Histological and histomorphometric study using an ultrasonic crestal sinus grafting procedure: a multicenter case study

Background: The aim of this study was to evaluate the efficacy of a hydrodynamic ultrasonic driven transcrestal sinus grafting procedure (Intralift ®, Acteon Company, Bordeaux, France) and the use of a bovine high temperature sintered grafting material in sinus sites with less than 5 mm remaining bone height with no additional autogenous bone in order to create a sufficient recipient site for implants. Material and Methods: 12 patients (16 sinus) in this multicenter case study were included. Using a crestal approach, bone under the sinus was prepared with ultrasonic tips until the Schneiderian membrane was reached. With a trumpet shaped instrument, the Schneiderian membrane was elevated. In the new created subantral space a high temperature sintered bovine grafting material was introduced (Bego Oss, BEGO Implant Systems GmbH & Co. KG, Bremen, Germany). After 6 months biopsies were taken with a trephine bur and histologies were generated following histomorphometric analysis. Results: The results showed new vital bone in average of 33.4% ± 17.05%, and 43.6% ± 16.70 of bone substitute material. No signs of abnormal inflammation were observed. Conclusions: This procedure (Intralift ®) allows, using a bovine material with no additional autogenous bone, new bone formation in the sinus in order to allow place implant subantraly

Treatment-assessment of Zygoma-tripod, -quadripod, -arch and Orbital floor Fractures in the Elderly Patient: Results of a Longitudinal Clinical Study of 20 years (1995-2015) with 1318 Patients in a General Traumatology-department and Evidence-based Treatm

The ever growing population of elderly patients aged 70 years and onwards are prone to facial injuries caused by a general degrading medical and mental state. Main cause for zygoma-tripod, -quadripod, –arch and orbital floor fractures are falls, followed by traffic accidents and only to a small extent violence. Surgical reduction for these types of fractures is recommended but not correlated to the general medical and mental state of this patient-group. Aim of the study was to compare the outcomes of surgical treatment versus non-surgical observation. Between 1995 and 2014 a total of 1318 patients – hospitalized for isolated zygoma- and correlated fractures – were initially screened for cause of accident, pain, hyp/anaesthesia of the corresponding infraorbital nerve, mandible mobility, facial emphysema/haematoma and diplopia and then distributed into three different groups: no functional and/or cosmetic surgery indication (X), surgery indication but denied by internist and/or anaesthesist due to high general medical risks (Y) and surgery indication and released for surgery by internist/anaesthesist (Z). Follow up for each group was performed on day 5, 7 and 1 month after date of injury. Pain assessment revealed a significant higher pain-load for group Z on the 5th and 7th day after injury. Mandible mobility, facial emphysema/haematoma and diplopia improved significantly better in group X and Y on day 5, 7 and after 1 month compared to group Z. Hyp/anaesthesia of the corresponding infraorbital nerve improved generally but not significant between all three groups. The results of this study suggest that indication for closed or even more for open-reduction surgery of isolated midface-bone fractures should be applied very restrictive and only in accordance with specialists for internal medicine and anaesthesiology for elderly patients and non-surgical observation might lead to better results both for life-quality and remaining life-time from the patients point of view.</p

Vertical Alveolar Crest Split and Widening—An Experimental Study on Cow Ribs, Ultrasonic Tool Development and Test on Human Cadaver Heads

Vertical alveolar crest splitting and horizontal distraction of narrow alveolar crests is limited when rotating and low frequency oscillating tools are used due to large amounts of procedural bone loss and poor handling provisions. Aim of this study was to determine the safest osteotomy depth and to develop ultrasonic-surgery- tips to enable flapless vertical crest splitting and distraction of narrow alveolar crests of 2 mm or less. The safest osteotomy depth was determined on a cow-rib-model. To enable a flapless crest splitting and widening procedure, prototype-tips for the Piezotome-device were developed and tested against mechanical tools (widening screws and distractors) on cow-ribs, as well as their safe use in the hands of novicesurgeons on human cadaver heads. A minimum vertical osteotomy depth of 7–8 mm revealed the least fracture rates (3%). The use of the ultrasonic distraction tools showed the least risk of procedural failures (2%). Twentythree Piezotome-trainees performed the procedure with the developed tips on fresh full human cadaver skulls with a success rate of 100%. The results of this study suggest that, with the use of ultrasonic surgical devices, the indication for vertical crest-splitting can be narrowed down to a crest width of 2 mm and even less and that it can be performed flapless, thus leaving the physiological bone-periosteum system fully intact

Biological Principles and Physiology of Bone Regeneration under the Schneiderian Membrane after Sinus Lift Surgery: A Radiological Study in 14 Patients Treated with the Transcrestal Hydrodynamic Ultrasonic Cavitational Sinus Lift (Intralift)

Introduction. Sinus lift procedures are a commonly accepted method of bone augmentation in the lateral maxilla with clinically good results. Nevertheless the role of the Schneiderian membrane in the bone-reformation process is discussed controversially. Aim of this study was to prove the key role of the sinus membrane in bone reformation in vivo. Material and Methods. 14 patients were treated with the minimal invasive tHUCSL-Intralift, and 2 ccm collagenous sponges were inserted subantrally and the calcification process followed up with CBCT scans 4 and 7 months after surgery. Results. An even and circular centripetal calcification under the sinus membrane and the antral floor was detected 4 months after surgery covering 30% of the entire augmentation width/height/depth at each wall. The calcification process was completed in the entire augmentation volume after 7 months. A loss of approximately 13% of absolute augmentation height was detected between the 4th and 7th month. Discussion. The results of this paper prove the key role of the sinus membrane as the main carrier of bone reformation after sinus lift procedures as multiple experimental studies suggested. Thus the importance of minimal invasive and rupture free sinuslift procedures is underlined and does not depend on the type of grafting material used

Cutting bone with drills, burs, lasers and piezotomes: A comprehensive systematic review and recommendations for the clinician

Background: New tools for bone-cutting were introduced to oral and maxillofacial surgery in the last decade, such as lasers and piezotomes.Purpose: to evaluate most recent evidence, when surgical procedures performed with drills or burs are compared with laser- and/or piezotome-surgical procedures in experimental and clinical studies and to assess possible advantages of their use in daily practice.Methods: a systematic search of various medical databases with specific keywords was performed, excluding studies published before 2006 for their possible invalidity by technological progress. Systematic reviews were assigned to Group 1, experimental studies ex vivo to Group 2, in vivo to Group3 and clinical studies to Group 4. All studies in each of the groups 2 – 4 were appraised regarding their evidence, starting with a value of 0 for no evidence of advantages of lasers and/or piezotomes compared to rotary instruments, 1 for moderate evidence with verifi ed clinical impact and 2 for strong evidence and signifi cant clinical impact and statistically processed for their Evidence Value (EV) in each group and their Overall mean Evidence Value (OmEV).Results: 129 studies were fi nally included for evaluation. Two systematic reviews concluded lack of evidence for lasers to be advantageous over burs/drills. Nine reviews for piezotomes reveal strong evidence piezotome-surgery to signifi cantly reduce morbidity and to enhance soft-tissue preservation. Comparative experimental and clinical studies of burs/drills vs lasers revealed a low EV in Group 2 (EV:0,8), Group 3 (EV:0,5) and Group 4 (EV:0,5) with an OmEV of 0,6. Comparative studies burs/drills vs piezotomes resulted in a signifi cant EV in all groups (Group 2: 1,4, Group 3: 1,3, Group 4: 1,59) with an OmEV of 1,4.Conclusions: the results suggest too little evidence to establish lasers as an alternative to rotary instruments. Piezotomes seem to defi ne a possible new gold-standard in bone cutting due to their improved bone-healing, almost bone-lossless and precise osteotomy design, precise depth-control, softtissue protection as well as reduced intrasurgical and post-surgical morbidity.</p