Single-Use Versus Multi-Use Implant Drills: Is There a Benefit?
Single-Use Versus Multi-Use Implant Drills: Is there a benefit?
Purpose:
The VA Office of Dentistry recently mandated that single-use implant drills become the new standard of care within the VA nationwide. In addition to the proposed benefit of reduction of infectious disease, manufacturers propose that the use of sharp, fresh drills in the single use system ensures a clean osteotomy for the implant with promise for better prognosis. A major potential downfall for the system is the increased burden of cost. The purpose of this study was to determine if the use of single-use Zimmer implant drills affected the overall outcome of implant placement relative to the standard, multi-use drill system and to determine whether or not this is a cost-effective means of treating a patient population that requires a high volume of implants.
Methods:
A prospective study was conducted in the Oral and Maxillofacial Surgery Clinic at the Veterans Affairs Medical Center in Cleveland, OH. Both single-use and multi-use Zimmer implant drills for the Tapered Screw-vent System were utilized. The site of implant placement was stratified into type I, type II, type III, or type IV bone. All surgery was conducted in a similar fashion, and ISQ values were taken using the Osstell system. An average ISQ value was obtained at time of placement, and at one week. Only patients with overall Osstell values showing initial stability (>50) were included in the study. Two tailed t-test was used to compare the means between the respective groups. A null hypothesis was made that there is no difference between the multi use implant drill system, and the disposable drill system. The alternative hypothesis was that there is a difference between the two systems. In addition, a cost benefit analysis was performed to determine whether single-use drills were a cost-effective means of treating the veteran patient population relative to multi-use drills.
Results:
When comparing disposable implant drills in type I bone vs. multi-use systems in type I bone at immediate placement of the implant, the p value was found to be 0.5943. When the same calculation was conducted in type II bone, the p value was found to be 0.7031. There was no ISQ data available for placement of implants with the multi-use system in type III bone. When comparing immediate ISQ values in implant placement in type IV bone, the p value was found to be 0.8344. When comparing the ISQ readings at one week in implants placed in type II bone between the two drill systems, the p value was found to be 0.5158. All of the results above were not deemed to be statistically significant. The p value in comparing placement at one week in type I bone between the single use and multi-use drills was found to be 0.0170, the only statistically significant result. Based on a cost benefit analysis, the cost to transition from multi-use to single-use drills was approximately $1.5 M per year across the VA healthcare system.
Conclusions:
Overall, there was a trend for higher ISQ values in implants placed with single-use drills when compared to multi-use drill, but this was found to be statistically significant only for implants placed in type I bone at one week post-op. These preliminary results indicate that there is no clinically significant difference between implant stability and viability with single-use versus multi-use Zimmer implant drills.