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Article

Heat Generation During Guided Bone Drilling: Bone Trephine Versus Pilot Drill

by
Gábor Pintér
1,
Gábor Braunitzer
2,
Eszter Nagy
3,
Kristóf Boa
1,
József Piffkó
1 and
Mark Adam Antal
3,*
1
Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary
2
dicomLAB Dental, Ltd., 6726 Szeged, Hungary
3
Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Tisza Lajos krt. 64-66, 6720 Szeged, Hungary
*
Author to whom correspondence should be addressed.
Lubricants 2025, 13(3), 115; https://doi.org/10.3390/lubricants13030115
Submission received: 28 January 2025 / Revised: 24 February 2025 / Accepted: 4 March 2025 / Published: 7 March 2025
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Abstract

:
In the last decade, the use of surgical guides in dentistry has expanded to include endodontic surgery, yet most studies have focused on accuracy rather than potential heat generation. This in vitro study evaluated heat generation during bone drilling with custom-made bone trephines, both with and without static surgical guides, and compared the results to those of 2 mm pilot drills. Drilling was performed on porcine rib bone specimens under controlled conditions, with heat generation measured using an infrared thermometer. None of the groups exceeded the critical temperature of 47 °C; although, the guided trephine group recorded the highest peak temperature (7.9 °C above baseline). Significant differences in heat increments were observed among the groups. Post hoc analyses revealed that the guided pilot drill produced significantly lower heat increments compared to the trephine groups, particularly during the penetration of the second cortical layer and at peak temperatures (p < 0.05). The use of a surgical guide did not limit the cooling and lubricating effects of irrigation in the trephine groups. Regression analyses confirmed a strong relationship between drilling time and temperature increase, with guided trephines showing a steeper temperature rise compared to pilot drills. These findings emphasize the importance of proper irrigation, sharp instruments, reduced drilling speeds, and careful technique to minimize heat generation during guided bone drilling procedures.

1. Introduction

Drilling into bone is a common practice in medical procedures and is essential for a variety of applications. In dentistry, bone drilling and cavity creation—known as osteotomy—are frequently required for specific interventions. This process inevitably generates heat, and if the temperature exceeds 47 °C (referred to as thermal injury), it can lead to cellular necrosis [1]. In dental procedures, this phenomenon has been extensively studied in implantology. It has been observed that overheating the bone can result in failed osseointegration [2], and exposure to temperatures as high as 50 °C for one minute can cause crestal bone resorption [3]. Thermal injury, particularly when irrigation is insufficient in dense bone, may lead to significant bone resorption [4]. Numerous factors influencing heat generation during drilling have been studied, including drill speed [5], applied force [6], drill diameter [7], sharpness [8], and irrigation [9]. The use of static surgical guides in implantology has become a gold standard over the past decade. However, it has been demonstrated that these surgical guides can obstruct coolant flow, reducing the volume of cooling fluid that reaches the drill and the bone [10]. This results in less effective cooling and the lubrication of the solution used, which is typically saline in most clinical scenarios. Consequently, experiments comparing surgical guides to freehand surgery have highlighted that higher bone temperatures can be observed during guided procedures [11,12,13]. Recently, the use of surgical guides in dentistry has expanded to include endodontic surgery, where the benefits of static surgical guides have been documented in numerous cases [14,15,16,17]. To enhance efficacy and facilitate one-step osteotomy with apex removal, the use of bone trephines has been proposed as the preferred drill for such interventions [15,17,18]. For improved accuracy, modified bone trephines have been recommended for this specific purpose. These modifications include the addition of a stopper and compatibility with the guiding sleeve, which ensures more precise osteotomy and apex removal [19]. Procedures performed using the custom trephine have been shown to be significantly more accurate than those performed with conventional bone trephines [20]. Furthermore, this custom trephine has been reported to be more precise than the commonly used pilot implant drill [21]. While there is some literature on the use of pilot implant drills (2 mm diameter) [8,22,23,24], studies also describe heat generation associated with conventional trephines [22,25].
In this in vitro study, drilling was performed on porcine rib bones using a custom-made endo-trephine, both with and without a static surgical guide. Additionally, drilling with a 2 mm pilot drill, used with a static surgical guide, served as the control group. The objective of this study was to assess the heat generation associated with the use of a bone trephine (specifically designed for endodontic surgery), under conditions where the cooling and lubricating effectiveness of the irrigating solution is compromised due to the presence of the surgical guide. We hypothesized that there would be no significant difference in intraosseous heat generation among the three study groups (freehand trephine, guided trephine, and guided pilot drill), regardless of whether a static surgical guide is used.

2. Materials and Methods

This in vitro study was conducted at the University of Szeged, Faculty of Dentistry. Because no animal was specifically sacrificed for the purpose of this research, formal IRB or ethical approval was deemed unnecessary; the porcine rib specimens were sourced as byproducts from routine food processing. A total of 36 drillings were performed (12 drillings per group), which aligns with sample sizes used in previous studies investigating thermal changes during bone drilling.
Porcine bone specimens (40–50 mm in length) were used to simulate human bone. Porcine rib bones were selected, because they are readily available, easy to handle, and possess thermophysical and anatomical properties ideal for such interventions, as demonstrated in multiple prior studies [26,27,28,29,30]. According to comprehensive research by Aerssens et al., pig and dog bones most closely resemble human bone [31]. Due to its anatomical similarities, the pig is considered an appropriate model for human craniofacial research [32]. Based on studies by Katranji and colleagues, the average cortical bone thickness in edentulous and dentate human jaws ranges between 1–2 mm and 1.6–2.0 mm, respectively [33]. The thickness of the selected porcine rib segments examined in this study also fell within this range. Sener et al. reported that temperature increases are significantly greater in cortical bone compared to deeper bone layers [34]. This finding has been corroborated by several other studies, which used rib bone specimens with cortical thicknesses similar to the human mandible and measured peak temperatures during drilling in the cortical bone [35,36]. All specimens were obtained from the same animal and stored at −10 °C in normal saline solution between experiments, as described by Sedlin and Hirsch [37]. The animal was not sacrificed specifically for this experiment.
Our measurements were designed to simulate the temperature rise during osteotomy preparation in guided periapical surgical procedures using a bone trephine specifically designed for endodontic surgery (Figure 1) [19]. The experiments were conducted at a standard drilling speed (800 rpm) [20,38] with a standard volume of external irrigation solution.
The drills and trephines were operated using a surgical handpiece (WS-75 L, WW&H Dentalwerk GmbH, Bürmoos, Austria) connected to an implant motor (SI-1023 Implantmed, W&H Dentalwerk GmbH, Bürmoos, Austria). The implant motor supplied continuous external irrigation with saline during the procedures (Figure 2).
The three study groups were as follows: (a) drilling with a trephine through a surgical guide (guided trephine—GT); (b) freehand drilling with a trephine (freehand trephine—FHT); and (c) drilling with a 2 mm diameter pilot (guided pilot—GP) drill through a surgical guide (Figure 3). The 2.0 mm pilot drill was selected from the implant surgical tray of the SMART Guide System (Dicomlab Dental Ltd., Szeged, Hungary). For group (c), a compatible narrowing sleeve (spoon) was used, as provided by the manufacturer and described in previous studies [23,39].
Prior to conducting the measurements, the specimens were warmed to room temperature (20–23 °C). Previous infrared thermographic studies by Augustin et al. demonstrated that the temperature rise during drilling reaches its peak in the cortical layer of the bone [35]. Based on this finding, the experiment was designed to measure the temperature of the bone around the drilled canal just before it penetrates the cortical layer, representing the peak intraosseous heat [8]. Temperature measurements were taken using an infrared thermometric device (HOLDPEAK 880NK, Zhuhai JiDa Huapu instrument Co., Ltd., Zhuhai, China). This device is equipped with two lasers that intersect at the focal point of the infrared measurement, enabling the precise targeting of the drill or trephine exit point (Figure 4a,b).
A static surgical guide was fabricated to simulate guided surgery. To achieve this, a CBCT scan of a bone specimen was taken, and a flat surface was selected as the surgical site to ensure the compatibility of the guide across all specimens. Two sleeves were designed, each with two additional pinholes for fixation, allowing the surgical guide to be securely fitted onto different surfaces of various bone specimens for multiple uses (Figure 5). The preparation of input images for planning, the surgical planning process, and the 3D printing of the surgical templates were performed entirely in accordance with the surgical guide production protocol of dicomLAB Dental Ltd. (Szeged, Hungary) [40]. Specifically, surgical planning was conducted using SMARTGuide 3.0 (dicomLAB Dental, Szeged, Hungary), and the surgical template was 3D printed using a multijet technology printer (ProJet MD3510, 3D Systems, Rock Hill, SC, USA). A total of 36 drillings were performed, with 12 drillings conducted in each study group.
The following parameters were recorded: initial temperature, temperature upon penetrating cortical layer 1, time required to penetrate cortical layer 1, temperature upon penetrating cortical layer 2, total drilling time, and peak temperature (which did not necessarily coincide with the temperature during cortical layer 2 penetration). Figure 6 summarizes the study procedures.

3. Statistical Analysis

The statistical analyses were performed using Jamovi version 2.3.28. Descriptive statistics, including means, standard deviations (SD), medians, minima, and maxima, were calculated for all measured parameters across the study groups (freehand trephine, guided trephine, and guided pilot drill). To assess the normality of data distributions, the Shapiro–Wilk test was applied, with W-statistics and associated p-values reported for each parameter.
Group comparisons were conducted using one-way analysis of variance (ANOVA) to evaluate differences between groups for parameters such as start temperature and peak temperature. When significant differences were observed, additional post hoc tests were applied to further examine intergroup comparisons. A general significance level of p < 0.05 was used for all statistical tests, with corrections applied for multiple comparisons, where necessary.
To explore the relationship between drilling time and temperature increase, linear regression analysis was performed. Regression coefficients (β values) were calculated to quantify the rate of temperature rise per second of drilling for each group. The statistical significance of the regression models was determined by evaluating p-values for the coefficients.

4. Results

The results of our measurements are shown in Table 1. The heat increments from the start of drilling to the penetration of cortical layers (C1 and C2) and the peak temperature were analyzed using one-way ANOVA. For the temperature increase from the start to the penetration of cortical layer 1 (C1), the ANOVA result approached significance (F = 3.0309, df = 2.33, p = 0.0619), indicating no significant group differences.
For the temperature increase from the start to the penetration of cortical layer 2 (C2), the ANOVA revealed a significant effect of the group (F = 16.1121, df = 2.33, p < 0.0001). Post hoc analyses showed that the guided pilot drill group produced significantly lower heat increments compared to the freehand trephine group (p = 0.0015) and the guided trephine group (p < 0.0001). However, no significant difference was found between the freehand trephine and guided trephine groups (p = 0.2253).
For the temperature increase from the start to the peak temperature, the ANOVA also indicated a significant group effect (F = 13.6390, df = 2.33, p < 0.0001). Post hoc comparisons revealed that the guided pilot drill group generated significantly lower peak heat increments compared to the freehand trephine group (p = 0.0046) and the guided trephine group (p < 0.0001). No significant difference was observed between the freehand trephine and guided trephine groups for peak temperature (p = 0.2183).
The relationship between drilling time and temperature increase was examined through linear regression analysis, with the results summarized in Figure 7. The regression coefficients (β) quantified the rate of temperature rise per second for each group. In the guided pilot drill group, the temperature increased at a rate of 0.0519 °C per second, indicating a slower and more controlled heat buildup. The freehand trephine group exhibited the steepest rate of temperature rise, with a coefficient of 0.0832 °C per second, reflecting the fastest heat generation. The guided trephine group demonstrated a moderate rate of temperature increase, with a coefficient of 0.0793 °C per second. All regression models were statistically significant (p < 0.05).

5. Discussion

Our results demonstrated that none of the measured temperature changes in the study groups reached the levels reported in the literature as damaging to bone [1,3]. Even the highest recorded temperature change, 7.9 °C, observed in the guided trephine (GT) group, remained within the acceptable range. However, it is important to note that the temperature changes measured during the penetration of the second cortical layer, as well as the peak temperatures, approached the threshold of the danger zone. Considering that a patient’s baseline temperature typically ranges between 36 and 37 °C, an additional increase of 8 °C brings the final temperature close to the critical 47 °C threshold [1]. Therefore, excessive irrigation is recommended when performing endodontic surgery with bone trephines and static surgical guides.
In this experiment, the instruments used were deliberately not brand new, which, as indicated in earlier studies, may reduce cutting efficiency and result in increased heat generation [5,41]. We found that peak temperatures were most commonly observed during the penetration of the second cortical layer. However, in some cases, temperature peaks occurred either slightly before or immediately after this point. Several factors may explain these observations. In certain instances, the rising temperature slightly decreased upon penetrating cortical layer 2, likely because irrigating solution reached the cortical layer during the penetration, cooling, and lubrication of the site. In other cases, once the drill emerged through the cortical layer, the thermometer may have recorded the drill temperature rather than that of the bone, particularly when the cylindrical trephine (with a 4.46 mm external diameter) became visible at the measurement site. This effect was observed only in the trephine groups (FHT and GT) and not in the pilot drill group, likely due to the 2 mm pilot drill’s smaller frictional contact area, which inherently reduces heat generation. Although the trephine is hollow and, thus, allows irrigation fluid to enter its center, its larger external surface can lead to increased friction and consequently higher temperature spikes.
The importance of proper irrigation for its cooling and lubricating effects during guided implant surgery has been emphasized by Migliorati et al. [42] and other studies [41]. This principle may also apply to guided endodontic surgery, as effective irrigation produces a similar cooling effect, further underscoring the safety of such interventions.
When comparing our results with similar studies, the main limitation is the lack of research examining the use of bone trephines in combination with surgical guides. However, studies investigating the use of drills with different diameters in guided surgery have reported similar patterns in heat changes during drilling [8,42]. It is worth noting that the results obtained with the 2 mm pilot drills in our study were somewhat better than those reported in the literature. One possible explanation is that our samples were initially at room temperature; whereas, in some other experiments, the baseline temperature was closer to 35 °C [8,41]. On the other hand, some studies have also utilized room temperature setups [42].
A potential limitation of our study is the use of an infrared thermometer for temperature measurements. While this method has been employed in several other studies [8,43,44], other researchers have described the use of thermocouples for similar measurements [24,39,45]. There is insufficient literature comparing the accuracy of these two methods for measuring heat generation during drilling. However, Harder et al. suggested that thermography provides a more accurate reflection of intraosseous temperature changes during implant site preparation compared to thermocouples [46].
On the other hand, as previously discussed, the critical point is penetration through cortical bone. Our results suggest that the cooling and lubricating effects were effective during both cortical penetrations, with no significant differences in temperature changes between the guided and non-guided trephine groups. This indicates that the surgical guide does not obstruct the cooling solution from reaching the drilling site.
However, given the significantly higher heat generation observed with the trephines compared to the pilot drills, it is advisable to exercise extra caution when using bone trephines for endodontic surgery. According to the literature, heat generation can be minimized by using sharper instruments [8], reducing drilling speed [5], and potentially employing cooler irrigation solutions [23,47].
Another apparent limitation of our study is that drilling was performed continuously until cortical layer 2 was fully penetrated, rather than following the intermittent drilling technique commonly recommended in clinical practice. This approach was chosen to ensure that the maximum heat generation was accurately recorded without the confounding effect of cooling pauses. Had we introduced pauses, temperature reductions between the drilling phases would have made direct comparisons between groups less reliable.
Moreover, in a clinical setting, bone tissue benefits from natural thermoregulation via blood circulation, which is absent in an in vitro model. As a result, temperatures recorded in this study may be higher than those typically observed in live surgical scenarios. However, this conservative approach serves as a worst-case scenario assessment, ensuring that, if critical temperature thresholds are not exceeded in our setup, the technique remains thermally safe under real clinical conditions.
While clinical recommendations emphasize intermittent drilling to prevent excessive heat buildup, such guidelines are specific to surgical procedures rather than experimental protocols designed to determine thermal limits. Our results should, therefore, be interpreted with this distinction in mind.
While this study provides valuable insights into intraosseous heat generation during guided and freehand drilling, several aspects warrant further investigation. One potential area of interest is how drilling through both the cortical bone and an actual tooth structure may influence heat generation, as the different physical properties of enamel and dentin could affect temperature dynamics.
Another important consideration is the optimization of irrigation protocols. Future studies could explore whether increasing irrigation volume, altering flow rate, or modifying irrigation channels (e.g., larger or additional perforations in the trephine) might further mitigate heat generation. Additionally, variations in trephine design—such as modifications to the number, size, or placement of perforations—could be evaluated to determine their impact on thermal management during drilling.
Finally, given that this was an in vitro study, future in vivo research could provide a deeper insight into how natural thermoregulation via blood circulation influences intraosseous temperature rise in clinical settings. Understanding these factors could contribute to further improving the safety and efficiency of guided surgical techniques in endodontic microsurgery.

6. Conclusions

  • This study confirms that root apex removal with a trephine is both safe and effective, even when performed with static navigation.
  • Our findings add to the existing literature on static navigation in endodontic surgery, specifically underscoring the safe use of custom trephines.
  • Although the specialized endodontic trephine is safe, adequate irrigation and lubricant effects remain critical to control heat generation.
  • Pre-cooling the irrigating solution can further reduce potential temperature spikes during drilling.
  • Overall, careful planning and technique optimization are essential to maintain thermal safety in guided endodontic surgeries.

Author Contributions

G.P.: investigation, conceptualization, methodology, writing—original draft, visualization. G.B.: methodology, data curation, formal analysis, writing—review and editing. E.N.: methodology, investigation, writing—review and editing. K.B.: investigation, writing—review and editing. J.P.: investigation, writing—review and editing. M.A.A.: conceptualization, supervision, writing—original draft. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Data Availability Statement

The analysis dataset is available from the corresponding author on reasonable request.

Conflicts of Interest

Author Gábor Braunitzer was employed by the company dicomLAB Dental, Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Abbreviations

The following abbreviations are used in this manuscript:
ANOVAAnalysis of variance
FHTFreehand trephine
GTGuided trephine
GPGuided pilot

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Figure 1. The endodontic bone trephine used in this study [19]. The red arrows indicate the openings that allow irrigation fluid to enter the hollow interior of the trephine, facilitating cooling and lubrication.
Figure 1. The endodontic bone trephine used in this study [19]. The red arrows indicate the openings that allow irrigation fluid to enter the hollow interior of the trephine, facilitating cooling and lubrication.
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Figure 2. Irrigating solution (saline) supplied by the implant motor entering the hollow interior of the trephine.
Figure 2. Irrigating solution (saline) supplied by the implant motor entering the hollow interior of the trephine.
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Figure 3. The three study groups: (a) drilling with a trephine through a surgical guide (GT); (b) freehand drilling with a trephine (FHT); and (c) drilling with a pilot drill through a surgical guide (GP).
Figure 3. The three study groups: (a) drilling with a trephine through a surgical guide (GT); (b) freehand drilling with a trephine (FHT); and (c) drilling with a pilot drill through a surgical guide (GP).
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Figure 4. (a) The experimental setting with the bone specimen, thermometer, and camera. (b) The experimental setup: (a) drill/trephine, (b) surgical guide, (c–e) porcine rib bone specimen, (c) cortical layer 1, (d) cancellous bone, (e) cortical layer 2, (f) yellow arrow indicating the direction and focus point of the infrared thermometric measurement, (g) infrared thermometer, (h) thermometer display visible to the video camera, (i) video camera, and (j) adjustable, rotating clamps for specimen fixation.
Figure 4. (a) The experimental setting with the bone specimen, thermometer, and camera. (b) The experimental setup: (a) drill/trephine, (b) surgical guide, (c–e) porcine rib bone specimen, (c) cortical layer 1, (d) cancellous bone, (e) cortical layer 2, (f) yellow arrow indicating the direction and focus point of the infrared thermometric measurement, (g) infrared thermometer, (h) thermometer display visible to the video camera, (i) video camera, and (j) adjustable, rotating clamps for specimen fixation.
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Figure 5. (a) Digital surgical plan, (b) fabricated surgical guide, (c) bone specimen after use, and (d) bone specimen and surgical guide secured with two fixation pins for experimental drilling.
Figure 5. (a) Digital surgical plan, (b) fabricated surgical guide, (c) bone specimen after use, and (d) bone specimen and surgical guide secured with two fixation pins for experimental drilling.
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Figure 6. A flowchart of the study procedures.
Figure 6. A flowchart of the study procedures.
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Figure 7. Linear regression lines for heat increments versus measured time, shown separately for the three study groups.
Figure 7. Linear regression lines for heat increments versus measured time, shown separately for the three study groups.
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Table 1. Descriptive results, including initial temperatures and temperature changes.
Table 1. Descriptive results, including initial temperatures and temperature changes.
ParameterFreehand Trephine
(FHT)		Guided Pilot
(GP)		Guided Trephine (GT)
Initial temperature (°C(±SD))22.63 (±1.39)22.98 (±1.35)21.82 (±1.15)
Mean temperature change to cortical 1 (°C(±SD))1.37 (±1.54)0.36 (±0.25)1.22 (±1.04)
Time to cortical 1 penetration (s(±SD))17.75 (±8.29)8.50 (±1.45)20.08 (±10.31)
Mean temperature change to cortical 2 (°C(±SD))2.88 (±1.54)0.72 (±0.3)3.82 (±1.77)
Time to cortical 2 penetration (total time) (s(±SD))34.25 (±11.64)12.75 (±1.54)30.33 (±13.85)
Mean temperature change to peak (°C(±SD))3.25 (±1.9)0.74 (±0.31)4.5 (±2.44)
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MDPI and ACS Style

Pintér, G.; Braunitzer, G.; Nagy, E.; Boa, K.; Piffkó, J.; Antal, M.A. Heat Generation During Guided Bone Drilling: Bone Trephine Versus Pilot Drill. Lubricants 2025, 13, 115. https://doi.org/10.3390/lubricants13030115

AMA Style

Pintér G, Braunitzer G, Nagy E, Boa K, Piffkó J, Antal MA. Heat Generation During Guided Bone Drilling: Bone Trephine Versus Pilot Drill. Lubricants. 2025; 13(3):115. https://doi.org/10.3390/lubricants13030115

Chicago/Turabian Style

Pintér, Gábor, Gábor Braunitzer, Eszter Nagy, Kristóf Boa, József Piffkó, and Mark Adam Antal. 2025. "Heat Generation During Guided Bone Drilling: Bone Trephine Versus Pilot Drill" Lubricants 13, no. 3: 115. https://doi.org/10.3390/lubricants13030115

APA Style

Pintér, G., Braunitzer, G., Nagy, E., Boa, K., Piffkó, J., & Antal, M. A. (2025). Heat Generation During Guided Bone Drilling: Bone Trephine Versus Pilot Drill. Lubricants, 13(3), 115. https://doi.org/10.3390/lubricants13030115

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