Bernabeu-Mira Juan Carlos, Soto-Peñaloza David, Peñarrocha-Diago Miguel, Camacho-Alonso Fabio, Rivas-Ballester Rebeca, Peñarrocha-Oltra David
Oral Surgery Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Gascó Oliag, 1, 46010, Valencia, Spain.
Department of Oral Surgery, University of Murcia, Murcia, Spain.
Clin Oral Investig. 2021 Jul;25(7):4251-4267. doi: 10.1007/s00784-021-03939-z. Epub 2021 Apr 24.
This paper aims to review the evidence comparing low-speed drilling without irrigation versus conventional drilling for dental implant osteotomy preparation.
A systematic review was carried out based on the PRISMA statement. Four databases and gray literature were searched up to November 2020. In vitro, animal, and clinical studies were included. The variables were temperature change, drilling time, quantity of harvested bone, osteotomy precision, marginal bone loss, implant success rate, osseointegration, and the histomorphologic characteristics and cellularity of the osteotomy and of the harvested bone. Different tools for the assessment of bias were applied for each study design.
A total of 626 articles were identified, of which 13 were included. Both low-speed drilling without irrigation (test group) and conventional drilling (control group) maintained temperatures below the critical temperature of 47 °C. The test group yielded a greater quantity and more beneficial cellular and histomorphologic properties of harvested bone, with a longer drilling time and greater osteotomy precision (p < 0.05). No significant results were obtained regarding drill wear, osseointegration, marginal bone loss, implant success rate, and histomorphology of the dental implant osteotomy (p > 0.05). The results, in particular on the osteotomy precision and quantity of harvested bone chips, should be interpreted with caution because outcomes are based in only one in vitro study.
Low-speed drilling without irrigation seems to be comparable to conventional drilling in preparing dental implant osteotomies. In some situations, low-speed drilling without irrigation might offer advantages over conventional drilling. The results should be interpreted with caution due to the low percentage of clinical human studies. Accordingly, more clinical studies are needed to improve the scientific evidence on this topic.
The low-speed drilling without irrigation is a valid technique for dental implant osteotomy preparation. Its higher quantity and quality of harvested autologous bone might be particularly beneficial in cases of dental implant placement with minor simultaneous bone regeneration.
本文旨在综述比较无冲洗低速钻孔与传统钻孔制备牙种植体截骨术的证据。
基于PRISMA声明进行系统评价。检索了4个数据库和灰色文献，截至2020年11月。纳入了体外、动物和临床研究。变量包括温度变化、钻孔时间、收获骨量、截骨精度、边缘骨丢失、种植体成功率、骨整合以及截骨术和收获骨的组织形态学特征及细胞性。针对每种研究设计应用了不同的偏倚评估工具。
共识别出626篇文章，其中13篇被纳入。无冲洗低速钻孔（试验组）和传统钻孔（对照组）均将温度维持在47℃的临界温度以下。试验组收获的骨量更多，且收获骨的细胞和组织形态学特性更有益，钻孔时间更长，截骨精度更高（p<0.05）。在钻头磨损、骨整合、边缘骨丢失、种植体成功率和牙种植体截骨术的组织形态学方面未获得显著结果（p>0.05）。由于结果仅基于一项体外研究，因此，尤其是关于截骨精度和收获骨屑量的结果应谨慎解释。
无冲洗低速钻孔在制备牙种植体截骨术方面似乎与传统钻孔相当。在某些情况下，无冲洗低速钻孔可能比传统钻孔具有优势。由于临床人体研究的比例较低，因此对结果的解释应谨慎。因此，需要更多的临床研究来完善关于该主题的科学证据。
无冲洗低速钻孔是一种用于牙种植体截骨术制备的有效技术。其收获的自体骨数量更多、质量更高，在同时进行少量骨再生的牙种植体植入病例中可能特别有益。
