Comparación entre la piezocirugía y los instrumentos rotativos convencionales en la lateralización del nervio dentario inferior / Comparison between the piezosurgery and the conventional rotary surgery in the lateralization of the inferior alveolar nerve

Introducción: la rehabilitación de pacientes desdentados mandibulares posteriores con implantes osteointegrados, se vuelve difícil cuando la cresta alveolar presenta una atrofia severa debido al recorrido superficial del canal mandibular. La lateralización del nervio dentario inferior es una alternativa terapéutica que posibilita la colocación de implantes convencionales y cortos en esta región. Objetivo: comparar la facilidad, efectividad y seguridad de la técnica quirúrgica convencional, realizada con fresas quirúrgicas, y la piezocirugía en la lateralización del nervio dentario inferior. Presentación del caso: paciente con ausencia bilateral de los molares inferiores y cresta alveolar atrófica fue tratada mediante lateralización del nervio dentario inferior y colocación simultánea de implantes. En el lado izquierdo, la lateralización fue realizada con fresas y en el lado derecho, con motor piezoeléctrico. Fue posible observar que la piezocirugía facilitó la técnica quirúrgica, y consecuentemente disminuyó el tiempo operatorio. A la vez, produjo una osteotomía más regular y con menos sangrado, lo cual mejoró la visualización del campo operatorio. Finalmente, el daño neural inmediato fue menor en el lado tratado con motor piezoeléctrico y con recuperación más rápida. Después de 3 meses de seguimiento, los implantes en ambos lados no presentaban pérdida ósea. Conclusiones: el uso del motor piezoeléctrico trajo más beneficios durante la lateralización del nervio dentario inferior, por la simplificación de la técnica quirúrgica y la reducción del sangrado y del daño neural en comparación con el uso de fresas convencionales(AU)

Introduction: the rehabilitation of edentulous posterior mandibular patients with bone-integrated implants becomes difficult when the alveolar crest presents a severe atrophy due to the superficial course of the mandibular canal. The inferior alveolar nerve lateralization is a therapeutic alternative that allows the placement of conventional and short implants in this region. Objective: to compare the easiness, effectiveness, and safety of the conventional surgical technique, performed with surgical drills, and piezosurgery in the lateralization of the inferior alveolar nerve. Case presentation: a patient with bilateral absence of the lower molars and atrophic alveolar crest was treated by lateralization of the inferior alveolar nerve and simultaneous implant placement. On the left side, the lateralization was made with drills and on the right side, with an electric piezotome. It was possible to observe that the piezosurgery facilitated the surgical technique, and consequently decreased the operative time. At the same time, it produced a more regular osteotomy and with less bleeding, which improved the visualization of the operative field. Finally, the immediate neural damage was lower on the side treated with the electric piezotome and with faster recovery. After 3 months of follow-up, the implants on both sides did not show bone loss. Conclusions: the use of the electric piezotome brought more benefits during the lateralization of the inferior alveolar nerve, by the simplification of the surgical technique and the reduction of bleeding and neural damage in comparison with the use of conventional drills(AU)

Maniobras quirúrgicas en la extracción del tercer molar evitando problemas postoperatorios: cirugía piezoeléctrica y aplicación de un compuesto multivitamínico / Surgical maneuvers in the third molar extraction avoiding postoperative problems: piezoelectric surgery and application of a multivitamin complex

La extracción de los terceros molares mandibulares es un procedimiento de rutina en cirugía maxilofacial, realizado de forma preventiva o asociada a una condición patológica existente y puede resultar en accidentes y complicaciones. Este estudio informa de un caso de extracción de tercer molar atípica, con hipercementosis, con proximidad con el nervio dentario inferior y riesgo de fractura mandibular, lo que complica la extracción quirúrgica. Para la extracción se utilizó piezocirugía asociada la exposición del conjunto de nervios a un compuesto multivitamínico para minimizar las secuelas neuronales consecuencia de la manipulación del nervio dentario inferior. La técnica utilizada en la lateralización del nervio dentario inferior se adaptó a las necesidades de extracción del tercer molar, resultando en la preservación de la sensibilidad del mentón...

The extraction of third molars in the mandible, is a routine procedure of the maxillofacial surgeons, performed preventively or associated with an existing pathological condition. It can result in accidents and complications, this study reports a case of atypical extraction of third molar, with hypercementosis, with a proximity to the inferior alveolar nerve, and the risk of mandibular fracture, complicating the surgical extraction. Piezosurgery device was used for extraction and after exposure multivitamin compound nerve bundle associated to minimize neural sequelae forward to handling the inferior alveolar nerve. The technique used in the lateralization of the inferior alveolar nerve, adapted to the needs of third molar extraction, resulted in the preservation of the sensitivity of the chin...

Effect of instrumentation using curettes, piezoelectric ultrasonic scaler and Er,Cr:YSGG laser on the morphology and adhesion of blood components on root surfaces: a SEM study

This study used scanning electron microscopy (SEM) to evaluate the morphology and adhesion of blood components on root surfaces instrumented by curettes, piezoelectric ultrasonic scaler and Er,Cr:YSGG laser. One hundred samples from 25 teeth were divided into 5 groups: 1) Curettes; 2) Piezoelectric ultrasonic scaler; 3) Curettes plus piezoelectric ultrasonic scaler; 4) Er,Cr:YSGG laser; 5) Curettes plus Er,Cr:YSGG laser. Ten samples from each group were used for analysis of root morphology and the other 10 were used for analysis of adhesion of blood components on root surface. The results were analyzed statistically by the Kruskall-Wallis and Mann-Whitney tests with a significance level of 5 percent. The group treated with curettes showed smoother surfaces when compared to the groups were instrumented with piezoelectric ultrasonic scaler and the Er,Cr:YSGG laser. The surfaces instrumented with piezoelectric ultrasonic scaler and Er,Cr:YSGG laser, alone or in combination with hand scaling and root planing, did not differ significantly (p>0.05) among themselves. No statistically significant differences (p>0.05) among groups were found as to the adhesion of blood components on root surface. Ultrasonic instrumentation and Er,Cr:YSGG irradiation produced rougher root surfaces than the use of curettes, but there were no differences among treatments with respect to the adhesion of blood components.

Esse estudo utilizou microscopia eletrônica de varredura (MEV) para avaliar a morfologia e a adesão de elementos sanguíneos em superfícies radiculares instrumentadas com curetas, ultrassom piezoelétrico e laser de Er,Cr:YSGG. Foram utilizadas no presente estudo 100 amostras provenientes de 25 dentes que foram divididas em 5 grupos: 1) Raspagem manual com curetas; 2) Raspagem com ultrassom; 3) Associação instrumento manual e ultrassom; 4)Irradiação do laser de Er,Cr:YSGG;5)Associação raspagem manual com irradiação com laser de Er,Cr:YSGG. Dez amostras de cada grupo foram utilizadas para análise da morfologia e as outras 10 foram utilizadas para a análise de adesão de elementos sanguíneos. As eletromicrografias foram analisadas através dos escores de adesão de elementos sanguíneos e pelo índice de morfologia radicular e os resultados foram analisados estatisticamente através dos testes de Kruskall-Wallis e de Mann-Whitney com nível de significância de 5 por cento. O grupo que foi tratado com instrumentos manuais apresentou superfície mais lisa em relação aos grupos que foram instrumentados com ultrassom e com o laser de Er,Cr:YSGG. As superfícies instrumentadas com ultrassom e com o laser de Er,Cr:YSGG de forma isolada ou associada a raspagem manual não apresentaram diferenças estatísticas entre si (p>0,05). Não houve diferenças estatísticas entre os grupos em relação a adesão de elementos sanguíneos(p>0,05). A instrumentação ultrassônica e a irradiação com o laser de Er,Cr:YSGG produziram superfícies radiculares mais rugosas em relação a raspagem com curetas, porém não houve diferenças entre os tratamentos com relação à adesão de elementos sanguíneos.