RESUMEN

BACKGROUND: Bone flap resorption is an issue after autologous cranioplasty. Critical temperatures above 50°C generated by power-driven craniotomy tools may lead to thermal osteonecrosis, a possible factor in resorption. This ex vivo study examined whether the tools produced excessive heat resulting in bone flap resorption. METHODS: Using swine scapulae maintained at body temperature, burr holes, straight and curved cuts, and wire-pass holes were made with power-driven craniotomy tools. Drilling was at the conventional feed rate (FR) plus irrigation (FR-I+), at a high FR plus irrigation (hFR-I+), and at high FR without irrigation (hFR-I-). The temperature in each trial was recorded by an infrared thermographic camera. RESULTS: With FR-I+, the maximum temperature at the burr holes, the cuts, and the wire-pass holes was 69.0°C, 56.7°C, and 46.2°C, respectively. With hFR-I+, these temperatures were 53.1°C, 52.1°C, and 46.0°C, with hFR-I- they were 56.0°C, 66.5°C, and 50.0°C; hFR-I- burr hole- and cutting procedures resulted in the highest incidence of bone temperatures above 50°C followed by FR-I+, and hFR-I+. At the site of wire-pass holes, only hFR-I- drilling produced this temperature. CONCLUSIONS: Except during prolonged procedures in thick bones, most drilling with irrigation did not reach the critical temperature. Drilling without irrigation risked generating the critical temperature. Knowing those characteristics may be a help to perform craniotomy with less thermal bone damage.

Asunto(s)

RESUMEN

In recent years, a major development in dental implantology has been the introduction of patient-specific 3D-printed surgical guides. The utilization of dental guides offers advantages such as enhanced accuracy in locating the implant sites, greater simplicity, and reliability in performing bone drilling operations. However, it is important to note that the presence of such guides may contribute to a rise in cutting temperature, hence increasing the potential hazards of thermal injury to the patient's bone. The aim of this study is to examine the drilling temperature evolution in two distinct methods for 3D-printed surgical dental guides, one utilizing an internal metal bushing system and the other using external metal reducers. Cutting tests are done on synthetic polyurethane bone jaw models using a lab-scale automated Computer Numeric Control (CNC) machine to find out the temperature reached by different drilling techniques and compare them to traditional free cutting configurations. Thermal imaging and thermocouples, as well as the development of numerical simulations using finite element modeling, are used for the aim. The temperature of the tools' shanks experienced an average rise of 2.4 °C and 4.8 °C, but the tooltips exhibited an average increase of around 17 °C and 24 °C during traditional and guided dental surgery, respectively. This finding provides confirmation that both guided technologies have the capability to maintain temperatures below the critical limit for potential harm to bone and tissue. Numerical models were employed to validate and corroborate the findings, which exhibited identical outcomes when applied to genuine bone samples with distinct thermal characteristics.

Asunto(s)

RESUMEN

BACKGROUND: We examined the effect of Kirschner wire (K-wire) reuse and use of oscillating mode on heat generation within cortical bone. METHODS: Two trocar-tipped K-wires were drilled through the diaphysis of each of 30 human metacarpals and phalanges: one K-wire was inserted in rotary mode and another in oscillating mode. Each wire was reused once. Thermocouples placed within the dorsal and volar bone adjacent to the K-wire drill path measured temperatures throughout each test. RESULTS: Peak cortex temperatures were 25°C to 164°C. Rotary drilling achieves peak temperatures quicker (31 ± 78 seconds vs 44 ± 78 seconds, P = .19) than oscillating drilling, but insertion time is also less, resulting in lower overall heat exposure. This effect is also seen when the K-wire is reused (34 ± 70 seconds vs 41 ± 85 seconds, P = .4). The length of time that cortical bone was exposed to critical temperatures (47°C or more) was significantly higher when a wire was reused (36 ± 72 seconds vs 43 ± 82 seconds, P = .008). Peak temperatures greater than 70°C (a temperature associated with instantaneous cell death) were observed on many occasions. CONCLUSIONS: Overall heat exposure may be higher if a K-wire is reused or inserted in oscillating mode. In the absence of external cooling, K-wire insertion into cortical bone can easily expose bone to temperatures that exceed 70°C and may increase the risk of osteonecrosis.

Asunto(s)

RESUMEN

INTRODUCTION: Excessive surgical trauma is believed to be among the most important causes for early implant losses. As thermal injury to the bone is not only dependent on the amount of generated heat but also on the tissue exposure time, and the greatest temperature increase was found within the withdrawing period, the entire osteotomy procedure with the parameters contributing to thermal damage is of particular clinical relevance. The aim of this study was to investigate the thermal performance of metal-based and ceramic implant drills regarding the temperature exposure time during the whole osteotomy process. MATERIALS AND METHODS: This investigation consisted of 240 individual preparations in total, comprising two different drilling depths (10 and 16 mm), two irrigation methods (external and without irrigation), two implant drill materials (stainless steel and zirconia), and three consecutive drill diameters per material (2.0/2.2, 2.8, and 3.5 mm) with 10 identical repetitions. Real-time multichannel temperature measurement was conducted during automated drilling procedures in standardized bovine bone specimens. RESULTS: The maximum temperature changes were highly associated with the time period of passive drill withdrawing (p ≤ 0.05), irrespective of drill material, drilling depth, or drill diameter. Statistically significant differences in temperature generation between stainless steel and ceramic drills were observed in irrigated testing sites at both drilling depths with smaller drill diameters (2.0/2.2 and 2.8 mm, p ≤ 0.05). CONCLUSION: Results of this in vitro study could demonstrate a strong association between the highest temperature increase and the passive withdrawing time period in both investigated drill materials. Considering these findings and the resulting thermal bone damage due to the whole surgical procedure, high overall temperatures in combination with a prolonged heat exposure time may impact the future osseointegration process.

Asunto(s)

RESUMEN

The mechanical drilling process is a typical step in treating bone fractures to fix broken parts with screws and plates. Drilling generates a significant amount of heat and elevates the temperature of the bone, which can cause thermal osteonecrosis and damage to the surrounding bone tissue and nerves. Thermal inertia between heat flux and temperature gradient in nonhomogeneous interior structural medium-like biological tissues is arguable. Therefore, this paper proposes an analytical model of heat propagation in bone drilling for orthopedic surgery based on the hyperbolic Pennes bioheat transfer equation (HPBTE). Drilling experiments in bovine cortical bone samples were also carried out using an infrared thermography approach to confirm the proposed analytical model. Around the drilled hole surface, thermal necrosis is spread out from 1 to 10 mm. Increased feed rate reduces necrosis penetration distance and increases intense bone necrosis. The HPBTE includes thermal relaxation time effect and internal convective function of tissue perfusion rate. As these factors are not considered in the parabolic heat transfer equation (PHTE), the results show that the HPBTE is more accurate in predicting temperature and thermal osteonecrosis than the PHTE. As a result, proposed analytical model is a handy tool for calculating temperature to avoid thermal damage while improving process efficiency. Furthermore, it has the capability of controlling the manual or robotic drilling procedure for minimally invasive operations.

Asunto(s)

RESUMEN

As drilling generates substantial bone thermomechanical damage due to inappropriate cutting tool selection, researchers have proposed various approaches to mitigate this problem. Among these, improving the drill bit design is one of the most feasible and economical solutions. The theory and applications in drill design have been progressing, and research has been published in various fields. However, pieces of information on drill design are dispersed, and no comprehensive review paper focusing on this topic. Systemizing this information is crucial and, therefore, the impetus of this review. Here, we review not only the state-of-the-art in drill bit designs-advances in surgical drill bit design-but also the influences of each drill bit geometries on bone damage. Also, this work provides future directions for this topic and guidelines for designing an improved surgical drill bit. The information in this paper would be useful as a one-stop document for clinicians, engineers, and researchers who require information related to the tool design in bone drilling surgery.

Asunto(s)

RESUMEN

OBJECTIVES: The aim of this study was to evaluate thermal effects of ceramic and metal implant drills during implant site preparation using a standardised bovine model. MATERIAL AND METHODS: A total of 320 automated intermittent osteotomies of 10- and 16-mm drilling depths were performed using zirconium dioxide-based and stainless steel drills. Various drill diameters (2.0/ 2.2, 2.8, 3.5, 4.2 mm ∅) and different cooling methods (without/ with external saline irrigation) were investigated at room temperature (21 ± 1°C). Temperature changes were recorded in real time using two custom-built multichannel thermoprobes in 1- and 2-mm distance to the osteotomy site. For comparisons, a linear mixed model was estimated. RESULTS: Comparing thermal effects, significantly lower temperatures could be detected with steel-based drills in various drill diameters, regardless of drilling depth or irrigation method. Recorded temperatures for metal drills of all diameters and drilling depths using external irrigation were below the defined critical temperature threshold of 47°C, whereas ceramic drills of smaller diameters reached or exceeded the harmful temperature threshold at 16-mm drilling depths, regardless of whether irrigation was applied or not. The results of this study suggest that the highest temperature changes were not found at the deepest point of the osteotomy site but were observed at subcortical and deeper layers of bone, depending on drill material, drill diameter, drilling depth and irrigation method. CONCLUSIONS: This standardised investigation revealed drill material and geometry to have a substantial impact on heat generation, as well as external irrigation, drilling depth and drill diameter.

Asunto(s)

RESUMEN

Thermal osteonecrosis is the in situ death of bone tissue as a result of excessively high temperatures. While the exact temperature at which thermal osteonecrosis occurs has not yet been determined, 50°C is the accepted critical value, as bone regeneration is almost completely impaired from this point on. Thermal osteonecrosis is a significant concern in orthopedic surgery, as it can compromise the bone-implant interface in fracture fixation, which, by definition, is a complication. A literature review was undertaken of the pertinent literature concerning heat generation from bone drilling and how this heat affects bone tissue. The Pubmed, ScienceDirect, and secondary (Cochrane Library) databases were searched up to December 2017 using keywords with the appropriate use of Boolean operators. Both simple text word searching and thesaurus searching were used to maximize the number of relevant articles retrieved. Reference tracking was performed via the retrieved articles to further extend the boundaries of the search. The level of evidence was Level V. It was identified that factors affecting heat generation during bone drilling were multifactorial and did not act independently of each other. Good quality evidence exists that both bone drilling parameters and the drill itself affect heat generation in bone during bone drilling. However, external irrigation is the most important variable and should always be used to keep the bone temperature below the critical value of 50°C. Future studies should focus on how the parameters of bone drilling interact with each other and how this influences heat generation in bone drilling. There is also a lack of in vivo studies on the human bone; this too should be further investigated.

RESUMEN

INTRODUCTION: There has been growing interest in minimally invasive foot surgery due to the benefits it delivers in post-operative outcomes in comparison to conventional open methods of surgery. One of the major factors determining the protocol in minimally invasive surgery is to prevent iatrogenic thermal osteonecrosis. The aim of the study is to look at various drilling parameters in a minimally invasive surgery setting that would reduce the risk of iatrogenic thermal osteonecrosis. METHOD: Sixteen fresh-frozen tarsal bones and two metatarsal bones were retrieved from three individuals and drilled using various settings. The parameters considered were drilling speed, drill diameter, and inter-individual cortical variability. Temperature measurements of heat generated at the drilling site were collected using two methods; thermocouple probe and infrared thermography. The data obtained were quantitatively analysed. RESULTS: There was a significant difference in the temperatures generated with different drilling speeds (p<0.05). However, there was no significant difference in temperatures recorded between the bones of different individuals and in bones drilled using different drill diameters. Thermocouple showed significantly more sensitive tool in measuring temperature compared to infrared thermography. CONCLUSION: Drilling at an optimal speed significantly reduced the risk of iatrogenic thermal osteonecrosis by maintaining temperature below the threshold level. Although different drilling diameters did not produce significant differences in temperature generation, there is a need for further study on the mechanical impact of using different drill diameters.

Asunto(s)

RESUMEN

The bone drilling process is very prominent in orthopedic surgeries and in the repair of bone fractures. It is also very common in dentistry and bone sampling operations. Due to the complexity of bone and the sensitivity of the process, bone drilling is one of the most important and sensitive processes in biomedical engineering. Orthopedic surgeries can be improved using robotic systems and mechatronic tools. The most crucial problem during drilling is an unwanted increase in process temperature (higher than 47 °C), which causes thermal osteonecrosis or cell death and local burning of the bone tissue. Moreover, imposing higher forces to the bone may lead to breaking or cracking and consequently cause serious damage. In this study, a mathematical second-order linear regression model as a function of tool drilling speed, feed rate, tool diameter, and their effective interactions is introduced to predict temperature and force during the bone drilling process. This model can determine the maximum speed of surgery that remains within an acceptable temperature range. Moreover, for the first time, using designed experiments, the bone drilling process was modeled, and the drilling speed, feed rate, and tool diameter were optimized. Then, using response surface methodology and applying a multi-objective optimization, drilling force was minimized to sustain an acceptable temperature range without damaging the bone or the surrounding tissue. In addition, for the first time, Sobol statistical sensitivity analysis is used to ascertain the effect of process input parameters on process temperature and force. The results show that among all effective input parameters, tool rotational speed, feed rate, and tool diameter have the highest influence on process temperature and force, respectively. The behavior of each output parameters with variation in each input parameter is further investigated. Finally, a multi-objective optimization has been performed considering all the aforementioned parameters. This optimization yielded a set of data that can considerably improve orthopedic osteosynthesis outcomes.

Asunto(s)

RESUMEN

Significant research exists regarding heat production during single-hole bone drilling. No published data exist regarding repetitive sequential drilling. This study elucidates the phenomenon of heat accumulation for sequential drilling with both Kirschner wires (K wires) and standard two-flute twist drills. It was hypothesized that cumulative heat would result in a higher temperature with each subsequent drill pass. Nine holes in a 3 × 3 array were drilled sequentially on moistened cadaveric tibia bone kept at body temperature (about 37 °C). Four thermocouples were placed at the center of four adjacent holes and 2 mm below the surface. A battery-driven hand drill guided by a servo-controlled motion system was used. Six samples were drilled with each tool (2.0 mm K wire and 2.0 and 2.5 mm standard drills). K wire drilling increased temperature from 5 °C at the first hole to 20 °C at holes 6 through 9. A similar trend was found in standard drills with less significant increments. The maximum temperatures of both tools increased from <0.5 °C to nearly 13 °C. The difference between drill sizes was found to be insignificant (P > 0.05). In conclusion, heat accumulated during sequential drilling, with size difference being insignificant. K wire produced more heat than its twist-drill counterparts. This study has demonstrated the heat accumulation phenomenon and its significant effect on temperature. Maximizing the drilling field and reducing the number of drill passes may decrease bone injury.

Asunto(s)

RESUMEN

Medical drills are subject to intensive wear due to mechanical factors which occur during the bone drilling process, and potential thermal and chemical factors related to the sterilisation process. Intensive wear increases friction between the drill and the surrounding bone tissue, resulting in higher drilling temperatures and cutting forces. Therefore, the goal of this experimental research was to develop a drill wear classification model based on multi-sensor approach and artificial neural network algorithm. A required set of tool wear features were extracted from the following three types of signals: cutting forces, servomotor drive currents and acoustic emission. Their capacity to classify precisely one of three predefined drill wear levels has been established using a pattern recognition type of the Radial Basis Function Neural Network algorithm. Experiments were performed on a custom-made test bed system using fresh bovine bones and standard medical drills. Results have shown high classification success rate, together with the model robustness and insensitivity to variations of bone mechanical properties. Features extracted from acoustic emission and servomotor drive signals achieved the highest precision in drill wear level classification (92.8%), thus indicating their potential in the design of a new type of medical drilling machine with process monitoring capabilities.

Asunto(s)

RESUMEN

Drilling of bone is a common procedure in orthopedic surgery to produce hole for screw insertion to fixate the fracture devices and implants. The increase in temperature during such a procedure increases the chances of thermal invasion of bone which can cause thermal osteonecrosis resulting in the increase of healing time or reduction in the stability and strength of the fixation. Therefore, drilling of bone with minimum temperature is a major challenge for orthopedic fracture treatment. This investigation discusses the use of fuzzy logic and Taguchi methodology for predicting and minimizing the temperature produced during bone drilling. The drilling experiments have been conducted on bovine bone using Taguchi's L25 experimental design. A fuzzy model is developed for predicting the temperature during orthopedic drilling as a function of the drilling process parameters (point angle, helix angle, feed rate and cutting speed). Optimum bone drilling process parameters for minimizing the temperature are determined using Taguchi method. The effect of individual cutting parameters on the temperature produced is evaluated using analysis of variance. The fuzzy model using triangular and trapezoidal membership predicts the temperature within a maximum error of ±7%. Taguchi analysis of the obtained results determined the optimal drilling conditions for minimizing the temperature as A3B5C1.The developed system will simplify the tedious task of modeling and determination of the optimal process parameters to minimize the bone drilling temperature. It will reduce the risk of thermal osteonecrosis and can be very effective for the online condition monitoring of the process.

Asunto(s)

RESUMEN

OBJECTIVES: Based on a novel standardized bovine specimen, the aim of this study was to investigate thermal effects of different irrigation methods during intermittent and graduated drilling. MATERIAL AND METHODS: Temperature changes during implant osteotomies (n = 320) of 10 and 16 mm drilling depths with various irrigation methods were investigated on manufactured uniform bone samples providing homogenous cortical and cancellous areas and analogous thermal conductivity comparable to human bone. Automated sequences were performed with surgical twist drills of 2 mm ∅ and conical drills of 3.5, 4.3 and 5 mm ∅. Real-time recording of temperature increase was done using two custom-built multichannel thermoprobes with 14 temperature sensors at a predefined distance of 1 and 2 mm to the final osteotomy. The effects of drilling depth, drilling diameter and irrigation methods on temperature changes were investigated by a linear mixed model. RESULTS: Using this uniform bone specimen, the greatest temperature rise was observed without any coolant supply with 29.87°C, followed by external with 28.47°C and then internal with 25.86°C and combined irrigation with 25.68°C. Significant differences (P ≤ 0.0156) between drill depths of 10 vs. 16 mm could be observed with all irrigation methods evaluated. With each of the irrigation methods, significantly higher temperature changes (P < 0.0001) during osteotomies could be observed between twist drills of 2 mm ∅ and conical drills of 3.5, 4.3 and 5 mm ∅. During 10 and 16 mm drilling osteotomies, external irrigation showed significantly higher temperatures (P < 0.05) for all conical drills compared with internal or combined irrigation, respectively. Significantly lower temperatures (P < 0.05) could be detected with internal or combined irrigation for the use of conical drills with various diameters and drilling depths. CONCLUSIONS: This fully standardized bone model provides optimized comparability for the evaluation of bone osteotomies and resulting temperature changes. As regards the efficiency of the various irrigation methods, it could be demonstrated that internal and combined irrigation appears to be more beneficial than external irrigation.

Asunto(s)

RESUMEN

OBJECTIVES: The purpose of this study was to evaluate the temperature changes during implant osteotomies with a combined irrigation system as compared to the commonly used external and internal irrigation under standardized conditions. MATERIAL AND METHODS: Drilling procedures were performed on VII bovine ribs using a computer-aided surgical system that ensured automated intermittent drilling cycles to simulate clinical conditions. A total of 320 drilling osteotomies were performed with twist (2 mm) and conical implant drills (3.5/4.3/5 mm) at various drilling depths (10/16 mm) and with different saline irrigation (50 ml/min) methods (without/external/internal/combined). Temperature changes were recorded in real time by two custom-built thermoprobes with 14 temperature sensors (7 sensors/thermoprobe) at defined measuring depths. RESULTS: The highest temperature increase during osteotomies was observed without any coolant irrigation (median, 8.01°C), followed by commonly used external saline irrigation (median, 2.60°C), combined irrigation (median, 1.51°C) and ultimately with internal saline irrigation (median, 1.48°C). Temperature increase with different drill diameters showed significant differences (P < 0.05) regarding drill depth, confirming drill depth and time of drilling as influencing factors of heat generation. Internal saline irrigation showed a significantly smaller temperature increase (P < 0.05) compared with combined and external irrigation. A combined irrigation procedure appears to be preferable (P < 0.05) to an external irrigation method primarily with higher osteotomy depths. CONCLUSIONS: Combined irrigation provides sufficient reduction in temperature changes during drilling, and it may be more beneficial in deeper site osteotomies. Further studies to optimize the effects of a combined irrigation are needed.

Asunto(s)

RESUMEN

BACKGROUND: Bone fracture treatment usually involves restoring of the fractured parts to their initial position and immobilizing them until the healing takes place. Drilling of bone is common to produce hole for screw insertion to fix the fractured parts for immobilization. Orthopaedic drilling during surgical process causes increase in the bone temperature and forces which can cause osteonecrosis reducing the stability and strength of the fixation. METHODS: A comprehensive review of all the relevant investigations carried on bone drilling is conducted. The experimental method used, results obtained and the conclusions made by the various researchers are described and compared. RESULT: Review suggests that the further improvement in the area of bone drilling is possible. The systematic review identified several consequential factors (drilling parameters and drill specifications) affecting bone drilling on which there no general agreement among investigators or are not adequately evaluated. These factors are highlighted and use of more advanced methods of drilling is accentuated. The use of more precise experimental set up which resembles the actual situation and the development of automated bone drilling system to minimize human error is addressed. CONCLUSION: In this review, an attempt has been made to systematically organize the research investigations conducted on bone drilling. Methods of treatment of bone fracture, studies on the determination of the threshold for thermal osteonecrosis, studies on the parameters influencing bone drilling and methods of the temperature measurement used are reviewed and the future work for the further improvement of bone drilling process is highlighted.