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Canullo L, Peñarrocha D, Peñarrocha M, Rocio AG, Penarrocha-Diago M. Piezoelectric vs. conventional drilling in implant site preparation: pilot controlled randomized clinical trial with crossover design. Clin Oral Implants Res 2013; 25:1336-43. [DOI: 10.1111/clr.12278] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 11/29/2022]
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Mandibular bone and soft tissues necrosis caused by an arsenical endodontic preparation treated with piezoelectric device. Case Rep Dent 2013; 2013:723753. [PMID: 24062957 PMCID: PMC3766612 DOI: 10.1155/2013/723753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 07/17/2013] [Indexed: 11/17/2022] Open
Abstract
This paper describes a case of wide mandibular bone necrosis associated with significant soft tissues injury after using an arsenical endodontic preparation in the right lower second molar for endodontic purpose. Authors debate about the hazardous effects of the arsenic paste and the usefulness of piezosurgery for treatment of this drug related bone necrosis.
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103
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Ghassemi A, Prescher A, Talebzadeh M, Hölzle F, Modabber A. Osteotomy of the nasal wall using a newly designed piezo scalpel--a cadaver study. J Oral Maxillofac Surg 2013; 71:2155.e1-6. [PMID: 24075234 DOI: 10.1016/j.joms.2013.07.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Achieving the desired outcome in rhinoplasty depends on many factors. Osteotomy and adjustment of the lateral nasal wall are important steps that necessitate careful planning and execution. A cadaver study was performed to evaluate the osteotomy result obtained with a newly designed piezoelectric-based scalpel. MATERIALS AND METHODS Twenty lateral osteotomies of the nasal wall were performed in 10 human cadaver noses. The osteotomies were conducted in 6 female and 4 male cadavers (age range, 65 to 83 yr; mean age, 74.8 yr). A specially designed Piezosurgery-based scalpel was used endonasally to perform the lateral osteotomy. Cutting of the bony nasal wall was performed subperiostally along the planned osteotomy route under tactile control. Digital infracturing was accomplished by applying gentle pressure. After completing the osteotomy, the osteotomy line and nasal mucosa were examined endoscopically. The skin cover was removed to examine the lateral bony nasal wall for the shape and amount of bone fragments, the osteotomy path, and mucosa involvement. RESULTS Using the Piezosurgery-based scalpel required a learning curve, but the handling was easy. It allowed an exact performance of the osteotomy and caused no mucosal tearing. If excessive force was used, the piezo tip stopped working. There was no comminuted fracture pattern and the lateral nasal wall remained in 1 piece. The duration of the osteotomy was 5 to 10 minutes on each side. CONCLUSION The piezoelectric-based scalpel is a useful tool, which can be used to perform osteotomy of the nasal wall. In addition, this specifically designed tool tip allows an endonasal approach, is easy to handle, and allows effective irrigation of the osteotomy region.
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Affiliation(s)
- Alireza Ghassemi
- Assistant Professor, Department of Oral, Maxillofacial, and Plastic Facial Surgery, University Hospital RWTH-Aachen, Aachen, Germany.
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Esteves JC, Marcantonio E, de Souza Faloni AP, Rocha FRG, Marcantonio RA, Wilk K, Intini G. Dynamics of bone healing after osteotomy with piezosurgery or conventional drilling - histomorphometrical, immunohistochemical, and molecular analysis. J Transl Med 2013; 11:221. [PMID: 24053147 PMCID: PMC3868312 DOI: 10.1186/1479-5876-11-221] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 09/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Piezosurgery is an osteotomy system used in medical and dental surgery. Many studies have proven clinical advantages of piezosurgery in terms of quality of cut, maneuverability, ease of use, and safety. However, few investigations have tested its superiority over the traditional osteotomy systems in terms of dynamics of bone healing. Therefore, the aim of this study was to evaluate the dynamics of bone healing after osteotomies with piezosurgery and to compare them with those associated to traditional bone drilling. METHODS One hundred and ten rats were divided into two groups with 55 animals each. The animals were anesthetized and the tibiae were surgically exposed to create defects 2 mm in diameter by using piezosurgery (Piezo group) and conventional drilling (Drill group). Animals were sacrificed at 3, 7, 14, 30 and 60 days post-surgery. Bone samples were collected and processed for histological, histomorphometrical, immunohistochemical, and molecular analysis. The histological analysis was performed at all time points (n = 8) whereas the histomorphometrical analysis was performed at 7, 14, 30 and 60 days post-surgery (n = 8). The immunolabeling was performed to detect Vascular Endothelial Growth Factor (VEGF), Caspase-3 (CAS-3), Osteoprotegerin (OPG), Receptor Activator of Nuclear Factor kappa-B Ligand (RANKL), and Osteocalcin (OC) at 3, 7, and 14 days (n = 3). For the molecular analysis, animals were sacrificed at 3, 7 and 14 days, total RNA was collected, and quantification of the expression of 21 genes related to BMP signaling, Wnt signaling, inflammation, osteogenenic and apoptotic pathways was performed by qRT-PCR (n = 5). RESULTS Histologically and histomorphometrically, bone healing was similar in both groups with the exception of a slightly higher amount of newly formed bone observed at 30 days after piezosurgery (p < 0.05). Immunohistochemical and qRT-PCR analyses didn't detect significant differences in expression of all the proteins and most of the genes tested. CONCLUSIONS Based on the results of our study we conclude that in a rat tibial bone defect model the bone healing dynamics after piezosurgery are comparable to those observed with conventional drilling.
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Affiliation(s)
- Jônatas Caldeira Esteves
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine - Harvard University, 188 Longwood Avenue, Boston, MA 02115 - REB 403, USA.
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Blus C, Szmukler-Moncler S, Giannelli G, Denotti G, Orrù G. Use of Ultrasonic Bone Surgery (Piezosurgery) to Surgically Treat Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ). A Case Series Report with at Least 1 Year of Follow-Up. Open Dent J 2013; 7:94-101. [PMID: 24044030 PMCID: PMC3772575 DOI: 10.2174/1874210601307010094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/16/2013] [Accepted: 04/30/2013] [Indexed: 12/05/2022] Open
Abstract
This preliminary work documents the use of a powerful piezosurgery device to treat biphosphonate-related osteonecrosis of the jaw (BRONJ) in combination with classical medication therapy. Eight patients presenting 9 BRONJ sites were treated, 2 in the maxilla and 7 in the mandible. Reason for biphosphonate (BiP) intake was treatment of an oncologic disease for 5 patients and osteoporosis for 3. The oncologic and osteoporosis patients were diagnosed with BRONJ after 35-110 months and 80-183 months of BiP treatment, respectively. BRONJ 2 and 3 was found in 4 patients. Resection of the bone sequestrae was performed with a high power ultrasonic (piezo) surgery and antibiotics were administrated for 2 weeks. Soft tissue healing was incomplete at the 2-week control but it was achieved within 1 month. At the 1-year control, soft tissue healing was maintained at all patients, without symptom recurrence. One patient with paraesthesia had abated; of the 2 pa-tients with trismus, one was healed, severity of the second trismus abated. This case report series suggests that bone resection performed with a high power ultrasonic surgery device combined with antibiotics might lead to BRONJ healing. More patients are warranted to confirm the present findings and assess this treatment approach.
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Affiliation(s)
- Cornelio Blus
- OBL, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy ; Private Practice, Torino, Italy
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106
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de Ávila Kfouri F, Duailibi MT, Bretos JLG, Carvalho AB, Pallos D, Duailibi SE. Piezoelectric osteotomy for the placement of titanium implants in rabbits: histomorphometry study. Clin Oral Implants Res 2013; 25:1182-8. [DOI: 10.1111/clr.12229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Flávio de Ávila Kfouri
- Pos-Graduate Program; Division of Plastic Surgery; Universidade Federal de São Paulo (UNIFESP); São Paulo SP Brazil
| | - Monica Talarico Duailibi
- Division of Plastic Surgery; Department of Surgery; Universidade Federal de São Paulo (UNIFESP); São Paulo SP Brazil
| | - José Luis Gonçalves Bretos
- Division of Plastic Surgery; Department of Surgery; Universidade Federal de São Paulo (UNIFESP); São Paulo SP Brazil
| | - Aluizio Barbosa Carvalho
- Division of Nephrology; Department of Medicine; Universidade Federal de São Paulo (UNIFESP); São Paulo SP Brazil
| | - Debora Pallos
- Department of Periodontics and Implantology; School of Dentistry; University of Santo Amaro; São Paulo SP Brazil
| | - Silvio Eduardo Duailibi
- Division of Plastic Surgery, Department of Surgery and Institute of Science and Technology; Universidade Federal de São Paulo (UNIFESP); São José dos Campos SP Brazil
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Reside J, Everett E, Padilla R, Arce R, Miguez P, Brodala N, De Kok I, Nares S. In vivo assessment of bone healing following Piezotome® ultrasonic instrumentation. Clin Implant Dent Relat Res 2013; 17:384-94. [PMID: 23763591 DOI: 10.1111/cid.12094] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This pilot study evaluated the molecular, histologic, and radiographic healing of bone to instrumentation with piezoelectric or high speed rotary (R) devices over a 3-week healing period. MATERIAL AND METHODS Fourteen Sprague-Dawley rats (Charles River Laboratories International, Inc., Wilmington, MA, USA) underwent bilateral tibial osteotomies prepared in a randomized split-leg design using Piezotome® (P1) (Satelec Acteon, Merignac, France), Piezotome 2® (P2) (Satelec Acteon), High-speed R instrumentation, or sham surgery (S). At 1 week, an osteogenesis array was used to evaluate differences in gene expression while quantitative analysis assessed percentage bone fill (PBF) and bone mineral density (BMD) in the defect, peripheral, and distant regions at 3 weeks. Qualitative histologic evaluation of healing osteotomies was also performed at 3 weeks. RESULTS At 1 week, expression of 11 and 18 genes involved in bone healing was significantly (p < .05) lower following P1 and P2 instrumentation, respectively, relative to S whereas 16 and 4 genes were lower relative to R. No differences in PBF or BMD were detected between groups within the osteotomy defect. However, significant differences in PBF (p = .020) and BMD (p = .008) were noted along the peripheral region between P2 and R groups, being R the group with the lowest values. Histologically, smooth osteotomy margins were present following instrumentation using P1 or P2 relative to R. CONCLUSIONS Piezoelectric instrumentation favors preservation of bone adjacent to osteotomies while variations in gene expression suggest differences in healing rates due to surgical modality. Bone instrumented by piezoelectric surgery appears less detrimental to bone healing than high-speed R device.
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Affiliation(s)
- Jonathan Reside
- Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, NC, USA
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Ronda M, Rebaudi A, Torelli L, Stacchi C. Expanded vs. dense polytetrafluoroethylene membranes in vertical ridge augmentation around dental implants: a prospective randomized controlled clinical trial. Clin Oral Implants Res 2013; 25:859-66. [DOI: 10.1111/clr.12157] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Lucio Torelli
- Department of Mathematics and Informatics; University of Trieste; Trieste Italy
| | - Claudio Stacchi
- Department of Medical, Surgical and Health Sciences; University of Trieste; Trieste Italy
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Rana M, Gellrich NC, Rana M, Piffkó J, Kater W. Evaluation of surgically assisted rapid maxillary expansion with piezosurgery versus oscillating saw and chisel osteotomy - a randomized prospective trial. Trials 2013; 14:49. [PMID: 23414112 PMCID: PMC3608968 DOI: 10.1186/1745-6215-14-49] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 01/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasonic bone-cutting surgery has been introduced as a feasible alternative to the conventional sharp instruments used in craniomaxillofacial surgery because of its precision and safety. The piezosurgery medical device allows the efficient cutting of mineralized tissues with minimal trauma to soft tissues. Piezoelectric osteotome has found its role in surgically assisted rapid maxillary expansion (SARME), a procedure well established to correct transverse maxillary discrepancies. The advantages include minimal risk to critical anatomic structures. The purpose of this clinical comparative study (CIS 2007-237-M) was to present the advantages of the piezoelectric cut as a minimally invasive device in surgically assisted, rapid maxillary expansion by protecting the maxillary sinus mucosal lining. METHODS Thirty patients (18 females and 12 males) at the age of 18 to 54 underwent a surgically assisted palatal expansion of the maxilla with a combined orthodontic and surgical approach. The patients were randomly divided into two separate treatment groups. While Group 1 received conventional surgery using an oscillating saw, Group 2 was treated with piezosurgery. The following parameters were examined: blood pressure, blood values, required medication, bleeding level in the maxillary sinus, duration of inpatient stay, duration of surgery and height of body temperature. RESULTS The results displayed no statistically significant differences between the two groups regarding laboratory blood values and inpatient stay. The duration of surgery revealed a significant discrepancy. Deploying piezosurgery took the surgeon an average of 10 minutes longer than working with a conventional-saw technique. However, the observation of the bleeding level in the paranasal sinus presented a major and statistically significant advantage of piezosurgery: on average the bleeding level was one category above the one of the remaining patients. CONCLUSION This method of piezoelectric surgery with all its advantages is going to replace many conventional operating procedures in oral and maxillofacial surgery. TRIAL REGISTRATION CIS 2007-237-M.
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Affiliation(s)
- Majeed Rana
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str, 1, Hannover, 30625, Germany.
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Bengazi F, Lang NP, Canciani E, Viganò P, Velez JU, Botticelli D. Osseointegration of implants with dendrimers surface characteristics installed conventionally or with Piezosurgery®. A comparative study in the dog. Clin Oral Implants Res 2012; 25:10-5. [PMID: 23231427 DOI: 10.1111/clr.12082] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2012] [Indexed: 12/01/2022]
Abstract
AIM The first aim of the present experiment was to compare bone healing at implants installed in recipient sites prepared with conventional drills or a piezoelectric device. The second aim was to compare implant osseointegration onto surfaces with and without dendrimers coatings. MATERIAL AND METHODS Six Beagles dogs were used in this study. Five implants with two different surfaces, three with a ZirTi(®) surface (zirconia sand blasted, acid etched), and two with a ZirTi(®)-modified surface with dendrimers of phosphoserine and polylysine were installed in the right side of the mandible. In the most anterior region (P2, P3), two recipient sites were prepared with drills, and one implant ZirTi(®) surface and one coated with dendrimers implants were installed at random. In the posterior region (P4 and M1), three recipient sites were randomly prepared: two sites with a Piezosurgery(®) instrument and one site with drill and two ZirTi(®) surface and one coated with dendrimers implants installed. Three months after the surgery, the animals were sacrificed for histological analysis. RESULTS No complications occurred during the healing period. Three implants were found not integrated and were excluded from analysis. However, n = 6 was obtained. The distance IS-B at the buccal aspect was 2.2 ± 0.8 and 1.8 ± 0.5 mm, while IS-C was 1.5 ± 0.9 and 1.4 ± 0.6 mm at the Piezosurgery(®) and drill groups, respectively. Similar values were obtained between the dendrimers-coated and ZirTi(®) surface implants. The BIC% values were higher at the drill (72%) compared to the Piezosurgery(®) (67%) sites. The BIC% were also found to be higher at the ZirTi(®) (74%) compared to the dendrimers-coated (65%) implants, the difference being statistically significant. CONCLUSION This study has revealed that oral implants may osseointegrate equally well irrespective of whether their bed was prepared utilizing conventional drills with abundant cooling or Piezosurgery(®). Moreover, the surface coating of implants with dendrimers phosphoserine and polylysine did not improve osseointegration.
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Affiliation(s)
- Franco Bengazi
- Faculty of Dentistry, University of Medical Science, La Habana, Cuba
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111
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Stelzle F, Frenkel C, Riemann M, Knipfer C, Stockmann P, Nkenke E. The effect of load on heat production, thermal effects and expenditure of time during implant site preparation - an experimental ex vivo comparison between piezosurgery and conventional drilling. Clin Oral Implants Res 2012. [PMID: 23186531 DOI: 10.1111/clr.12077] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Piezoelectric surgery (PS) is meant to be a gentle osteotomy method. The aim of this study was to compare piezosurgical vs. conventional drilling methods for implant site preparation (ISP) - focusing on load-dependent thermal effect on hard tissue and the expenditure of ISP time. MATERIALS AND METHODS Three hundred and sixty ISP were performed on ex vivo pig heads using piezosurgery, spiral burs (SB) and trephine burs (TB). The load applied was increased from 0 to 1000 g in 100-g intervals. Temperature within the bone was measured with a thermocouple, and duration was recorded with a stop watch. Thermal effects were histomorphometrically analysed. Twelve ISPs per technique were performed at the lateral wall of the maxillary sinus. RESULTS PS yields the highest mean temperatures (48.6 ± 3.4°C) and thermal effects (200.7 ± 44.4 μm), both at 900-1000 g. Duration is reduced with a plus of load and significantly longer in either case for PS (P < 0.05). There is a correlation of the applied load with all other examined factors for PS and TB. Temperature and histological effects decrease for SB beyond 500 g. CONCLUSIONS PS yields significantly higher temperatures and thermal tissue alterations on load levels higher than 500 g and is significantly slower for ISP compared to SB and TB. For ISP with PS, a maximum load of 400 g should be maintained.
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Affiliation(s)
- Florian Stelzle
- Department of Oral and Maxillofacial Surgery, Erlangen University Hospital, Erlangen, Germany
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112
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Controlled Ridge Expansion Using a Two-Stage Split-Crest Technique With Ultrasonic Bone Surgery. IMPLANT DENT 2012; 21:163-70. [DOI: 10.1097/id.0b013e318249f50b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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113
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Brugnami F, Caiazzo A, Mehra P. Piezosurgery-assisted, flapless split crest surgery for implant site preparation. J Maxillofac Oral Surg 2012; 13:67-72. [PMID: 24644400 DOI: 10.1007/s12663-012-0377-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/21/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Bucco-lingual resorption of the alveolar ridge can, at times, be predictably corrected at the time of implant placement. Among the different options available to achieve this are a group of surgical techniques described as split crest or split ridge procedures. Most of these procedures require the use of a mallet and some type of chisels and/or osteotomes; they are very technique-sensitive and can be uncomfortable for patients. Recently, alternative tools to split the crest have been presented, and these include the newer bone expanders and the piezoelectric scalpel. A flapless approach to implant dentistry has become popular with the aim to alleviate post treatment side effects, accelerate healing and avoid bone resorption caused by flap elevation. METHODS We present a technique combining the use of a piezoelectric scalpel and a tapered bone expander in a flapless fashion as a novel way to perform split crest procedures with an aim to optimize outcomes and acceptability by patients. RESULTS All implants were successfully placed and the resorbed ridge expanded in the same setting. Findings were confirmed by postoperative cone beam cat scan (CBCT) evaluation. CONCLUSIONS This new technique is a predictable approach for split crest procedures and has high acceptability by patients and is technically simple for surgeons.
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Affiliation(s)
| | | | - Pushkar Mehra
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, 100 East Newton Street, G-407, Boston, MA 02118 USA
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Stacchi C, Chen ST, Raghoebar GM, Rosen D, Poggio CE, Ronda M, Bacchini M, Di Lenarda R. Malpositioned osseointegrated implants relocated with segmental osteotomies: a retrospective analysis of a multicenter case series with a 1- to 15-year follow-up. Clin Implant Dent Relat Res 2012; 15:836-46. [PMID: 22376067 DOI: 10.1111/j.1708-8208.2012.00444.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This multicenter case series evaluates retrospectively the clinical outcomes of malpositioned implants surgically relocated in a more convenient position by segmental osteotomies. MATERIALS AND METHODS Authors who published, on indexed journals or books, works about malpositioned implant correction by segmental osteotomies were contacted. Five centers, out of 11 selected, accepted to participate in this study. The dental records of patients who underwent implant relocation procedures were reviewed. Implant survival rates were analyzed and a blinded assessor examined clinical photos and periapical radiographs to evaluate esthetic outcome (pink esthetic score [PES]) and changes of marginal bone level over time. Patients were requested to fill a verbal rating scale form about discomfort, compliance, and satisfaction related to the procedure. RESULTS Fifteen malpositioned implants relocated by segmental osteotomies were followed for a period ranging from 1 to 15 years (mean 6.0 ± 3.9 years). The overall implant survival rate from baseline to the last follow-up visit was 100%. The mean marginal bone loss was 0.36 mm at the 12-month follow-up visit and no relevant further changes were observed at the following examinations. Significant esthetic improvement was recorded at 1-year examination with PES evaluation (p < .0001). Patients' feedback described this procedure as not excessively invasive and uncomfortable, reporting a high final satisfaction rate. CONCLUSIONS The present study suggests that implant relocation with segmental osteotomies could be an effective alternative method to correct the position of unrestorable malpositioned implants in a single-stage surgery.
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Affiliation(s)
- Claudio Stacchi
- Contract professor, Department of Medical Sciences, University of Trieste, Trieste, Italy senior fellow, School of Dental Science, University of Melbourne, Melbourne, Vic. Australia professor, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands senior surgeon, Department of Oral and Maxillofacial Surgery, Meir Hospital, Kfar Saba, Israel adjunct assistant professor, Prosthodontics Department, University of Rochester, Rochester, MN, USA private practice, Genova, Italy private practice, Milano, Italy professor, Department of Medical Sciences, University of Trieste, Trieste, Italy
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Rashad A, Sadr-Eshkevari P, Weuster M, Schmitz I, Prochnow N, Maurer P. Material attrition and bone micromorphology after conventional and ultrasonic implant site preparation. Clin Oral Implants Res 2012; 24 Suppl A100:110-4. [PMID: 22248387 DOI: 10.1111/j.1600-0501.2011.02389.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Little is known about the recently introduced ultrasonic implant site preparation. The purpose of this study was to compare material attrition and micromorphological changes after ultrasonic and conventional implant site preparations. MATERIAL AND METHODS Implant site preparations were performed on fresh bovine ribs using one conventional (Straumann, Freiburg, Germany) and two ultrasonic (Piezosurgery; Mectron Medical Technology, Carasco, Italy and Variosurg; NSK, Tochigi, Japan) systems with sufficient saline irrigation. Sections were examined by environmental scanning electron microscopy (ESEM). Energy-dispersive X-ray spectroscopy (EDX) was performed to evaluate the metal attrition within the bone and the irrigation fluid. RESULTS ESEM After conventional osteotomy, partially destroyed trabecular structures of the cancellous bone that were loaded with debris were observed, whereas after ultrasonic implant site preparations, the anatomic structures were preserved. EDX: None of the implant site preparation methods resulted in metal deposits in the adjacent bone structures. However, within the irrigation liquid, there was significantly higher metal attrition with ultrasonic osteotomy (P < 0.0001 and P < 0.0001 for Mectron and NSK, respectively). Whereas for Straumann system used, 15.5% of the SEM/EDX findings were drill-origin metals, this percentage increased to 37.3% and 37.9% with the application of Mectron and NSK, respectively. CONCLUSIONS Ultrasonic implant site preparation is associated with the preservation of bone microarchitecture and with the increased attrition of metal particles. Therefore, copious irrigation seems to be even more essential for ultrasonic implant site preparation than for the conventional method.
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Affiliation(s)
- Ashkan Rashad
- Department of Oral and Maxillofacial Surgery, Klinikum Reinkenheide-Bremerhaven gGmbH, Postbrookstraße 103, 27574, Bremerhaven, Germany
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Pirodda A, Raimondi MC, Ferri GG. Piezosurgery in otology: a promising device but not always the treatment of choice. Eur Arch Otorhinolaryngol 2011; 269:1059. [PMID: 22105566 DOI: 10.1007/s00405-011-1841-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 11/09/2011] [Indexed: 11/24/2022]
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117
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Omar O, Suska F, Lennerås M, Zoric N, Svensson S, Hall J, Emanuelsson L, Nannmark U, Thomsen P. The influence of bone type on the gene expression in normal bone and at the bone-implant interface: experiments in animal model. Clin Implant Dent Relat Res 2011; 13:146-56. [PMID: 19438950 DOI: 10.1111/j.1708-8208.2009.00195.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies on the biological processes in different bone types and the reaction of different bone types to biomaterials are often hindered because of the difficulties in sampling procedures and lack of sensitive techniques. PURPOSE The purpose was to assess the suitability of quantitative polymerase chain reaction (qPCR) for investigation of the biological differences between cortical and trabecular bone types and their responses to biomaterials. MATERIALS AND METHODS Gene expression of selected markers in rat bone samples from different locations was evaluated. Samples were harvested by trephines from the trabecular femoral epiphysis, cortico-trabecular proximal tibial metaphysic, and the cortical distal tibial metaphysis. Gene expression was also evaluated at the surfaces of anodically oxidized implants retrieved from cortical and trabecular sites after 3 days of implantation. mRNA in the bone samples and in the tissue associated with the implant surfaces was extracted and quantified using qPCR. Tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), alkaline phosphatase (ALP), osteocalcin (OC), tartrate-resistant acid phosphatase (TRAP), cathepsin K (CATK), and 18S ribosomal subunits (18S) were analyzed. RESULTS In the bone samples, higher expression of ALP, OC, TRAP, and CATK was found in femoral epiphysis compared to proximal or distal tibial metaphysis, indicating a higher turnover in the trabecular bone. On the other hand, TNF-α and IL-1β showed higher expression in both tibia sites compared with the femur site, which suggests higher inflammatory potential in the cortical bone. In response to the oxidized implants trabecular bone expressed a higher level of IL-1β, whereas the implants in cortical bone were associated with higher expression of ALP and OC. CONCLUSION There are biological differences between cortical and trabecular bone types, both in the normal steady-state condition and in response to biomaterials. Such differences can be characterized and discriminated quantitatively using a sensitive technique such as qPCR.
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Affiliation(s)
- Omar Omar
- Department of Biomaterials, Sahlgrenska Academy at University of Göteborg, Sweden.
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118
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Baker JA, Vora S, Bairam L, Kim HI, Davis EL, Andreana S. Piezoelectric vs. conventional implant site preparation: ex vivo implant primary stability. Clin Oral Implants Res 2011; 23:433-7. [PMID: 22092442 DOI: 10.1111/j.1600-0501.2011.02286.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aims to determine differences in primary stability between implants placed in cortical bone following Piezoelectric or conventional site preparation, as assessed by resonance frequency analysis (RFA) and reverse torque testing (RTT). MATERIAL AND METHODS Four fresh bovine ribs were acquired and surgical guides fabricated with five sites per rib (n = 20), for proper site preparation. Implant sites were prepared via conventional drilling technique as per manufacturer's instruction (Implantium) or via Piezoelectric (Mectron) implant site preparation using the Implant Prep kit. Twenty 10 mm long, 3.6 mm diameter Implantium implants were placed with 35 Ncm torque; 10 implants per preparation method. RFA was assessed via the Osstell Mentor. Five values were taken per implant. All implants where subjected to a reverse torque in increasing increments of 5 until 50 Ncm force was reached. RESULTS The five RFA values per site were averaged and plotted by placement technique. A paired t-test statistical analysis was run. The average RFA values showed no statistical significance between the 10 test (RFA = 69.04 ± 5.11) and 10 control (RFA = 70.94 ± 6.41) sites (P > 0.05). All implants in both groups withstood RTT up to 50 Ncm force without movement and thus showed no statistical differences. CONCLUSION Results of this ex vivo study imply that the Piezoelectric implant site preparation affords similar primary implant stability in comparison to conventional rotary instrumentation in cortical bone.
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Affiliation(s)
- Justin A Baker
- University at Buffalo School of Dental Medicine, Buffalo, NY 14214, USA.
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119
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Stacchi C, Vercellotti T, Torelli L, Furlan F, Di Lenarda R. Changes in Implant Stability Using Different Site Preparation Techniques: Twist Drills versus Piezosurgery. A Single-Blinded, Randomized, Controlled Clinical Trial. Clin Implant Dent Relat Res 2011; 15:188-97. [DOI: 10.1111/j.1708-8208.2011.00341.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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120
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Hollstein S, Hoffmann E, Vogel J, Heyroth F, Prochnow N, Maurer P. Micromorphometrical analyses of five different ultrasonic osteotomy devices at the rabbit skull. Clin Oral Implants Res 2011; 23:713-718. [DOI: 10.1111/j.1600-0501.2011.02185.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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121
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Anitua E, Begoña L, Orive G. Clinical evaluation of split-crest technique with ultrasonic bone surgery for narrow ridge expansion: status of soft and hard tissues and implant success. Clin Implant Dent Relat Res 2011; 15:176-87. [PMID: 21453394 DOI: 10.1111/j.1708-8208.2011.00340.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the split-crest technique with ultrasonic bone surgery for implant placement in patients with narrow ridges, focusing on the status of soft and hard tissues and on implant success rate, at least 6 months after implant loading. MATERIALS AND METHODS During September 2007 and November 2008, 15 patients received 37 implants (BTI implants) with split-crest surgical procedure using ultrasonic bone surgery. Plasma rich in growth factors (PRGF®) was applied during split crest procedure to promote tissue regeneration. Implant surfaces were humidified with PRGF to accelerate osseointegration. Patients were recalled for a final clinical evaluation at least 6 months after implant loading. Clinical assessment included the status of soft and hard tissues around implants, and implants' success rate. RESULTS Thirty-seven implants in 15 patients were evaluated between July 2009 and January 2010. The status of soft tissues was very good, showing adequate plaque index, bleeding index, and probing depth values. Success rate of implants at the end of follow-up (between 11 and 28 months after insertion) was 100%. Bone ridge was measured and compared at final examination showing a mean ridge expansion of 3.35 mm (SD: 0.34). CONCLUSIONS Split-crest with ultrasonic bone surgery can be considered an effective and safe procedure for narrow ridge expansion.
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122
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Stübinger S, Nuss K, Pongratz M, Price J, Sader R, Zeilhofer HF, von Rechenberg B. Comparison of Er:YAG laser and piezoelectric osteotomy: An animal study in sheep. Lasers Surg Med 2011; 42:743-51. [PMID: 20886507 DOI: 10.1002/lsm.20946] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES It was the aim of this study to compare the feasibility of complete osteotomy of long bones in sheep using a newly designed variable square pulsed Er:YAG laser and piezoelectric surgery. In addition to uneventful bone healing after laser osteotomy, the goal was to assess the possibility to cut thick bony structures with both techniques in a surgically acceptable time frame of 2-3 minutes. MATERIAL AND METHODS A tibia midshaft osteotomy was performed in 24 sheep using either an Er:YAG laser (n = 12) or piezoelectric device (n = 12). Laser and piezoelectric groups were divided in two subgroups (n = 6) with sheep sacrificed after 2 and 3 months, respectively. A complete radiological, histological and histomorphometric analysis was performed to compare the course of bone/fracture healing and remodelling. RESULTS Laser and piezoelectric osteotomies of the sheep tibia up to a depth of 22 mm were possible without any thermal damage. Radiological and histological results after 2 months showed primary gap healing with distinct periosteal callus formation on the transcortex. After 3 months, radiological and histological analysis revealed less callus formation on the transcortex, with almost no visible osteotomy gap and a distinct formation of lamellar bone crossing the original osteotomy gap. CONCLUSION Er:YAG laser osteotomy can successfully be used in long bones with a depth of up to 22 mm, thus challenging the dogma of adverse effects of laser osteotomy due to thermal or other damages.
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Affiliation(s)
- Stefan Stübinger
- Competence Center for Applied Biotechnology and Molecular Medicine, University of Zürich, Winterthurerstr. 190, CH-8057 Zürich, Switzerland.
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123
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Pavlíková G, Foltán R, Horká M, Hanzelka T, Borunská H, Sedý J. Piezosurgery in oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2010; 40:451-7. [PMID: 21176870 DOI: 10.1016/j.ijom.2010.11.013] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 10/09/2010] [Accepted: 11/17/2010] [Indexed: 11/28/2022]
Abstract
This review summarizes current knowledge and experience with piezosurgery, a promising, meticulous and soft tissue-sparing system for bone cutting, based on ultrasonic microvibrations. The main advantages of piezosurgery include soft tissue protection, optimal visibility in the surgical field, decreased blood loss, less vibration and noise, increased comfort for the patient and protection of tooth structure. To date it has been indicationed for use in oral and maxillofacial surgery, otorhinolaryngology, neurosurgery, ophthalmology, traumatology and orthopaedics. The main indications in oral surgery are sinus lift, bone graft harvesting, osteogenic distraction, ridge expansion, endodontic surgery, periodontal surgery, inferior alveolar nerve decompression, cyst removal, dental extraction and impacted tooth removal. In conclusion, piezosurgery is a promising technical modality for different aspects of bone surgery with a rapidly increasing number of indications throughout the whole field of surgery.
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Affiliation(s)
- G Pavlíková
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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124
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Slotte C, Lennerås M, Göthberg C, Suska F, Zoric N, Thomsen P, Nannmark U. Gene Expression of Inflammation and Bone Healing in Peri-Implant Crevicular Fluid after Placement and Loading of Dental Implants. A Kinetic Clinical Pilot Study Using Quantitative Real-Time PCR. Clin Implant Dent Relat Res 2010; 14:723-36. [DOI: 10.1111/j.1708-8208.2010.00309.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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125
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Holtzclaw DJ, Toscano NJ, Rosen PS. Reconstruction of Posterior Mandibular Alveolar Ridge Deficiencies With the Piezoelectric Hinge–Assisted Ridge Split Technique: A Retrospective Observational Report. J Periodontol 2010; 81:1580-6. [DOI: 10.1902/jop.2010.100093] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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126
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Stacchi C, Bonino M, Di Lenarda R. Surgical relocation of a malpositioned, unserviceable implant protruding into the maxillary sinus cavity. A clinical report. J ORAL IMPLANTOL 2010; 38:417-23. [PMID: 20822469 DOI: 10.1563/aaid-joi-d-10-00107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Malpositioned implants always result in significant mechanical and aesthetic restorative challenges. This case report describes the correction of position of an unserviceable osseointegrated implant also protruding into the maxillary sinus cavity. This surgical technique facilitated the relocation of an implant-bony segment into a more favorable aesthetic and biomechanical position in a single stage surgery.
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Affiliation(s)
- Claudio Stacchi
- Department of Medical Sciences, University of Trieste, Trieste, Italy.
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127
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Cardoni A. Enhancing oral implantology with power ultrasonics. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2010; 57:1936-1942. [PMID: 20875983 DOI: 10.1109/tuffc.2010.1641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Oral implantology is the branch of dentistry focused on the reconstruction of missing teeth and their supporting structures with natural or synthetic substitutes. Conventional instruments used during oral implantation exhibit severe operational limitations, especially in the presence of limited surgical access, anatomically delicate bone structures, and proximity to soft tissues, because of the high risk of injury. This paper illustrates the design and performance characteristics of two novel ultrasonic devices developed to improve the implantation process. The working frequency of both systems is in the 25 to 26 kHz range and the acoustic power is modulated in line with the specific operations. The first tuned device presented in this work relies on a planar vibration at its tip to drill holes in bone. The second exploits a longitudinal-flexural composite vibration mode which facilitates the insertion of dental implants into the jawbone. The vibration characteristics of the proposed systems are investigated using finite element (FE) models subsequently validated by experimental modal analysis (EMA). Ultimately, the operational benefits of the investigated devices are supported by clinical evidence.
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Affiliation(s)
- Andrea Cardoni
- Department of Mechanical Engineering, University of Glasgow, Glasgow, UK.
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128
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Stübinger S, Biermeier K, Bächi B, Ferguson SJ, Sader R, von Rechenberg B. Comparison of Er:YAG laser, piezoelectric, and drill osteotomy for dental implant site preparation: A biomechanical and histological analysis in sheep. Lasers Surg Med 2010; 42:652-61. [DOI: 10.1002/lsm.20944] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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129
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Omar O, Svensson S, Zoric N, Lennerås M, Suska F, Wigren S, Hall J, Nannmark U, Thomsen P. In vivo gene expression in response to anodically oxidized versus machined titanium implants. J Biomed Mater Res A 2010; 92:1552-66. [PMID: 19431206 DOI: 10.1002/jbm.a.32475] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A quantitative polymerase chain reaction technique (qPCR) in combination with scanning electron microscopy was applied for the evaluation of early gene expression response and cellular reactions close to titanium implants. Anodically oxidized and machined titanium miniscrews were inserted in rat tibiae. After 1, 3, and 6 days the implants were unscrewed and the surrounding bone was retrieved using trephines. Both the implants and bone were analyzed with qPCR. A greater amount of cells, as indicated with higher expression of 18S, was detected on the oxidized surface after 1 and 6 days. Significantly higher osteocalcin (at day 6), alkaline phosphatase (at days 3 and 6), and cathepsin K (at day 3) expression was demonstrated for the oxidized surface. Higher expression of tumor necrosis factor-alpha (at day 1) and interleukin-1beta (at days 1 and 6) was detected on the machined surfaces. SEM revealed a higher amount of mesenchymal-like cells on the oxidized surface. The results show that the rapid recruitment of mesenchymal cells, the rapid triggering of gene expression crucial for bone remodeling and the transient nature of inflammation, constitute biological mechanisms for osseointegration, and high implant stability associated with anodically oxidized implants.
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Affiliation(s)
- Omar Omar
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Sweden.
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130
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González-García A, Diniz-Freitas M, Somoza-Martín M, García-García A. Ultrasonic osteotomy in oral surgery and implantology. ACTA ACUST UNITED AC 2009; 108:360-7. [DOI: 10.1016/j.tripleo.2009.04.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 04/01/2009] [Accepted: 04/13/2009] [Indexed: 10/20/2022]
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131
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Labanca M, Azzola F, Vinci R, Rodella LF. Piezoelectric surgery: Twenty years of use. Br J Oral Maxillofac Surg 2008; 46:265-9. [DOI: 10.1016/j.bjoms.2007.12.007] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2007] [Indexed: 10/22/2022]
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