title: Novel hybrid drilling protocol: evaluation for the implant healing--thermal changes, crestal bone loss, and bone-to-implant contact.
abstract: OBJECTIVE
  To evaluate a new hybrid drilling protocol, by the analysis of thermal changes in vitro, and their effects in the crestal bone loss and bone-to-implant contact in vivo.
  
  
  METHODS
  Temperature changes during simulated osteotomies with a hybrid drilling technique (biologic plus simplified) (test) versus an incremental drilling technique (control) were investigated. One hundred and twenty random osteotomies were performed (60 by group) in pig ribs up to 3.75-mm-diameter drill to a depth of 10 mm. Thermal changes and time were recorded by paired thermocouples. In a parallel experiment, bilateral mandibular premolars P2, P3, P4, and first molar M1 were extracted from six dogs. After 2-month healing, implant sites were randomly prepared using either of the drilling techniques. Forty eight implants of 3.75 mm diameter and 10 mm length were inserted. The dogs were euthanized at 30 and 90 days, and crestal bone loss (CBL) and bone-to-implant contact (BIC) were evaluated.
  
  
  RESULTS
  The control group showed maximum temperatures of 35.3 °C ± 1.8 °C, ΔT of 10.4 °C, and a mean time of 100 s/procedure; meanwhile, the test group showed maximum temperatures of 36.7 °C ± 1.2 °C, ΔT of 8.1 °C, and a mean time of 240 s/procedure. After 30 days, CBL values for both groups (test: 1.168 ± 0.194 mm; control: 1.181 ± 0.113 mm) and BIC values (test: 43 ± 2.8%; control: 45 ± 1.3%) were similar, without significant differences (P > 0.05). After 90 days, CBL (test: 1.173 ± 0.187 mm; control: 1.205 ± 0.122 mm) and BIC (test: 64 ± 3.3%; control: 64 ± 2.4%) values were similar, without significant differences (P > 0.05). The BIC values were increased at 90 days in both groups compared with the 30-day period (P < 0.05).
  
  
  CONCLUSIONS
  Within the limitations of this study, the new hybrid protocol for the preparation of the implant bed without irrigation, increase the temperature similarly to the incremental conventional protocol, and requires twice the time for the completion of the drilling procedure in vitro. Crestal bone loss and bone-to-implant contact in the hybrid drilling protocol are comparable with the conventional drilling protocol and do not affect the osseointegration process in vivo.
authors: General and Implant Dentistry, University of Murcia, Murcia, Spain.
authors: José Luis
authors: JL
authors: Calvo-Guirado
authors: Implant Dentistry, University of Murcia, Murcia, Spain.
authors: Jorge
authors: J
authors: Delgado-Peña
authors: Restorative Dentistry, University of Murcia, Murcia, Spain.
authors: Jose E
authors: JE
authors: Maté-Sánchez
authors: International University of Catalonia, Barcelona, Spain.
authors: Javier
authors: J
authors: Mareque Bueno
authors: Prosthodontics, Stony Brook University, Stony Brook, NY, USA.
authors: Rafael Arcesio
authors: RA
authors: Delgado-Ruiz
authors: School of dental Medicine, Stony Brook University, Stony Brook, NY, USA.
authors: Georgios E
authors: GE
authors: Romanos
mesh_terms: D000539:Alveolar Process / Q000601:surgery*; D000818:Animals; D001641:Bicuspid; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D004285:Dogs; D020007:Implants, Experimental; D008334:Mandible / Q000601:surgery; D016348:Osseointegration / Q000502:physiology; D010027:Osteotomy / Q000379:methods; D012272:Ribs / Q000601:surgery; D013552:Swine; D013696:Temperature; D014945:Wound Healing / Q000502:physiology
chemical_list: D015921:Dental Implants
keywords: animal studies; biologic drilling; bone-to-implant contact; crestal bone loss; histomorphometry; incremental drilling