation in which the lingual cortical bone is perforated-a situation that could lead to negative repercussions in a clinical setting.

Surgical success of drilling in oral implantology depends on the sense of force on the fingers or feeling of a dental clinician, which is related to the quality of trabecular bone in the jawbone expressed by apparent mechanical characteristics. As the mechanical properties of trabecular bone depend on the bone volume fraction, microstructure, and many other factors closely related to individual differences, a probabilistic numerical procedure to assess drilling force is proposed. Using a micro-CT-based jawbone model, a first-order perturbation-based stochastic homogenization method was employed to estimate the possible scattering of apparent mechanical properties of the trabecular bone region. The complicated drilling problem was simplified to sequential linear static FEAs, to which the predicted apparent Young's modulus and shearing moduli in the drilling direction were applied. The FEAs demonstrated that the homogenized mechanical properties showed anisotropy, which might lead to differences in the drilling forces at different drilling angles. The numerically estimated drilling forces were shown by the expected value, 50 %-probability result, and 90 %-probability result and revealed that one patient among two or ten patients would probably have poor bone quality. There was a remarkable difference in the drilling forces between the expected value and the 90 %-probability result.

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