Effect of flapless piezopuncture on maxillary canine distalization. A preliminary randomized controlled trial

Several methods have been described to shorten orthodontic treatments, but the main disadvantage is their invasiveness. Animal studies have shown that piezopuncture can accelerate the rate of tooth movement without causing collateral damage. Objective: To evaluate the clinical outcome, in terms of safety and efficacy, of a flapless piezopuncture on maxillary canine distalization. Methods: A split-mouth randomized clinical trial was carried out on five patients. Piezopuncture was performed on a random side of the maxillary arch to assess the rate of canine movement on the stimulated side, compared to the non-stimulated control side after 15 (T1), 30 (T2), and 60 (T3) days. Also, immediate side effects and changes in buccal bone thickness after one year were assessed. Results: Distalization on the intervention versus control side at T1 was 1.24±0.21mm versus 0.64±0.33mm (p=0.005); at T2 it was 2.00±0.28mm versus 1.36±0.49mm (p=0.046); and at T3 it was 4.28±0.66mm versus 3.65±0.88mm (p=0.102). No adverse effects related to the surgical procedure were observed or reported by patients. The thickness of the buccal bone plate showed no significant changes. Conclusions: Flapless piezopuncture accelerates the rate of tooth movement in orthodontic patients over the first 15 days and its effect declines over the next 45 days.

Application of minimally invasive ultrasonic osteotome in robotic-assisted sacral tumor resection / 中华骨科杂志

Sacral tumors are surgically challenging and at a high risk of complications. In recent years, robotic-assisted resection has been gradually applied in sacral tumors, but it is difficult to remove bone tissue by present robotic instruments, which limits the application of surgical robot in sacral tumor. The present study aimed to explore the application range and therapeutic effect of minimally invasive ultrasonic osteotome in robotic-assisted sacral tumor resection. Eighteen patients underwent robotic-assisted sacral tumor resection in the First Affiliated Hospital of Sun Yat-Sen University from May 2015 to March 2021 by the Da Vinci robotic surgical system. Among them three patients who underwent osteotomy with minimally invasive ultrasonic osteotome were enrolled. There were 2 males and 1 female, aged 24, 32, 71 years, respectively. The tumors included 2 schwannomas and 1 ganglioneuroma. The operation time, bleeding volume and postoperative hospitalization days were recorded. The recurrence and complications were evaluated during follow-up. The operative time of the 3 patients was 80, 240 and 300 minutes, and the intraoperative bleeding volume was 30, 30 and 100 ml. Complete resection was performed in 2 cases and intralesional resection in 1 case. The postoperative hospital stay was 5, 3 and 7 days respectively. The follow-up time was 58, 17 and 31 months respectively. No tumor recurrence was found during the follow-up. As regards complications, only one patient had left foot pain after operation, and there were no other intraoperative or postoperative complications. The therapeutic advantages of ultrasonic osteotome combined with the Da Vinci robotic surgical system can achieve precise osteotomy, reduce intraoperative bleeding and accelerate postoperative recovery for certain patients with sacral tumors.

Cervical ventral slot in rabbits (Oryctolagus cuniculus). Piezosurgery versus conventional technique

ABSTRACT Purpose To investigate the applicability of piezosurgery for cervical ventral slot (CVS), comparing it with the conventional technique of using high-speed burs for bone wear. Methods Thirty rabbits (Oryctolagus cuniculus) were divided into two treatment groups (T1 and T2) corresponding to CVS between C3-C4. In T1, the surgery was performed with piezoelectric apparatus, and in T2 with high-speed burs. The evaluated parameters were: duration of each stage of surgery, temperature variations during CVS, visibility of the surgical field, intra and postoperative complications, and anesthetic monitoring. At 14, 28, and 56 postoperative days, five animals from each treatment group were submitted for histopathological study of the surgical site. Results Compared with T2, T1 had more precise bone cut, and better visibility of the operative field, although it required longer total surgical time (p = 0.02) and triggered a greater number of intraoperative complications (p < 0.01), microscopic lesions in the spinal cord (p < 0.05), and transient neurological deficits in the postoperatively (p < 0.05). Conclusions It is necessary to perform surgical planning and have several tips of the piezoelectric instrument available for the safe use of the piezoelectric device in neurosurgery.

Rinoplastia preservadora piezoelétrica: uma abordagem alternativa para tratamento de nariz bífido em fissura facial nº 0 de Tessier / Piezoelectric preservative rhinoplasty: an alternative approach for treating bifid nose in Tessier No. 0 facial cleft

O manejo do nariz bífido na fissura facial de Tessier nº 0 é controverso devido às suas características, como uma ampla abóbada óssea, baixa altura dorsal, excesso de pele, volume de partes moles e cartilagens laterais superiores e inferiores distantes. Técnicas conservadoras de rinoplastia, utilizando instrumentos piezelétricos, podem ser uma boa opção para o tratamento do nariz bífido, pois preservam o teto e as cartilagens laterais superiores e realizam uma osteotomia mais precisa. Relatamos o tratamento de nariz bífido em um menino de 13 anos com fissura facial nº 0, no qual foi realizada a rinoplastia conservadora com auxílio de material piezoelétrico. Dado o excesso de pele e tecidos moles, optou-se por uma abordagem transcutânea completamente externa. Para osteotomias, fraturas laterais sob visão direta assistida por piezo foram realizadas para ter um melhor controle do estreitamento da abóbada óssea. As cartilagens laterais superiores e as válvulas nasais internas foram preservadas e reaproximadas à linha média com suturas em "U" horizontais, a fim de obter projeção da abóbada cartilaginosa. Um grande segmento de pele e tecidos moles foi extirpado após estreitamento da abóbada nasal. Um ano de acompanhamento mostra uma pirâmide óssea estreita, melhor projeção e definição de ponta, mas persistindo com um nariz verticalmente curto. Técnicas conservadoras de rinoplastia, assistidas por piezoelétricas, podem ser uma opção para o tratamento do nariz bífido, exigindo um acompanhamento a longo prazo e um estudo com mais casos.

The bifid nose management in Tessier nº 0 facial cleft is controversial due to its characteristics, such as a wide bone vault, low dorsal height, excessive skin, soft tissues volume, and distant upper and lower lateral cartilages. Conservative rhinoplasty techniques, using piezoelectric instruments, can be a good option for the bifid nose treatment, as they preserve the roof and upper lateral cartilages and perform a more accurate osteotomy. We report the treatment of bifid nose in a 13-year-old boy with facial cleft No. 0, to whom was performed conservative rhinoplasty with the aid of piezoelectric material. Given the excess of skin and soft tissues, a completely external transcutaneous approach was chosen. For osteotomies, lateral fractures under direct piezo-assisted vision were performed to have better control of the bone vault narrowing. The upper lateral cartilages and the internal nasal valves were preserved and brought back to the midline with horizontal "U" sutures to obtain a projection of the cartilaginous vault. A large segment of skin and soft tissue was excised after narrowing the nasal vault. A year of follow-up shows a narrow bone pyramid, better projection, and tip definition, but persisting with a vertically short nose. Conservative rhinoplasty techniques, assisted by piezoelectrics, may be an option for bifid nose treatment, requiring long-term follow-up and a study with more cases.

Clinical study of the minimally invasive extraction of impacted supernumerary teeth in 85 cases / 口腔疾病防治

Objective@# To explore the surgical design and surgical Methods for the minimally invasive extraction of embedded supernumerary teeth and to provide a reference for clinical practice.@* Methods@# A total of 87 embedded supernumerary teeth were removed from 85 patients. CBCT examination was performed before the operation. The nearest surgical approach was selected based on the distance between the embedded supernumerary teeth and the bony plate of the buccal tongue (lip and palate). The CBCT measuring ruler measured the maximum diameter of the impacted dental crown. According to the radius of the buccal and tongue directions of the crown, the upper and lower boundaries (bucco-lingual direction) of the bone to be deboned were determined with reference to the top of the alveolar crest or adjacent enamel cementum. A horizontal vertical line was made from the point to the meridian, and the length of the horizontal line was 1/2 the diameter of the impacted multiple crown. Thus, the radius determined the horizontal starting and ending points of the bone to be boneless. A trapezoidal or arcuate incision was made with an electric knife under block anesthesia and local infiltration anesthesia. The incision retained the gingival papilla. The upper and lower as well as the near and far midpoints of the bone were marked with a bone ruler. Starting from the midpoint area, the upper and lower points were connected. The mesial bone was removed in the mesial direction, and the range of the removed bone was slightly larger than the radius of the crown, showing the crown of the embedded supernumerary teeth. A surgical impact air handpiece with a 45-degree elevation angle or a piezosurgery device was used to divide the crown of the embedded supernumerary teeth into two parts. The crown and dental tissues were removed in pieces, the surgical area was cleaned and rinsed, and the wound was closed. Anti-inflammatory and swelling treatments were administered after the operation, and painkillers were prepared. The patients were revisited 7 days after the operation to check for wound healing. We asked and recorded the amount of painkillers taken by the patients. @*Results@#All patients had good wound healing 7 days after the operation, and the wounds were sutured. There was no swelling on the maxillofacial surface, and the degree of opening was basically normal. No other complications such as infection or numbness occurred. Fifty-eight patients did not take painkillers. @*Conclusion@#CBCT can be used to locate the embedded supernumerary teeth in bone. The surgical approach can be chosen based on the principle of proximity. During the surgery, the bone ruler is used to accurately locate the bone and remove the embedded supernumerary teeth in pieces, which can achieve a minimally invasive effect.

Treatment of benign tumors in thoracic spinal canal by modified replanting posterior ligament complex applying piezoelectric osteotomy / 中国修复重建外科杂志

Objective: To investigate the feasibility and effectiveness of modified replanting posterior ligament complex (PLC) applying piezoelectric osteotomy in the treatment of primary benign tumors in thoracic spinal canal. Methods: The clinical data of 38 patients with primary benign tumors in thoracic spinal canal between March 2014 and March 2016 were retrospectively analyzed. There were 16 males and 22 females, aged from 21 to 72 years (mean, 47.1 years). The disease duration ranged from 6 to 57 months (mean, 32.6 months). Pathological examination showed 24 cases of schwannoma, 6 cases of meningioma, 4 cases of ependymoma, 2 cases of lipoma, and 2 cases of dermoid cyst. The lesions located in 18 cases of single segment, 15 cases of double segments, and 5 cases of three segments. The length of the tumors ranged from 0.7 to 6.5 cm. There were boundaries between the tumors and the spinal cord, cauda equina, and nerve roots. The preoperative Japanese Orthopaedic Association (JOA) score was 12.2±2.3 and the thoracic Cobb angle was (11.7±2.7)°. Modified PLC replantation and microsurgical resection were performed with piezoelectric osteotomy. Continuity of uniside supraspinal and interspinous ligaments were preserved during the operation. The PLC was exposed laterally. After removing the tumors under the microscope, the pedicled PLC was replanted in situ and fixed with bilateral micro-reconstruction titanium plate. X-ray film, CT, and MRI examinations were performed to observe spinal stability, spinal canal plasty, and tumor resection after operation. The effectiveness was evaluated by JOA score. Results: The operation time was 56-142 minutes (mean, 77.1 minutes). The intraoperative blood loss was 110-370 mL (mean, 217.2 mL). The tumors were removed completely and the incisions healed well. Three cases complicated with cerebrospinal fluid leakage, and there was no complications such as spinal cord injury and infection. All the 38 patients were followed up 24-28 months (mean, 27.2 months). There was no internal fixation loosening, malposition, or other related complications. At last follow-up, X-ray films showed no sign of kyphosis and instability. CT showed no displacement of vertebral lamina and reduction of secondary spinal canal volume, and vertebral lamina healed well. MRI showed no recurrence of tumors. At last follow-up, the thoracic Cobb angle was (12.3±4.1)°, showing no significant difference when compared with preoperative value ( t=0.753, P=0.456). JOA score increased to 23.7±3.8, showing significant difference when compared with preoperative value ( t=15.960, P=0.000). Among them, 14 cases were excellent, 18 were good, 6 were fair, and the excellent and good rate was 84.2%. Conclusion: Modified replanting PLC applying piezoelectric osteotomy and micro-reconstruction with titanium plate for the primary benign tumors in thoracic spinal canal can reconstruct the anatomy of the spinal canal, enable patients to recover daily activities quickly. It is an effective and safe treatment.

Application of the modified split crest technique of piezosurgery in mandible molar area / 实用医学杂志

Objective To evaluate the therapeutic outcome of horizontal bone augmentation by using the modified split crest technique of piezosurgery in mandible molar area. Methods The present study reviewed the record of 15 patients from 2016 January to 2017 March in the department of oral implantology center of Stomato-logical Hospital of Southern Medical University,who underwent the modified split crest technique of piezosurgery in mandible molar area. Preoperative CBCT was performed to determine the bone thickness of the toothless alveo-lar crest of the mandibular posterior region,and the bone thickness was less than 3 mm. The modified split crest technique of piezosurgery was performed for the horizontal bone augmentation at mandibular posterior region. Meanwhile,GBR and the postoperative CBCT were performed to determine the bone width increments,followed with 1-week anti-inflammatory therapy postoperation. Three months after the operations,the bone width incre-ment was examined by CBCT. SPSS13.0 software was used to analyze the collected data. Results The modified split crest technique of piezosurgery in mandible molar area was successfully established,resulting in the mini-mal operative wounds and the slight postoperative reaction,without obvious infection. The postoperative crest width increase achieved 6.05 ± 0.65 mm. At 3 months after operation,the crest width increase reduced to(5.81 ± 0.61)mm. There were significant differences of the alveolar ridge thickness between the preoperative and post-operative patients(P<0.05). There were significant differences between the preoperative crest width and the 3 months after treatment(P<0.05). Conclusion Horizontal bone augmentation of the modified split crest tech-nique of piezosurgery was efficient,which could be performed in very narrow alveolar ridge,and which was rela-tively safe and accurate,with less trauma. No damage was observed to the soft tissue,and the cutting direction can be well controlled.

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)

Resección de osteoma fronto-naso-maxilar: desafío anatómico con asistencia de estereolitografía y sistema piezoeléctrico / Resection of fronto-naso-maxillary osteoma: anatomic challenge assisted with stereolithography and piezoelectric system

Los osteomas fronto-etmoidales son los tumores benignos más frecuentes de los senos paranasales, pudiendo evolucionar con complicaciones por compresión de estructuras adyacentes. Se presenta el caso de una paciente de 63 años de edad, que consultó por aumento de volumen nasofrontal, cefalea y diplopía. Tras el examen clínico, se evidenció una asimetría facial con lateralización del bulbo ocular derecho y exoftalmo. La tomografía de los senos paranasales mostró una lesión que ocupa parcialmente el seno frontal, etmoidal y parte de la cavidad nasal. Los cuidados anatómicos y planificación quirúrgica se desarrollaron en un modelo estereolitográfico mientras que la cirugía de exéresis total se realizó con ayuda del sistema piezoeléctrico. El examen histológico confirmó el diagnostico de osteoma. Se obtuvo una reconstrucción exitosa, recuperando totalmente simetría y función ocular.

Fronto-ethmoidal osteomas are the most frequent benign tumors of the paranasal sinuses, and may evolve with complications by compression of adjacent structures. The case is a 63-year-old female patient, who consulted about increased nasofrontal volume, headache and diplopia. After the clinical exam, she presented a facial asymmetry with lateralization of the right eyeball and exophthalmus. Computed tomography of the sinuses showed a lesion that partially occupies the frontal sinus, ethmoidal sinus and part of the nasal cavity. The anatomical care and surgical planning was developed in a stereolithographic model while the total excision surgery was performed with the help of the piezoelectric system. Histological examination confirmed the diagnosis of osteoma. A successful reconstruction is obtained, fully recovering symmetry and ocular function.

Clinical application of painless oral anesthesia instrument combined with piezosurgery in the orthodontic traction of impacted maxillary anterior teeth / 口腔疾病防治

Objective @#To investigate the clinical efficacy of painless oral anesthesia combined with piezosurgery compared with ordinary cassette syringe combined with high speed turbine handpiece in the Fenestration operation of orthodontic traction of impacted maxillary anterior teeth.@*Methods @#A total of 128 cases of impacted maxillary anterior teeth were treated with Fenestration operation and orthodontic traction, and the patients were randomly divided into two groups. Group A (64 patients) received painless oral anesthesia combined with piezosurgery. Group B (64 patients) received ordinary cassette syringe combined with high speed turbine handpiece. The cooperation of fenestration and the swelling and pain after operation were compared between the 2 groups.@*Results @#The proportion of 0 and Ⅰ in the anesthesia group was 45.3% and 31.3% respectively, and the conventional group 0 and I accounted for 32.8% and 20.3% respectively. The difference between the two groups was statistically significant (Z=-2.676, P < 0.05). The pateints' cooperative degree in group A was better than that in group B (P < 0.05). The ratio of pain and swelling in the anesthesia instrument combined with Piezosurgery group was 81.2%, the conventional group had a grade I ratio of 59.4%, and the anesthesia instrument combined with Piezosurgery group was lighter than the conventional group, The difference was statistically significant (Z=-2.777, P < 0.05); anesthesia combined with Piezosurgery group after surgery accounted for 81.2% of the swelling, the conventional group of pain accounted for 71.9%, There was significant difference between the two groups (Z=-2.097, P < 0.05). Symptoms and signs as swelling and pain degree in group A were relatively minor than those in group B (P < 0.05). @*Conclusion @#It is worthy clinical promotion to use Painless oral anesthesia combined with piezosurgery in the fenestration and orthodontic traction of impacted maxillary anterior teeth, for its better cooperation and minor post-surgery reaction.

Influência do ultrassom cirúrgico em cirurgias de terceiros molares inferiores: estudo clínico prospectivo, randomizado, duplo cego e "boca-dividida" / Influence of surgical ultrasound used in flap detachment in lower third molar surgeries: a prospective, randomized, double-blind and split-mouth clinical study

Proposição: o objetivo deste estudo foi avaliar os efeitos do deslocamento tecidual por meio de ultrassom cirúrgico no pós-operatório de cirurgias de exodontia de terceiros molares inferiores. Material e Método: fizeram parte do estudo dez pacientes com os dois terceiros molares inferiores indicados para exodontia. Durante a exodontia, um dos dentes foi incluído no grupo Piezo, onde o deslocamento do retalho foi realizado com pontas de motor de ultrassom, enquanto que o no grupo Controle o deslocamento foi realizado com descolador de Molt. Os pacientes foram avaliados nos períodos de 1, 3, 7 e 14 dias pós-operatórios. Os parâmetros avaliados foram o tempo cirúrgico, dor, trismo e edema. Resultados: a média do tempo cirúrgico de 10,07 minutos para o grupo Controle e 17,21 minutos parra o grupo Piezo. Não houve diferença estatisticamente significante entre os grupos no que se refere a dor e trismo em nenhum dos períodos avaliados (p>0,05). Houve diferença estatisticamente significante no edema entre o grupo Piezo e grupo Controle aos 3 dias pós-operatórios, sendo maior edema no grupo Controle (p=0,038). Contudo, nos demais períodos analisados não houve diferença (p>0,05). Conclusão: o uso do ultrassom cirúrgico no deslocamento tecidual do retalho em cirurgias de exodontia de terceiros molares inferiores promoveu menor edema nos estágios iniciais do pós-operatório, entretanto não influenciou nos demais parâmetros analisados (trismo e dor)(AU)

Aim:The aim of this study was to evaluate the effects of tissue detachment by surgical ultrasound in the postoperative period of lower third molar extraction surgery. Material and Method: ten patients with the two lowers third molars indicated for exodontia were included in the study. During the exodontia, one of the teeth was included in the Piezo group, where flap detachment was performed with ultrasound motor tips, while in the Control group the detachment was performed with a Molt elevator. The patients were evaluated at 1, 3, 7 and 14 postoperative days. The parameters evaluated were surgical time, pain, trismus and edema. Results: the mean surgical time of 10.07 minutes for the Control group and 17.21 minutes for the Piezo group. There were no statistically significant differences between the groups with regard to pain and trismus in any of the assessed periods (P> ​​0.05). There was a statistically significant difference in edema between the Piezo group and the control group at 3 days post-operatively, with larger edema in the Control group (P = 0.038). However, in the other periods analyzed, there was no difference in edema (P> 0.05). Conclusion: the use of surgical ultrasound in tissue flap detachment in lower third molar extraction surgery resulted in less edema in the initial postoperative stages, but did not influence the other analyzed parameters (trismus and pain)(AU)

Influence of Piezosurgery on Bone Healing around Titanium Implants: A Histological Study in Rats

Abstract The aim of this study was to evaluate histomorphometrically the influence of two techniques of dental implant site preparation on bone healing around titanium implants. Fifteen male Wistar rats (±300 g) were used in the study. Each tibia was randomly assigned to receive the implant site preparation either with a conventional drilling technique (control - DRILL group) or with a piezoelectric device (PIEZO group). The animals were sacrificed after 30 days and then the following histomorphometric parameters were evaluated (percentage) separately for cortical and cancellous regions: proportion of mineralized tissue (PMT) adjacent to implant threads (500 μm adjacent); bone area within the threads (BA) and bone-implant contact (BIC). The results demonstrated that there were no statistically significant differences between both groups for cancellous BIC (p>0.05) and cortical PMT (p>0.05). On the other hand, a higher percentage of BA was observed in the PIEZO group in the cortical (71.50±6.91 and 78.28±4.38 for DRILL and PIEZO groups, respectively; p<0.05) and cancellous regions (9.62±4.06 and 19.94±14.18 for DRILL and PIEZO groups, respectively; p<0.05). The piezosurgery also showed higher PMT values in the cancellous zone (9.35±5.54 and 18.72±13.21 for DRILL and PIEZO groups, respectively; p<0.05). However, the DRILL group presented better results for BIC in cortical region (80.42±10.88 and 70.25±16.93 for DRILL and PIEZO groups, respectively; p<0.05). In conclusion, for the implant site preparation, the piezosurgery was beneficial to bone healing rates in the cancellous bone region, while the drill technique produced better results in the cortical bone.

Resumo O objetivo deste estudo foi avaliar histomorfometricamente a influência de duas técnicas de preparo para implante dentário sobre a reparação óssea ao redor de implantes de titânio. Foram utilizados 15 ratos machos Wistar, com aproximadamente 300 g. Uma tíbia dos animais foi aleatoriamente selecionada para o preparo do leito para instalação de um implante de titânio com um motor rotatório convencional (Grupo ROTATÓRIO) e a outra com ultrassom cirúrgico piezoelétrico (Grupo PIEZO). Após 30 dias, os animais foram sacrificados e foram avaliados os seguintes parâmetros histomorfométricos (em porcentagem), separadamente, para a região cortical e medular: a proporção de tecido mineralizado (PTM) na região adjacente ao implante (500 μm adjacentes); área de tecido mineralizado (AO) dentro dos limites das roscas do implante e a extensão de tecido ósseo em contato direto (CD) com a superfície do implante. Os resultados deste estudo mostraram que não foram observadas diferenças para CD na região medular (p>0,05) e para PTM na região cortical (p>0,05). Por outro lado, um maior preenchimento das roscas foi observado quando utilizou-se ultrassom cirúrgico piezoelétrico tanto na região cortical (71,50±6,91 e 78,28±4,38 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05) quanto na região medular (9,62±4,06 e 19,94±14,18 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05). Resultados semelhantes foram observados para o parâmetro PTM na região medular (9,35±5,54 e 18,72±13,21 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05). No entanto, o grupo ROTATÓRIO foi superior ao grupo PIEZO em relação a CD na região cortical (80,42±10,88 e 70,25±16,93 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05). Pode-se concluir que, para o preparo do leito para implantes, a piezocirurgia favoreceu o reparo ósseo na região medular, enquanto a técnica convencional promoveu melhores resultados no osso cortical.

Applicational evaluation of split tooth extractions of upper molars using piezosurgery / 北京大学学报(医学版)

Objective:To evaluate the efficacy of Piezosurgery in split teeth extractions.Methods:A single-center,randomized,split-mouth study was performed using a consecutive serious of unrelated healthy patients attending the departing of oral and maxillofacial surgery,Peking University School and Hospital of Stomatology.40 patients were selected for extraction of maxillary molars without reservation value,splitting or nonvital teeth.They were divided into control (20 patients)and test groups (20 pa-tients)randomly.Surgical treatments for both groups were under local anesthesia.Molar teeth of control group were extracted by common equipments like dental elevators,chisels,forceps,etc.While molar teeth of experimental group were extracted by Piezosurgery,aided with the use of common equipments if needed.Then we compared the duration of surgery,frequency of the usage of chisels,expansion of post-operative bony socket surgical discomfort and postoperative pain between two groups.Results:The ave-rage of operation time was (629.5 ±171.0)s in control group and (456.0 ±337.2)s in test group.The buccal alveolar bone reduced (1.07 ±0.64)mm in control group and (1.49 ±0.61)mm in test group. There was a significant difference between the two groups (P 0.05).Conclusion:Piezosugery can be better to preserve alveolar bone,re-duce trauma and patient’s fear.Application of the piezosugery reflect the characteristics of minimally in-vasive extraction,which has the value of promotion.The Piezosurgery technique have the advantage of re-ducing change of buccal alveolar bone during the surgery,but a longer surgical time was required when compared with the conventional technique.VAS value of surgical discomfort,expansion of postoperative bony socket and the operative fear rate,there were no significant difference.Minimally invasive tooth ex-traction technique has good clinical results and high satisfaction.Piezosurgery proved its worth as the in-strument adapted to limiting the destruction of bone tissue.

Comparison between a piezoelectric device and rotary instruments in implant site preparation: an in vivo morphological, histological analysis using pigs / Comparação entre o sistema piezoelétrico e fresas na preparação de nichos para implantes: análise morfológica tecidual in vivo em suínos

OBJECTIVE: To carry out a histological comparison, at different postoperative periods, of bone tissue repair after implant site preparations on the tibia of pigs using both a piezoelectric device and rotary instruments. METHODS: Surgical procedures were performed on the tibia of four pigs. Five perforations were made in the left tibia using star shaped piezosurgery tips (Piezosonic Driller(r)) and five perforations in the right tibia using carbon coated rotary drills (DSP Biomedical(r)). The pigs were then sacrificed at 2, 7, 14, and 28 days. The tibiae were removed and the tissues were prepared for histological processing and analysis under a light microscope. RESULTS: The histological analyses showed similar results at 2 days and both groups presented inflammatory infiltrate. At 7 days, the drill system produces a regular surface preparation and the process of bone repair was greater when compared with the piezoelectric device. At 14 days the presence of new bone formation was more intense with the drill system. However, at 28 days both systems showed similar results, with the presence of an organized, newly formed bone tissue. CONCLUSION: It was possible to conclude that both implant site preparations, using the piezoelectric device and rotatory instruments, resulted in similar bone neoformation at 28 days. .

OBJETIVO: Comparar os aspectos histomorfológicos do tecido ósseo após osteotomias realizadas em tíbias de suínos com sistema piezoelétrico e instrumentos rotatórios em diferentes tempos pós-operatórios. MÉTODOS: Procedimentos cirúrgicos foram realizados em tíbias de quatro suínos, sendo que cada animal recebeu cinco perfurações na tíbia esquerda utilizando sistema piezoelétrico com pontas em forma de estrela (Piezosonic Driller(r)) e cinco perfurações na tíbia direita utilizando fresas rotatórias com revestimento de carbono(DSP Biomedical(r)). Os animais foram sacrificados nos tempos pós-operatórios de 2, 7, 14 e 28 dias. As tíbias foram removidas e o material foi processado para exame histológico em microscopia de luz. RESULTADOS: Ao exame histológico, observou-se após 2 dias, achados semelhantes para os 2 grupos, revelando a presença de tecido compatível com um coágulo junto a um infiltrado inflamatório no leito osteotomizado. Aos sete dias, os preparos realizados com fresas se mostraram mais regulares e houve sinais de maior neoformação óssea próxima ao tecido ósseo remanescente quando comparados ao sistema piezoelétrico. No grupo de 14 dias ficou evidente maior neoformação óssea ao longo de todo leito cirúrgico no grupo de fresas, enquanto o sistema piezoelétrico apresentou neoformação óssea dispersa, porém ao final de 28 dias, a análise morfológica tecidual foi semelhante em ambos os grupos, com a presença de trabeculado ósseo reorganizado. CONCLUSÃO: Pode-se concluir que os achados da análise morfológica revelaram que tanto o sistema piezoelétrico como as fresas na preparação de nichos para implantes promoveram neoformação óssea semelhante, evidenciando a presença de trabeculado ósseo reorganizado aos 28 dias. .

Use of human fascia lata in rat calvarial bone defects

Tooth loss leads to a decrease in alveolar bone volume, and consequently to the need for guided bone regeneration (GBR) techniques to restore bone anatomy, and the adequate choice of therapy. Fascia lata membrane (FLM) has been used in surgical procedures in neurology, orthopedics, otorhinolaryngology, cardiology, vascular surgery, gynecology, and dentistry for guided tissue regeneration. The aim of the present preliminary study was to evaluate bone tissue response in rat calvarial bone defects covered with human fascia lata membrane (FLM). Eight Wistar rats, 230g body weight, were subjected to bone surgery to create a 5x5mm long/ 1mm deep calvarial bone defect on either side of the median suture, using a piezoelectric scalpel and irrigation. The animals were treated according to the following protocol: Group I (GI): placement of a single layer of FLM (Biotar, Rosario, Prov. de Santa Fe, Argentina) to cover the defects; Group II (GII): double layer of FLM to cover the defects; Group III: no membrane; Group IV: control. All the animals were euthanized 60 days post-surgery; the heads were resected, radiographed, decalcified, and processed for embedding in paraffin and Hematoxylin-Eosin and Masson's trichrome staining. All bone defects covered with a single or double layer of FLM showed adequate osteogenesis, and none exhibited an inflammatory response. Groups III and IV Control showed scant osteogenesis and no alterations in soft tissues. The results obtained with this experimental model show biocompatibility of FML with the surrounding tissues at the studied time points. No alterations were observed in osteocytic lacunae or osteocytes in the bone after osteotomy using a piezoelectric scalpel. Further studies need to be conducted to assess bone tissue response to FLM in combination with bone substitutes.

La perdida de piezas dentarias conlleva la disminucion volumetrica del hueso alveolar y la necesidad de recurrir a tecnicas de regeneracion osea guiada (ROG) para restablecer las condiciones anatomicas y aplicar las terapeuticas adecuadas. La membrana de fascia lata (MFL) ha sido utilizada en intervenciones quirurgicas del area neurologica, ortopedica, otorrinolaringologica, cardiologica, vascular, ginecologica y odontologica para regeneracion tisular guiada. El objetivo de este trabajo preliminar fue evaluar la respuesta tisular de defectos oseos en calota de rata recubiertos con MFL. Se utilizaron 8 ratas Wistar de 230 gr de peso, a las que se les realizo en la calota 2 defectos oseos de 5 x 5 mm de lado por 1 mm de profundidad, con bisturi piezoelectrico e irrigacion, a ambos lados de la linea media, segun tecnica estandarizada. Se realizo el siguiente protocolo: Grupo I (G I): colocacion de una sola capa de MFL (Biotar, Rosario, Prov. de Santa Fe, Argentina) para cubrir el defecto; Grupo II (G II): colocacion de MFL en doble capa para cubrir el defecto; Grupo III (G III): sin membrana; Grupo IV (G IV): control. Se les provoco la eutanasia a los 60 dias. Las calotas fueron resecadas, radiografiadas y procesadas, previa descalcifica - cion, para su inclusion en parafina y coloracion con Hematoxilina-Eosina y Tricromico de Masson. En todos los defectos oseos recubiertos con MFL simple o doble se evidencio una adecuada osteogenesis y ausencia de respuesta inflamatoria y macrofagos. El G III y el G Sham evidenciaron escasa osteogenesis y no mostraron alteraciones en el tejido blando. La MFL en el modelo experimental utilizado evidencio una respuesta compatible con el tejido circundante en los periodos estudiados. El tejido oseo remanente a la osteotomia con bisturi piezoelectrico presento las lagunas osteociticas ocupadas con osteocitos y sin alteraciones. En estudios futuros se evaluara la respuesta tisular con MFL y utilizando un sustituto oseo.

The effect of piezosurgery with cvd tip in osteotomy in rat parietal bone: histologic and histomorphometric analysis / O efeito da piezocirurgia com ponta cvd em osteotomia no osso parietal de ratos: estudo histológico e histomorfométrico

O objetivo deste trabalho foi avaliar histológica e histomorfometricamente o efeito da piezocirurgia com ponta CVD em osteotomia realizada no osso parietal de ratos, comparativamente com a resposta do tecido ósseo frente ao protocolo padrão de osteotomia com brocas de tungstênio em baixa rotação. Material e Métodos: Defeitos foram feitos nos ossos parietais de 20 ratos Wistar machos, usando a ponta CVD e broca. Após 3, 7, 14 e 28 dias cinco animais foram sacrificados em cada período e o osso contendo os defeitos submetidos às análises histológica e histomorfométrica. Os resultados obtidos da histomorfometria foram submetidos à análise estatística RM ANOVA com nível de significância de α = 0,05. Os resultados obtidos foram submetidos ainda ao teste de comparação múltipla de Tukey. Resultados: A piezocirurgia promoveu corte preciso e mais lento com menos perda óssea, menor sangramento durante a cirurgia, favorecendo condições para uma reparação mais rápida em comparação com o método tradicional de osteotomia. Os resultados mostraram que nos períodos analisados diferença estatisticamente significativa entre os dois tipos de tratamento (p <0,05). Poucas células inflamatórias, formação óssea rápida, ferida cirúrgica limpa no grupo experimental em todos os períodos. Conclusão: A utilização da piezocirurgia com ponta CVD provou-se válida para a osteotomia, com cortes mais precisos, menos danos aos tecidos, resposta inflamatória menos pronunciada e formação óssea mais rápida nos primeiros períodos quando comparada com a broca de tungstênio em baixa velocidade...

The aim of this study was to compare the response of bone tissue in osteotomy under piezosurgery using a CVD tip in rat parietal bone in contrast with the standard protocol using lowspeed tungsten burs. Material and Methods: A bone defect model was created in parietal bone of 20 male Wistar rats using CVD tip and drill. Five animals were sacrificed after 3, 7, 14 and 28 days and bone containing the defects was submitted to the histologic and histomorphometric analysis. The results of histomorphometry were statistically analyzed using RM ANOVA with a significance level of α = 0.05. The results were still subjected to Tukey’s multiple comparison test. Results: The results showed statistically significant difference (p < 0.05) between the two types of treatment in the analyzed periods. Piezosurgery promoted slower and more precise cut with less bone loss and less bleeding during surgery, promoting conditions for a faster repair compared to the traditional method of osteotomy, fewer inflammatory cells, faster bone formation and cleaner surgical wound in the experimental group in all periods. Conclusion: The use of CVD tip in piezosurgery was proven to be valid for osteotomy, with more precise cuts, less tissue damage, less fewer pronounced inflammatory response and faster bone formation in the early healing periods when compared with low-speed tungsten burs...

Efeito de três sistemas de osteotomia: ultrassom cirúrgico, laser Er, Cr: YSGG e sistema rotatório: sobre o processo de osseointegração e reparo de defeitos ósseos em tíbia de ratos. Estudo histomorfométrico, imuno-histoquímico e biomecânico / Effect of three osteotomy systems: Piezosurgery, ER, Cr: YSGG laser and rotary system: on osseointegration and repair of bone defects in tibia of rats. Histomorphometrical, immunohistochemical and biomechanical study

O objetivo deste trabalho foi avaliar o processo de reparo ósseo e a osseointegração de implantes inseridos em leitos cirúrgicos preparados por meio de Brocas Convencionais, Ultrassom Piezoelétrico e LASER Er,Cr:YSGG. Como objetivo secundário, foi testada a habilidade do ultrassom cirúrgico de estumilar a liberação de citocinas e fatores de crescimento ósseo durante o processo de reparo. Para tanto, dois estudos distintos foram conduzidos. No Estudo 1, 144 ratos foram divididos em 3 grupos (Grupos Broca, LASER e Piezo) com 48 animais cada. Mini implantes usinados foram instalados em ambas as tíbias de cada animal em alvéolos cirúrgicos preparados pelos 3 sistemas testados de acordo com o grupo ao qual o animal pertencia Após a intervenção cirúrgica, 8 animais por grupo foram sacrificados aos 0, 3, 7, 14, 30 e 60 dias pós-operatórios.. O implante da tíbia direita foi utilizado para o ensaio de torque de remoção e o da tíbia esquerda, para análise de ContatoOsso-Implante (COI) e Fração de Área Ocupada por Osso (FAOO). No Estudo 2, 174 animais foram divididos nos mesmos grupos experimentais ­ Broca, Piezo e Laser ­ com 63, 63 e 48 animais cada, respectivamente. Defeitos ósseos de 2mm de diâmetro foram produzidos na tíbia direita dos animais usando um dos três dispositivos testados de acordo com o grupo ao qual o animal foi designado. Oito animais de cada grupo foram sacrificados aos 0, 3, 7, 14 30 e 60 dias e a cicatrização óssea foi analisada por histomorfometria e detecção imunohistoquímica de Osteocalcina, Osteoprotegerina, Rankl, Vegf e Caspase-3. Cinco animais dos Grupos Broca e Piezo foram sacrificados aos 3, 7 e 14 dias e o espécimes coletados foram utilizados para análise de PCR quantitativo (Q-PCR). Os resultados do Estudo 1 demonstraram a osseointegração dos implantes no três grupos estudados. No Grupo Broca a formação óssea ocorreu mais precocemente, porém um aumento significativo no torque de remoção ocorreu somente aos 30 dias. Nos Grupos Laser e Piezo o torque de remoção aumentou precocemente e o reparo ósseo ao redor do implante foi progressivamente aumentado até os períodos tardios. Os resultados do Estudo 2 demonstraram diferenças no padrão de corte do dispositivos testados, onde Proca e Piezo produziram osteotomias regulares enquanto o LASER produziu osteotomias irregulares com carbonização das margens do defeito. A neoformação óssea foi maior nos Grupos Piezo e Laser ao longo dos períodos de reparo, porém essa diferença foi detectada estatisticamente somente aos 30 dias entre grupos Piezo e Broca (p<0.05). A expressão de caspase-3 foi significativamente menor aos 7 dias no Grupo Laser em comparação ao grupo broca. Os resultados do Q-PCR evidenciaram expressões elevadas de Runx2 e Caspase-3 nos grupos Broca e Piezo aos 7 dias, respectivamente (p<0,05). A análise dos resultados permite concluir que as osteotomias produzidas pelos três dispositivos testados são comparáveis, em termos de processo cicatricial e a formação óssea ao redor de implantes; e que o reparo ósseo produzido por ultrassom cirúrgico não possui o reparo ósseo acelerado pela liberação de fatores de crescimento

The aim of this study was to evaluate the bone healing process and osseointegration of implants placed in sockets prepared by conventional Drills, Piezosurgery and Er,Cr:YSGG laser. As a secondary objective we tested the hability of Piezosurgery of enhancing the bone repair by releasing of citokynes and growth factor. Therefore, two different studies were conducted. In study 1, 144 rats were assigned to 3 groups: Groups Drill, Laser and Piezo, with 48 animals in each group. Machined mini-implants were placed in both tibiae of each animal in sockets prepared by the three tested systems, according to the group in which it was assigned. After the surgical procedures, 8 animals were sacrificed postoperatively at 0, 3, 7, 14, 30 and 60 days in each group. The implant of the right tibia was used for removal torque test and the left tibia implant was used for Bone-to-Implant Contact (BIC) and Bone Area Fraction Occupancy (BAFO) analysis. In Study 2, 174 animals were ssigned to the same experimental Goups - Drill, Piezo and Laser ­ with 63, 63 and 48 animals in each group. Bone defects with 2mm in diameter were created in the righ tibia of each animal using one of the three tested devices according to the group in which it was assigned. Eight animals of each group was sacrificed at 0, 3, 7, 14 , 30 and 60 days and bone healing were analyzed by means of histomorphometry and immunohistochemical detection of Osteocalcin, Osteoprotegerin, Rankl, Vegf and Caspase-3. Also, 5 animals form Gorups Drill and Piezo were sacrificed at 3, 7 and 14 days and the bone samples were used for quantitative PCR (QPCR) analysis. Results of Study 1 demonstrated implant osseointegration in all experimental groups. The Group Drill presented early bone formation, however, significant increasing in torque removal values occurred only at 30 days. In Groups Laser and Piezo, removal torque increased early and bone healing around the implant was progressively increased until later time-points. Results gotten from Study 2 showed differences on the cut characteristics among the tested devices, where Drill and Piezo produced regular osteotomies whilst Laser produced irregular osteotomies with carbonization at the defect margins. Bone neoformation was higher in Groups Piezo and Laser along the time-points, however, this difference was statistically significant only at 30 days between Groups Piezo and Drill (p<0.05). Expression of Caspase-3 was significantly lower at 7 days in Group Laser in comparison to Group Drill. Results of QPCR analysis demonstrated higher expression of Runx2 and Caspase-3 in Groups Drill and Piezo at 7 days respectively (p<0.05). According to the results it can be concluded that osteotomies produced by the three tested devices are comparable in terms of healing and bone formation around the implants; and piezosurgery has not the ability of accelerate the bone healing by an increased releasing of growth factors

Horizontal Ridge Augmentation with Piezoelectric Hinge-Assisted Ridge Split Technique in the Atrophic Posterior Mandible / 대한악안면성형재건외과학회지

Onlay bone grafting, guided bone regeneration, and alveolar ridge split technique are considered reliable bone augmentation methods on the horizontally atrophic alveolar ridge. Among these techniques, alveolar ridge split procedures are technique-sensitive and difficult to perform in the posterior mandible. This case report describes successful implant placement with the use of piezoelectric hinge-assisted ridge split technique in an atrophic posterior mandible.

Rapid orthodontics with flapless piezoelectric corticotomies: first clinical experiences / Ortodoncia rápida con corticotomías piezoeléctricas sin colgajo: primeras experiencias clínicas

One of the biggest challenges an orthodontic patient faces is the time spent wearing brackets. Over the years, several surgical techniques have been developed to address this issue and reduce the overall treatment time. These combine bone-healing mechanisms with orthodontic loads to accelerate tooth movement. Although effective, these techniques are also quite invasive in nature, requiring the elevation of buccal and lingual full-thickness flaps with extensive decortications of the buccal and lingual alveolar bone. Moreover, these techniques run the risk of teeth devitalization, avascular necrosis of the osseous block, alveolar resorption, and the risks of complications, with low acceptance by the patient. This manuscript reports three cases treated with a novel, flapless approach for minimally invasive rapid orthodontic (MIRO). This procedure includes radiographic-guided micro incisions and localized piezoelectric corticotomies. The clinical implications of this technique are discussed herein. MIRO reduces orthodontic treatment time, avoiding the reported adverse effects of accelerated orthodontics.

Uno de los mayores desafíos que enfrenta un paciente de ortodoncia es el tiempo que lleva usar brackets. A través de los años, varias técnicas quirúrgicas se han desarrollado para hacer frente a este problema y reducir el tiempo total de tratamiento. Estas combinan los mecanismos de cicatrización ósea, con cargas de ortodoncia para acelerar el movimiento de los dientes. Aunque eficaz, estas técnicas son bastante invasivas, que requieren la elevación de colgajos bucales y linguales de espesor total con decorticaciones extensas del hueso alveolar bucal y lingual. Por otra parte, con estas técnicas se corre el riesgo de desvitalización dentaria, necrosis avascular del bloque óseo, reabsorción alveolar, y los riesgos de complicaciones, con baja aceptación por parte del paciente. Este trabajo reporta tres casos tratados con un nuevo enfoque sin colgajo para ortodoncia rápida mínimamente invasiva (MIRO - minimally invasive rapid orthodontic). Este procedimiento incluye microincisiones guiadas por radiografías y corticotomías piezoeléctricas localizadas. Las implicaciones clínicas de esta técnica se analizan en este documento. MIRO reduce el tiempo de tratamiento de ortodoncia, evitando los efectos adversos reportados por la ortodoncia acelerada.

Multicenter clinical study on the hydrodynamic piezoelectric internal sinus elevation (HPISE) technique

OBJECTIVES: This study was to evaluate the effect of vertical bone gain and success rate and analyze the failure cases using the hydrodynamic piezoelectric internal sinus elevation (HPISE) technique. MATERIALS AND METHODS: Patients who had been operated in the three centers including Daegu Catholic University Medical Center were selected for this study. The mucoperiosteal flap was elevated, and the sinus floor was then broken by specially designed piezoelectric insert, with hydraulic pressure applied to the sinus membrane for even elevation. Afterward, implants were placed. Panoramic radiogram or computed tomogram was taken before and after surgery and at the second operation and prosthesis placement. Later, changes in vertical height were measured and compared. The survival rate was based on the criteria of Buser et al. and Cochran et al. RESULTS: In this study, 8 implants failed out of a total of 169 implants, resulting a success rate of 95.3%. These failure cases were due to insufficient initial stability or sinus membrane perforation. The mean of radiographic vertical height change at prosthesis placement was 5.7 mm (0.5-10.5 mm). CONCLUSION: In this study, HPISE technique was found to be a predictable treatment for atrophic maxilla and an alternative technique to the lateral approach.