Dental implant insertion requires the preparation of the implant bed via surgical drilling. During this stage, irrigation is essential to avoid thermal damage to the surrounding bone. Surgical guides enhance the accuracy of the implant site preparation, but they mask the drilling site, hampering coolant delivery. A variety of designs are aimed at improving the coolant access to the target site. Using standard dental implant simulation software, this paper presents an in-house design and 3D printing workflow for building surgical guides that incorporate a coolant channel directed toward the entry point of the burr. The proposed design was evaluated in terms of the bone temperature elevations caused by drilling performed at 1500 rpm, under an axial load of 2 kg, and irrigation with 40 mL/min of saline solution at 25 °C. Temperature measurements were performed on porcine femoral pieces, in the middle of the cortical bone layer, at 1 mm from the edge of the osteotomy. The mean temperature rise was 3.2 °C for a cylindrical sleeve guide, 2.7 °C for a C-shaped open-sleeve guide, and 2.1 °C for the guide with an incorporated coolant channel. According to a one-way ANOVA, the differences between these means were marginally insignificant (p = 0.056). The individual values of the peak temperature change remained below the bone damage threshold (10 °C) in all cases. Remarkably, the distribution of the recorded temperatures was the narrowest for the guide with internal irrigation, suggesting that, besides the most effective cooling, it provides the most precise control of the intraosseous temperature. Further studies could test different design variants, experimental models (including live animals), and might involve computer simulations of the bone temperature field.

Dental implant bed preparation involves surgical drilling. Heat generated in this process can cause a temperature elevation beyond the bone damage limit (10 °C), affecting the osseointegration of the implant. Surgical templates ensure accurate implant placement, but they limit the access of the irrigation fluid. This study evaluated the hypothesis that surgical guides with internal cooling prevent bone heating more effectively than classical guides. To eliminate biological variability, this study was conducted on artificial bone pieces that mimic the bone density of the human mandible. We created a surgical template that incorporated four pairs of guides—one classical (CLA) and one with internal cooling (INT) in each pair. For each specimen, we randomly selected the type of surgical guide to start with and performed four osteotomies with a 2.7 mm-diameter drill; then, we widened each hole with a 3.3 mm drill and finalized it with a 3.7 mm drill. The temperature was recorded by thermocouples placed at 0.8 mm from the prospective edge of the final osteotomy. In 168 measurements (12 osteotomies on 14 specimens) conducted for each type of surgical guide, the mean temperature rise was 7.2 ± 4.9 °C (mean ± standard deviation) for CLA and 5.0 ± 3.8 °C for INT. The mean differences between temperature elevations were 1.5 °C, 2.1 °C, and 3.0 °C for the first, second, and third drill, and they were statistically significant: the p-values of Student’s t-test were 0.004, 0.01, and 0.001, respectively. Although the mean temperatures remained safe, temperature rises exceeded 10 °C in 23.8% (9.5%) of the osteotomies performed in the presence of CLA (INT). Taken together, our results suggest that surgical guides with internal cooling ensure a significant drop in the temperature rise caused by implant site drilling.

Background/Objectives: The All-on-4 technique is a minimally invasive approach for full-arch oral rehabilitation. In cases of anterior bone resorption, the classic All-on-4 configuration may be limited by insufficient bone for axial implant insertion. An effective alternative is the “M” configuration, where all four implants are inserted at approximately 30°. This report presents a clinical case of full-arch rehabilitation using personalized surgical guides with internal cooling, designed to optimize irrigation and prevent thermal bone damage. Methods: A 57-year-old female patient underwent digital planning and flapless guided implant surgery. At the maxilla, four DENTIS SQ implants were inserted in an “M”-shaped configuration (4 × 10 mm anterior, 4 × 14 mm posterior). Before insertion, implant beds were prepared using surgical templates with internal irrigation channels. At the mandible, four posterior implants (4 × 8 mm) were placed using dentally supported guides with internal cooling. The surgical guides were designed using Implastation and Blue Sky Plan, 3D-printed in biocompatible resin and sterilized before use. We performed the osteotomies under controlled irrigation with continuous saline flow through the integrated cooling channels. Results: The guides ensured accurate implant positioning. We did not observe intraoperative complications, and all implants achieved primary stability above 35 N·cm. Postoperative healing was uneventful, with minimal edema and no mucosal dehiscence. These indirect clinical indicators suggest that the guide also ensured effective cooling. Radiographic follow-up confirmed correct 3D positioning and intimate bone-implant contact. Conclusions: This case study shows that personalized surgical guides with integrated coolant channels may provide a safe and precise solution for flapless All-on-4 “M” rehabilitations, reducing thermal risks and enhancing surgical accuracy.

Purpose: This study evaluates the thermodynamic benefits of including an irrigation fluid channel in the design of surgical guides used for dental implant site drilling. Materials and Methods: Two types of guides suitable for hosting artificial bone plates that mimic the mechanical properties of human alveolar bone were designed: a classical guide (CLA—a splint with a guiding cylinder) and a guide with an internal coolant channel (INT). They were fabricated from titanium powder by selective laser melting. Graduated drillings were performed using a pilot bur followed by two larger ones; infrared thermography was used to record the temperature of the drill upon exit and the peak temperature of the specimen right after the bur's retraction. Results: The rise in bone temperature (mean ± standard deviation) while drilling through the CLA (INT) guide was 13.2 ± 3.6 (9.0 ± 3.4)°C for Drill 1, 4.3 ± 1.0 (2.1 ± 1.0)°C for Drill 2, and 2.1 ± 0.6 (0.4 ± 0.5)°C for Drill 3; the differences were statistically significant ( p < 0.0032). To characterize individual differences between pairs of drillings conducted with different guides, Bland–Altman analysis was performed for the most thermogenic step. The mean difference between temperature elevations recorded with CLA and INT was −5.8°C, whereas the limits of agreement were 2.9°C and −14.4°C. In 95% of the cases, INT displayed more efficient cooling than CLA. Conclusion: Surgical guides with incorporated coolant channels ensure better heat removal than conventional guides. Further research is needed to assess bone overheating within a few hundred micrometers from the osteotomy edge.

Recent advancements in dental adhesive technology have demonstrated the significant benefits of incorporating magnetic nanoparticles (MNPs) into resin adhesives

Background and Objectives: Conventional dental adhesives doped with magnetic nanoparticles (MNPs) hold the promise of preventing microleakages. However, esthetic concerns have motivated the quest for coatings capable of masking the dark color of MNPs. This study aims to quantify regional chromatic differences between teeth restored using dental adhesives with different MNP content. Materials and Methods: We prepared cavities in 42 artificial molars and 9 extracted teeth and divided them into 6 groups: Group 0 (G0), G1, and G2, comprising 14 artificial teeth each and G0e, G1e, and G2e, comprising 3 extracted teeth each. In G0 and G0e, we applied the commercial adhesive, in G1 and G1e we applied the adhesive loaded with MNPs with dual coating (SiO₂ followed by Ca(OH)₂), whereas in G2 and G2e we applied the adhesive doped with uncoated MNPs. For the statistical analysis of color differences, we employed Bland–Altman plots and the one-sample t-test. Results: G1 was similar to G0 in terms of color coordinate distribution, whereas G2 was different. Compared to G0, dental fillings from G1 had mean differences of (−0.56, 0.18, −0.07) in the CIELAB color coordinates (L*, a*, b*), respectively, whereas the mean differences between G2 and G0 were (−15.6, −3.5, −15.7). The CIEDE2000 color differences were 1.5 [1.3, 1.6] between G1 and G0 (mean [95% confidence interval]) and 17.0 [16.0, 18.0] between G2 and G0. Nevertheless, 24.4% of the point pairs compared exceeded the acceptability limit for color difference (1.8). Conclusions: Although the silica and calcium hydroxide coating is highly effective in alleviating the esthetic impact of MNP-laden dental adhesives, further research is warranted to reduce between-specimen variability.