QUINTESSENCE I NTERNATI ONAL

ORAL SURGERY

Heang-Gon Kim

Volumetric comparison of three different innovative

bone collecting devices for autogenous bone grafts
Heang-Gon Kim, DDS'/Shin-Young Park, DDS, MSD, PhDVHyun-Chang Lim, DDS, MSD3/
Ji-Youn Hong, DDS, MSD, PhDVSeung-ll Shin, DMD, MSD, PhD4/Jong-H yuk Chung, DMD, MSD, PhD5/
Yeek Herr, DMD, MSD, PhD 6/Seung-Yun Shin, DDS, MSD, PhD 7

Objective: The aim of this study was to evaluate the clinical
relevance of three different bone collecting devices in a volu­
metric comparison. Method and Materials: Bone harvesting
for the collection of bone particles was performed on bovine
mandibles. Three different types of bone collecting devices
(Tests 1, 2, and 3) were used. Ten drilling sites in each group
were prepared and bone particles were collected. Bone parti­
cles were sieved twice in sieves with 500 pm and 1,000 pm
openings. The bone particles were divided into three groups:
< 500 pm (SP), 500-1,000 pm (MP), and >1,000 pm (LP). Total
wet volume, fractional wet volume, fractional dry volume, and
weight were measured. The shape of the dried particles was
examined using a microscope. Results: All particles in all three
groups had a wood shaving-like appearance. With Test 1 and
Test 2, LP were the most common (0.510 ± 0.064 mL, 0.430
± 0.067 mL), and in Test 3, MP was the most common
(0.112 ± 0.019 mL). Among the SP and MP, the wet volume of
Test 3 was significantly greater than those of Tests 1 and 2
(P< .001). However, among the LP, the wet volume sequential­
ly increased from Test 1, to Test 2, and Test 3 (P< .001). The
proportion of dry volume was similar to that of wet volume.
Conclusion: Three innovative bone collecting devices could
collect comparable amounts of bone particles to commercially
available bone graft materials. (Quintessence Int 2015;46:807-
815; doi: 10.3290/j.qi.a34458)

Key words: autogenous bone graft, bone collector, oral implantology, particle size

1Graduate Student, Department of Periodontoiogy, School of Dentistry, Kyung Im p la n ta tio n is a successful p ro cedure in d e n ta l reha­
Hee University, Seoul, Korea.
b ilita tio n . This p ro ce d u re o fte n requires g u id e d bone
2Clinical Faculty, Department of Periodontoiogy, Section of Dentistry, Seoul
National University Bundang Hospital, Sungnam, Korea.
re g e n e ra tio n or bon e grafts w h e n th e alveolar ridge is

3Clinical Assistant Professor, Department o f Periodontoiogy, School o f Dentistry, a tro p h ic or if im p la n t dehiscence is present. O f th e var­
Kyung Hee University, Seoul, Korea.
ious bone g ra ft m aterials, a u to g e n o u s bone is consid­
’ Assistant Professor, Department of Periodontoiogy, Institute o f Oral Biology,
School of Dentistry, Kyung Hee University, Seoul, Korea.
ered th e g o ld standard because o f its superior b io c o m ­

’ Associate Professor and Chairman, Department of Periodontoiogy, Institute of p a tib ility , o ste o g e n icity, o s te o c o n d u c tiv ity , and osteo-
Oral Biology, School of Dentistry, Kyung Hee University, Seoul, Korea.
in d u c tio n .1-2 T here are m a n y m e th o d s to c o lle c t
’ Professor, Department of Periodontoiogy, Institute of Oral Biology, School of
Dentistry, Kyung Hee University, Seoul, Korea.
a u to g e n o u s b o n e in th e m o u th . A u to g e n o u s bon e

'Associate Professor, Department o f Periodontoiogy, Institute o f Oral Biology,
School of Dentistry, Kyung Hee University, Seoul, Korea.
Correspondence: Associate Professor Seung-Yun Shin, Department of
Periodontoiogy, Institute of Oral Biology, School of Dentistry, Kyung
Hee University, Seoul, Korea, 130-872. Email: ssyislet@khu.ac.kr
grafts can be collected in e ith e r p a rticu la te o r b lock
fo rm .3'5 A u to g e n o u s b one in p a rticu la te fo rm can be
collected using hand chisels, burs, or bone collectors.6'8
If p ro tru d e d alveolar bone, such as to ru s and exostosis,

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Kim et al
is present around the im plant site, a hand instrum ent
such as an Ochseinbein chisel and mallet may be useful
to collect the autogenous bone. These sites allow for
the easy collection o f autogenous bone. When the col­
lected bone particles are grafted onto the dehiscence
or fenestration bone defects o f the im plant site, new
bone form ation can be successful and stable results
m aintained.911
A bone scraper (Safescraper curve, Meta), which
consists o f a blade, body, and collection chamber, can
be used to scrape cortical bone around the surgical
field to place in the chamber.812 A trephine bur can be
used to collect bone cores at the chin or retromolar
area and has the advantage o f allowing for the collec­
tion o f large amounts o f autogenous bone core (diam­
eter 5 to 7 m m ).13 However, a dd itional steps are
required to crush the bone core w ith a bone crusher or
bone mill if particulate bone is necessary. There is also
the possibility o f dam aging the nerve w ith excessive
drilling because there is no stop. Another bone collect­
ing device such as a bone collector is connected to the
suction. Sufficient bone can be obtained w ith o u t an
additional surgical site.14-15 However, this device is not
appropriate to use in the maxilla where there is not
enough cortical bone. A lth ou g h co nta m in atio n is
another lim itation o f this method, preoperative chlor-
hexidine m outh rinse fo r 1 m in ute showed good
results, w ith o u t infection.16 Anitua et al17 suggested a
novel d rillin g procedure fo r collecting autogenous
bone during im plant site preparation procedures. They
drilled at low speed (20 to 80 rpm) w ith o u t irrigation,
which was useful when a small am ount o f bone was
needed, and had the advantage th a t no additional sur­
gical site was necessary. However, the authors did not
report on the am ount o f bone debris.
There have been many efforts to collect autogenous
bone more easily and faster. Several innovative devices
for collecting autogenous bone are available. These
devices have been designed to collect more bone
debris than im plant drills. The aim o f this study was to
evaluate the clinical relevance o f three different bone
collecting devices in a volum etric comparison.
808
METHOD AND MATERIALS
Description of three bone collecting devices
Three different types o f currently available bone col­
lecting devices were used in the present study. They
have been designed to collect autogenous bone parti­
cles using a rotating drilling system. They are recom­
mended for use at low speed (200 to 300 rpm). They
have stops to prevent overdrilling to the nerve, and
also to collect bone particles.
• Test 1: A uto Chip Maker, N eobiotech. This is a
straight, cylindrical device w ith an em pty center. It
has tw o flutes and a 15-mm plastic cap that extends
to the tip end. The role o f the plastic cap is not only
to collect the bone particles during the drilling, but
also to function as a 4-mm stop. The device has a
protruded point at the tip o f the drill to allow for
initial drilling stability on the cortical bone.
• Test 2: AutoBone Collector, Osstem Implant. This is
a tw ist drill th a t has tw o flutes and a 10-mm metal
cap that extends to 4 mm below the tip end. It has a
protruded p oint on the fro n t portion o f the drill to
help stabilize the initial drilling.
• Test 3: Dentium Harvest Drill, Dentium. This is also a
tw ist drill th a t has tw o flutes, and a 16-mm metal
cap that extends to 4 mm below the tip end. It was
designed to be used w ith o u t a stop during im plant
site preparation for harvesting autogenous bone.
The diameters of Tests 1,2, and 3 were 5.0 mm, 5.0 mm,
and 4.4 mm respectively. The description o f each
device and the protocol suggested by the m anufactur­
ers is summarized in Table 1.
In vitro experiment
The experimental protocol was designed by modifying a
previously described in vitro experiment for bone collec­
tion.6-18 Briefly, bone harvesting for the collection o f bone
particles was performed on bovine mandibles. Frozen
mandible bone was left for 3 hours at room temperature
for thawing. The periosteum was removed w ith perios­
teal elevators to expose the cortical bone. Three different
types o f bone collecting devices were used (Fig 1).
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T a b le 1 Characteristics o f th e th ree inn o vative bone collecting devices and th e m anufacturers' protocols

Shape Flute number Diameter (mm) Length (mm) Speed (rpm) Torque (N-cm)
Test 1 Straight and hollow 2 5.0 14 (stop 4 mm) 300 10
Test 2 Twist 2 5.0 14 (stop 4 mm) 300 10
Test 3 Twist 2 4.4 20 (stop 4 mm) 200 50

Figs la to 1c The three types

of autogenous bone collecting
devices used in the present
study: (a) Test 1 (Auto Chip
Maker, Neobiotech); (b) Test 2
(AutoBone Collector, Osstem
Implant); (c) Test 3 (Harvest
Drill, Dentium).

Ten drilling sites in each group were prepared using

the implant engine (Surgic XT Plus, NSK) under irriga­
tion. All drilling sites were prepared on bovine mandi­
ble body (Fig 2). The drilling speed was 300 rpm in Tests
1 and 2, and 200 rpm in Test 3, according to the manu­
facturers' instructions. Bone particles were collected in
a small bowl after drilling with the devices. Particles
around the preparation holes were also collected with
thorough saline irrigation. The bone particles were
packed into a 1-mL syringe to measure the total wet
volume. The bone particles were then sieved using Fig 2 Drilling sites in the bovine mandible.
sieves (Chunggye) with 500-pm and 1,000-pm open­
ings. The bone particles were divided into three groups:
• < 500 pm (small particles; SP) 24 hours at room temperature, the fractional dry vol­
• 500 - 1,000 pm (medium particles; MP) ume was measured. In addition, the total dry volume
• > 1,000 pm (large particles; LP). and weight were measured. A JW-1 electronic-scale
(Acorn) was used for measuring dry weight. Three more
Each group was packed into a 1-mL syringe and the drilling sites in each group were prepared to evaluate
fractional wet volume was measured. After drying for the size distribution of particles.

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Figs 3a to 3c Microscopic views of bone particles from Test 1 (original magnification x20): (a) large particles (LP); (b) medium particles
(MP); and (c) small particles (SP).
Microscopic analysis
The shape and size of the dried particles were exam­
ined using an Olympus BX51 fluorescence microscope
and an illuminator (DLS-1OOHD, Daeshin I Tech). Digital
images were captured by Olympus software (DP Con­
troller v2.1.1.231). The size distribution of particles was
also evaluated using digital images.
Statistical analysis
Statistical analysis was performed using a computer
program (SPSS v17.0). Nonparametric tests were used.
Intergroup and intragroup comparisons of the proper­
ties of the collected bone particles were statistically
evaluated using the Kruskal-Wallis test followed by the
Mann-Whitney test. A P value of < .05 was considered
statistically significant.
RESULTS
Microscopic analysis
Particles were shown to have a wood shaving-like
appearance in all three groups. However, this charac­
teristic feature was more clearly found with increasing
particle size, especially in LP. SP seemed to be the
crushed fragments from MP and LP. Among the three
kinds of bone collecting devices, the particles from Test
3 had less pronounced wood-shaving shape compared
to the bone from Tests 1 and 2. No specific difference in
shape between the particles from the three devices was
found within each size (LP, MP, or SP; Fig 3).
810
Quantitative analysis
Table 2 and Fig 4 show the wet volume among the
three groups. Drilling time was less than 15 seconds in
all groups. The total wet volumes of Tests 1 and 2 were
greater than that of Test 3 (P < .001). Among bone par­
ticles that were LP, the wet volume of Tests 1,2, and 3
significantly and sequentially increased (P < .001). How­
ever, among the bone particles that were SP and MP,
the wet volume of Test 3 was significantly greater than
that of Tests 1 and 2 (P< .001). In the intragroup com­
parison of wet volume, the particle proportion in Tests
1 and 2 showed a similar pattern; most of the wet vol­
ume was LP followed by MP and SP. However, MP
made up the greatest proportion of the bone particles
in Test 3 (Fig 4). The number of particles of clinically
useful size (> 500 pm) showed a similar pattern. Most of
the wet volume was LP followed by MP and SP
(Table 2).
Table 3 and Fig 5 show the dry volume among the
three groups. The proportion of dry volume was similar
to that of wet volume. Table 4 shows the intragroup
comparison of total dry weight. The total dry weight of
Test 1 was significantly more than for Test 3 (P < .001),
but not than Test 2 (P = .052). Both the wet volume and
the dry volume in Test 1 were significantly greater than
in Tests 2 and 3.
Figures 6 and 7 show the size distribution of parti­
cles among the three groups. SP was the most common
in all test groups, and in particular SP accounted for
more than 50% in Test 3. LP was the most common in
Test 1.
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Table 2 Wet volume (mL) of the bone particles collected

from the three different bone collecting devices
(mean ± standard deviation)

Particle size Test 1 Test 2 Test 3 P value

Total 0.531 +0.060 0.491 ± 0.049* 0.237 ± 0.043 <.001

< 500 pm (SP) 0.007 ± 0.008 0.017 ± 0.009 0.063 + 0.018 <.001

500-1,000 pm (MP) 0.034 + 0.012 0.053 ± 0.022 0.112 + 0.019 <.001

>1,000 pm (LP) 0.510 + 0.064 0.430 ± 0.067 0.021 ±0.016 <.001

> 500 pm (MP + LP) 0.544 + 0.062 0.483 ± 0.053 0.133 + 0.026 <.001

P value <.001 <.001 .001

* There were no significant differences between Tests 1 and 2 (P = .088).

Fig 4 The measurement of wet volume (mL) of the
bone particles from the three bone collecting devices.

Table 3 Dry volume (mL) of the bone particles collected

from the three different bone collecting devices
(mean ± standard deviation)

Particle size Test 1 Test 2 Test 3 P value

Total 0.468 ± 0.081 0.406 ± 0.079' 0.119 + 0.032 <.001

< 500 pm (SP) 0.006 ± 0.002 0.010 + 0.006 0.044 + 0.018 <.001

500-1000 pm (MP) 0.040 ± 0.041 0.037 + 0.013* 0.083 ± 0.024 <.001

> 1000 pm (LP) 0.511 ±0.080 0.415 + 0.075 0.012 + 0.004 <.001
> 500 pm (MP + LP) 0.551 ± 0.085 0.452 ± 0.081 0.094 ± 0.023 <.001
Test 1 Test 2 Test 3
Rvalue < .001 <.001 <.001 Bone-collecting device
*No significant differences between Tests 1 and 2 (P = .096).
FigS The measurement of dry volume (mL) of the
fNo significant differences between Tests 1 and 2 (P = .445).
bone particles from the three bone collecting devices.

Table 4 Total dry weight (mg) of bone particles collected

from the three different bone collecting devices
(mean ± standard deviation)

Test 1 Test 2 Test 3 P value

Total dry w eight 0.099 + 0.020 0.082 ± 0.009* 0.046 ± 0.011 <.001

* No significant differences between Tests 1 and 2 (P = .052).

DISCUSSION size have been reported. Small particles showed more

In the present study, the am ount and the size distribu­
tion o f autogenous bone particles were evaluated when
three types o f innovative bone collecting devices were
used. The result was comparable to other studies on
bone graft particle size. Many studies on graft particle
rapid resorption, greater surface area, and enhanced
osteogenesis compared w ith large particles.19-22 Many
studies have suggested particles o f various size for
grafting and bone regeneration.20'23'24 Decalcified freeze-
dried bone allografts (DFDBAs) ranging from 250 to 420
pm showed better bone induction than DFDBA ranging

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Figs 6a to 6c Microscopic views o f bone particles (original magnification x12.5): (a) Test 1; (5,1 Test 2; (c) Test 3.
Test 1 Test 2 Test 3
Bone-collecting device
Fig 7 The size distribution of bone particles from three bone
collecting devices.
from 1,000 to 2,000 pm.25 However, other researchers
have shown th a t bone particles ranging from 500 to
1,000 pm result in more new bone form ation than larger
particles after 4 weeks.22'26'28 Based on these data, tw o
types o f particle-sized bone graft materials are available
on the market: 250 to 1,000 pm, or > 1,000 pm.
Bone particles collected during im plant site prepar­
ation have been studied. Characteristics o f mesenchy­
mal stem cells were found in stromal cells from bone
chips during im plant osteotomy.29The authors isolated
human alveolar bone derived stromal cells from the
bone chips. These cells were positive fo r early mesen­
chymal stem cell markers such as STRO-1 and CD146.
The quality o f the bone particle can be influenced by
the drilling speed, drilling tim e, and the drill's shape.
Jeong et al18 studied the effect o f im plant drilling speed
on the com position o f the particles collected during
site preparation w ith the Branemark system drill. They
used 1,500 rpm and 800 rpm speeds during the collec­
tion o f the bone particles in the bovine mandible. The
812
d rillin g speed did n ot affect th e to ta l volum e and
w eight o f the bone debris. However, drilling at 800 rpm
produced a larger percentage o f large particles (> 500
pm) than drilling at 1,500 rpm. In the present study, the
am ount o f LP was greater in Tests 1 and 2 (300 rpm)
than in Test 3 (200 rpm). Park et al6 studied the effect of
im plant drill design on particle size and found th a t
tapered- and stepped-shaped drills produced smaller
bone particles than parallel- or tapered-shaped drills.
They also reported th a t the group in which osteotom y
was perform ed at 2,000 rpm had significantly more
large particles (> 500 pm) than the group w ith osteot­
omy performed at 1,000 rpm. The authors suggested
th a t other factors such as drill geom etry had a larger
influence on bone particle size than d rilling speed. In
th eir study, the parallel tw isted drill was a more favor­
able design for collecting larger bone particles and a
greater collectable quantity o f bone than the tapered
stepped-shaped drill. They also reported that drills w ith
a large web and narrow flute produced more small
particles and a lower am ount o f bone particles. In the
present study, Test 3 collected fewer bone particles
than Tests 1 and 2. The difference in drill design could
explain this result. In clinical situations, Test 3 w ith o u t
using the stop during im plant site preparation could
collect acceptable amounts o f bone particles w ith o u t
an additional donor site.
The donor site could be another factor affecting
particle properties (Table 5). In the present study, the
donor site was bovine m andible body w ith cortical
bone thickness o f approxim ately 5 mm. Because all
three devices were m ounted w ith a 4-mm stop, all col­
lected bone particles were cortical bone. The cortical
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Table 5 Measurement of bone thickness in the human mandible

Study Study design M e as u re m en t M easuring site V a lu e (m m ) Notes

Al-Jandan Cortical bone Mandibular 1st molar 2.5(1.6-3.5)

CBCT
et aI30 thickness Mandibular 2nd molar 3.18(2-5.25)
Mandibular 1st molar 2.76 ± 0.62

Leong Cadaver(Boley Cortical bone Mandibular 2nd molar 2.81 ± 0.67

et al31 gauge caliper) thickness Mandibular 3rd molar 2.53 ± 0.65
Total 2.70 ±0.15
Cortical bone 1.32-2.43 5 mm below the root apex:
Cadaver Cortical and
Park Mandibular the internal margin of the
sectioning and cancellous bone
et al32 symphysis Cancellous bone inferior border of the man­
scanning thickness 3.30-6.75
dible

Yates Cortico-cancellous Mandibular ramus 5.12(4.69-5.60)

Cadaver
et al33 bone thickness Mandibular symphysis 7.82 (7.37-8.30)
CBCT, cone beam computed tomography; NA, not applicable.

bone thickness in the human m andible is usually less
than 4 mm.30'33 Al-Jandan et al30 evaluated the cortical
bone thickness o f th e m andible using CBCT and
reported th a t the mean thickness at the apex o f the
m andibular second molar was 3.18 mm. The labial cor­
tical plate o f the m id-m andibular symphyseal region
was 1.26 to 2.31 mm thick and became thicker from the
superior to the inferior region. In one cadaver study,
the buccal bone o f the m andibular molar area was 2.61
to 2.87 mm thick.31 The am ount o f bone could have
been smaller if cancellous bone had been collected
along w ith the cortical bone in a clinical situation.
Several authors have recommended th a t an appro­
priate particle size is 250 to 1,000 pm.20'22'2425 In the
present study, there were 0.544 mL, 0.483 mL, and
0.133 mL o f > 500 pm-sized particles in Tests 1,2, and 3,
respectively. Savant et al34 collected 0.195 mL o f w et
bone particles using a bone collector during single
im plant site preparation. Kainulainen et al35 collected
0.09 to 0.12 mL o f bone for a Straumann im plant site
preparation w hile Young et al15 collected 0.054 g of
bone for a Frialit-2 im plant site. The volumes o f bone
particles collected during the present three types of
im plant drilling procedures were less than 0.13 mL in
bovine rib bone (unpublished results). Although the
devices used in the present study need additional surgi­
cal sites, the am ount o f collected bone was much larger
than in other studies using im plant drills. For clinically
useful sizes (> 500 pm), Tests 1 and 2 collected 0.544 mL
and 0.483 mL at one drilling, respectively. Because com­
mercial bone graft material is usually approxim ately
0.5 m Lor 1.0 mL, one or tw o uses of these devices could
collect autogenous bone particles equivalent to com ­
mercially available bone graft materials (Fig 8). In addi­
tion, these devices allow safety by using a stop, and are
free from the salivary contam ination th a t is found w ith
aspiration-collecting technique devices.
In clinical situations, many factors would differ from
the conditions in the present study. First, the study
used bovine m andible cortical bone. As previously
described, cortical bone thickness is d iffe re n t in
humans. In clinical situations, less bone could be col­
lected in cases o f thin cortical bone. Second, all col­
lected particles had a wood shaving-like appearance. If
large-sized particles are compressed during bone col­
lecting or grafting, they could be broken into small­
sized particles, which w ould decrease the volum e o f
particles. Third, it is not easy to collect SP because most
SP w ould be lost during saline irrigation.
CONCLUSION
In this in vitro study, three different types o f autoge­
nous bone harvesting drills were com pared w ith

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Figs 8a to 8d Clinical picture of autogenous bone collection using Test 1. (a) Preoperative view. There is soft tissue depression at the
position of the mandibular right second premolar, (b) After flap reflection, the alveolar socket is not fully filled with new bone, (c)
Autogenous bone was collected from the mandibular buccal shelf using Test 1 (diameter 4 mm; inset), (d) Three months later cortical
bone had almost been regenerated with new bone (circle).
regards to the characteristics of the bone particle col­
lected. Three innovative bone collecting devices could
collect sufficient amounts of bone particle to use clini­
cally, and enough to provide an alternative to the use
of commercially available bone graft materials.
ACKNOW LEDGM ENT
This study was supported by the Kyung Hee Medical Center Research
Fund by Young-Hyuk Kwon, Professor Emeritus of Kyung Hee University.
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