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임플랜트 식립부위 형성시 골조직의 온도변화에 관한 연구
A STUDY ON THE TEMPERATURE CHANGES OF BONE TISSUES DURING IMPLANT SITE PREPARATION

김평일   (서울대학교 치과대학 치과보철학교실UU0000691  ); 김영수   (서울대학교 치과대학 치과보철학교실UU0000691  ); 장경수   (서울대학교 치과대학 치과보철학교실UU0000691  ); 김창회   (서울대학교 치과대학 치과보철학교실UU0000691  );
  • 초록

    The purpose of this study is to examine the possibility of thermal injury to bone tissues during an implant site preparation under the same condition as a typical clinical practice of $Br{\aa}nemark$ implant system. All the burs for $Br{\aa}nemark$ implant system were studied except the round bur The experiments involved 880 drilling cases : 50 cases for each of the 5 steps of NP, 5 steps of RP, and 7 steps of WP, all including srew tap, and 30 cases of 2mm twist drill. For precision drilling, a precision handpiece restraining system was developed (Eungyong Machinery Co., Korea). The system kept the drill parallel to the drilling path and allowed horizontal adjustment of the drill with as little as $1{\mu}m$ increment. The thermocouple insertion hole. that is 0.9mm in diameter and 8mm in depth, was prepared 0.2mm away from the tapping bur the last drilling step. The temperatures due to countersink, pilot drill, and other drills were measured at the surface of the bone, at the depths of 4mm and 8mm respectively. Countersink drilling temperature was measured by attaching the tip of a thermocouple at the rim of the countersink. To assure temperature measurement at the desired depths, 'bent-thermocouples' with their tips of 4 and 8mm bent at $120^{\circ}$ were used. The profiles of temperature variation were recorded continuously at one second interval using a thermometer with memory function (Fluke Co. U.S.A.) and 0.7mm thermocouples (Omega Co., U.S.A.). To simulate typical clinical conditions, 35mm square samples of bovine scapular bone were utilized. The samples were approximately 20mm thick with the cortical thickness on the drilling side ranging from 1 to 2mm. A sample was placed in a container of saline solution so that its lower half is submerged into the solution and the upper half exposed to the room air, which averaged $24.9^{\circ}C$ . The temperature of the saline solution was maintained at $36.5^{\circ}C$ using an electric heater (J. O Tech Co., Korea). This experimental condition was similar to that of a patient s opened mouth. The study revealed that a 2mm twist drill required greatest attention. As a guide drill, a twist drill is required to bore through a 'virgin bone,' rather than merely enlarging an already drilled hole as is the case with other drills. This typically generates greater amount of heat. Furthermore, one tends to apply a greater pressure to overcome drilling difficulty, thus producing even greater amount heat. 150 experiments were conducted for 2mm twist drill. For 140 cases, drill pressure of 750g was sufficient, and 10 cases required additional 500 or 100g of drilling pressure. In case of the former. 3 of the 140 cases produced the temperature greater than $47^{\circ}C$ , the threshold temperature of degeneration of bone tissue (1983. Eriksson et al.) which is also the reference temperature in this study. In each of the 10 cases requiring extra pressure, the temperature exceeded the reference temperature. More significantly, a surge of heat was observed in each of these cases This observations led to addtional 20 drilling experiments on dense bones. For 10 of these cases, the pressure of 1,250g was applied. For the other 10, 1.750g were applied. In each of these cases, it was also observed that the temperature rose abruptly far above the thresh old temperature of $47^{\circ}C$ , sometimes even to 70 or $80^{\circ}C$ . It was also observed that the increased drilling pressure influenced the shortening of drilling time more than the rise of drilling temperature. This suggests the desirability of clinically reconsidering application of extra pressures to prevent possible injury to bone tissues. An analysis of these two extra pressure groups of 1,250g and 1,750g revealed that the t-statistics for reduced amount of drilling time due to extra pressure and increased peak temperature due to the same were 10.80


  • 주제어

    Drilling heat generation .   Thermocouple .   Drilling pressure .   Drilling time .   Reusing drills .   2mm twist drill.  

  • 참고문헌 (22)

    1. Eriksson A. Albrektsson T. Temperature threshold levels for heat-induced bone tissue injury : A vital microscopic study in rabbit. J Prosthet Dent 1983:50:101-107 
    2. Kerawala CJ, Martin IC, Allan W, Williams ED. The effects of operature technique and bur design on temperature during osseous preparation for osteosynthesis self-tapping screws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999:88:145-150 
    3. Wachter R, Stroll P. Increase ot temperature during osteotomy. In vitro and in vivo investgations. Int J Oral Maxillofac Surg 1991:20:245-249 
    4. Sevitt S. Pathological sequelae of burns. Proc R Soc Med 1954:47:225-228 
    5. Iyer S, Weiss C, Mehta A. Effects of drill speed on heat production and the rate and quality of bone formation in dental implant osteotomies. Part 1 : Relatationship between drill speed and heat production. Int J Prosthodont 1997:10:411-414 
    6. Brisman DL. The effect of speed, pressure, and time on bone temperature during the drilling of implant sites. Int J Oral Maxillofac Implants 1996:11:35-37 
    7. Moon ES, Lim HS, Cho IH. A study on the heat generation of bone drilling burs according to irrigation during implantation of dental implant. J Kor Academy of Pros 1999:37:433-453 
    8. Sutter F, Krekeler G, Schwammerger AW, Sutter FJ. Atraumatic surgical technique and implant bed preperation. Quintessence Int 1992:23:811-816 
    9. Moritz AR, Henriques FC Jr. Studies of thermal injury. Am J Path 1947;23:695-720 
    10. Cordioli G, Majzoub Z. Heat generation during implant site preparation. An in vitro study. Int J Oral Maxillofac Implants 1997:12:186-193 
    11. Abouzgia MB, James DF. Temperature rise during drilling through bone. Int J Oral Maxillofac Implants 1997:12:342-353 
    12. Yacker M, Klein M.: The effect of irrigation on osteotomy depth and bur diameter. Int J Oral Maxillofac Implants., 1996:11: 634-638 
    13. Watanabe F, Tawade Y, Komatus S, Hata Y. Heat distribution in bone during preparation of implant sites: heat annalysis by real-time thermography. Int J Oral Maxillofac Implants. 1992:7:212-219 
    14. Hwang HW, Lee SC, Kim YG, Ryu DM, Lee BS, Clinical study of dental implant: requirements for successful osseointegration. KAID 1999:18:1-9 
    15. Albrektsson T, Zarb G, Worthington P, Eriksson A. The long-term efficacy of currently used dental implants. A review and proposed criteria for success. Int J Oral Maxillofac Implants 1986: 1: 11-25 
    16. Eriksson R, Adell. Temperature during drilling for the placement of implants using the osseointegration technique. J Oral Maxllofac Surg 1986:44:4-7 
    17. Benington IC, Biagioni PA. Crossey PJ. Hussey DL, Sheridan S, Lamey PJ. Temperature changes in bovin mandibular bone during implant site preparation: an assessment using infra-red thermography. J Dent 1996:24:263-267 
    18. Krause WR, Bredbury DW, Kelly JE, Lunceford EM. Temperature elevation in orthopedic cutting operations. J Biomech Eng 1982: 15: 267-275 
    19. Lee JG, Yang JH. Lee SH. A study on the effect of rotational speeds of the trephine mill on the temperature of surrounding bone during dental implantation procedure and osseointegration of implants. J Kor Academy of Pros 1992:30:167-190 
    20. Mathews LS. Hirsch C. Temperatures measured in human cortical bone when drilling. J Bone Joint Surg 1972:54:297-308 
    21. Albrektsson T. Branemark PI. Hansson HA, Lindstro J. Osseointegrated titanium implants. : Requirements for ensuring a long lasting, direct bone ankorage in man. Acta Orthop Scand 1981:52:155-170 
    22. Bachus KN, Rondina MT, Hutchinson DT. The effects of drilling force on cortical temperatures and their duration: an vitro study. Medical Engineering & Physics 2000:22: 685-691 

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  • 김평일 (1)

    1. 1977 "하악 전방 운동로에 관한 연구" 大韓齒科醫師協會誌 = The journal of the Korean dental association 15 (9): 732~737    
  • 김영수 (111)

  • 장경수 (17)

  • 김창회 (88)

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