# Heat Generated during Dental Implant Placement: A Scoping Review
## 2 Materials and Methods
### Surgical Guide and Design  
Computer-assisted implant planning emerged in the late 1990s [81]. The use of three-dimensional imaging techniques for planning implant placement brought immediate advantages, including improved accuracy of placement, preservation of anatomical structures like nerves, vessels, and the roots of adjacent teeth, and the ability to avoid invasive surgical techniques such as bone augmentation by adjusting the implant angle within the available bone. Furthermore, the position of the restoration is visualized and determined prior to surgery, ensuring predictable aesthetics and function.  
At the time of surgery, a surgical guide designed using implant planning software is used. Made from resin attached to the teeth adjacent to the surgical site, the axis of the implant is determined by the bur sleeve. Despite variations in design, the guide structure tends to cover the surgical site, limiting irrigation from reaching the surgical site.  
Several studies have explored potential differences in terms of bone site heating between guided and freehand approaches.  
A 2013 study by [PERSON] et al. [82] found that preparation under surgical guidance resulted in an increase in bone temperature compared to conventional preparation techniques, although it did not lead to detrimental effects on bone healing.  
Similar results were found by [PERSON] et al. in 2014, [PERSON] et al. in 2016, [PERSON] et al. in 2021, and [PERSON] et al. in 2019 [83; 84; 85; 86].  
[PERSON] et al. [87] conducted a study to evaluate the influence of guide design on the volume of coolant reaching the surgical site. This study analyzed different designs, from the most to the least overhanging, and found variations in total irrigation volume and bone temperature across different guide designs, but also concluded that critical temperatures for bone healing were not reached.  
Another study by [PERSON] et al. [88] proposed using open or perforated bushings to improve irrigation during surgery. In fact, the use of conventional cylindrical bushings has been shown to lead to greater heat generation compared to other designs, hindering cooling fluid flow.  
Another study [89] reported no obvious increases in bone temperature with variations in rail design and irrigation conditions.  
A 2023 investigation by [PERSON] et al. [90] compared two main groups of surgical guides, open (limiting) and closed (non-limiting) surgical guides. This study found that the open guides led to greater heat production, especially in the initial phase of osteotomy, though this finding was deemed clinically irrelevant.  
A different study [91] explored how the closed traditional guide can also be modified to improve irrigation in the operating site, resulting in significant reductions in heat generation.  
Similar results were found in [PERSON] et al.'s study, where the open guides showed better results in terms of intra-operator bone temperatures [67].  
[PERSON] et al. found no significant difference between external irrigation and the modified internal irrigation added to the surgical guide [92].  
Some studies have shown external irrigation sufficient to control bone temperature [93], even with the flapless technique [94], while using the surgical guide.  
[PERSON] et al. showed a possible way to modify the surgical guide to improve irrigation and reduce bone heating [95; 96; 97].