Take home messages

Tests carried out by IDI Evolution have allowed to endow the TMM3 micromotor with a special interfaced alerting surgeons when they run the risk of overheating bone when preparing the implant site; this increases the patient’s safety, as well as the predictability of success concerning the whole rehabilitation.

The core of the TMM3 micromotor lies in its ability to dynamically measure the energy exchanged with the tissue, while the steps leading to implant insertion are being carried out. This provides it with the ability to accurately and reliably measure bone density through the use of a specific probe, and to dynamically measure primary stability through the Integral of the torque-depth curve recorded during implant insertion.

The very same dynamic measurement of energy comes into play at a further stage of the implant insertion protocol: drilling into the bone bed using a twist-drill. The TMM3 motor is, in fact, capable of calculating, at any moment, how much energy the drill is transferring to the bone.

The fate of this energy is twofold: a part overcomes the physical resistance of the bone tissue, entering it and thus creating the implant tunnel; another part, however, is dissipated as heat generated by friction, that is – in turn - transferred to the tissue. This condition is well known to be a risk: excessive temperature increase can indeed cause tissue thermal damage - which, in the most severe cases, can lead to osteonecrosis.

This should be prevented - as repeatedly stated in the literature - by using abundant irrigation, preferably cooled, and adapting the drilling technique - carefully choosing the design of the drill, always checking its wear, modifying how it is made to enter the tissue, and appropriately modulating its rotation speed.

Until now, surgeons operated according to their experience; today TMM3 adds to their skills by measuring the energy exchange between the drill and the tissue, and providing them with this piece of information. This was made possible by specific thermomechanical studies, conducted on different model systems, that have allowed IDI Evolution to build precise sets of data describing how various bone density, drill type, rotation speed combinations may affect the thermal risk.

In practice, IDI Evolution has assessed such combinations through appropriate studies, and, based on the results, has developed special TMM3 algorithms which allow the system to alert the surgeon if, while drilling, the energy exchanged with the bone tissue may make its temperature to exceed a given risk threshold, providing the operator with both visual and acoustic signals.

Such thresholds were defined through specific validation studies conducted by the IDI Research and Development for this specific purpose.
Thus, thanks to IDI Evolution, the surgeons’ skill is now complemented by the objectivity of measuring the dynamic exchange of energy when drilling: to make implantology even more predictable and safer.

References

Chakraborty S, Moufti MA, Kheder W. The Effect of Dental Implant Drills Materials on Heat Generation in Osteotomy Sites: A Systematic Review. Eur J Dent. 2024 Feb;18(1):65-72. doi: 10.1055/s-0043-1768472.
Link to the article

Möhlhenrich SC, Modabber A, Steiner T, Mitchell DA, Hölzle F. Heat generation and drill wear during dental implant site preparation: systematic review. Br J Oral Maxillofac Surg. 2015 Oct;53(8):679-89. doi: 10.1016/j.bjoms.2015.05.004. IF: 1.800 (2022)
Link to the article 
IF: 2,000 (2025)

 


What is the importance for clinical research?

The tests that have been carried out show that the energy exchanged when drilling bone can be measured with enough accuracy to predict conditions that could lead to tissue thermal damage possibly affecting osteointegration. This paves the way to investigate which drill designs are most effective in creating lower friction or whether differences drilling parameters, such as resorting to low-speed drilling under specific conditions (D1 bone) etc. may ensure safer implant site preparation.

What is the impact on everyday operations?

Oral surgeons can rely on a system that allows to avert the risk thermal damage. The system, in fact, warns them during drilling when such risk conditions occur - allowing them to adapt their technique while operating greatly adding to the patient safety and the surgery outcome.

In support of IDI Evolution devices

TMM3 is an all-round tool for consistent implant placement. It provides crucial information at all steps: it measures bone density, assess the drilling protocol, evaluate primary stability – thus validating each operational choice. This is achieved by providing surgeons with objective data that allow them to continuously refine their technique, increasing the surgical success and providing the patient with an even more certain outcome. 

Other Publications

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We have paved the way to provide objective protocols for undersizing the cortical layer, making the clinical procedure reproducible, and the outcome predictable in terms of MBL

The relationship between the extent of cortical undersizing, the primary stability it allows to achieve, the early and late marginal bone resorption it may induce has still not been clarified: studies on this matter are contradictory and inconclusive.
However, IDI Evolution systems are the only ones capable of site-specific discrimination and operator-independent assessment of different combinations of cortical thickness and cancellous density, providing a measure of implant primary stability, the Torque-Depth Integral, which also evaluates the mechanical stress exerted on the cortical thickness.

Read moreabout We have paved the way to provide objective protocols for undersizing the cortical layer, making the clinical procedure reproducible, and the outcome predictable in terms of MBL

We have demonstrated that the IDI bone density diagnosis system can distinguish between different cortical-trabecular combinations, paving the way for a new objective bone classification

The research carried out by IDI Evolution shows that TMM3 measures even bone quality, that is the combination of a given cortical layer thickness and a given trabecular density.

Read moreabout We have demonstrated that the IDI bone density diagnosis system can distinguish between different cortical-trabecular combinations, paving the way for a new objective bone classification

We have defined an objective method for rationally choosing both the protocol for preparing the implant site and the shape and dimensions of the implant to be used

The Integral of the torque-depth curve, measured by TMM3 during implant insertions, varies predictably in relation to how underprepared the implant tunnel is.
The variation of the Integral is also predictable when altering the implant geometry, both in terms of shape (conical, cylindrical, etc.) and dimensions (diameter/length).
The mathematical algorithms describing these variations are also influenced by bone density.

Read moreabout We have defined an objective method for rationally choosing both the protocol for preparing the implant site and the shape and dimensions of the implant to be used