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Research Papers

A Thermal and Biological Analysis of Bone Drilling

[+] Author and Article Information
Maziar Aghvami, John B. Brunski, U. Serdar Tulu

Division of Plastic and Reconstructive Surgery,
Department of Surgery,
School of Medicine,
Stanford University,
Stanford, CA 94304

Chih-Hao Chen

Division of Plastic and Reconstructive Surgery,
Department of Surgery,
School of Medicine,
Stanford University,
Stanford, CA 94304;
Craniofacial Research Center,
Department of Plastic and
Reconstructive Surgery,
Chang Gung Memorial Hospital,
Chang Gung University School of Medicine,
Taoyuan 33305, Taiwan

Jill A. Helms

Division of Plastic and Reconstructive Surgery,
Department of Surgery,
School of Medicine,
Stanford University,
Stanford, CA 94304
e-mail: jhelms@stanford.edu

1Corresponding author.

Manuscript received January 24, 2018; final manuscript received May 4, 2018; published online June 21, 2018. Assoc. Editor: Ram Devireddy.

J Biomech Eng 140(10), 101010 (Jun 21, 2018) (8 pages) Paper No: BIO-18-1050; doi: 10.1115/1.4040312 History: Received January 24, 2018; Revised May 04, 2018

With the introduction of high-speed cutting tools, clinicians have recognized the potential for thermal damage to the material being cut. Here, we developed a mathematical model of heat transfer caused by drilling bones of different densities and validated it with respect to experimentally measured temperatures in bone. We then coupled these computational results with a biological assessment of cell death following osteotomy site preparation. Parameters under clinical control, e.g., drill diameter, rotational speed, and irrigation, along with patient-specific variables such as bone density were evaluated in order to understand their contributions to thermal damage. Predictions from our models provide insights into temperatures and thresholds that cause osteocyte death and that can ultimately compromise stability of an implant.

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References

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Figures

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Fig. 1

Bone drilling, schematics, and heat generation: (a) an example of drilling in the rat maxillary alveolar bone; note the relative size of the drill to the anatomic location, e.g., the edentulous ridge, (b) schematic of bone cutting and the associated zones of heat generation, (c) the drill and parameters; adapted from Ref. [10], and (d) heat from drilling cortical bone and the linear relationships between heat and drill diameter for different rotational speeds

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Fig. 2

Computational domain. The majority of osteotomies in the oral cavity are generated in healed extraction sites; this condition was replicated in a model organism (rat): μCT images: (a) osteotomy in alveolar bone, and (b) superimposed on which is a schematic of the heat transfer during bone drilling. (c) Computational model, which takes into account the appropriate bone density, and boundary conditions. The heat flux was applied at the drill tip, which was moved vertically.

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Fig. 3

Validation of the heat transfer model. Computational and experimental bone temperatures versus (a) drilling duration and (b) radial distance from the drill. Computational results agreed well with previous experimental data and demonstrated that peak temperatures occurred in the immediate vicinity of an osteotomy.

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Fig. 4

Distribution of apoptotic osteocytes and calculated temperatures demonstrate a correlation between biological and thermal assessments. (a) Using TUNEL staining, a zone of apoptosis (arrow) is evident around the edge of the osteotomy (dotted line). The distribution of dying osteocytes corresponds to (b) calculated temperatures in the immediate vicinity of the drill. The threshold temperature for osteocyte apoptosis was determined as ∼47 °C. Both the biological response (TUNEL staining) and the temperature contours are shown at the same relative magnification.

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Fig. 5

Average maximum bone temperatures as a function of radial distance from the drill for various bone densities and clinical drilling protocols. (a) N = 500 rpm; D = 1.6 mm, (b) N = 500 rpm; D = 5.0 mm, (c) N = 1000 rpm; D = 1.6 mm, (d) N = 1000 rpm; D = 5.0 mm, (e) N = 1500 rpm; D=1.6 mm, and (f) N = 1500 rpm; D = 5.0 mm. The gray horizontal line indicates the threshold for the thermally affected zone. Temperature distributions and thermally affected zones were calculated for clinical and patient-specific parameters.

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Fig. 6

Relative contribution of drilling parameters to the size of thermally affected zone: (a) drill diameter, (b) rotational speed, (c) irrigation, and (d) bone density, i.e., BV/TV. The results indicated that rotational speed, irrigation, and bone density are critically important in the extent of cell death resulting from osteotomy site preparation.

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