Although the importance of atraumatic preparation of bone when placing osseointegrated implants has long been emphasised, the situation during placement of self-tapping screws has received little attention. Since the production of excessively high temperatures during osseous drilling is known to impair bony regeneration, the strict thermal criteria that are set for implant placement should theoretically be extended to trauma and orthognathic internal fixation.
Investigation: Temperatures achieved during drilling thawed human cadaveric bone prior to the insertion of osteosynthesis self-tapping screws were measured in vivo with thermocouples. Combinations of two drilling systems and two bur designs were studied. Variations in surgical technique were incorporated by altering both the force applied by the operator and the application of irrigant. Statistical significance was examined using Student's t-test.
Findings: One of the two bur designs and careful operator technique were associated with significantly smaller increases in temperature. Irrigation had the greatest effect on temperature recorded, with the absence of irrigant resulting in temperatures in excess of 70ºC. These findings emphasise the importance of careful surgical technique and constant irrigation during osseous preparation if the potential for bone regeneration around osteosynthesis self-tapping screws is to be maximised.
Kerawala CJ, Martin IC, Allan W, Williams ED. The effects of operator technique and bur design on temperature during osseous preparation for osteosynthesis self-taping screws. Oral Surg Med Oral Pathol Oral Radiol Endod 1999;88:145-50.
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