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Hamidi A, Bayhaqi YA, Drusová S, Navarini AA, Cattin PC, Canbaz F, Zam A. Multimodal feedback systems for smart laser osteotomy: Depth control and tissue differentiation. Lasers Surg Med 2023; 55:900-911. [PMID: 37870158 DOI: 10.1002/lsm.23732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES The study aimed to improve the safety and accuracy of laser osteotomy (bone surgery) by integrating optical feedback systems with an Er:YAG laser. Optical feedback consists of a real-time visual feedback system that monitors and controls the depth of laser-induced cuts and a tissue sensor differentiating tissue types based on their chemical composition. The developed multimodal feedback systems demonstrated the potential to enhance the safety and accuracy of laser surgery. MATERIALS AND METHODS The proposed method utilizes a laser-induced breakdown spectroscopy (LIBS) system and long-range Bessel-like beam optical coherence tomography (OCT) for tissue-specific laser surgery. The LIBS system detects tissue types by analyzing the plasma generated on the tissue by a nanosecond Nd:YAG laser, while OCT provides real-time monitoring and control of the laser-induced cut depth. The OCT system operates at a wavelength of 1288 ± 30 nm and has an A-scan rate of 104.17 kHz, enabling accurate depth control. Optical shutters are used to facilitate the integration of these multimodal feedback systems. RESULTS The proposed system was tested on five specimens of pig femur bone to evaluate its functionality. Tissue differentiation and visual depth feedback were used to achieve high precision both on the surface and in-depth. The results showed successful real-time tissue differentiation and visualization without any visible thermal damage or carbonization. The accuracy of the tissue differentiation was evaluated, with a mean absolute error of 330.4 μm and a standard deviation of ±248.9 μm, indicating that bone ablation was typically stopped before reaching the bone marrow. The depth control of the laser cut had a mean accuracy of 65.9 μm with a standard deviation of ±45 μm, demonstrating the system's ability to achieve the pre-planned cutting depth. CONCLUSION The integrated approach of combining an ablative laser, visual feedback (OCT), and tissue sensor (LIBS) has significant potential for enhancing minimally invasive surgery and warrants further investigation and development.
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Affiliation(s)
- Arsham Hamidi
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Yakub A Bayhaqi
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Sandra Drusová
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Alexander A Navarini
- Digital Dermatology, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, Center for medical Image Analysis and Navigation (CIAN), University of Basel, Allschwil, Switzerland
| | - Ferda Canbaz
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Azhar Zam
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Division of Engineering, New York University Abu Dhabi, Abu Dhabi, UAE
- Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Tandon School of Engineering, New York University, Brooklyn, New York, USA
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Xiao L, Guo J, Wang H, He Q, Xu Y, Yuan L, Yi Q, Zhang Q, Wang J, Min S, Zhao M, Xin X, Chen H. Thermal damage and the prognostic evaluation of laser ablation of bone tissue-a review. Lasers Med Sci 2023; 38:205. [PMID: 37676517 DOI: 10.1007/s10103-023-03868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
In recent years, an increasing number of scientists have focused on conducting experiments on laser ablation of bone tissue. The purpose of this study was to summarize the prognosis of tissue and the extent of thermal damage in past hard tissue ablation experiments, and review the evidence for the feasibility of laser osteotomy in surgery. An electronic search of PubMed, China National Knowledge Infrastructure (CNKI), and Web of Science (WOS) for relevant English-language articles published through June 2023 was conducted. This review includes 48 literature reports on laser ablation of hard tissues from medical and biological perspectives. It summarizes previous studies in which the ideal ablation rate, depth of ablation, and minimal damage to bone tissue and surrounding soft tissues were achieved by changing the laser type, optimizing the laser parameter settings, or adding adjuvant devices. By observing their post-operative healing and inflammatory response, this review aims to provide a better understanding of pulsed laser ablation of hard tissues. Previous studies suggest that laser osteotomy has yielded encouraging results in bone resection procedures. We believe that low or even no thermal damage can be achieved by experimentally selecting a suitable laser type, optimizing laser parameters such as pulse duration and frequency, or adding additional auxiliary cooling devices. However, the lack of clinical studies makes it difficult to conclusively determine whether laser osteotomy is superior in clinical applications.
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Affiliation(s)
- Liuyi Xiao
- Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Junli Guo
- Institute of Optics and Electronics, Chinese Academy of Sciences, Chengdu, 610209, China
- Key Laboratory of Optical Engineering, Chinese Academy of Sciences, Chengdu, 610209, China
| | - Huan Wang
- Ophthalmology Department, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Qianxiong He
- Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Yang Xu
- Ophthalmology Department, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Lu Yuan
- Ophthalmology Department, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Qianya Yi
- Ophthalmology Department, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Qian Zhang
- West China Forth University Hospital Ophthalmology Department, Chengdu, 610044, China
| | - Jin Wang
- Institute of Optics and Electronics, Chinese Academy of Sciences, Chengdu, 610209, China
- Key Laboratory of Optical Engineering, Chinese Academy of Sciences, Chengdu, 610209, China
| | - Shaokun Min
- Qianjiang Xinhua Middle School, Chongqing, 404100, China
| | - Menghan Zhao
- Pujiang County People's Hospital, Chengdu, 611630, China
| | - Xiaorong Xin
- Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
| | - Hui Chen
- Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200080, China.
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, 200080, China.
- National Clinical Research Center for Eye Diseases, Shanghai, 200080, China.
- University of Shanghai for Science and Technology, Shanghai, 200093, China.
- Chengdu Medical College, Chengdu, 610083, China.
- Key Laboratory of Sichuan Province Ophthalmopathy Prevention & Cure and Visual Function Protection, Chengdu, 610209, China.
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Kanazirski N, Vladova D, Neychev D, Raycheva R, Kanazirska P. Effect of Er:YAG Laser Exposure on the Amorphous Smear Layer in the Marginal Zone of the Osteotomy Site for Placement of Dental Screw Implants: A Histomorphological Study. J Funct Biomater 2023; 14:376. [PMID: 37504871 PMCID: PMC10381257 DOI: 10.3390/jfb14070376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
The placement of dental screw implants typically involves the use of rotary techniques and drills to create a bone bed. This study explores the potential benefits of combining this method with an Er:YAG laser. Split osteotomies were performed on 10 jaws of euthanized domestic pigs (Sus scrofa domestica), with 12 mandibular implant osteotomies in each jaw, divided into 4 groups. In order to make a comprehensive assessment of the effect of Er:YAG lasers, histomorphological techniques were used to measure the reduction in amorphous layer thickness after Er:YAG laser treatment, both with and without the placement of dental screw implants from different manufacturers. Following bone decalcification and staining, the thickness of the amorphous layer was measured in four groups: Group A-osteotomy performed without Er:YAG laser treatment-had amorphous layer thicknesses ranging from 21.813 to 222.13 µm; Group B-osteotomy performed with Er:YAG laser treatment-had amorphous layer thicknesses ranging from 6.08 to 64.64 µm; Group C-an implant placed in the bone without laser treatment-had amorphous layer thicknesses of 5.90 to 54.52 µm; and Group D-an implant placed after bone treatment with Er:YAG laser-had amorphous layer thicknesses of 1.29 to 7.98 µm. The examination and photomicrodocumentation was performed using a LEICA DM1000 LED microscope (Germany) and LAS V 4.8 software (Leica Application Suite V4, Leica Microsystems, Germany). When comparing group A to group B and group C to D, statistically significant differences were indicated (p-value = 0.000, p < 0.05). The study demonstrates the synergistic effects and the possibility of integrating lasers into the conventional implantation protocol. By applying our own method of biomodification, the smear layer formed during rotary osteotomy can be reduced using Er:YAG lasers. This reduction leads to a narrower peri-implant space and improved bone-to-implant contact, facilitating accelerated osseointegration.
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Affiliation(s)
- Nikolay Kanazirski
- Department of Oral Surgery, Faculty of Dental Medicine, Medical University-Plovdiv, 4000 Plovdiv, Bulgaria
| | - Diyana Vladova
- Department of Veterinary Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, Trakia University, 6000 Stara Zagora, Bulgaria
| | - Deyan Neychev
- Department of Oral Surgery, Faculty of Dental Medicine, Medical University-Plovdiv, 4000 Plovdiv, Bulgaria
| | - Ralitsa Raycheva
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University-Plovdiv, 4000 Plovdiv, Bulgaria
| | - Petya Kanazirska
- Department of Imaging Diagnostics, Dental Allergology and Physiotherapy, Faculty of Dental Medicine, Medical University-Plovdiv, 4000 Plovdiv, Bulgaria
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Pacheco-Vergara MJ, Benalcázar-Jalkh EB, Nayak VV, Bergamo ETP, Cronstein B, Zétola AL, Weiss FP, Grossi JRA, Deliberador TM, Coelho PG, Witek L. Employing Indirect Adenosine 2 A Receptors (A 2AR) to Enhance Osseointegration of Titanium Devices: A Pre-Clinical Study. J Funct Biomater 2023; 14:308. [PMID: 37367272 DOI: 10.3390/jfb14060308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/20/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
The present study aimed to evaluate the effect of dipyridamole, an indirect adenosine 2A receptors (A2AR), on the osseointegration of titanium implants in a large, translational pre-clinical model. Sixty tapered, acid-etched titanium implants, treated with four different coatings ((i) Type I Bovine Collagen (control), (ii) 10 μM dipyridamole (DIPY), (iii) 100 μM DIPY, and (iv) 1000 μM DIPY), were inserted in the vertebral bodies of 15 female sheep (weight ~65 kg). Qualitative and quantitative analysis were performed after 3, 6, and 12 weeks in vivo to assess histological features, and percentages of bone-to-implant contact (%BIC) and bone area fraction occupancy (%BAFO). Data was analyzed using a general linear mixed model analysis with time in vivo and coating as fixed factors. Histomorphometric analysis after 3 weeks in vivo revealed higher BIC for DIPY coated implant groups (10 μM (30.42% ± 10.62), 100 μM (36.41% ± 10.62), and 1000 μM (32.46% ± 10.62)) in comparison to the control group (17.99% ± 5.82). Further, significantly higher BAFO was observed for implants augmented with 1000 μM of DIPY (43.84% ± 9.97) compared to the control group (31.89% ± 5.46). At 6 and 12 weeks, no significant differences were observed among groups. Histological analysis evidenced similar osseointegration features and an intramembranous-type healing pattern for all groups. Qualitative observation corroborated the increased presence of woven bone formation in intimate contact with the surface of the implant and within the threads at 3 weeks with increased concentrations of DIPY. Coating the implant surface with dipyridamole yielded a favorable effect with regard to BIC and BAFO at 3 weeks in vivo. These findings suggest a positive effect of DIPY on the early stages of osseointegration.
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Affiliation(s)
- Maria Jesus Pacheco-Vergara
- Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
| | - Ernesto Byron Benalcázar-Jalkh
- Department of Prosthodontic and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-901, SP, Brazil
| | - Vasudev V Nayak
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Edmara T P Bergamo
- Department of Prosthodontic and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-901, SP, Brazil
- Division of Biomaterials, New York University College of Dentistry, 345 E 24th St., Room 902D, New York, NY 10010, USA
| | - Bruce Cronstein
- Department of Medicine, New York University Langone Medical Center, New York, NY 10016, USA
| | - André Luis Zétola
- Oral and Maxillofacial Surgeon, Chairman of Implantology, SOEPAR, Curitiba 80730-000, PR, Brazil
| | | | | | | | - Paulo G Coelho
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Lukasz Witek
- Division of Biomaterials, New York University College of Dentistry, 345 E 24th St., Room 902D, New York, NY 10010, USA
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY 11201, USA
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Bhargava N, Perrotti V, Caponio VCA, Matsubara VH, Patalwala D, Quaranta A. Comparison of heat production and bone architecture changes in the implant site preparation with compressive osteotomes, osseodensification technique, piezoelectric devices, and standard drills: an ex vivo study on porcine ribs. Odontology 2023; 111:142-153. [PMID: 35852778 PMCID: PMC9810586 DOI: 10.1007/s10266-022-00730-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/05/2022] [Indexed: 01/07/2023]
Abstract
This study aimed at investigating differences in heat generation and bone architecture following four different implant site preparation techniques: compressive osteotomes, conventional drills, osseodensification (OD mode with osseodensification drills), and piezoelectric systems. Porcine rib bones were used as a model for implant surgery. Thermocouples were employed to measure temperature changes, and micro-CT to assess the bone architecture. The primary stability and insertion torque values of the implants placed in the differently prepared sites were assessed. The temperature changes were higher with Piezo. The average primary stability using the ISQ scale was the greatest for drills (76.17 ± 0.90) and the lowest for osteotomes (71.50 ± 11.09). Insertion torque was significantly higher with the osseodensification method (71.67 ± 7.99 Ncm) in comparison to drills, osteotomes, and piezo. Osteotomes showed the highest bone to implant contact percentage (39.83 ± 3.14%) and average trabecular number (2.02 ± 0.21 per mm), while drills exhibited the lowest (30.73 ± 1.65%; 1.37 ± 0.34 per mm). Total implant site bone volume was the highest with osseodensification (37.26 ± 4.13mm3) and the lowest for osteotomes (33.84 ± 3.84mm3). Statistical analysis showed a high primary stability and decrease in temperature during implant site preparation with osseodensification technique. The results support the use of osseodensification technique for implant site preparation.
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Affiliation(s)
- Nishith Bhargava
- Dental School, University of Western Australia, Perth, WA, Australia
| | - Vittoria Perrotti
- Deptartment of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara, Via dei Vestini, 31, 66100, Chieti, Italy.
| | | | | | - Diana Patalwala
- Centre for Microscopy, Characterization and Analysis, The University of Western Australia, Perth, WA, Australia
| | - Alessandro Quaranta
- School of Dentistry, University of Sydney, Sydney, NSW, Australia
- Scientific and Education Director, Smile Specialists Suite, Newcastle-Sydney, NSW, Australia
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Ha TT, Thieringer FM, Bammerlin M, Cordier D. High Precision Bone Cutting by Er: YAG Lasers Might Minimize the Invasiveness of Navigated Brain Biopsies. Front Oncol 2022; 11:690374. [PMID: 35047381 PMCID: PMC8762267 DOI: 10.3389/fonc.2021.690374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
Biopsies of brain tissue are sampled and examined to establish a diagnosis and to plan further treatment, e.g. for brain tumors. The neurosurgical procedure of sampling brain tissue for histologic examination is still a relatively invasive procedure that carries several disadvantages. The “proof of concept”-objective of this study is to answer the question if laser technology might be a potential tool to make brain biopsies less invasive, faster and safer. Laser technology might carry the opportunity to miniaturize the necessary burr hole and also to angulate the burr hole much more tangential in relation to the bone surface in order to take biopsies from brain regions that are usually only difficult and hazardous to access. We examined if it is possible to miniaturize the hole in the skull bone to such a high extent that potentially the laser-created canal itself may guide the biopsy needle with sufficient accuracy. The 2-dimensional, i.e. radial tolerance of the tip of biopsy needles inserted in these canals was measured under defined lateral loads which mimic mechanical forces applied by a surgeon. The canals through the skull bones were planned in angles of 90° (perpendicular) and 45° relative to the bone surface. We created a total of 33 holes with an Er : YAG laser in human skull bones. We could demonstrate that the achievable radial tolerance concerning the guidance of a biopsy needle by a laser created bone canal is within the range of the actual accuracy of a usual navigated device if the canal is at least 4 mm in length. Lateral mechanical loads applied to the biopsy needle had only minor impact on the measurable radial tolerance. Furthermore, in contrast to mechanical drilling systems, laser technology enables the creation of bone canals in pointed angles to the skull bone surface. The latter opens the perspective to sample biopsies in brain areas that are usually not or only hazardous to access.
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Affiliation(s)
- Thanh Tu Ha
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Florian M Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland.,Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | | | - Dominik Cordier
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
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Benalcázar Jalkh EB, Parra M, Torroni A, Nayak VV, Tovar N, Castellano A, Badalov RM, Bonfante EA, Coelho PG, Witek L. Effect of supplemental acid-etching on the early stages of osseointegration: A preclinical model. J Mech Behav Biomed Mater 2021; 122:104682. [PMID: 34311324 DOI: 10.1016/j.jmbbm.2021.104682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/03/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effect of two surface modifications on early osseointegration parameters of conical implants in a translational pre-clinical model. MATERIALS AND METHODS Conical implants with progressive trapezoidal threads and healing chambers were evaluated consisting of two different surface conditions: 1) Implacil surface (IMP Sur), and 2) Implacil surface + Supplemental Acid-etching (IMP Sur + AE). Surface characterization comprised of the evaluation of roughness parameters (Sa, Sq and Sdr), surface energy and contact angle. Subsequently, implants were installed in the ilium crest of nine female sheep (weighing ~65 kg). Torque out, histological and histomorphometric analyses were conducted after 3 and 6 weeks in-vivo. The percentage of bone to implant contact (%BIC) and bone area fraction occupancy within implant threads (%BAFO) were quantified, and the results were analyzed using a general linear mixed model analysis as function of surface treatment and time in-vivo. RESULTS Supplemental acid etching significantly increased Sa and Sq roughness parameters without compromising the surface energy or contact angle, and no significant differences with respect to Sdr. Torque-out testing yielded significantly higher values for IMP Sur + AE in comparison to the IMP Sur at 3- (62.78 ± 15 and 33.49 ± 15 N.cm, respectively) and 6-weeks (60.74 ± 15 and 39.80 ± 15 N.cm, respectively). Histological analyses depicted similar osseointegration features for both surfaces, where an intramembranous-type healing pattern was observed. At histomorphometric analyses, IMP Sur + AE implants yielded higher values of BIC in comparison to IMP Sur at 3- (40.48 ± 38 and 27.98 ± 38%, respectively) and 6-weeks (45.86 ± 38 and 34.46 ± 38%, respectively). Both groups exhibited a significant increase in %BAFO from 3 (~35%) to 6 weeks (~44%), with no significant differences between surface treatments. CONCLUSION Supplemental acid-etching and its interplay with implant thread design, positively influenced the BIC and torque-out resistance at early stages of osseointegration.
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Affiliation(s)
- Ernesto B Benalcázar Jalkh
- University of Sao Paulo - Bauru School of Dentistry, Department of Prosthodontics and Periodontology, Bauru, SP, Brazil; Department of Biomaterials, New York University College of Dentistry, New York, NY, USA
| | - Marcelo Parra
- PhD Program in Morphological Sciences, Center of Excellence in Morphological and Surgical Studies Faculty of Medicine, Universidad de La Frontera, Temuco, Chile; Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Andrea Torroni
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY, USA
| | - Vasudev Vivekanand Nayak
- Department of Biomaterials, New York University College of Dentistry, New York, NY, USA; Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, USA
| | - Nick Tovar
- Department of Biomaterials, New York University College of Dentistry, New York, NY, USA; Department of Oral and Maxillofacial Surgery, New York University, Langone Medical Center and Bellevue Hospital Center, New York, NY, USA
| | - Arthur Castellano
- Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil; Federal University of Parana, Curitiba, Brazil
| | - Rafael M Badalov
- Department of Biomaterials, New York University College of Dentistry, New York, NY, USA
| | - Estevam A Bonfante
- University of Sao Paulo - Bauru School of Dentistry, Department of Prosthodontics and Periodontology, Bauru, SP, Brazil
| | - Paulo G Coelho
- Department of Biomaterials, New York University College of Dentistry, New York, NY, USA; Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY, USA; Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, USA
| | - Lukasz Witek
- Department of Biomaterials, New York University College of Dentistry, New York, NY, USA; Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, USA.
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Gabrić D, Aumiler D, Vuletić M, Gjorgievska E, Blašković M, Mladenov M, Pavlić V. Thermal Evaluation by Infrared Thermography Measurement of Osteotomies Performed with Er:YAG Laser, Piezosurgery and Surgical Drill-An Animal Study. MATERIALS 2021; 14:ma14113051. [PMID: 34205094 PMCID: PMC8199930 DOI: 10.3390/ma14113051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022]
Abstract
The bone healing process following osteotomy may vary according to the type of surgical instrumentation. The aim of the present in vivo study was to determine thermal changes of the bone tissue following osteotomies performed by Er:YAG laser ablation in contact and non-contact modes, piezoelectric surgery, and surgical drill using an infrared thermographic camera. For each measurement, the temperature before the osteotomy-baseline (Tbase) and the maximal temperature measured during osteotomy (Tmax) were determined. Mean temperature (ΔT) values were calculated for each osteotomy technique. The significance of the difference of the registered temperature between groups was assessed by the ANOVA test for repeated measures. Mean baseline temperature (Tbase) was 27.9 ± 0.3 °C for contact Er:YAG laser, 29.9 ± 0.3 °C for non-contact Er:YAG laser, 29.4 ± 0.3 °C for piezosurgery, and 28.3 ± 0.3 °C for surgical drill. Mean maximum temperature (Tmax) was 29.9 ± 0.5 °C (ΔT = 1.9 ± 0.3 °C) for contact Er:YAG laser, 79.1 ± 4.6 °C (ΔT = 49.1 ± 4.4 °C) for non-contact Er:YAG laser, 29.1 ± 0.2 °C (ΔT = −0.2 ± 0.3 °C) for piezosurgery, and 27.3 ± 0.4 °C (ΔT = −0.9 ± 0.4 °C) for surgical drill. Statistically significant temperature changes were observed for the non-contact laser. The results of the study showed beneficial effects of the osteotomy performed by the Er:YAG laser used in the contact mode of working as well as for piezosurgery, reducing the potential overheating of the bone tissue as determined by means of infrared thermography.
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Affiliation(s)
- Dragana Gabrić
- Department of Oral Surgery, School of Dental Medicine, University Hospital Center, University of Zagreb, 10000 Zagreb, Croatia;
| | | | - Marko Vuletić
- Department of Oral Surgery, School of Dental Medicine, University Hospital Center, University of Zagreb, 10000 Zagreb, Croatia;
- Correspondence:
| | - Elizabeta Gjorgievska
- Department of Pediatric and Preventive Dentistry, Faculty of Dental Medicine, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia;
| | - Marko Blašković
- Department of Oral Surgery, Faculty of Dental Medicine, University Hospital Center, University of Rijeka, 51000 Rijeka, Croatia;
| | - Mitko Mladenov
- Faculty of Natural Sciences and Mathematics, Institute of Biology, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia;
| | - Verica Pavlić
- Department of Periodontology and Oral Medicine, Medical Faculty, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
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Holzinger D, Ureel M, Wilken T, Müller AA, Schicho K, Millesi G, Juergens P. First-in-man application of a cold ablation robot guided laser osteotome in midface osteotomies. J Craniomaxillofac Surg 2021; 49:531-537. [PMID: 33994295 DOI: 10.1016/j.jcms.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/21/2020] [Accepted: 01/12/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to assess the clinical applicability of robot guided laser osteotomy for clinical application. This is the initial report on 14 consecutive patients requiring an orthognathic procedure with a midface osteotomy (no restrictions made on the surgical indication itself) who have undergone surgery by means of the Cold Ablation Laser Osteotome CARLO® (AOT Advanced Osteotomy Tools, Basle, Switzerland), which is an integrated system, functionally comprising: an Er:YAG laser source, intended to perform osteotomies using cold laser ablation, a robot arm that controls the position of the laser source, an optical tracking device that provides a continuous and accurate measurement of the position of the laser source and of reference elements attached to instruments or bones, a navigation system (software) that is able to read preoperatively defined planned osteotomies, and - under the control of a surgeon - performs the planned osteotomies. Safety was assessed by unimpaired postoperative healing and the absence of device related injuries; performance was assessed as ability to cut the maxilla along the preoperatively planned cutting path with a rage of accuracy of 2mm. Cold ablation robot-guided laser osteotomy could successfully be performed in 14 consecutive patients. No intraoperative complications or technical failure occurred. All osteotomies were within an average deviation of 0.80 mm (±0.26 mm) of the virtually preplanned location. The registration procedure to set up the robot at the beginning of the operation required a mean time of 4.6 min (±5.3min). In this report we describe the effective and successful routine use of Cold ablation robot-guided laser osteotomy in an actual clinical setting. It is a promising technical innovation that has the potential to set new standards for accuracy and safety in orthognathic surgery.
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Affiliation(s)
- Daniel Holzinger
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Austria.
| | - Matthias Ureel
- Department of Cranio-Maxillofacial Surgery, University Hospital, Basel, Switzerland
| | | | - Andreas A Müller
- Department of Cranio-Maxillofacial Surgery, University Hospital, Basel, Switzerland
| | - Kurt Schicho
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Austria
| | - Gabriele Millesi
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Austria
| | - Philipp Juergens
- Department of Cranio-Maxillofacial Surgery, University Hospital, Basel, Switzerland; MKG Arabellapark - Private Clinic for Oral & Maxillofacial Surgery, Germany
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Fujiwara S, Kato S, Bengazi F, Urbizo Velez J, Tumedei M, Kotsu M, Botticelli D. Healing at implants installed in osteotomies prepared either with a piezoelectric device or drills: an experimental study in dogs. Oral Maxillofac Surg 2020; 25:65-73. [PMID: 32803459 DOI: 10.1007/s10006-020-00895-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/11/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare osseointegration and marginal bone level at implants placed in osteotomies prepared with either conventional drills or a piezoelectric device. MATERIAL AND METHODS Three months after the extraction of all mandibular premolars and first molars, two recipient sites were selected. The osteotomies were randomly prepared with either conventional drills (drill sites) or a piezoelectric device (piezoelectric sites). Implants were installed and a submerged healing was allowed. The animals were euthanized in groups of six after 4 and 8 weeks of healing. Biopsies were obtained for histological preparation. Coronal level of osseointegration (bone level) and bone-to-implant contact percentage (BIC%) were evaluated. RESULTS After 4 weeks of healing, the bone level was 0.6 ± 0.9 mm for the piezoelectric sites and 1.6 ± 0.7 mm for the drill sites (p = 0.173). After 8 weeks, the respective measures were 0.9 ± 0.3 mm and 1.0 ± 1.1 mm (p = 0.917). After 4 weeks of healing, a new bone apposed onto the implant surface was found at fractions of 54.9 ± 6.7% and 55.1 ± 16.6% for the piezoelectric and the drill sites, respectively (p = 0.674). The respective total bone fractions, including new and old bone, was 64.0 ± 4.8% and 63.4 ± 20.4% (p = 0.917). After 8 weeks, a new bone increased to 67.4 ± 6.7% and 62.9 ± 12.5% for the piezoelectric and the drill sites, respectively (p = 0.463). The respective total bone fractions were 70.4 ± 5.5% and 67.8 ± 12.1% (p = 0.753). CONCLUSIONS The use of a piezoelectric device for implant site preparation is a safe procedure that allows a proper integration since the early periods of healing similar to that observed using conventional drills.
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Affiliation(s)
| | - Shingo Kato
- ARDEC Academy, Viale Giovanni Pascoli 67, Rimini, Italy
- , Nishinomiya City, Hyogo, Japan
| | - Franco Bengazi
- Faculty of Dentistry, University of Medical Science, La Habana, Cuba
| | | | - Margherita Tumedei
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Mitsuo Kotsu
- ARDEC Academy, Viale Giovanni Pascoli 67, Rimini, Italy
- , Suita City, Osaka, Japan
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Baek KW, Dard M, Zeilhofer HF, Cattin PC, Juergens P. Comparing the Bone Healing After Cold Ablation Robot-Guided Er:YAG Laser Osteotomy and Piezoelectric Osteotomy-A Pilot Study in a Minipig Mandible. Lasers Surg Med 2020; 53:291-299. [PMID: 32529785 DOI: 10.1002/lsm.23281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE To take major advantage of erbium-doped yttrium aluminium garnet (Er:YAG) lasers in osteotomy-like freedom of cutting geometries and high accuracy-the integration and miniaturization of the robot, laser, and navigation technology was tried and applied to minipigs. The investigators hypothesized laser osteotomy would render acceptable bone healing based on the intraoperative findings and postoperative cut surface analysis. STUDY DESIGN/MATERIALS AND METHODS We designed and implemented a comparative bone-cutting surgery in the minipig mandible with a cold ablation robot-guided Er:YAG laser osteotome (CARLO) and a piezoelectric (PZE) osteotome. The sample was composed of different patterns of defects in the mandibles of six grown-up female Goettingen minipigs. The predictor variable was Er:YAG osteotomy and PZE osteotomy. The outcome variable was the cut surface characteristics and bone healing at 4 and 8 weeks postoperatively. Descriptive and qualitative comparison was executed. RESULTS The sample was composed of four kinds of bone defects on both sides of the mandibles of six minipigs. We observed more bleeding during the operation, open-cut surfaces, and a faster healing pattern with the laser osteotomy. There was a possible association between the intraoperative findings, postoperative cut surface analysis, and the bone healing pattern. CONCLUSIONS The results of this study suggest that characteristic open-cut surfaces could explain favorable bone healing after laser osteotomy. Future studies will focus on the quantification of the early healing characteristics after laser osteotomy, its diverse application, and the safety feature. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Kyung-Won Baek
- Department of Biomedical Engineering, Hightech Research Center of Cranio-Maxillofacial Surgery (HFZ), University of Basel, Gewerbestrasse 14-16, Allschwil, 4123, Switzerland
| | - Michel Dard
- Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York.,Institut Straumann AG, Peter Merian-Weg 12, Basel, 4002, Switzerland
| | - Hans-Florian Zeilhofer
- Department of Biomedical Engineering, Hightech Research Center of Cranio-Maxillofacial Surgery (HFZ), University of Basel, Gewerbestrasse 14-16, Allschwil, 4123, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, Center for Medical Image Analysis & Navigation, University of Basel, Gewerbestrasse 14, Allschwil, 4123, Switzerland
| | - Philipp Juergens
- Department of Cranio-Maxillofacial Surgery, University Hospital of Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,MKG-Chirurgie Arabellapark Praxis für Mund-, Kiefer- und Gesichtschirurgie, Arabellastr. 17, München, 81925, Germany
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12
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Zhao W, Michalik D, Ferguson S, Hofstetter W, Lemaître J, von Rechenberg B, Bowen P. Rapid evaluation of bioactive Ti-based surfaces using an in vitro titration method. Nat Commun 2019; 10:2062. [PMID: 31048680 PMCID: PMC6497645 DOI: 10.1038/s41467-019-09673-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/16/2019] [Indexed: 11/25/2022] Open
Abstract
The prediction of implant behavior in vivo by the use of easy-to-perform in vitro methods is of great interest in biomaterials research. Simulated body fluids (SBFs) have been proposed and widely used to evaluate the bone-bonding ability of implant materials. In view of its limitations, we report here a rapid in vitro method based on calcium titration for the evaluation of in vivo bioactivity. Using four different titanium surfaces, this method identifies that alkaline treatment is the key process to confer bioactivity to titanium whereas no significant effect from heat treatment is observed. The presence of bioactive titanium surfaces in the solution during calcium titration induces an earlier nucleation of crystalline calcium phosphates and changes the crystallization pathway. The conclusions from this method are also supported by the standard SBF test (ISO 23317), in vitro cell culture tests using osteoblasts and in vivo animal experiments employing a pelvic sheep model.
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Affiliation(s)
- Weitian Zhao
- Institute of Materials, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - David Michalik
- Musculoskeletal Research Unit, University of Zürich, Zürich, Switzerland
| | - Stephen Ferguson
- Institute for Biomechanics, ETH-Zürich, Zürich, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Willy Hofstetter
- Graduate School of Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Jacques Lemaître
- Institute of Materials, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit, University of Zürich, Zürich, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Paul Bowen
- Institute of Materials, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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13
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Tretto P, Fabris V, Cericato G, Sarkis-Onofre R, Bacchi A. Does the instrument used for the implant site preparation influence the bone–implant interface? A systematic review of clinical and animal studies. Int J Oral Maxillofac Surg 2019; 48:97-107. [DOI: 10.1016/j.ijom.2018.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/27/2018] [Accepted: 04/09/2018] [Indexed: 12/13/2022]
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14
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Alifarag AM, Lopez CD, Neiva RF, Tovar N, Witek L, Coelho PG. Atemporal osseointegration: Early biomechanical stability through osseodensification. J Orthop Res 2018. [PMID: 29537128 DOI: 10.1002/jor.23893] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Osseointegration, the direct functional and structural connection between device and bone is influenced by multiple factors such as implant macrogeometry and surgical technique. This study investigated the effects of osseodensification drilling techniques on implant stability and osseointegration using trabecular metal (TM) and tapered-screw vent (TSV) implants in a low-density bone. Six skeletally mature sheep were used where six osteotomy sites were prepared in each of the ilia, (n = 2/technique: Regular [R] (subtractive), clockwise [CW], and counterclockwise [CCW]). One TM and one TSV implant was subsequently placed with R osteotomy sites prepared using a conventional (subtractive) drilling protocol as recommended by the implant manufacturer for low density bone. CW and CCW drilling sites were subjected to osseodensification (OD) (additive) drilling. Evaluation of insertion torque as a function of drilling technique showed implants subjected to R drilling yielded a significant lower insertion torque relative to samples implanted in OD (CW/CCW) sites (p < 0.05). Histomorphometric analysis shows that the osseodensification demonstrates significantly greater values for bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). Histological analysis shows the presence of bone remnants, which acted as nucleating surfaces for osteoblastic bone deposition, facilitating the bridging of bone between the surrounding native bone and implant surface, as well as within the open spaces of the trabecular network in the TM implants. Devices that were implanted via OD demonstrated atemporal biomechanical stability and osseointegration. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2516-2523, 2018.
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Affiliation(s)
- Adham M Alifarag
- College of Medicine, SUNY Upstate Medical University, Syracuse, New York.,Department of Biomaterials and Biomimetics, New York University College of Dentistry, 433 1st Ave, Room 862, New York, New York 10010
| | - Christopher D Lopez
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, 433 1st Ave, Room 862, New York, New York 10010.,Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Comparative Medicine, New York University School of Medicine, New York, New York.,Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York
| | - Rodrigo F Neiva
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, Florida
| | - Nick Tovar
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, 433 1st Ave, Room 862, New York, New York 10010
| | - Lukasz Witek
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, 433 1st Ave, Room 862, New York, New York 10010
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, 433 1st Ave, Room 862, New York, New York 10010.,Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York
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15
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Augello M, Baetscher C, Segesser M, Zeilhofer HF, Cattin P, Juergens P. Performing partial mandibular resection, fibula free flap reconstruction and midfacial osteotomies with a cold ablation and robot-guided Er:YAG laser osteotome (CARLO ®) - A study on applicability and effectiveness in human cadavers. J Craniomaxillofac Surg 2018; 46:1850-1855. [PMID: 30146105 DOI: 10.1016/j.jcms.2018.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 07/10/2018] [Accepted: 08/01/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Aim of the study was to prove the safety, accuracy characteristics of contact-free laser osteotomy executed with the cold ablation and robot-guided Er:YAG laser osteotome in a human cadaver test. MATERIAL AND METHODS On six human cadavers mandible resections with a swallowtail like pattern were performed with the laser system on each side. The defects were reconstructed with a fibula graft of identical design and enlarged by 0.2 units. Mandibles and fibulas width as well surgery times were recorded. Additionally a Le Fort I and median mandible split were done. Macroscopically, the bone margins were examined for necrosis. RESULTS Laser osteotomies of the mandible up to a depth of 23 mm were possible without any thermal damage. Repeatability and precision of the system could be easily assessed. With the navigation system precise control of localization was achievable. Mean surgery time for the mandible resection was 13.32 min and for the fibula osteotomy 12.38 min. CONCLUSION The simply transmission of a cold ablation and robot-guided laser osteotome in an operation room identical environment for surgical interventions could be demonstrated. Precise osteotomy patterns with freedom in the design and carbonisation-free cut surfaces have been shown.
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Affiliation(s)
- Marcello Augello
- Department of Cranio-Maxillofacial Surgery, (Head: Prof. Dr. Dr. Dr. H.C. Hans-Florian Zeilhofer), Hospital Aarau, Aarau, Switzerland; Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Allschwil, Switzerland.
| | | | | | - Hans-Florian Zeilhofer
- Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Allschwil, Switzerland; Department of Cranio-Maxillofacial Surgery, University Hospital, Basel, Switzerland
| | - Philippe Cattin
- Center for Medical Image Analysis and Navigation, University of Basel, Allschwil, Switzerland
| | - Philipp Juergens
- Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Allschwil, Switzerland; Department of Cranio-Maxillofacial Surgery, University Hospital, Basel, Switzerland
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Comparative microstructural analysis of bone osteotomies after cutting by computer-assisted robot-guided laser osteotome and piezoelectric osteotome: an in vivo animal study. Lasers Med Sci 2018; 33:1471-1478. [PMID: 29654421 DOI: 10.1007/s10103-018-2502-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
Most industrial laser applications utilize computer and robot assistance, for guidance, safety, repeatability, and precision. In contrast, medical applications using laser systems are mostly conducted manually. The advantages can be effective only when the system is coupled to a robotic guidance, as operating by hand does not reach the required accuracy. We currently developed the first laser osteotome which offers preoperative planning based on CT data, robot guidance, and a precise execution of the laser cuts. In an animal trial, our system was used to create a grid pattern of the same depth on the inner layer of parietal bone in 12 adult sheep. The same bone cuts were done with piezoelectric osteotome on the contralateral side. The micro-CT and histological analysis showed more new mineralized bone in the laser group compared to the piezoelectric group. As well, a cutting pattern with especially a constant osteotomy depth in the laser group was demonstrated. The here presented autonomous osteotomy tool shows not only an advantage in early bone healing stage but additionally sharp bone cuts with a very high accuracy and freely selectable design cuts.
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17
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Sendyk DI, de Oliveira NK, Pannuti CM, da Graça Naclério-Homem M, Wennerberg A, Deboni MCZ. Conventional Drilling Versus Piezosurgery for Implant Site Preparation: A Meta-Analysis. J ORAL IMPLANTOL 2018; 44:400-405. [PMID: 29583059 DOI: 10.1563/aaid-joi-d-17-00091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to evaluate if the stability of dental implants varies between dental implants placed by piezosurgery compared with those placed by conventional drilling. An electronic search in MEDLINE, SCOPUS, and the Cochrane Library was undertaken until August 2016 and was supplemented by manual searches and by unpublished studies at OpenGray. Only randomized controlled clinical trials that reported implant site preparation with piezosurgery and with conventional drilling were considered eligible for inclusion in this review. Meta-analyses were performed to evaluate the impact of piezosurgery on implant stability. Of 456 references electronically retrieved, 3 were included in the qualitative analysis and quantitative synthesis. The pooled estimates suggest that there is no significant difference between piezosurgery and conventional drilling at baseline (weighted mean differences [WMD]: 2.20; 95% confidence interval [CI]: -5.09, 9.49; P = .55). At 90 days, the pooled estimates revealed a statistically significant difference (WMD: 3.63; 95% CI: 0.58, 6.67, P = .02) favoring piezosurgery. Implant stability may be slightly improved when osteotomy is performed by a piezoelectric device. More randomized controlled clinical trials are needed to confirm these findings.
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Affiliation(s)
- Daniel Isaac Sendyk
- 1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Natacha Kalline de Oliveira
- 1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Claudio Mendes Pannuti
- 2 Department of Stomatology, Division of Periodontics, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Ann Wennerberg
- 3 Department of Prosthodontics, Faculty of Dentistry, Malmö University, Malmö, Sweden
| | - Maria Cristina Zindel Deboni
- 1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
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18
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Troedhan A, Mahmoud ZT, Wainwright M, Khamis MM. Cutting bone with drills, burs, lasers and piezotomes: A comprehensive systematic review and recommendations for the clinician. ACTA ACUST UNITED AC 2017. [DOI: 10.17352/2455-4634.000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
PURPOSE The aim of this study was to review the scientific evidence about the laser osteotomy in implant bed preparation. METHODS An electronic search was performed on relevant English articles up to April 2016 in the PubMed, Scopus, and Google Scholar databases. RESULTS Twenty-two articles (1 clinical, 13 animal, and 8 ex vivo studies) were included. Implant sites prepared by erbium family lasers and drill showed comparable results regarding the percentage of bone-to-implant contact, values of biomechanical tests, and healing process. Selection of proper laser wavelength and parameters was of paramount importance to minimize the risk of thermal bone damage. Lack of depth control and long time needed for implant site osteotomy with laser were the most challenging concerns for its clinical applicability. Computer-guided laser osteotomy showed promise for future use of laser osteotomy in clinical settings. CONCLUSION Evidence from animal studies shows promising results regarding laser osteotomy in implant site preparation. However, because of the lack of clinical studies, it is not possible to make a conclusive result whether there is superiority of laser osteotomy in clinical practice.
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Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki AA, Romanos GE, Taniguchi Y, Sasaki KM, Zeredo JL, Koshy G, Coluzzi DJ, White JM, Abiko Y, Ishikawa I, Izumi Y. Periodontal and peri-implant wound healing following laser therapy. Periodontol 2000 2017; 68:217-69. [PMID: 25867988 DOI: 10.1111/prd.12080] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 12/18/2022]
Abstract
Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO2 , neodymium-doped yttrium-aluminium-garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft-tissue management. With development of the erbium-doped yttrium-aluminium-garnet (Er:YAG) and erbium, chromium-doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft-tissue management to hard-tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri-implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti-inflammatory agents, phototherapy using lasers and light-emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low- and high-level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri-implant diseases. This article discusses the outcomes of laser therapy in soft-tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri-implant treatment, focusing on postoperative wound healing of periodontal and peri-implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.
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Rajitha Gunaratne GD, Khan R, Fick D, Robertson B, Dahotre N, Ironside C. A review of the physiological and histological effects of laser osteotomy. J Med Eng Technol 2016; 41:1-12. [DOI: 10.1080/03091902.2016.1199743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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22
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Esteves JC, de Souza Faloni AP, Macedo PD, Nakata PB, Chierici Marcantonio RA, Intini G, Marcantonio E. Effects on Bone Repair of Osteotomy With Drills or With Erbium, Chromium: Yttrium-Scandium-Gallium-Garnet Laser: Histomorphometric and Immunohistochemical Study. J Periodontol 2015; 87:452-60. [PMID: 26693695 DOI: 10.1902/jop.2015.150406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser has been widely used in the dental clinic; however, few studies have demonstrated the advantages of the use of this laser for bone osteotomies. The purpose of this study is to evaluate and compare the bone repair process of defects generated by the Er,Cr:YSGG laser or conventional drills. METHODS Ninety-six rats were divided into two groups of 48 animals (drill group and laser group). After surgical exposure of the right tibia, the animals were subjected to a 2-mm-diameter osteotomy created by conventional drills (drill group) or by the Er,Cr:YSGG laser (laser group). The animals were sacrificed 0, 3, 7, 14, 30, and 60 days after the creation of the defect, and histologic sections were obtained and used for histomorphometric and immunohistochemical analyses for the detection of osteocalcin, osteoprotegerin, receptor activator of nuclear factor κ-B ligand, vascular endothelial growth factor, and caspase-3. RESULTS The osteotomy with the drill produced well-delimited and smooth walls, whereas the osteotomies in the laser group were irregular and presented an amorphous basophilic line and bone necrosis that was slowly resorbed during the repair process. Despite these characteristics, bone repair was similar between groups at various time points, and, at 60 days, the defects in both groups were completely repaired by newly formed bone. CONCLUSION The repair process of osteotomies created by the Er,Cr:YSGG laser, despite producing thermal damage to bone tissue, is comparable to that with conventional drills.
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Affiliation(s)
- Jônatas Caldeira Esteves
- Department of Dental Clinic, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Paula de Souza Faloni
- Department of Health Sciences, Implantology Postgraduation Course, University Center of Araraquara (UNIARA), Araraquara, São Paulo, Brazil
| | - Paula Delello Macedo
- Department of Diagnosis and Surgery, Division of Periodontology, Araraquara Dental School, Univ Estadual Paulista (UNESP), Araraquara, São Paulo, Brazil
| | - Patrícia Borges Nakata
- Department of Diagnosis and Surgery, Division of Periodontology, Araraquara Dental School, Univ Estadual Paulista (UNESP), Araraquara, São Paulo, Brazil
| | - Rosemary Adriana Chierici Marcantonio
- Department of Diagnosis and Surgery, Division of Periodontology, Araraquara Dental School, Univ Estadual Paulista (UNESP), Araraquara, São Paulo, Brazil
| | - Giuseppe Intini
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, MA.,Harvard Stem Cell Institute, Cambridge, MA
| | - Elcio Marcantonio
- Department of Diagnosis and Surgery, Division of Periodontology, Araraquara Dental School, Univ Estadual Paulista (UNESP), Araraquara, São Paulo, Brazil
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Abstract
Piezosurgery, or the use of piezoelectric devices, is being applied increasingly in oral and maxillofacial surgery. The main advantages of this technique are precise and selective cuttings, the avoidance of thermal damage, and the preservation of soft-tissue structures. Through the application of piezoelectric surgery, implant-site preparation, bone grafting, sinus-floor elevation, edentulous ridge splitting or the lateralization of the inferior alveolar nerve are very technically feasible. This clinical overview gives a short summary of the current literature and outlines the advantages and disadvantages of piezoelectric bone surgery in implant dentistry. Overall, piezoelectric surgery is superior to other methods that utilize mechanical instruments. Handling of delicate or compromised hard- and soft-tissue conditions can be performed with less risk for the patient. With respect to current and future innovative surgical concepts, piezoelectric surgery offers a wide range of new possibilities to perform customized and minimally invasive osteotomies.
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Affiliation(s)
- Stefan Stübinger
- Hightech Research Center of Cranio-maxillofacial Surgery, University of Basel, Allschwil, Switzerland
| | | | - Britt-Isabelle Berg
- Department of Cranio-maxillofacial Surgery, University Hospital Basel, Basel, Switzerland ; Division of Oral and Maxillofacial Radiology, Columbia University Medical Center, New York, NY, USA
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Baek KW, Deibel W, Marinov D, Griessen M, Bruno A, Zeilhofer HF, Cattin P, Juergens P. Clinical applicability of robot-guided contact-free laser osteotomy in cranio-maxillo-facial surgery: in-vitro simulation and in-vivo surgery in minipig mandibles. Br J Oral Maxillofac Surg 2015; 53:976-81. [PMID: 26305341 DOI: 10.1016/j.bjoms.2015.07.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/24/2015] [Indexed: 11/25/2022]
Abstract
Laser was being used in medicine soon after its invention. However, it has been possible to excise hard tissue with lasers only recently, and the Er:YAG laser is now established in the treatment of damaged teeth. Recently experimental studies have investigated its use in bone surgery, where its major advantages are freedom of cutting geometry and precision. However, these advantages become apparent only when the system is used with robotic guidance. The main challenge is ergonomic integration of the laser and the robot, otherwise the surgeon's space in the operating theatre is obstructed during the procedure. Here we present our first experiences with an integrated, miniaturised laser system guided by a surgical robot. An Er:YAG laser source and the corresponding optical system were integrated into a composite casing that was mounted on a surgical robotic arm. The robot-guided laser system was connected to a computer-assisted preoperative planning and intraoperative navigation system, and the laser osteotome was used in an operating theatre to create defects of different shapes in the mandibles of 6 minipigs. Similar defects were created on the opposite side with a piezoelectric (PZE) osteotome and a conventional drill guided by a surgeon. The performance was analysed from the points of view of the workflow, ergonomics, ease of use, and safety features. The integrated robot-guided laser osteotome can be ergonomically used in the operating theatre. The computer-assisted and robot-guided laser osteotome is likely to be suitable for clinical use for ostectomies that require considerable accuracy and individual shape.
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Affiliation(s)
- K-W Baek
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - W Deibel
- Medical Image Analysis Center, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland; Advanced Osteotomy Tools AG, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - D Marinov
- Advanced Osteotomy Tools AG, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - M Griessen
- Medical Image Analysis Center, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland; Advanced Osteotomy Tools AG, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - A Bruno
- Advanced Osteotomy Tools AG, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - H-F Zeilhofer
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - Ph Cattin
- Medical Image Analysis Center, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - Ph Juergens
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
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Baek KW, Deibel W, Marinov D, Griessen M, Dard M, Bruno A, Zeilhofer HF, Cattin P, Juergens P. A comparative investigation of bone surface after cutting with mechanical tools and Er:YAG laser. Lasers Surg Med 2015; 47:426-32. [PMID: 25945815 DOI: 10.1002/lsm.22352] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite of the long history of medical application, laser ablation of bone tissue became successful only recently. Laser bone cutting is proven to have higher accuracy and to increase bone healing compared to conventional mechanical bone cutting. But the reason of subsequent better healing is not biologically explained yet. In this study we present our experience with an integrated miniaturized laser system mounted on a surgical lightweight robotic arm. STUDY DESIGN/MATERIALS AND METHODS An Erbium-doped Yttrium Aluminium Garnet (Er:YAG) laser and a piezoelectric (PZE) osteotome were used for comparison. In six grown up female Göttingen minipigs, comparative surgical interventions were done on the edentulous mandibular ridge. Our laser system was used to create different shapes of bone defects on the left side of the mandible. On the contralateral side, similar bone defects were created by PZE osteotome. Small bone samples were harvested to compare the immediate post-operative cut surface. RESULTS The analysis of the cut surface of the laser osteotomy and conventional mechanical osteotomy revealed an essential difference. The scanning electron microscopy (SEM) analysis showed biologically open cut surfaces from the laser osteotomy. The samples from PZE osteotomy showed a flattened tissue structure over the cut surface, resembling the "smear layer" from tooth preparation. CONCLUSIONS We concluded that our new finding with the mechanical osteotomy suggests a biological explanation to the expected difference in subsequent bone healing. Our hypothesis is that the difference of surface characteristic yields to different bleeding pattern and subsequently results in different bone healing. The analyses of bone healing will support our hypothesis.
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Affiliation(s)
- Kyung-Won Baek
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Schanzenstrasse 46, Basel, 4031, Switzerland
| | - Waldemar Deibel
- Medical Image Analysis Centre, University of Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Advanced Osteotomy Tools AG, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Dilyan Marinov
- Advanced Osteotomy Tools AG, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Mathias Griessen
- Medical Image Analysis Centre, University of Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Advanced Osteotomy Tools AG, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Michel Dard
- Periodontology and Implant Dentistry, New York University College of Dentistry, 345E. 24th Street, New York City, 10010
| | - Alfredo Bruno
- Advanced Osteotomy Tools AG, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Hans-Florian Zeilhofer
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Schanzenstrasse 46, Basel, 4031, Switzerland
| | - Philippe Cattin
- Medical Image Analysis Centre, University of Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Philipp Juergens
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Schanzenstrasse 46, Basel, 4031, Switzerland
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Stübinger S, Nuss K, Bürki A, Mosch I, le Sidler M, Meikle ST, von Rechenberg B, Santin M. Osseointegration of titanium implants functionalised with phosphoserine-tethered poly(epsilon-lysine) dendrons: a comparative study with traditional surface treatments in sheep. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:87. [PMID: 25644101 DOI: 10.1007/s10856-015-5433-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
The aim of this study was to analyse the osseointegrative potential of phosphoserine-tethered dendrons when applied as surface functionalisation molecules on titanium implants in a sheep model after 2 and 8 weeks of implantation. Uncoated and dendron-coated implants were implanted in six sheep. Sandblasted and etched (SE) or porous additive manufactured (AM) implants with and without additional dendron functionalisation (SE-PSD; AM-PSD) were placed in the pelvic bone. Three implants per group were examined histologically and six implants were tested biomechanically. After 2 and 8 weeks the bone-to-implant contact (BIC) total values of SE implants (43.7±12.2; 53.3±9.0%) and SE-PSD (46.7±4.5; 61.7±4.9%) as well as AM implants (20.49±5.1; 43.9±9.7%) and AM-PSD implants (19.7±3.5; 48.3±15.6%) showed no statistically significant differences. For SE-PSD and AM-PSD a separate analysis of only the cancellous BIC demonstrated a statistically significant difference after 2 and 8 weeks. Biomechanical findings proved the overall increased stability of the porous implants after 8 weeks. Overall, the great effect of implant macro design on osseointegration was further supported by additional phosphoserine-tethered dendrons for SE and AM implants.
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Affiliation(s)
- Stefan Stübinger
- Musculoskeletal Research Unit, Equine Hospital, Vetsuisse Faculty ZH, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland,
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Stübinger S, Waser J, Hefti T, Drechsler A, Sidler M, Klein K, von Rechenberg B, Schlottig F. Evaluation of local cancellous bone amelioration by poly-L-DL-lactide copolymers to improve primary stability of dental implants: a biomechanical study in sheep. Clin Oral Implants Res 2014; 26:572-80. [PMID: 24989873 DOI: 10.1111/clr.12445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical performance of local cancellous bone amelioration by a 70:30 poly-(L-lactide-co-D,L-Lacide) copolymer with two different implant designs on primary stability and after 4 and 12 weeks of healing time. MATERIAL AND METHODS In six sheep, n = 36 implants (TH) with a conditioned, sandblasted, thermal acid-etched micro-rough surface and n = 36 implants (NB) with a highly crystalline and phosphate-enriched anodized titanium oxide surface were placed in the pelvic bone. Using an ultrasound-based process named Constant Amelioration Process (CAP), half of peri-implant trabecular bone structures were locally tested with 70:30 poly-(L-lactide-co-D,L-Lacide) copolymer in both implant groups, TH and NB. The CAP technology employs ultrasonic energy to liquefy 70:30 poly-(L-lactide-co-D,L-Lacide) which enters the inter-trabecular space, leading to local reinforcement of the cancellous bone structure after solidification of the copolymer. The CAP test group was compared with reference implants placed with the conventional site preparation according to the manufacturers' description. Primary stability was assessed by the measurement of torque-in values and implant stability quotient (ISQ; n = 18 per group). Secondary stability was analyzed by biomechanical removal torque testing after 4 and 12 weeks (n = 9 per group). RESULTS Insertion torque value (23.3 N cm ± 13.6) of reference TH implants demonstrated a statistically significant (P = 0.00) difference in comparison with test TH implants (41.9 N cm ± 19.5). Reference NB implants revealed a statistically significant (P = 0.03) lower insertion torque value (23.7 N cm ± 13.5) than test NB implants (39.7 N cm ± 18.6). ISQ values increased for all implants from initial implant placement until sacrifice at 12 weeks. Reference TH implants tended to result in an increase in torque values from 4 weeks (181.9 N cm ± 22.8) to 12 weeks (225.7 N cm ± 47.4). This trend could be also proven for implants of test sites (4 week: 176.8 N cm ± 24.1; 12 week: 201.5 N cm ± 53.4). For reference, NB implants a non-significant increase in removal torque values from 4 weeks (146. 7 N cm ± 18.0) to 12 weeks (170.2 N cm ± 40.4) was observed. Removal torque values of test NB implants did not increase from 4 weeks (153.3 N cm ± 21.5) to 12 weeks (146.1 N cm ± 37.5). CONCLUSION Biomechanical data proved significantly enhanced primary stability of dental implants after local amelioration without long-term sequelae and irrespective of implant design. After 4- and 12-week healing time, removal torque of locally test implants was as high as for control implants, and osseointegration was therefore not influenced by the CAP process. No correlation between ISQ values and torque values was found.
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Affiliation(s)
- Stefan Stübinger
- Musculoskeletal Research Unit, Equine Hospital, Vetsuisse Faculty ZH, University of Zurich, Zurich, Switzerland; Center of Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Ernst S, Stübinger S, Schüpbach P, Sidler M, Klein K, Ferguson SJ, von Rechenberg B. Comparison of two dental implant surface modifications on implants with same macrodesign: an experimental study in the pelvic sheep model. Clin Oral Implants Res 2014; 26:898-908. [PMID: 24954017 DOI: 10.1111/clr.12411] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of this study was to compare two different surfaces of one uniform macro-implant design in order to focus exclusively on the osseointegration properties after 2, 4 and 8 weeks and to discuss the animal model chosen. MATERIAL AND METHODS In six mature sheep, n = 36 implants with a highly crystalline and phosphate-enriched anodized titanium oxide surface (TiU) and n = 36 implants with a hydrophilic, sandblasted, large grit and acid-etched surface (SLA) were placed in the pelvic bone. TiU implants were custom-made to match the SLA implant design. The implant stability and bone-to-implant contact (BIC) were assessed by resonance frequency (ISQ), backscatter scanning electron microscopy (B-SEM), light microscopy (LM), micro-CT and intravital fluorochrome staining. Biomechanical removal torque testing was performed. RESULTS Overall, no statistically significant differences in BIC total (trabecular + cortical) between TiU and SLA were found via LM and B-SEM. BIC values (B-SEM; LM) in both groups revealed a steady rise in trabecular bone attachment to the implant surface after 2, 4 and 8 weeks. In the 2- to 4-week time interval in the TiU group (P = 0.005) as well as in the SLA group (P = 0.01), a statistically significant increase in BIC trabecular could be observed via LM. B-SEM values confirmed the statistically significant increase for TiU (P = 0.001). In both groups, BIC trabecular values after 8 weeks were significantly higher (P ≤ 0.05) than after 2 weeks (B-SEM; LM). Biomechanical data confirmed the histological data. CONCLUSION The two surfaces proved comparable osseointegration in this sheep model.
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Affiliation(s)
- Sabrina Ernst
- Musculoskeletal Research Unit (MRSU), Vetsuisse Faculty ZH, Equine Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Stübinger
- Musculoskeletal Research Unit (MRSU), Vetsuisse Faculty ZH, Equine Hospital, University of Zurich, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Peter Schüpbach
- Research Laboratory for Microscopy and Histology, Horgen, Switzerland
| | - Michéle Sidler
- Musculoskeletal Research Unit (MRSU), Vetsuisse Faculty ZH, Equine Hospital, University of Zurich, Zurich, Switzerland
| | - Karina Klein
- Musculoskeletal Research Unit (MRSU), Vetsuisse Faculty ZH, Equine Hospital, University of Zurich, Zurich, Switzerland
| | | | - Brigitte von Rechenberg
- Musculoskeletal Research Unit (MRSU), Vetsuisse Faculty ZH, Equine Hospital, University of Zurich, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Plötz C, Schelle F, Bourauel C, Frentzen M, Meister J. Ablation of porcine bone tissue with an ultrashort pulsed laser (USPL) system. Lasers Med Sci 2014; 30:977-83. [PMID: 24458532 DOI: 10.1007/s10103-014-1520-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/08/2014] [Indexed: 11/29/2022]
Abstract
Ultrashort pulsed lasers (USPLs) represent a new generation of laser systems in the field of biophotonical applications. In terms of a pilot project, the study was carried out to evaluate the ablation parameters of bone tissue regarding the medical use of such a laser technology in dentistry. Specimens from ribs of freshly slaughtered pigs were assembled and irradiated with an USP Nd:YVO4 laser (pulse duration 8 ps at 1,064 nm with repetition rates between 50 and 500 kHz) using eligible average output powers in the range of 3.5-9 W and fluences between 1 and 2.5 J/cm(2). Square-shaped cavities of 1-mm edge length in the bone compacta were created employing a scanner system. Cavities were analyzed with an optical profilometer to determine the ablated volume. Ablation rate was calculated by the ablated volume and the recorded irradiation time by the scanner software. Additionally, samples were examined histologically to investigate side effects of the surrounding tissue. Formed cavities showed a precise and sharp-edged appearance in bone compacta. Optimized ablation rate of 5.2 mm(3)/min without any accompanying side effects was obtained with an average output power of 9 W, a pulse repetition rate of 500 kHz, and an applied fluence of 2.5 J/cm(2). Provided that the used laser system will be advanced and adjusted for clinical applications, the outcome of this study shows auspicious possibilities for the use of USPL systems in the preparation of bone tissue.
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Affiliation(s)
- Christina Plötz
- Department of Operative and Preventive Dentistry, Dental Faculty, Bonn University, Welschnonnenstrasse 17, 53111, Bonn, Germany
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30
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Sotsuka Y, Nishimoto S, Tsumano T, Kawai K, Ishise H, Kakibuchi M, Shimokita R, Yamauchi T, Okihara SI. The dawn of computer-assisted robotic osteotomy with ytterbium-doped fiber laser. Lasers Med Sci 2013; 29:1125-9. [PMID: 24241973 DOI: 10.1007/s10103-013-1487-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 11/03/2013] [Indexed: 11/25/2022]
Abstract
Currently, laser radiation is used routinely in medical applications. For infrared lasers, bone ablation and the healing process have been reported, but no laser systems are established and applied in clinical bone surgery. Furthermore, industrial laser applications utilize computer and robot assistance; medical laser radiations are still mostly conducted manually nowadays. The purpose of this study was to compare the histological appearance of bone ablation and healing response in rabbit radial bone osteotomy created by surgical saw and ytterbium-doped fiber laser controlled by a computer with use of nitrogen surface cooling spray. An Ytterbium (Yb)-doped fiber laser at a wavelength of 1,070 nm was guided by a computer-aided robotic system, with a spot size of 100 μm at a distance of approximately 80 mm from the surface. The output power of the laser was 60 W at the scanning speed of 20 mm/s scan using continuous wave system with nitrogen spray level 0.5 MPa (energy density, 3.8 × 10(4) W/cm(2)). Rabbits radial bone osteotomy was performed by an Yb-doped fiber laser and a surgical saw. Additionally, histological analyses of the osteotomy site were performed on day 0 and day 21. Yb-doped fiber laser osteotomy revealed a remarkable cutting efficiency. There were little signs of tissue damage to the muscle. Lased specimens have shown no delayed healing compared with the saw osteotomies. Computer-assisted robotic osteotomy with Yb-doped fiber laser was able to perform. In rabbit model, laser-induced osteotomy defects, compared to those by surgical saw, exhibited no delayed healing response.
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Affiliation(s)
- Yohei Sotsuka
- Department of Plastic Surgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya City, Hyogo Prefecture, 663-8501, Japan,
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31
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A report on the use of Er:YAG laser for pilot hole drilling prior to miniscrew insertion. Lasers Med Sci 2013; 30:605-9. [PMID: 23793415 DOI: 10.1007/s10103-013-1374-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
Abstract
The aim of the present in vitro study was to investigate the required time period of the Er:YAG laser that is used for drilling through cortical bone when pilot hole drilling is needed before miniscrew insertion. Even though Er:YAG laser is used in various in vivo and in vitro studies, there is no accepted procedure of laser for depth control during drilling through cortical bone. The study sample consisted of 120 cortical bone segments having 1.5 and 2.0 mm of cortical bone thickness. An Er:YAG laser, with a spot size of 1.3 mm and an air-water spray of 40-50 ml/min, was used. The laser was held 2 mm away from and perpendicular to the bone surface with different laser settings. Twelve specimens were prepared for each subgroup. As the cortical bone thickness increased, the time needed to drill through the bone increased. Frequency increase directly caused a decrease in irradiation duration. When three different frequency, three different energy, and four different power values were tested for both the 1.5- and 2-mm cortical bone thicknesses, the shortest duration needed to drill through cortical bone was seen in the 3.6-W (300 mJ-12 Hz) setting. When pilot holes are drilled prior to miniscrew placement in 1.5 to 2 mm of cortical bone using Er:YAG laser, the most appropriate value is found with the 3.6-W (300 mJ-12 Hz) setting.
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32
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Jimbo R, Tovar N, Yoo DY, Janal MN, Anchieta RB, Coelho PG. The effect of different surgical drilling procedures on full laser-etched microgrooves surface-treated implants: an experimental study in sheep. Clin Oral Implants Res 2013; 25:1072-7. [DOI: 10.1111/clr.12216] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Ryo Jimbo
- Department of Prosthodontics; Faculty of Odontology; Malmo University; Malmo Sweden
| | - Nick Tovar
- Department of Biomaterials and Biomimetics; New York University; New York NY USA
| | - Daniel Y. Yoo
- Department of Biomaterials and Biomimetics; New York University; New York NY USA
| | - Malvin N. Janal
- Department of Epidemiology and Health Promotion; New York University; New York NY USA
| | - Rodolfo B. Anchieta
- Department of Biomaterials and Biomimetics; New York University; New York NY USA
| | - Paulo G. Coelho
- Department of Biomaterials and Biomimetics; New York University; New York NY USA
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33
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Stübinger S, Mosch I, Robotti P, Sidler M, Klein K, Ferguson SJ, von Rechenberg B. Histological and biomechanical analysis of porous additive manufactured implants made by direct metal laser sintering: a pilot study in sheep. J Biomed Mater Res B Appl Biomater 2013; 101:1154-63. [PMID: 23564723 DOI: 10.1002/jbm.b.32925] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 01/07/2013] [Accepted: 02/17/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES It was the aim of this study to analyze osseointegrative properties of porous additive manufactured titanium implants made by direct metal laser sintering in a sheep model after an implantation period of 2 and 8 weeks. MATERIAL AND METHODS Three different types of implants were placed in the pelvis of six sheep. In each sheep were placed three standard machined (M), three sandblasted and etched (SE), and three porous additive manufactured (AM) implants. Of these three implants (one per type) were examined histologically and six implants were tested biomechanically. Additionally a semiquantitative histomorphometrical and qualitative fluorescent microscopic analysis were performed. RESULTS After 2 and 8 weeks bone-to-implant-contact (BIC) values of the AM surface (2w: 20.49% ± 5.18%; 8w: 43.91% ± 9.69%) revealed no statistical significant differences in comparison to the M (2w: 20.33% ± 11.50%; 8w: 25.33% ± 4.61%) and SE (2w: 43.67 ± 12.22%; 8w: 53.33 ± 8.96%) surfaces. AM surface showed the highest increase of the BIC between the two observation time points. Considering the same implantation period histomorphometry and fluorescent labelling disclosed no significant differences in the bone surrounding the three implants groups. In contrast Removal-torque-test showed a significant improve in fixation strength (P ≤ 0.001) for the AM (1891.82 ± 308, 44 Nmm) surface after eight weeks in comparison to the M (198.93±88,04 Nmm) and SE (730.08 ± 151,89 Nmm) surfaces. CONCLUSION All three surfaces (M, SE, and AM) showed sound osseointegration. AM implants may offer a possible treatment option in clinics for patients with compromised bone situations.
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Affiliation(s)
- Stefan Stübinger
- Musculoskeletal Research Unit, Equine Hospital, Vetsuisse Faculty ZH, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland; Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
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34
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Strbac GD, Giannis K, Unger E, Mittlböck M, Watzek G, Zechner W. A novel standardized bone model for thermal evaluation of bone osteotomies with various irrigation methods. Clin Oral Implants Res 2013; 25:622-31. [PMID: 23347297 DOI: 10.1111/clr.12090] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Based on a novel standardized bovine specimen, the aim of this study was to investigate thermal effects of different irrigation methods during intermittent and graduated drilling. MATERIAL AND METHODS Temperature changes during implant osteotomies (n = 320) of 10 and 16 mm drilling depths with various irrigation methods were investigated on manufactured uniform bone samples providing homogenous cortical and cancellous areas and analogous thermal conductivity comparable to human bone. Automated sequences were performed with surgical twist drills of 2 mm ∅ and conical drills of 3.5, 4.3 and 5 mm ∅. Real-time recording of temperature increase was done using two custom-built multichannel thermoprobes with 14 temperature sensors at a predefined distance of 1 and 2 mm to the final osteotomy. The effects of drilling depth, drilling diameter and irrigation methods on temperature changes were investigated by a linear mixed model. RESULTS Using this uniform bone specimen, the greatest temperature rise was observed without any coolant supply with 29.87°C, followed by external with 28.47°C and then internal with 25.86°C and combined irrigation with 25.68°C. Significant differences (P ≤ 0.0156) between drill depths of 10 vs. 16 mm could be observed with all irrigation methods evaluated. With each of the irrigation methods, significantly higher temperature changes (P < 0.0001) during osteotomies could be observed between twist drills of 2 mm ∅ and conical drills of 3.5, 4.3 and 5 mm ∅. During 10 and 16 mm drilling osteotomies, external irrigation showed significantly higher temperatures (P < 0.05) for all conical drills compared with internal or combined irrigation, respectively. Significantly lower temperatures (P < 0.05) could be detected with internal or combined irrigation for the use of conical drills with various diameters and drilling depths. CONCLUSIONS This fully standardized bone model provides optimized comparability for the evaluation of bone osteotomies and resulting temperature changes. As regards the efficiency of the various irrigation methods, it could be demonstrated that internal and combined irrigation appears to be more beneficial than external irrigation.
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Affiliation(s)
- Georg D Strbac
- Department of Oral Surgery, Bernhard Gottlieb University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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