Bone Temperature Variation Using a 3D-Printed Surgical Guide with Internal Irrigation

Michele Stocchero,Arianna Zoppello,Giulia Brunello,Stefano Sivolella,Lisa Biasetto,Francesco Cavallin

doi:10.3390/app11062588

Michele Stocchero, Arianna Zoppello + Show 4 more

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https://doi.org/10.3390/app11062588

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Abstract

Bone overheating is a possible cause of implants early failure. When a surgical guide is used, the risk of heat injury is greater due to the reduced efficacy of the irrigation. The aim of this ex vivo study was to evaluate the effect of an additional built-in irrigation on bone temperature variation during implant osteotomy. Twelve bovine ribs were used. Cone beam computerized tomography (CBCT) was performed and a 3D-printed surgical guide with additional built-in irrigation tubes was produced for each rib. A total of 48 osteotomies were prepared, to compare the supplementary internal irrigation system (Group A) with external irrigation alone (Group B), no irrigation (Group C) and with free-hand surgery with external irrigation (Group D). Temperature was measured by three thermocouples placed at depths of 1.5, 7, and 12 mm. The largest temperature variation at each thermocouple showed median values of 3.0 °C, 1.9 °C, and 2.3 °C in Group 1; 2.3 °C, 1.7 °C, and 0.9 °C in Group 2; 3.2 °C, 1.6 °C, and 2.0 °C in Group 3; 2.0 °C, 2.0 °C, and 1.3 °C in Group 4, respectively. No differences were found among the four groups. In general, the highest temperature increase was observed with the use of the first drill (cortical perforator). Post-experimental CBCT revealed the presence of radiopaque material clogging the aperture of the internal irrigation channels. Additional internal irrigation was not found to significantly contribute to decrease bone temperature in this ex vivo setting.

Highlights

Introduction published maps and institutional affilOverheating is a possible cause of implants failure during the early phases of healing, due to an excessive thermal stress to the bone [1,2,3].Frictional heat is always generated during implant site preparation with cutting tools at high speed [4,5] and during implant insertion [6]
Is indicated as follows: (*) Cortical Perforator drill; (●) 2.0 mm; (▲) 2.75 mm; (✦) 3.0 largest temperature variation at the bone crest: 1.5 mm (Tc1) showed a median of 3.0 ◦ C (IQR 2.4–3.4 ◦ C) in mm The twist drills
Group 1, which was not statistically different than Group 2, Group 3, or Group 4

Summary

Introduction

Introduction published maps and institutional affilOverheating is a possible cause of implants failure during the early phases of healing, due to an excessive thermal stress to the bone [1,2,3].Frictional heat is always generated during implant site preparation with cutting tools at high speed [4,5] and during implant insertion [6]. Overheating is a possible cause of implants failure during the early phases of healing, due to an excessive thermal stress to the bone [1,2,3]. When bone is exposed to excessive heat, tissue necrosis can be triggered [7]. It has been demonstrated that the threshold temperature for bone tissue viability is 47 ◦ C for 1 min and a linear relationship between time of exposure and the extent of the damaged area has been observed [8]. Heat causes a dehydration of the tissue, a denaturation of membrane proteins, a decrease in osteoblastic and osteoclastic activity, and interrupts the microcirculation contributing to cells necrosis [9,10]. Necrotic tissue is more prone to bacterial infections [10]

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