Tooth sectioning for coronectomy: how to perform?

Szalma, József; Vajta, László; Olasz, Lajos; Lempel, Edina

doi:10.1007/s00784-018-2466-2

Cited by 11 publications

(9 citation statements)

References 41 publications

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“…In addition, while our in vitro experiment was able to control and keep drilling parameters constant, intraorally parameters are continuously changing and, e.g., axial load may reach higher or even extreme values. Moreover, intraorally the maximum amount (~60 ml/min) of irrigation may already disturb the patient, so according to the surgeons' choice or in some intraoral critical situations (retromolar area, disturbing effect of excessive soft tissues or the flap) a reduced irrigation volume can occur [14, 32]. With a reduced irrigation, maximum temperatures may be significantly higher [33].…”

Section: Discussionmentioning

confidence: 99%

Recommended Drilling Parameters of Tungsten Carbide Round Drills for the Most Optimal Bone Removals in Oral Surgery

Szalma

Klein

Lovász

et al. 2018

BioMed Research International

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Background High temperatures during drilling can cause thermal osteonecrosis and abnormal wound healing. According to our best knowledge, a widely accepted recommendation for optimal drilling parameters in routine oral surgery bone removals does not exist. Purpose Our aim was to investigate the correlations of different drilling parameters, including axial load and revolution speed on drilling temperatures and preparation times. Materials and Methods Standard, 5 mm deep cavities were drilled in 20 PCF (lb/ft3) dens polyurethane blocks with 3 mm (50PCF) cortical layer using new and worn, 3.1mm in diameter tungsten carbide round drills. Worn drills were used in 50 impacted third molar operations before. Axial loads of 3N, 10N, and 25N and speeds of 4.000-8.000-16.000-40.000 revolutions per minute (rpm) were tested. Temperature differences of drilling parameters were calculated by 1-way ANOVA, followed by Tukey's HSD post hoc tests. Time differences and differences among “optimal” and “suboptimal” groups (with the cut-off value of 3°C and 3s) were estimated by Kruskal-Wallis test with pairwise comparisons. P<0.05 was considered significant. Results The highest mean temperatures with new and worn drills were 4.64±0.53°C and 6.89±1.16°C, while drilling times varied between 0.16±0.02s and 22.77±5.45s. A 3°C and 3s cut-off value classified drillings significantly to (1) optimal [3N and 8000-16000-40000 rpm or 10N and 4000-8000-16000-40000 rpm] or suboptimal due to (2) high temperatures or (3) long preparation times. Using worn drills, the following parameters should be avoided: 3N with 4.000-8.000 rpm, 10N with 40000 rpm, and 25N at any revolutions. Discussion The study extensively mapped the drilling temperatures and preparation times of tungsten carbide round drills. Temperatures did not exceed 10°C during drillings with maximal amount of cooling, as well as the drilling parameters, which kept temperatures and preparation times in the most optimal range which were clearly established.

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Section: Discussionmentioning

confidence: 99%

Recommended Drilling Parameters of Tungsten Carbide Round Drills for the Most Optimal Bone Removals in Oral Surgery

Szalma

Klein

Lovász

et al. 2018

BioMed Research International

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“…Nowadays, minimally traumatic tooth extraction is widely applied, since it improves the clinical outcome, including reducing healing time, discomfort and inflammation [ 1 , 2 ]. Furthermore, a contra-angle high-speed hand-piece bur made of steel with a tungsten carbide or diamond coating is one of the methods used for tooth sectioning during minimally traumatic extraction of impacted mandibular third molars [ 3 – 5 ]. During tooth sectioning, more than one cut is frequently necessary in the impacted tooth, and the breakage of the high-speed hand-piece bur might take place during extraction of an impacted mandibular third molar when the instrument is not properly selected and the bur improperly used [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Breakage and displacement of the high-speed hand-piece bur during impacted mandibular third molar extraction: three cases

Xie

Chen

et al. 2022

BMC Oral Health

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Background The high-speed hand-piece bur is one of the methods to perform tooth sectioning during the minimally traumatic extraction of impacted mandibular third molars. During tooth sectioning, the breakage of the bur might take place when it is improperly used. Three cases of the breakage and displacement of a high-speed hand-piece bur during extraction are reported, aiming to remind dental surgeons of this complication. Case presentation The bur fragment in case 1 was embedded in the mandibular bone under the previously removed crown of tooth 48 and distal to tooth 47. The bur fragment in case 2 was embedded in the lingual edge of the socket and partly beneath the mucosa on the lingual side. The position of the bur fragment in case 3 was similar to that of case 1 but was completely embedded in the spongious bone. The three cases were performed by first-year residents, and all of the bur fragments were successfully removed by attending doctors after accurately locating them by radiological examination. Conclusions In order to avoid breakage of the high-speed hand-piece bur, the number of uses of the bur should be monitored and the integrity and state of the bur should be carefully checked. Moreover, light pressure with little lateral force should be used during tooth sectioning. If bur breakage and displacement occur, the retrieval protocol should be determined based on the imaging findings and conducted as soon as possible to avoid serious consequences.

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“…Tooth enamel and dentin preparations—as hardest materials in the human body—may have unfortunately unpleasant temperature consequences [ 1 ]. The specifications of the drill (drill material and geometry) and drilling conditions (revolution speed, axial pressure, and irrigation method) strongly influence intrapulpal temperatures intraoperatively [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, reducing irrigation may result in more limited visualization during fine and precise movements; moreover, chip clogging of the drill and increased friction can occur [ 6 , 19 ]. With a less effective drill, preparation times and temperatures may also increase [ 1 , 20 ]. Higher and longer lasting temperature peaks, and specifically those exceeding the 5.5 °C increase threshold, may lead to pulpal necrosis, and an excessive temperature increase of 3–10 °C can lead to periodontal malformations (e.g., alveolar bone necrosis, bone loss, and ankylosis) [ 1 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…With a less effective drill, preparation times and temperatures may also increase [ 1 , 20 ]. Higher and longer lasting temperature peaks, and specifically those exceeding the 5.5 °C increase threshold, may lead to pulpal necrosis, and an excessive temperature increase of 3–10 °C can lead to periodontal malformations (e.g., alveolar bone necrosis, bone loss, and ankylosis) [ 1 , 21 ]. Based on previous research, a flow rate of 30–50 mL/min of coolant is adequate [ 22 – 24 ], although the International Organization for Standardization recommended a rate of 50 mL/min in 2017 [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of spray air settings of speed-increasing contra-angle handpieces on intrapulpal temperatures, drilling times, and coolant spray pattern

Lempel

Szalma

2021

Clin Oral Invest

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Objectives Decreasing aerosol leaks are of great interest, especially in the recent era of COVID-19. The aim was to investigate intrapulpal heat development, coolant spray patterns, and the preparation efficiency of speed-increasing contra-angle handpieces with the spray air on (mist) or off (water jet) settings during restorative cavity preparations. Methods Standard-sized cavities were prepared in 80 extracted intact human molar teeth using diamond cylindrical drills with a 1:5 speed-increasing contra-angle handpiece. A custom-made device maintained the standardized lateral drilling force (3 N) and predetermined depth. Temperatures were measured using intrapulpal thermocouple probes. The four experimental groups were as follows: mist cooling mode at 15 mL/min (AIR15), water jet cooling mode at 15 mL/min (JET15), mist cooling mode at 30 mL/min (AIR30), and water jet cooling mode at 30 mL/min (JET30). The coolant spray pattern was captured using macro-photo imaging. Results The JET15 group had the highest increase in temperature (ΔT = 6.02 °C), while JET30 (ΔT = 2.24 °C; p < 0.001), AIR15 (ΔT = 3.34 °C; p = 0.042), and AIR30 (ΔT = 2.95 °C; p = 0.003) had significantly lower increases in temperature. Fine mist aerosol was formed in the AIR15 and AIR30 preparations but not in the JET15 and JET30 preparations (p < 0.001). The irrigation mode had no influence on the preparation time (p = 0.672). Conclusions Water jet irrigation using coolant at 30 mL/min appeared to be the optimal mode. Considering the safe intrapulpal temperatures and the absence of fine mist aerosols, this mode can be recommended for restorative cavity preparations. Clinical significance To increase infection control in dental practices, the water jet irrigation mode of speed-increasing handpieces with coolant flow rates of 30 mL/min should be considered for restorative cavity preparations.

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Tooth sectioning for coronectomy: how to perform?

Abstract: The correct insert can significantly reduce excessive heat and operation time during coronectomy procedures.

Cited by 11 publications

References 41 publications

Recommended Drilling Parameters of Tungsten Carbide Round Drills for the Most Optimal Bone Removals in Oral Surgery

Recommended Drilling Parameters of Tungsten Carbide Round Drills for the Most Optimal Bone Removals in Oral Surgery

Breakage and displacement of the high-speed hand-piece bur during impacted mandibular third molar extraction: three cases

Effect of spray air settings of speed-increasing contra-angle handpieces on intrapulpal temperatures, drilling times, and coolant spray pattern

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