The influence of the maxillary sinus on maxillary posterior tooth endodontic microsurgery / 口腔疾病防治

@#Endodontic microsurgery is one effective method for preserving teeth affected by periapical disease, and is also an essential technique for treating difficult cases. However, due to the restricted operating space at the posterior site and the proximity of the root apex to the maxillary sinus, endodontic surgery in the posterior maxillary area represents great challenges. This article summarizes the anatomical relationship between the maxillary sinus and the maxillary posterior teeth, the influence on endodontic microsurgery, and the application of assistive techniques on maxillary posterior teeth, such as 3D-printed surgical guides and ultrasonic osteotomes. Literature review results show that the spatial relationship between the apex of maxillary posterior teeth and the maxillary sinus is usually divided into three categories: the apex enters the maxillary sinus; the apex contacts the bottom of the maxillary sinus; and there is a distance between the apex and the bottom of the maxillary sinus. CBCT should be performed before the operation, and the periapical state of the tooth and the maxillary sinus and the distance between the lesions and the sinus floor should be considered to evaluate the difficulty of the operation. Meanwhile, during surgery, equipment such as surgical guides, endoscopes and ultrasonic osteotomes should be used to ensure that the operation is safer, reliable, precise and less invasive, but the clinical popularity of ultrasonic osteotomes still needs further promotion. Moreover, high-quality clinical studies on the long-term effects of micro-apical surgery in the posterior maxillary area are still lacking.

Thoracic Spine Stenosis: Does Ultrasonic Osteotome Improve Outcome in Comparison to Conventional Technique?

@#Introduction: To investigate the efficacy of Ultrasonic Bone Scalpel (UBS) in thoracic spinal stenosis (TSS) in comparison to traditional technique. Materials and methods: A total of 55 patients who had undergone conventional surgery (Group A) are compared with 45 patients of UBS (Group B) in TSS. The primary outcome measure of Modified Japanese Orthopaedic Association score (m JOA) with neurological complications and dural injury were assessed. Secondary outcome measures of total blood loss (TBL), time duration of surgery (ORT) and length of hospital stay (LHS) were analysed. Results: The pre-operative mJOA score 5.00(4.00-6.00) in the group A and 5.00(4.00-6.00) in the group B improved to 7.00(7.00-8.00) in the group A and 9.00(9.00-10.00) in the group B, respectively (P<0.001) at final average follow-up of 117.55 months for group A and 75.69 months in group B. More significant grade of myelopathy improvement and mJOA recovery rate (RR) were noted in group B. The TBL, ORT and LHS were more favourable in group B as compared to group A (p<0.0001). The group A had 9 (16.36%) neurological deficits compared to 2 (4.44%) in group B (p<0.001). Dural tears occurred in both groups (A=11, B=9). It was more frequent and not repairable in group A but without significant statistical difference. Conclusions: UBS can reduce neurological deficits and improve outcomes in TSS. Secondarily, reduced blood loss, lesser surgical time and reduced LHS are significant added advantages of this new technology.

Retrospective study on the merits of bone grafts and the influence of implant protrusion length after osteotome sinus elevation surgery / 华西口腔医学杂志

OBJECTIVES@#This study aims to evaluate the endo-sinus bone remodeling of dental implants placed via osteotome sinus floor elevation (OSFE) after 6 months and using different implant protrusion lengths and bone grafts through cone beam computed tomography (CBCT).@*METHODS@#Ninety-six patients with 124 implants were included and assigned into four groups. Group 1: implant protrusion length4 mm with bone graft; group 3: implant protrusion length4 mm without bone graft. Apical bone gain (ABG), cortical bone gain (CBG), bone density gain (BDG), and marginal bone loss (MBL) were observed and analyzed at baseline and 6 months after implant surgery.@*RESULTS@#The CBG in grafted groups 1 and 2 was higher than that in non-grafted groups. The ABG and BDG were higher in non-grafted groups 3 and 4 than in grafted groups, and the levels in group 3 were higher than those in group 4. The CBG in grafted group 2 was higher than that in group 1. No significant difference was observed in MBL analysis.@*CONCLUSIONS@#The BDG of IPL4 mm implant when bone grafts were not applied. No relevance was observed between IPL and CBG. Bone grafts can accelerate endo-sinus bone remodeling by increasing CBG and dissipating the influence of IPL on BDG.

Application of ultrasonic osteotome in the posterior lumbar interbody fusion surgery by unilateral fenestration and bilateral decompression in the treatment of degenerative lumbar spinal stenosis / 中国修复重建外科杂志

Objective: To compare the effectiveness of posterior lumbar interbody fusion (PLIF) by unilateral fenestration and bilateral decompression with ultrasounic osteotome and traditional tool total laminectomy decompression PLIF in the treatment of degenerative lumbar spinal stenosis. Methods: The clinical data of 48 patients with single-stage degenerative lumbar spinal stenosis between January 2017 and June 2017 were retrospectively analyzed. Among them, 27 patients were treated with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome (group A), and 21 patients were treated with total laminectomy and decompression PLIF with traditional tools (group B). There was no significant difference in gender, age, stenosis segment, degree of spinal canal stenosis, and disease duration between the two groups ( P>0.05), which was comparable. The time of laminectomy decompression, intraoperative blood loss, postoperative drainage volume, and the occurrence of operation-related complications were recorded and compared between the two groups. Bridwell bone graft fusion standard was applied to evaluate bone graft fusion at last follow-up. Visual analogue scale (VAS) score was used to evaluate the patients' lumbar and back pain at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) score was used to evaluate the patients' lumbar and back function improvement before operation and at 6 months after operation. Results: The time of laminectomy decompression in group A was significantly longer than that in group B, and the intraoperative blood loss and postoperative drainage volume were significantly less than those in group B ( P0.05). At last follow-up, according to Bridwell criteria, there was no significant difference in bone graft fusion between the two groups ( Z=-0.065, P=0.949); the fusion rates of groups A and B were 96.3% (26/27) and 95.2% (20/21) respectively, with no significant difference ( χ2=0.001, P=0.979 ). Conclusion: The treatment of lumbar spinal stenosis with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome can achieve similar effectiveness as traditional tool total laminectomy and decompression PLIF, reduce intraoperative blood loss and postoperative drainage, and reduce lumbar back pain during short-term follow-up. It is a safe and effective operation method.

Safety and effectiveness of ultrasonic osteotome in posterior cervical laminectomy decompression and fusion / 中国修复重建外科杂志

Objective: To explore the safety of ultrasonic osteotome used in posterior cervical laminectomy decompression surgery and its effect on surgical outcome. Methods: A clinical data of 52 patients with ossification of posterior longitudinal ligament of cervical spine (C-OPLL) undergoing posterior cervical laminectomy decompression and fusion (PCLDF) between April 2013 and April 2017 was retrospectively analysed. The patients were divided into two groups according to whether using the ultrasonic osteotome during operation: group A (20 cases, ultrasonic osteotome group) and group B (32 cases, traditional gun-clamp decompression group). There was no significant difference in gender, age, body weight, height, preoperative hemoglobin, and Japanese Orthopedic Association (JOA) score between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization time, complications, hemoglobin at 1 day after operation, and JOA score at 6 months after operation were recorded and compared between the two groups, and the improvement rate of JOA was calculated. Results: The operation time and intraoperative blood loss in group A were significantly less than those in group B ( P0.05). The hemoglobin of group B was slightly higher than that of group A at 1 day after operation, but there was no significant difference between the two groups ( t=-1.260, P=0.214). All the patients were followed up 6-10 months (mean, 7.6 months). No serious complications such as C 5 nerve paralysis, dural tear, infection, epidural hematoma, deep venous thrombosis, pulmonary embolism, transfusion allergy, or shock occurred during and after operation. The JOA scores of the two groups were significant improved at 6 months after operation when compared with preoperative scores ( P0.05). Conclusion: Compared with the traditional gun-clamp decompression, the effectiveness of PCLDF in treatment of C-OPLL by using ultrasonic osteotome is comparable, but the latter can effectively reduce the operation time and blood loss.

Use of an Ultrasonic Osteotome for Direct Removal of Beak-Type Ossification of Posterior Longitudinal Ligament in the Thoracic Spine

Direct removal of beak-type ossification of posterior longitudinal ligament at thoracic spine (T-OPLL) is a challenging surgical technique due to the potential risk of neural injury. Slipping off the cutting surface of a high-speed drill may result in entrapment in neural structures, leading to serious complications. Removal of T-OPLL with an ultrasonic osteotome, utilizing back and forth micro-motion of a blade rather than rotatory-motion of drill, may reduce such complications. We have applied the ultrasonic osteotome for posterior circumferential decompression of T-OPLL for three consecutive patients with beak-type OPLL and have described the surgical techniques and patient outcomes. The preoperative chief complaint was gait disturbance in all patients. Japanese orthopedic association scores (JOA) was used for functional assessment. Scores measured 2/11, 5/11, 2/11, and 4/11 for each patient. The ventral T-OPLL mass was exposed after posterior midline approach, laminotomy and transeversectomy. The T-OPLL mass was directly removed with an ultrasonic osteotome and instrumented segmental fixation was performed. The surgeries were uneventful. Detailed surgical techniques were presented. Gait disturbance was improved in all patients. Dural tear occurred in one patient without squeal. Postoperative JOA was 6/11, 10/11, 8/11, and 8/11 (recovery rate; 44%, 83%, 67%, and 43%) respectively at 18, 18, 10, and 1 months postoperative. T-OPLL was completely removed in all patients as confirmed with computed tomography scan. We hope that surgical difficulties in direct removal of T-OPLL might be reduced by utilizing ultrasonic osteotome.

Osteotome sinus floor elevation without bone grafting and simultaneous implant placement in the atrophic maxilla: A pilot study.

Aims: This study evaluated the clinical and radiographic outcome of implants placed in the posterior maxilla with the osteotome sinus floor elevation (OSFE) technique without graft material. Materials and Methods: Twenty-seven 4.1-mm-diameter dental implants (Straumann AG, Basel, Switzerland) were placed to 17 sinuses with residual bone height of ≤10 mm and ≥5 mm to rehabilitate 23 molar and 4 premolar sites. Implants were simultaneously placed with the OSFE procedure without graft material. Results: All implants were successfully integrated after 8-12 weeks healing time. At the 2-year follow-up, all the implants presented the survival criteria proposed by Buser et al. and Cochran et al. Conclusion: The OSFE technique without grafting material may be predictable because the success rate was 100% in this study. Implants gained endo-sinus bone despite the lack of graft material. More patients and longer follow-up are needed to validate the results of this pilot study.

Aesthetic correction of septal deviation with nasal deformify / 中华医学美学美容杂志

Objectives To explore a comprehensive approach for the functional and aesthetic correction of septal deviation. Methods From Jan. 2007 to Dec. 2009, 48 patients with deviation of the frontier and ceiling border of the septal cartilage, 6 males, 42 females, average age of 26.5 years, were surgically treated with a comprehensive use of several techniques, such as septoplasty, reconstruction of septal support, precise osteotomies and nasal tip plasty. Results Functional improvement achieved in all the patients, contour satisfaction achieved in 91.7 % patients; 30 patients were very satisfied, and 14 satisfied with the outcome. Conclusions With the thorough understanding of surgical anatomy of the nose and the use of comprehensive surgical approach, satisfactory outcomes can be achieved both functionally and aesthetically in patients with septal deviation.

THE COMPARATIVE EVALUATION USING HATCH REAMER TECHNIQUE AND OSTEOTOME TECHNIQUE IN SINUS FLOOR ELEVATION

0.05). 2. At the total success rate, osteotome group was 92.4% and Hatch reamer group was 94.9%. There was no statistically significant difference between the two groups (P > 0.05). 3. On the discomfort during the operation by using numerical rating scale, osteotome group was 2.87 +/- 0.83 and Hatch reamer group was 1.12 +/- 0.64. There was statistically significant difference between the two groups (P < 0.05). The Hatch reamer group' clinical results was similar to osteotome group and we thought that Hatch reamer technique can overcome the faults of osteotome technique.

Comparison of implant survival rate by sinus lifting technique in implantation with sinus lift / 대한치주과학회지

PURPOSE: The purpose of this study was comparison of survival rate of implant as two sinus elevation techniques and when window opening procedure had done it was comparison of survival rate of implant between the procedure of implantation after 6 month of sinus elevation to allow healing period and that of implantation with sinus elevation simultaneously. MATERIAL AND METHODS: All 79 of patients treated at DanKook University Dental Hospital Dept. of Periodontics for 164 implantation of maxillary posterior edentulous area with sinus elevation. Sinus elevation technique was divided of the technique : Osteotome technique and window opening technique. RESULT: 14 implants among 96 implants was failed implants of using osteotome for sinus elevation whereas one implant of 68 implants was failed of using window opening technique. CONCLUSION: Window opening technique had higher survival rate than osteotome technique. In case of window opening, there was no significant difference of immediate implantation and delayed implantation.

Physeal Defect Model of Rabbit's Tibia : Conventional Curettage vs Box Osteotome Method / 대한정형외과연구학회지

PURPOSE: In many previous animal studies on cell therapy to the physeal defect, the defect was made by curetting the physeal cartilage with a scalpel, a syringe needle, or a curette. Authors questioned the validity of this method because it may be accompanied by the risk of incomplete removal of physis. MATERIALS AND METHODS: Eight-week-old New Zealand White rabbits were used. In the scalpel group(n=32), a physeal defect was made on the medial half of the bilateral proximal tibiae by the conventional curettage method as previously described. In the box osteotome group (n=16), physis and adjoining eiphyseal and metphyseal bone segments were removed with a box osteotome and a motorized burr. RESULTS: Histological examination showed that, in the scalpel group, incomplete removal of physeal cartilage was observed in 14 of 38 (37%) tibiae sacrificed between Day 1 and 7, while all of the 20 (100%) in the box osteotome group showed complete removal of physeal cartilage. CONCLUSION: The results show the high risk of incomplete removal of physeal cartilage with the conventional curettage method. We believe that our method using a box osteotome and a motorized burr is better in terms of ease and validity in creating physeal defect.

The Effect of Osteotome Technique on Primary Implant Stability according to Bone Quality / 대한치주과학회지

The primary stability of implants is an important factor to predict the osseointegration. Recently, the resonance frequency analysis has been used to measure the primary stability. It is an objective method to monitor the stability of implants during healing phase. This study is to validate the differences in the effect of the osteotome method according to the bone quality as well the thickness of cortical bone. Two hundred seventy implants of 3.75mm in diameter(Neoplant, Neobiotech, Korea) were placed in 135 bovine ribs. The bone quality is classified into 3 classes according to the number of bone marrow spaces which implants would be placed, and then classified into 9 subclasses after the ribs were trimmed. Two implants were placed in 15 specimens of each class. The conclusion were as follows: 1. In case of less dense cancellous bone, the oseotome method is more effective in primary stability rather than the drilling method(p<0.05). 2. If there was cortical bone, it is more advantagous to get stronger primary stability. 3. If cancellous bone is more dense or if cortical bone exists, there is no statistical significance between drilling and osteotome method(p<0.05).

The effect of osteotome technique on primary implant stability according to implant fixture diameter / 대한치주과학회지

Primary stability is a fundamental criteria of implant success. There has been various trials to increase initial stability and bone to implant contact. The objective of osteotome technique is to preserve all the existing bone by minimizing or even eliminating the drilling sequence of the surgical protocol. The bone layer adjacent to the osteotomy site is progressively compacted with various bone condensers(osteotomes) this will result in a denser bone to implant contact. This improved bone density helps to optimize primary implant stability in low density bone. The use of wide implant is one of methods to increse primary stability. They can be used in special situations in which they can increase the surface area available for implant anchorage and improve their primary stability The aim of this study was to evaluate the influence of the osteotome technique and implant width on primary stability. Osteotome technique was compared with conventional drilling method by resonance frequency measurments according to the implant fixtures diameter. The results were as follows: 1. The average of ISQ value was sightly higher in osteotome technique, but there was not statistically significant in regular and narrow implant(p<0.05). 2. Either osteotome technique or conventional technique, ISQ value was significantly higer as increasing of implant diameter(p<0.05). 3. ISQ value of drilling technique was higer than those of osteotome technique in wide implant. It was assumed to be caused by difference in final preparation diameter.

Implantation Using Osteotome Sinus Floor Elevation Procedure

Rhinoplasty Using Percutaneous Osteotomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A precise osteotomy is a requirement for successful rhinoplasty. Osteotomy in rhinoplasty is frequently performed via intranasal route through vestibular incision or can be performed by percutaneous approach. The latter has never been reported in the domestic journal. Thus, we aimed to evaluate in this study the usefulness of rhinoplasty using percutaneous osteotomy. MATERIALS AND METHODS: The pateints age ranged from 19 to 38 years. Surgeries were performed on 6 cases who underwent rhinoplasty during the period of October 1999 to February 2000. Osteotomy via external approach was used with the aid of a sharp, straight 2 mm osteotome. RESULT: Irregularity, scoliosis, and broadness of nasal bony pyramid in the study subjects were successfully corrected using percutaneous osteotomy. During the procedure, hemomhage was minimal. Postoperatively, ecchymosis and edema was negligible and scarring was barely perceptible. However, one female patient who have fair complexion complained of osteotomy scar. CONCLUSION: Our results indicate that the percutaneous osteotomy may be used as a good alternative for the osteotomy approach but must used in judicious manner because of osteotomy scar.