Effect of drill quality on biological damage in bone drilling

Abstract

Bone drilling is a universal procedure in orthopaedics for fracture fixation, installing implants, or reconstructive surgery. Surgical drills are subjected to wear caused by their repeated use, thermal fatigue, irrigation with saline solution, and sterilization process. Wear of the cutting edges of a drill bit (worn drill) is detrimental for bone tissues and can seriously affect its performance. The aim of this study is to move closer to minimally invasive surgical procedures in bones by investigating the effect of wear of surgical drill bits on their performance. The surface quality of the drill was found to influence the bone temperature, the axial force, the torque and the extent of biological damage around the drilling region. Worn drill produced heat above the threshold level related to thermal necrosis at a depth equal to the wall thickness of an adult human bone. Statistical analysis showed that a sharp drill bit, in combination with a medium drilling speed and drilling at shallow depth, was favourable for safe drilling in bone. This study also suggests the further research on establishing a relationship between surface integrity of a surgical drill bit and irreversible damage that it can induce in delicate tissues of bone using different drill sizes as well as drilling parameters and conditions.

Thermographic analysis of perforations in polyurethane blocks performed with experimental conical drill bit in comparison to conventional orthopedic drill bit: a preliminary study

“…No correlation was found between the number of perforations and MT, even when evaluating the groups together ( r = 0.047; p = 0.747) or separately (G1: r = 0.014; p = 0.948 and G2: r = 0.118; p = 0.576), suggesting that there was no significant wear on the drill bits to influence the perforation temperature over the five perforations of each drill. Alam et al related the use of worn drills to the need to increase axial force and drilling time, which caused higher temperatures during bone drilling [ 8 ]. However, in the aforementioned work, tests were executed with drills that drilled 50, 100, 150 and 200 times.…”

“…Therefore, it is feasible to compare the five perforations of each drill in the present study, with no influence on thermal variables depending on the number of perforations. Furthermore, in routine orthopedic procedures, the same drill bit is used to perform several drillings [ 8 ], which allows simulating a surgical reality, with respect to the number of perforations, in the present study.…”

“…Thermal necrosis may be related to cell apoptosis and reabsorption, infection, and early loosening of implants, resulting in direct or indirect loss of stability of the osteosynthesis fixation systems [ 6 – 8 ].…”

Surface structure characteristics of dental implants and their potential changes following installation: a literature review

“…Use of drill bits with smaller dimensions and implants with tapered geometries can result in good stability and local compression 52 . Although a drill bit with a much smaller diameter than the implant may ensure initial primary stability, it can cause bone necrosis due to bone remodeling, which reduces primary stability 53 .…”

“…Although a drill bit with a much smaller diameter than the implant may ensure initial primary stability, it can cause bone necrosis due to bone remodeling, which reduces primary stability 53 .…”