Sartori et al. - ScienceDirect

J Oral Maxillofac Surg
70:e608-e621, 2012
Evaluation of Deformation, Mass Loss,
and Roughness of Different Metal Burs
After Osteotomy for
Osseointegrated Implants
Elisa Mattias Sartori, DDS,* Élio Hitoshi Shinohara, DDS, PhD,†
Daniela Ponzoni, DDS, PhD,‡
Luis Eduardo Marques Padovan, DDS, MSc, PhD,§
Laiz Valgas, Eng, PhD,储 and Alexsander Luiz Golin, Eng, MSc¶
Purpose: This study used bovine ribs to comparatively assess the deformation, roughness, and mass
loss for 3 different types of surface treatments with burs, used in osteotomies, for the installation of
osseointegrated implants.
Materials and Methods: The study used 25 bovine ribs and 3 types of helical burs (2.0 mm and 3.0
mm) for osteotomies during implant placement (a steel bur [G1], a bur with tungsten carbide film coating
in a carbon matrix [G2], and a zirconia bur [G3]), which were subdivided into 5 subgroups: 1, 2, 3, 4,
and 5, corresponding to 0, 10, 20, 30, and 40 perforations, respectively. The surface roughness (mean
roughness [Ra], partial roughness, and maximum roughness) and mass (in grams) of all the burs were
measured, and the burs were analyzed in a scanning electron microscope before and after use. Data were
tabulated and statistically analyzed by use of the Kruskal-Wallis test, and when a statistically significant
difference was found, the Dunn test was used.
Results: There was a loss of mass in all groups (G1, G2, and G3), and this loss was gradual, according
to the number of perforations made (1, 2, 3, 4, and 5). However, this difference was not statistically
significant (P ⬍ .05). Regarding the roughness, G3 presented an increase in Ra, partial roughness, and
maximum roughness (P ⬍ .05) compared with G2 and an increase in Ra compared with G1. There was
no statistically significant difference (P ⬎ .05) between G1 and G2. The scanning electron microscopy
analysis found areas of deformation in all the 2.0-mm samples, with loss of substrates, and this
characteristic was more frequent in G3.
Conclusions: The 2.0-mm zirconia burs had a greater loss of substrates and abrasive wear in the cutting
area. They also presented an increased roughness when compared with the steel and the tungsten
carbide coating film in carbon matrix. There was no statistically significant difference (P ⬍ .05) between
G1 and G2 in any mechanical test carried out.
© 2012 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 70:e608-e621, 2012
*MSc in Oral and Maxillofacial Surgery, São Paulo State University, Araçatuba, Brazil.
†Associate Professor, Department of Surgery and Integrated Clinics, São Paulo State University, Araçatuba, Brazil.
‡Assistant Professor, Department of Surgery and Integrated Clinics, São Paulo State University, Araçatuba, Brazil.
§Professor, Department of Surgery and Implantology, University
of Sagrado Coração, Bauru, Brazil.
储Colaborator Professor, Latin American Institute of Dental Research and Education, Curitiba, Brazil.
¶Engineer manager, Neodent, Curitiba, Brazil.
Address correspondence and reprint requests to Dr Sartori:
Manoel Marques Rosa Avenue, 1639, Ap 12, Fernandópolis-SP,
Brazil 15600-000; e-mail: [email protected]
© 2012 American Association of Oral and Maxillofacial Surgeons
0278-2391/12/7011-0$36.00/0
http://dx.doi.org/10.1016/j.joms.2012.07.050
e608
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SARTORI ET AL
FIGURE 1. Measurement of ribs with digital caliper. The ribs were at least 15 mm in length.
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
The rehabilitative treatment of edentulous patients
greatly advanced after the discovery of osseointegration
by Dr Brånemark. This discovery led to a new type of
fixed prosthesis supported by osseointegrated implants.
Initially, Brånemark et al1 stated that osseointegration
was “direct contact between living haversian bone and
the implant.” They also stated that the parameters of a
successful implant were individual immobility of the
implant not connected to the prosthesis when examined clinically, lack of evidence of peri-implant radiolu-
cency shown by radiography, annual bone loss of up to
0.2 mm, and the absence of irreversible or persistent
signs and symptoms, such as pain, infection, neuropathy, paresthesia, or violation of the mandibular canal.2
With the evolution of the implant, other factors
were also brought to light, such as nontraumatic surgical technique to the bone during the implant preparation and installation.3,4
To prepare for the installation of implants, we used
rotary cutting instruments (burs) at high speed. The
FIGURE 2. Bovine ribs in a saline bath at 37°C for 15 minutes, to simulate body temperature.
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
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heat generated by this friction can create an area of
devitalized bone in the preparation of an osteotomy.5
Because of the low thermal conductivity of cortical
bone, the distribution of heat occurs slowly and the
temperature may remain high even with the use of
external irrigation.6
The heat generated during the osteotomy is related
to the bur’s cutting power.4 Sharp burs cut more
efficiently than worn burs. Further proof can be seen
in the study by Matthews and Hirsch,7 who showed
that worn burs cause a more significant and continuous temperature rise than new burs.
The length of time that a bur remains sharp depends on the composition and surface treatment of
each bur,4 as well as the quality of the bone tissue.
Different designs of burs have been introduced to
improve the efficiency of cutting bone.3 In addition,
the use of coatings such as diamond coating (WC/C)
and titanium nitride (TiN) was developed to improve
the cutting of burs.
Ercoli et al8 tested different types of burs from the
following companies: Nobel Biocare (Göteborg, Sweden), 3i/Implant Innovations (Palm Beach Gardens,
Florida), Steri-Oss (Göteborg, Sweden), Implamed
(Attleboro, Massachusetts), Paragon (Encino, CA),
PROPERTIES OF METAL BURS AFTER OSTEOTOMY
Straumann (Waldenburg, Switzerland), and Lifecore
(Chaska, Minnesota). They were used on bovine ribs
and had different types of alloys and coatings. Each
bur was used for 100 osteotomies. The 2.0-mm Nobel
Biocare and 3i/Implant Innovations burs had a higher
cutting power than the other brands. The 2.0-mm
burs with low hardness (Implamed) presented deformation of the cutting area, loss of sharpness, and
fracture. The TiN-coated burs (Steri-Oss and Paragon)
had better cutting power with less loss of sharpness
than the uncoated burs. The authors concluded that
the design, type of material, and mechanical properties of the bur significantly affect the cutting efficiency and durability. They also concluded that burs
for implant osteotomies could be used numerous
times without resulting in a significant temperature
rise of the bone tissue.
Bayerlein et al9 used spherical burs made from
zirconium oxide and aluminum oxide mixed with
ceramics on the jaws of pigs in their study. They
concluded that more studies should be carried out
with these types of burs, because doubts remained
over their clinical use with regard to cleaning, sterilization, and the type of damage that is caused to the
FIGURE 3. A, Handpiece (NSK) coupled to an electric rotation engine, with irrigation and digitally controlled torque (Surgic XT). B, The
handpiece was attached to an arm adapted to move vertically.
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
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SARTORI ET AL
structure (such as microscratches, which reduce their
longevity and the number of times they can be used).
In vitro and in vivo studies on the quantification
and qualification of the generated heat and the bone
damage do not measure the mechanical properties of
the burs, such as mass loss, surface roughness, and
deformation. There is also a lack of comparisons between burs with passivation surface treatment and
burs coated with tungsten carbide in a carbon matrix
(WC/C) and zirconia burs.
The objective of this study was to comparatively
assess the deformation, roughness, and mass loss of 3
different types of burs (steel, tungsten carbide coating
on steel matrix [WC/C], and zirconia), used in osteotomies of bovine rib, for the installation of implants.
Materials and Methods
For this research, bovine ribs were selected as the
experimental animal model. Considering that the animals were not killed for the experiments, the project
was not submitted to the ethics committee on animal
research.8,10 In this context it is important to consider
that all bovine ribs were purchased at a butcher shop
and kept frozen until the experiments were performed.
The study used 25 pieces of rib that were 15 cm in
length and all from the same region of the animal. The
ribs were removed 1 day after death, and they were
refrigerated for a sufficient amount of time to enable
cutting and removal of parts. After the removal of
the periosteum, the ribs were retained at ⫺5°C until
use. The portions of the rib that were selected were at
least 15 mm thick. A digital caliper was used for the
measurements (Fig 1). The ribs that did not meet this
criterion were replaced.
Fifteen minutes before the ribs were perforated,
they were removed from refrigeration and heated in a
0.9% saline solution bath at 37°C (Fig 2). This was to
simulate human body temperature without the cooling affecting the results. An electric engine (Surgic
XT; Neodent, Curitiba, Brazil) with a speed of 800
rpm for the manufacture of bone defects and a reducing contra-angle of 20:1 (NSK, Suzano, Brazil) were
used.
FIGURE 4. A, Sequential perforations with the 2.0-mm bur. B, Sequential perforations with the 3.0-mm bur.
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
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PROPERTIES OF METAL BURS AFTER OSTEOTOMY
FIGURE 5. A and B, Mass measurement of burs by use of a high-precision scale.
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
There were 30 helical burs (fifteen 2.0-mm burs and
fifteen 3.0-mm burs) used in the study. In addition,
external irrigation was carried out with a 0.9% sodium
chloride solution (Darrow, Rio de Janeiro, Brazil) during the entire preparation. The handpiece was attached to a mechanical arm adapted for vertical movement (Fig 3) so that the pressure exerted on the
handpiece was constant during cutting.
For the comparative evaluation, the samples were divided into 3 groups as follows: group 1 (G1) comprised
burs with passivation surface treatment (smooth), as
commercially suggested (American Society for Testing and Materials [ASTM] F899-09); group 2 (G2)
comprised burs with the application of a tungsten
carbide film in a carbon matrix (WC/C) (ASTM F89909); and group 3 (G3) comprised machined zirconia
burs (smooth) (ASTM 1161-02c).
Each of the 3 groups consisted of five 2.00-mm helical
milling and five 3.0-mm helical burs. Five subgroups
were established (1, 2, 3, 4, and 5) corresponding to the
number of osteotomies carried out with the same burs
(0, 10, 20, 30, and 40, respectively).
MECHANICAL TESTS BEFORE AND AFTER USE
Some common characteristics between the groups
were initially assessed with the new specimens and
without any mechanical stress. At the end of the uses
of 10, 20, 30 and 40, testing of all 3 groups of samples
was repeated for comparison. The following tests
were carried out:
●
●
●
Integrity of sharpening— evaluations of geometric features and the integrity of the sharp region
before and after the perforations (Fig 4) to qualitatively characterize the wear of the specimens;
Mass determination—measurements before and
after perforations to assess wear regarding mass
loss in all specimens (Fig 5);
Roughness measurement—measurements before
and after perforations to assess superficial wear
and the consequent increase of roughness in the
specimens (Fig 6).
ANALYSIS BY SCANNING ELECTRON MICROSCOPY
The burs that were used in the osteotomies were
assessed by scanning electron microscopy (SSX-550;
Shimadzu, Kyoto, Japan) with magnifications of 50⫻
and 30⫻ for the 2.0- and 3.0-mm burs, respectively, in
all groups and subgroups 1 and 5 (Fig 7). The magnifications enabled an image of the front of the sharptipped region of the burs (Figs 8-13).
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SARTORI ET AL
FIGURE 6. Roughometer used for roughness measurements of specimens.
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
MEASUREMENT OF MASS OF SAMPLES
The mass was measured with a Precision Digital
Scale (MARTE, Marte Científica, Duque de Caxias, Rio
de Janeiro, Brazil) to 4 decimal places. The scale had
an insulated glass compartment where the samples
were placed and remained free of interference from
air displacement (Fig 5).
DETERMINATION OF ROUGHNESS
The roughness values were obtained with a roughometer (M1; Mahr, Göttingen, Germany), with measure-
ments of mean roughness (Ra) (in micrometers), partial
roughness (Rz) (in micrometers), and maximum roughness (Rmax) (in micrometers) at a length of 5.60 mm
along the cutting region of the burs, with five 0.80-mm
cutoffs. To make these measurements, the specimens
were horizontally fixed with the aid of tongs (Fig 6).
STATISTICAL ANALYSIS
The data obtained were analyzed with the KruskalWallis test. When there was a statistically significant
difference, the data were submitted to the Dunn test.
FIGURE 7. SEM used for qualitative assessment of wear of specimens.
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
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PROPERTIES OF METAL BURS AFTER OSTEOTOMY
FIGURE 8. SEM images of sharp region of a G1 2.0-mm bur without perforations (A) and after 40 perforations (B).
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
Results
ANALYSIS WITH SCANNING
ELECTRON MICROSCOPY
A scanning electron microscope (SEM) was used to
analyze the sharpness of the used burs. Figures 8
through 13 show the new, unused burs (ie, they were
subjected to no mechanical stress) and the specimens
after use.
Figures 8, 10, and 12 show the specimens of G1,
G2, and G3, respectively, with 2.0-mm burs in the
new, unused condition and after 40 perforations. In
all samples, it is possible to note areas of deformation
of the metal, with loss of substrates. G3 had the
highest degree of wear. The 2.0-mm bur in G2 was
deformed in the cutting area and had small areas with
signs of loss of coating on the active tip. There was
deposition of substrates in G1.
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SARTORI ET AL
FIGURE 9. SEM images of sharp region of a G1 3.0-mm bur without perforations (A) and after 40 perforations (B).
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
Figures 9, 11, and 13 show the specimens of G1,
G2, and G3, respectively, with 3.0-mm burs in the
new, unused condition and after 40 perforations.
There are small areas with loss of substrates in G2 and
G3. G1 has small areas with deformation of the metal.
DETERMINATION OF MASS LOSS
The burs of the same group had different masses at
the baseline measurements.
Mass loss was observed in all groups (G1, G2, and
G3), and this decrease was gradual (Fig 14), according
to the number of perforations made. However, the
difference was not statistically significant (P ⬍ .05).
DETERMINATION OF SURFACE ROUGHNESS
(MEAN, PARTIAL, AND MAXIMUM ROUGHNESS)
There was no statistically significant difference
(P ⬍ .05) among subgroups 1, 2, 3, 4, and 5 in G1, G2,
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PROPERTIES OF METAL BURS AFTER OSTEOTOMY
FIGURE 10. SEM images of sharp region of a G2 2.0-mm bur without perforations (A) and after 40 perforations (B).
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
and G3 for the 2.0- and 3.0-mm burs regarding Ra, Rz,
and Rmax. However, the roughness varied among the
groups. Thus, when evaluating G1, G2, and G3, one
can note the following:
●
●
G3 had a higher roughness when compared with
G1 and G2.
G3 had a significant (P ⬍ .05) increase in Ra (Fig
15), Rz (Fig 16), and Rmax (Fig 17) compared
with G1.
●
●
G3 had a significant (P ⬍ .05) increase in Ra
compared with G2 (Fig 15).
The difference between G1 and G2 regarding Ra,
Rz, and Rmax was not statistically significant
(P ⬍ .05).
Discussion
Most studies on burs for osteotomies for installation
of dental implants focus on the relationship among
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FIGURE 11. SEM images of sharp region of a G2 3.0-mm bur without perforations (A) and after 40 perforations (B).
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
rotational speed, axial force applied, depth of the bur,
and the generation of temperature, but there are 2
factors that can influence the frictional heat that have
not received much attention in studies: the design
and the loss of sharpness of the bur during repetitive
use.11 Temperature was not measured in this study,
because the literature has already presented results on
this subject.3,5-8,11-15
Our objective was to present results based on mechanical properties regarding the reuse of burs. No
studies were found in the literature with a similar
methodology, so it is difficult to correlate the results
and make direct comparisons.
Various animal models have been used for such
studies: tibia of rabbits,16 rabbit mandibles,12 mandibles and maxillae of pigs,13 cortical and medullary
bovine blocks,4,14,15,17,18 pork ribs, mandibles of
dogs,19 and cattle ribs.8,10 In this study the bovine rib
model was chosen because it provides a good bone
density and a proportion between cortical bone and
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PROPERTIES OF METAL BURS AFTER OSTEOTOMY
FIGURE 12. SEM images of sharp region of a G3 2.0-mm bur without perforations (A) and after 40 perforations (B).
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
bone marrow that is similar to the human mandibular
bone.8 In addition, it is easy to obtain and handle.
Many studies assess burs at 1,500 to 2,500
rpm3,4,8,10,12,13,16 and report that there is a reduction
in temperature when used at high speed. However,
the bone type and skill of the operator should also be
discussed, as in the study of Reingewirtz et al.20 They
conclude that for type I or II cortical bone, lower
speeds (400-600 rpm) enable a more precise preparation of the bone, and further damage to the adjacent
bone tissue is avoided, which could compromise the
surgical cavity. Despite the fact that several studies
have been reported using higher-speed drilling such
as 1,500 to 2,500 rpm,3,4,8,11-13,16 our experiments
were performed with a speed of 800 rpm to prepare
the cavities in a bovine rib model with more precision. Moreover, it would be reasonable to evaluate
such aspects with lower-speed drilling. In fact, the
difference in drilling speed may influence the putative
clinical applicability of our data, as well the compar-
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SARTORI ET AL
FIGURE 13. SEM images of sharp region of a G3 3.0-mm bur without perforations (A) and after 40 perforations (B).
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral Maxillofac Surg 2012.
ison between results obtained with higher-speed drilling experiments.
The stainless steel burs served as a control group
for the analyses. This is because stainless steel has
been used for a long time by professionals for osteotomy during implant placement and numerous studies
have shown stainless steel burs’ mechanical properties and sharpness after use.3,8,12,13,16 The burs with a
tungsten carbide coat in a carbon matrix (WC/C)
were developed to increase the resistance to abrasive
wear and the cutting power, as well as to reduce heat
generation and increase surface hardness.20 Zirconia
burs were developed for the preparation of implant
beds because they allegedly have better characteristics than steel burs; for example, they are more resistant and remain sharper longer.9
The SEM showed that there was less deformation in
the cutting region in G2 compared with G1 and that
there were areas of substrate deposition in G1. However, G2 had small areas where there was a loss of
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FIGURE 14. Analysis of mass loss for G1, G2, and G3 for both
2.0- and 3.0-mm burs.
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral
Maxillofac Surg 2012.
PROPERTIES OF METAL BURS AFTER OSTEOTOMY
FIGURE 16. Analysis of Rz measurements for G1, G2, and G3 for
both 2.0- and 3.0-mm burs.
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral
Maxillofac Surg 2012.
coating on the active tip of the bur. This corroborates
the findings of Ercoli et al,8 where the steel burs were
found to have deposition of substrates and the burs
with TiN coating had areas of wear, damage, and loss
of sharpness. In G3 there were several areas of wear
in the cutting region and loss of substrates on both
the 2.0- and 3.0-mm burs. This result is different from
the study by Bayerlein et al,9 where there was no
evidence of loss of material or sharpness on the zirconium oxide burs after 10 perforations.
There was not a statistically significant mass loss
difference (P ⬍ .05) when we compared G1, G2, and
G3 or the subgroups (1, 2, 3, 4, and 5) for the 2.0- and
3.0-mm burs. There was no statistically significant
difference (P ⬍ .05) between G1 and G2 when we
analyzed the increase in roughness (Ra, Rz, and
Rmax). However, G3 had a higher Ra than G1 and G2
and had a higher Rz and Rmax than G1.
Taken together, these results showed the absence
of mass loss after serial perforations in steel burs, burs
with tungsten carbide film coating in a carbon matrix,
and zirconia burs. In this context, it seems to be
FIGURE 15. Analysis of measurements of Ra for G1, G2, and G3
for both 2.0- and 3.0-mm burs.
FIGURE 17. Analysis of Rmax measurements for G1, G2, and G3
for both 2.0- and 3.0-mm burs.
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral
Maxillofac Surg 2012.
Sartori et al. Properties of Metal Burs After Osteotomy. J Oral
Maxillofac Surg 2012.
SARTORI ET AL
important to consider that all burs were cleaned in
running water and air dried after use, before the
measurements were taken, to avoid interfering in the
measurements of mass, roughness, and SEM.
In fact, the absence of mass loss after serial perforations may not be related to absence of bur wear
once a significant increase in roughness was detected
in zirconia burs, when compared with steel burs and
burs with tungsten carbide film coating in a carbon
matrix. Therefore other studies must be carried out to
evaluate the putative influence of increased roughness in drilling procedures using zirconia burs. It also
has been suggested that the presence of zirconia in
dental burs can make an important contribution because of a more gentle surgical technique in the
implant bed preparation compared with conventional
steel cutters.9
Despite these findings, the effects of the process of
cleaning and sterilization were not quantified in this
research. Therefore other studies must be carried out
to improve knowledge on the interaction between
bur roughness and the sterilization process. These
data certainly may serve as a basis for development of
more effective strategies for drilling procedures, as
well as reduction in biological damage during implant
placement.
According to the methodology used, our conclusions are as follows:
●
●
●
In all groups there was a loss of cutting power
after 40 perforations for the 2.0-mm burs using a
drilling speed of 800 rpm; the zirconia burs had
the greatest qualitative loss of substrates.
The 2.0-mm burs in all groups were more worn
than the 3.0-mm burs using a drilling speed of
800 rpm.
The zirconia burs had a higher roughness (P ⬍
.05) when compared with the other groups.
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