Abstract
The preservation of bone viability at an osteotomy site is a critical variable for subsequent implant osseointegration. Recent biomechanical studies evaluating the consequences of site preparation led us to rethink the design of bone-cutting drills, especially those intended for implant site preparation. We present here a novel drill design that is designed to efficiently cut bone at a very low rotational velocity, obviating the need for irrigation as a coolant. The low-speed cutting produces little heat and, consequently, osteocyte viability is maintained. The lack of irrigation, coupled with the unique design of the cutting flutes, channels into the osteotomy autologous bone chips and osseous coagulum that have inherent osteogenic potential. Collectively, these features result in robust, new bone formation at rates significantly faster than those observed with conventional drilling protocols. These preclinical data have practical implications for the clinical preparation of osteotomies and alveolar bone reconstructive surgeries.
Highlights
The medical and dental professions, with few exceptions, adapted commercially available tools for use that were developed for drilling other materials [1]
Metal drills are end-cutting tools, e.g., only the tip of the drill is engaged in producing a hole, and the same is true for the vast majority of bone-cutting drills [2]
We studied the biological responses to osteotomy site preparation in multiple animal species [6,7,8,9] including humans [10], and these analyses, coupled with computational and finite element modeling [5], prompted us to reconsider the design of a bone-cutting tool, optimized for osteotomy site preparation
Summary
The medical and dental professions, with few exceptions, adapted commercially available tools for use that were developed for drilling other materials [1]. Bone-cutting tools, which are largely predicated on the design of metal-cutting instruments. Metal drills are end-cutting tools, e.g., only the tip of the drill is engaged in producing a hole, and the same is true for the vast majority of bone-cutting drills [2]. Metal drills and most bone drills are designed to cut at a high rotational velocity, which means that the drill can be advanced with minimal axial thrust force [3]. Metal and bone drills generally have a relatively small rake angle, which means that particles generated by cutting are typically scattered from the site to avoid obstructing the drill. Metal drilling typically requires a lubricant that serves as a coolant [4]; in bone cutting, these functions are replaced by saline irrigation [5]
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