Professional Documents
Culture Documents
Volumetric Comparison of Three Different Innovativ
Volumetric Comparison of Three Different Innovativ
ORAL SURGERY
Heang-Gon Kim
Objective: The aim of this study was to evaluate the clinical groups had a wood shaving-like appearance. With Test 1 and
relevance of three different bone collecting devices in a volu Test 2, LP were the most common (0.510 ± 0.064 mL, 0.430
metric comparison. Method and Materials: Bone harvesting ± 0.067 mL), and in Test 3, MP was the most common
for the collection of bone particles was performed on bovine (0.112 ± 0.019 mL). Among the SP and MP, the wet volume of
mandibles. Three different types of bone collecting devices Test 3 was significantly greater than those of Tests 1 and 2
(Tests 1, 2, and 3) were used. Ten drilling sites in each group (P< .001). However, among the LP, the wet volume sequential
were prepared and bone particles were collected. Bone parti ly increased from Test 1, to Test 2, and Test 3 (P< .001). The
cles were sieved twice in sieves with 500 pm and 1,000 pm proportion of dry volume was similar to that of wet volume.
openings. The bone particles were divided into three groups: Conclusion: Three innovative bone collecting devices could
< 500 pm (SP), 500-1,000 pm (MP), and >1,000 pm (LP). Total collect comparable amounts of bone particles to commercially
wet volume, fractional wet volume, fractional dry volume, and available bone graft materials. (Quintessence Int 2015;46:807-
weight were measured. The shape of the dried particles was 815; doi: 10.3290/j.qi.a34458)
examined using a microscope. Results: All particles in all three
Key words: autogenous bone graft, bone collector, oral implantology, particle size
1Graduate Student, Department of Periodontoiogy, School of Dentistry, Kyung Im p la n ta tio n is a successful p ro cedure in d e n ta l reha
Hee University, Seoul, Korea.
b ilita tio n . This p ro ce d u re o fte n requires g u id e d bone
2Clinical Faculty, Department of Periodontoiogy, Section of Dentistry, Seoul
National University Bundang Hospital, Sungnam, Korea.
re g e n e ra tio n or bon e grafts w h e n th e alveolar ridge is
3Clinical Assistant Professor, Department o f Periodontoiogy, School o f Dentistry, a tro p h ic or if im p la n t dehiscence is present. O f th e var
Kyung Hee University, Seoul, Korea.
ious bone g ra ft m aterials, a u to g e n o u s bone is consid
’ Assistant Professor, Department of Periodontoiogy, Institute o f Oral Biology,
School of Dentistry, Kyung Hee University, Seoul, Korea.
ered th e g o ld standard because o f its superior b io c o m
’ Associate Professor and Chairman, Department of Periodontoiogy, Institute of p a tib ility , o ste o g e n icity, o s te o c o n d u c tiv ity , and osteo-
Oral Biology, School of Dentistry, Kyung Hee University, Seoul, Korea.
in d u c tio n .1-2 T here are m a n y m e th o d s to c o lle c t
’ Professor, Department of Periodontoiogy, Institute of Oral Biology, School of
Dentistry, Kyung Hee University, Seoul, Korea.
a u to g e n o u s b o n e in th e m o u th . A u to g e n o u s bon e
'Associate Professor, Department o f Periodontoiogy, Institute o f Oral Biology, grafts can be collected in e ith e r p a rticu la te o r b lock
School of Dentistry, Kyung Hee University, Seoul, Korea.
fo rm .3'5 A u to g e n o u s b one in p a rticu la te fo rm can be
Correspondence: Associate Professor Seung-Yun Shin, Department of collected using hand chisels, burs, or bone collectors.6'8
Periodontoiogy, Institute of Oral Biology, School of Dentistry, Kyung
Hee University, Seoul, Korea, 130-872. Email: ssyislet@khu.ac.kr If p ro tru d e d alveolar bone, such as to ru s and exostosis,
is present around the im plant site, a hand instrum ent METHOD AND MATERIALS
such as an Ochseinbein chisel and mallet may be useful
to collect the autogenous bone. These sites allow for Description of three bone collecting devices
the easy collection o f autogenous bone. When the col Three different types o f currently available bone col
lected bone particles are grafted onto the dehiscence lecting devices were used in the present study. They
or fenestration bone defects o f the im plant site, new have been designed to collect autogenous bone parti
bone form ation can be successful and stable results cles using a rotating drilling system. They are recom
m aintained.911 mended for use at low speed (200 to 300 rpm). They
A bone scraper (Safescraper curve, Meta), which have stops to prevent overdrilling to the nerve, and
consists o f a blade, body, and collection chamber, can also to collect bone particles.
be used to scrape cortical bone around the surgical • Test 1: A uto Chip Maker, N eobiotech. This is a
field to place in the chamber.812 A trephine bur can be straight, cylindrical device w ith an em pty center. It
used to collect bone cores at the chin or retromolar has tw o flutes and a 15-mm plastic cap that extends
area and has the advantage o f allowing for the collec to the tip end. The role o f the plastic cap is not only
tion o f large amounts o f autogenous bone core (diam to collect the bone particles during the drilling, but
eter 5 to 7 m m ).13 However, a dd itional steps are also to function as a 4-mm stop. The device has a
required to crush the bone core w ith a bone crusher or protruded point at the tip o f the drill to allow for
bone mill if particulate bone is necessary. There is also initial drilling stability on the cortical bone.
the possibility o f dam aging the nerve w ith excessive • Test 2: AutoBone Collector, Osstem Implant. This is
drilling because there is no stop. Another bone collect a tw ist drill th a t has tw o flutes and a 10-mm metal
ing device such as a bone collector is connected to the cap that extends to 4 mm below the tip end. It has a
suction. Sufficient bone can be obtained w ith o u t an protruded p oint on the fro n t portion o f the drill to
additional surgical site.14-15 However, this device is not help stabilize the initial drilling.
appropriate to use in the maxilla where there is not • Test 3: Dentium Harvest Drill, Dentium. This is also a
enough cortical bone. A lth ou g h co nta m in atio n is tw ist drill th a t has tw o flutes, and a 16-mm metal
another lim itation o f this method, preoperative chlor- cap that extends to 4 mm below the tip end. It was
hexidine m outh rinse fo r 1 m in ute showed good designed to be used w ith o u t a stop during im plant
results, w ith o u t infection.16 Anitua et al17 suggested a site preparation for harvesting autogenous bone.
novel d rillin g procedure fo r collecting autogenous
bone during im plant site preparation procedures. They The diameters of Tests 1,2, and 3 were 5.0 mm, 5.0 mm,
drilled at low speed (20 to 80 rpm) w ith o u t irrigation, and 4.4 mm respectively. The description o f each
which was useful when a small am ount o f bone was device and the protocol suggested by the m anufactur
needed, and had the advantage th a t no additional sur ers is summarized in Table 1.
gical site was necessary. However, the authors did not
report on the am ount o f bone debris. In vitro experiment
There have been many efforts to collect autogenous The experimental protocol was designed by modifying a
bone more easily and faster. Several innovative devices previously described in vitro experiment for bone collec
for collecting autogenous bone are available. These tion.6-18 Briefly, bone harvesting for the collection o f bone
devices have been designed to collect more bone particles was performed on bovine mandibles. Frozen
debris than im plant drills. The aim o f this study was to mandible bone was left for 3 hours at room temperature
evaluate the clinical relevance o f three different bone for thawing. The periosteum was removed w ith perios
collecting devices in a volum etric comparison. teal elevators to expose the cortical bone. Three different
types o f bone collecting devices were used (Fig 1).
T a b le 1 Characteristics o f th e th ree inn o vative bone collecting devices and th e m anufacturers' protocols
Shape Flute number Diameter (mm) Length (mm) Speed (rpm) Torque (N-cm)
Test 1 Straight and hollow 2 5.0 14 (stop 4 mm) 300 10
Test 2 Twist 2 5.0 14 (stop 4 mm) 300 10
Test 3 Twist 2 4.4 20 (stop 4 mm) 200 50
Figs 3a to 3c Microscopic views of bone particles from Test 1 (original magnification x20): (a) large particles (LP); (b) medium particles
(MP); and (c) small particles (SP).
< 500 pm (SP) 0.007 ± 0.008 0.017 ± 0.009 0.063 + 0.018 <.001
< 500 pm (SP) 0.006 ± 0.002 0.010 + 0.006 0.044 + 0.018 <.001
> 1000 pm (LP) 0.511 ±0.080 0.415 + 0.075 0.012 + 0.004 <.001
> 500 pm (MP + LP) 0.551 ± 0.085 0.452 ± 0.081 0.094 ± 0.023 <.001
Test 1 Test 2 Test 3
Rvalue < .001 <.001 <.001 Bone-collecting device
*No significant differences between Tests 1 and 2 (P = .096).
FigS The measurement of dry volume (mL) of the
fNo significant differences between Tests 1 and 2 (P = .445).
bone particles from the three bone collecting devices.
Total dry w eight 0.099 + 0.020 0.082 ± 0.009* 0.046 ± 0.011 <.001
Figs 6a to 6c Microscopic views o f bone particles (original magnification x12.5): (a) Test 1; (5,1 Test 2; (c) Test 3.
bone thickness in the human m andible is usually less than in other studies using im plant drills. For clinically
than 4 mm.30'33 Al-Jandan et al30 evaluated the cortical useful sizes (> 500 pm), Tests 1 and 2 collected 0.544 mL
bone thickness o f th e m andible using CBCT and and 0.483 mL at one drilling, respectively. Because com
reported th a t the mean thickness at the apex o f the mercial bone graft material is usually approxim ately
m andibular second molar was 3.18 mm. The labial cor 0.5 m Lor 1.0 mL, one or tw o uses of these devices could
tical plate o f the m id-m andibular symphyseal region collect autogenous bone particles equivalent to com
was 1.26 to 2.31 mm thick and became thicker from the mercially available bone graft materials (Fig 8). In addi
superior to the inferior region. In one cadaver study, tion, these devices allow safety by using a stop, and are
the buccal bone o f the m andibular molar area was 2.61 free from the salivary contam ination th a t is found w ith
to 2.87 mm thick.31 The am ount o f bone could have aspiration-collecting technique devices.
been smaller if cancellous bone had been collected In clinical situations, many factors would differ from
along w ith the cortical bone in a clinical situation. the conditions in the present study. First, the study
Several authors have recommended th a t an appro used bovine m andible cortical bone. As previously
priate particle size is 250 to 1,000 pm.20'22'2425 In the described, cortical bone thickness is d iffe re n t in
present study, there were 0.544 mL, 0.483 mL, and humans. In clinical situations, less bone could be col
0.133 mL o f > 500 pm-sized particles in Tests 1,2, and 3, lected in cases o f thin cortical bone. Second, all col
respectively. Savant et al34 collected 0.195 mL o f w et lected particles had a wood shaving-like appearance. If
bone particles using a bone collector during single large-sized particles are compressed during bone col
im plant site preparation. Kainulainen et al35 collected lecting or grafting, they could be broken into small
0.09 to 0.12 mL o f bone for a Straumann im plant site sized particles, which w ould decrease the volum e o f
preparation w hile Young et al15 collected 0.054 g of particles. Third, it is not easy to collect SP because most
bone for a Frialit-2 im plant site. The volumes o f bone SP w ould be lost during saline irrigation.
particles collected during the present three types of
im plant drilling procedures were less than 0.13 mL in
bovine rib bone (unpublished results). Although the
CONCLUSION
devices used in the present study need additional surgi In this in vitro study, three different types o f autoge
cal sites, the am ount o f collected bone was much larger nous bone harvesting drills were com pared w ith
Figs 8a to 8d Clinical picture of autogenous bone collection using Test 1. (a) Preoperative view. There is soft tissue depression at the
position of the mandibular right second premolar, (b) After flap reflection, the alveolar socket is not fully filled with new bone, (c)
Autogenous bone was collected from the mandibular buccal shelf using Test 1 (diameter 4 mm; inset), (d) Three months later cortical
bone had almost been regenerated with new bone (circle).
11. Widmark G, Ivanoff CJ. Augmentation o f exposed implant threads with 23. Bobyn JD, Wilson GJ, MacGregor DC, Pilliar RM, Weatherly GC. Effect o f pore
autogenous bone chips: prospective clinical study. Clin Implant Dent Relat size on the peel strength o f attachment o f fibrous tissue to porous-surfaced
Res 2000;2:178-183. implants. J Biomed Mater Res 1982;16:571-584.
12. Trombelli L, Farina R, Marzola A, Itro A, Calura G. GBR and autogenous cortical 24. Xu H, Shimizu Y, Asai S, Ooya K. Experimental sinus grafting with the use of
bone particulate by bone scraper for alveolar ridge augmentation: a 2-case deproteinized bone particles o f different sizes. Clin Oral Implants Res
report. Int J Oral Maxillofac Implants 2008;23:111—116. 2003;14:548-555.
13. Nkenke E, Radespiel-Troger M, Wiltfang J, Schultze-Mosgau S, Winkler G, 25. Urist MR, Silverman BF, Buring K, Dubuc FL, Rosenberg JM. The bone induc
Neukam FW. Morbidity o f harvesting o f retromolar bone grafts: a prospective tion principle. Clin Orthop Relat Res 1967;53:243-283.
study. Clin Oral Implants Res 2002;13:514-521.
26. Fonseca RJ, Clark PJ, Burkes EJ Jr, Baker RD. Revascularization and healing of
14. Kainulainen V, Oikarinen K. Comparison o f four bone collectors designed for onlay particulate autologous bone grafts in primates. J Oral Surg 1980,38:
oral and maxillofacial surgery: an in vitro study. Clin Oral Implants Res 572-577.
1998;9:327-332.
27. Fonseca RJ, Nelson JF, Clark PJ, Frost DE, Olson RA. Revascularization and
15. Young MP, Worthington HV, Lloyd RE, Drucker DB, Sloan P, Carter DH. Bone healing o f onlay particulate allogeneic bone grafts in primates. J Oral Maxillo
collected during dental implant surgery: a clinical and histological study. Clin fac Surg 1983;41:153-162.
Oral Implants Res 2002;13:298-303.
28. Springer IN, Terheyden H, Geiss S, Harle F, Hedderich J, Acil Y. Particulated
16. Young MP, Korachi M, Carter DH, Worthington HV, McCord JF, Drucker DB. bone grafts: effectiveness o f bone cell supply. Clin Oral Implants Res
The effects o f an immediately pre-surgical chlorhexidine oral rinse on the 2004;15:205-212.
bacterial contaminants of bone debris collected during dental implant sur
29. Park JC, Kim JC, Kim YT, et al. Acquisition of human alveolar bone-derived
gery. Clin Oral Implants Res 2002;13:20-29.
stromal cells using minimally irrigated implant osteotomy: in vitro and in vivo
17. Anitua E, Carda C, Andia I. A novel drilling procedure and subsequent bone evaluations. J Clin Periodontol 2012;39:495-505.
autograft preparation: a technical note. Int J Oral Maxillofac Implants
30. Al-Jandan BA, Al-Sulaiman AA, Marei HF, Syed FA, Almana M. Thickness of
2007;22:138-145.
buccal bone in the mandible and its clinical significance in mono-cortical
18. Jeong CH, Kim DY, Shin SY, Hong J, Kye SB, Yang SM. The effect o f implant screws placement. A CBCT analysis. Int J Oral Maxillofac Surg 2013;42:77-81.
drilling speed on the composition o f particle collected during site prepar
31. Leong DJ, Li J, Moreno I, Wang HL. Distance between external cortical bone
ation. J Korean Acad Periodontol 2009;39:S253—S259.
and mandibular canal for harvesting ramus graft: a human cadaver study. J
19. Pallesen L, Schou S, Aaboe M, Hjorting-Hansen E, Nattestad A, Melsen F. Periodontol 2010;81:239-243.
Influence o f particle size o f autogenous bone grafts on the early stages of
32. Park HD, Min CK, Kwak HH, Youn KH, Choi SH, Kim HJ. Topography o f the
bone regeneration: a histologic and stereologic study in rabbit calvarium. Int
outer mandibular symphyseal region w ith reference to the autogenous bone
J Oral Maxillofac Implants 2002;17:498-506.
graft. Int J Oral Maxillofac Surg 2004;33:781-785.
20. Zaner DJ, Yukna RA. Particle size o f periodontal bone grafting materials. J
33. Yates DM, Brockhoff HC 2nd, Finn R, Phillips C. Comparison o f intraoral harvest
Periodontol 1984;55:406-409.
sites for corticocancellous bone grafts. J Oral Maxillofac Surg 2013;71:497—
21. Schallhorn RG. Present status o f osseous grafting procedures. J Periodontol 504.
1977;48:570-576.
34. Savant TD, Smith KS, Sullivan SM, Owen WL. Bone volume collected from
22. Shapoff CA, Bowers GM, Levy B, Mellonig JT, Yukna RA. The effect o f particle dental implant sites during osteotomy. J Oral Maxillofac Surg 2001 ;59:
size on the osteogenic activity o f composite grafts o f allogeneic freeze-dried 905-907.
bone and autogenous marrow. J Periodontol 1980;51:625-630.
35. Kainulainen VT, Kainulainen TJ, Oikarinen KS, Carmichael RP, Sandor GK. Per
formance o f six bone collectors designed for dental implant surgery. Clin Oral
Implants Res 2006;17:282-287.