A Novel Irrigation System to Reduce Heat Generation during Guided Implantology: An In Vitro Study

Abstract

The purpose of this in vitro study is to evaluate the effectiveness of incorporating a new irrigation system into a surgical guide and monitor its effect on heat generation during implant bed preparation. A total of 48 surgically guided osteotomies were performed on 12 bovine ribs divided into 4 groups, using different irrigation techniques: Group A (test) had entry and exit channels incorporated into the guide; Group B had a similar design with an entry channel only; Group C had conventional external irrigation; and Group D (control) had no irrigation. Heat generation during the osteotomies was measured using thermocouples placed at a depth of 2 mm and 6 mm. The lowest mean temperature was observed in Group A (22.1 °C at 2 mm and 21.4 °C at 6 mm), which was statistically significant when compared with Groups C and D (p < 0.001). Group A showed a lower mean temperature compared with Group B as well; however, it was statistically significant only at 6 mm depth (p < 0.05). In conclusion, the proposed surgical guide has significantly reduced heat generation during implant osteotomy compared to conventional external irrigation. The integration of an exit cooling channel can resolve limitations found in previously designed surgical guides such as debris blockage and can be easily incorporated into computer designing and 3D printing software.

Cooling Efficiency of Sleeveless 3D-Printed Surgical Guides with Different Cylinder Designs

“…Our results align with a recent study by Parvizi et al [29], who designed a multichannel surgical guide for drilling adjacent implants. This guide featured a built-in irrigation channel and an exit irrigation channel.…”

Assessment of Thermal Osteonecrosis during Bone Drilling Using a Three-Dimensional Finite Element Model

“…While numerous technical studies have explored methods to mitigate the heat effects on bone, such as utilising coolant irrigation, optimising drill bit geometry [9], enhancing wear resistance [47], implementing step-power drilling [48], etc., there is no conclusive evidence to indicate that irrigation cooling is universally adopted as a standard practice, despite strong recommendations from major implant manufacturers. However, clinically, irrigation cooling is standard practice and is strongly advocated for by leading implant manufacturers [49][50][51][52].…”

The 3D Printing and Evaluation of Surgical Guides with an Incorporated Irrigation Channel for Dental Implant Placement

“…Nevertheless, less attention has been paid to measurements of the intraosseous temperature increments caused by osteotomy guided by templates with built-in irrigation pipes. To our knowledge, this problem has been addressed by three studies so far [24][25][26]. Stocchero et al tested surgical guides with internal cooling on bovine rib specimens and did not find any benefits compared to classical guides [25].…”

“…Teich et al, on the other hand, demonstrated significantly more effective cooling when the irrigation fluid was guided toward the osteotomy site via a pair of internal irrigation fluid channels [26]. Parvizi et al conceived an internally cooled surgical guide that incorporated both an entry and exit channel for the cooling agent and found a significant reduction in the intraosseous temperature [24] within the experimental framework employed previously by Stocchero et al [25].…”

“…Investigations of the intraosseous temperature elevation during guided implant placement have gathered momentum in recent years [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Bone cooling during surgical drilling is most commonly achieved by directing a stream of physiological saline solution onto the target site.…”