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Wojcik T, Morawska M, Ferri J, Müller-Gerbl M, Nicot R. Robotic calvarial bone sampling. J Craniomaxillofac Surg 2023; 51:603-608. [PMID: 37806905 DOI: 10.1016/j.jcms.2023.09.004] [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: 07/14/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
The aim of this study was to assess the feasibility of complex unicortical calvarial harvesting by using the Cold Ablation Robot-Guided Laser Osteotome (CARLO® primo+). A cadaveric study was performed with a progressive complexity of the bone harvesting. This preliminary study on the cadaveric cranial vault area examined the tracking precision, the strategies, settings and durations of harvesting, the accuracy of the unicortical bone cutting, and the risk of dura exposition. All sampling was realised with no more difficulty than that experienced during the standard procedure. No bicortical cutting occurred during CARLO® primo + robot-guided laser cutting. During the second sampling, dura was partially exposed due to improper angulation of the curved osteotome during harvesting. Complex unicortical calvarial harvesting using robot-guided laser appears to be feasible and safe. In the future, robotic approaches will probably replace current surgical techniques using cutting guides and help reduce intraoperative inaccuracies due to the human factor.
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Affiliation(s)
- Thomas Wojcik
- Univ. Lille, CHU Lille, INSERM, Oral and Maxillo-Facial Surgery Department, U1008 - Advanced Drug Delivery Systems, F-59000, Lille, France.
| | | | - Joël Ferri
- Univ. Lille, CHU Lille, INSERM, Oral and Maxillo-Facial Surgery Department, U1008 - Advanced Drug Delivery Systems, F-59000, Lille, France.
| | | | - Romain Nicot
- Univ. Lille, CHU Lille, INSERM, Oral and Maxillo-Facial Surgery Department, U1008 - Advanced Drug Delivery Systems, F-59000, Lille, France; Univ. Lille, Centrale Lille, CNRS, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France.
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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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First-Hand Experience and Result with New Robot-Assisted Laser LeFort-I Osteotomy in Orthognathic Surgery: A Case Report. J Pers Med 2023; 13:jpm13020287. [PMID: 36836521 PMCID: PMC9962026 DOI: 10.3390/jpm13020287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND We report the world's first developer-independent experience with robot-assisted laser Le Fort I osteotomy (LLFO) and drill-hole marking in orthognathic surgery. To overcome the geometric limitations of conventional rotating and piezosurgical instruments for performing osteotomies, we used the stand-alone robot-assisted laser system developed by Advanced Osteotomy Tools. The aim here was to evaluate the precision of this novel procedure in comparison to the standard procedure used in our clinic using a computer-aided design/computer-aided manufacturing (CAD/CAM) cutting guide and patient-specific implant. METHODS A linear Le-Fort-I osteotomy was digitally planned and transferred to the robot. The linear portion of the Le-Fort I osteotomy was performed autonomously by the robot under direct visual control. Accuracy was analyzed by superimposing preoperative and postoperative computed tomography images, and verified intraoperatively using prefabricated patient-specific implant. RESULTS The robot performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 1.5 mm on average between the planned and the performed osteotomy. In the robot-assisted intraoperative drillhole marking of the maxilla, which was performed for the first time worldwide, were no measurable deviations between planning and actual positioning. CONCLUSION Robotic-assisted orthognathic surgery could be a useful adjunct to conventional drills, burrs, and piezosurgical instruments for performing osteotomies. However, the time required for the actual osteotomy as well as isolated minor design aspects of the Dynamic Reference Frame (DRF), among other things, still need to be improved. Still further studies for final evaluation of safety and accuracy are also needed.
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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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Miniature parallel robot with submillimeter positioning accuracy for minimally invasive laser osteotomy. ROBOTICA 2021. [DOI: 10.1017/s0263574721000990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractTo overcome the physical limitations of mechanical bone cutting in minimally invasive surgery, we are developing a miniature parallel robot that enables positioning of a pulsed laser with an accuracy below 0.25 mm and minimizes the required manipulation space above the target tissue. This paper presents the design, control, device characteristics, functional testing, and performance evaluation of the robot. The performance of the robot was evaluated within the scope of a path-following experiment. The required accuracy for continuous cuts was achieved and reached 0.176 mm on the test bench.
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Winter F, Wilken T, Bammerlin M, Shawarba J, Dorfer C, Roessler K. Navigated, Robot-Driven Laser Craniotomy for SEEG Application Using Optical Coherence Tomography in an Animal Model. Front Robot AI 2021; 8:695363. [PMID: 34277720 PMCID: PMC8278282 DOI: 10.3389/frobt.2021.695363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives: We recently introduced a navigated, robot-driven laser beam craniotomy for use with stereoelectroencephalography (SEEG) applications. This method was intended to substitute the hand-held electric power drill in an ex vivo study. The purpose of this in vivo non-recovery pilot study was to acquire data for the depth control unit of this laser device, to test the feasibility of cutting bone channels, and to assess dura perforation and possible cortex damage related to cold ablation. Methods: Multiple holes suitable for SEEG bone channels were planned for the superior portion of two pig craniums using surgical planning software and a frameless, navigated technique. The trajectories were planned to avoid cortical blood vessels using magnetic resonance angiography. Each trajectory was converted into a series of circular paths to cut bone channels. The cutting strategy for each hole involved two modes: a remaining bone thickness mode and a cut through mode (CTR). The remaining bone thickness mode is an automatic coarse approach where the cutting depth is measured in real time using optical coherence tomography (OCT). In this mode, a pre-set measurement, in mm, of the remaining bone is left over by automatically comparing the bone thickness from computed tomography with the OCT depth. In the CTR mode, the cut through at lower cutting energies is managed by observing the cutting site with real-time video. Results: Both anesthesia protocols did not show any irregularities. In total, 19 bone channels were cut in both specimens. All channels were executed according to the planned cutting strategy using the frameless navigation of the robot-driven laser device. The dura showed minor damage after one laser beam and severe damage after two and three laser beams. The cortex was not damaged. As soon as the cut through was obtained, we observed that moderate cerebrospinal fluid leakage impeded the cutting efficiency and interfered with the visualization for depth control. The coaxial camera showed a live video feed in which cut through of the bone could be identified in 84%. Conclusion: Inflowing cerebrospinal fluid disturbed OCT signals, and, therefore, the current CTR method could not be reliably applied. Video imaging is a candidate for observing a successful cut through. OCT and video imaging may be used for depth control to implement an updated SEEG bone channel cutting strategy in the future.
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Affiliation(s)
- Fabian Winter
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Julia Shawarba
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Use of an Ultrasonic Aspirator in Removal of an Orbital Rim Hemangioma. Ophthalmic Plast Reconstr Surg 2021; 37:e117-e120. [PMID: 33481536 DOI: 10.1097/iop.0000000000001886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intraosseous hemangiomas are rare bony neoplasms that infrequently develop in the calvarium or facial bones. Due to their highly vascular nature, biopsy or resection of these tumors can present a surgical challenge, with reports of significant blood loss during tumor resection. Traditional surgical resection of intraosseous hemangiomas often includes the use of high speed oscillating or sagittal saws. Ultrasonic aspirators, which spare adjacent soft-tissue structures and minimize blood loss, have been successfully used in resection of firm soft tissue masses of the orbit; however, this technology has not been demonstrated in the treatment of a vascular tumor in the orbit. The authors present the case of a 37-year-old woman who presented with an intraosseous hemangioma at the left inferior orbital rim and maxilla; the mass was successfully resected with the aid of a Sonopet Ultrasonic Aspirator bone knife. The knife allowed for simultaneous emulsification and cautery of the bone encasing the mass with low risk to sensitive surrounding tissue.
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Cold Ablation Robot-Guided Laser Osteotome (CARLO ®): From Bench to Bedside. J Clin Med 2021; 10:jcm10030450. [PMID: 33498921 PMCID: PMC7865977 DOI: 10.3390/jcm10030450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background: In order to overcome the geometrical and physical limitations of conventional rotating and piezosurgery instruments used to perform bone osteotomies, as well as the difficulties in translating digital planning to the operating room, a stand-alone robot-guided laser system has been developed by Advanced Osteotomy Tools, a Swiss start-up company. We present our experiences of the first-in-man use of the Cold Ablation Robot-guided Laser Osteotome (CARLO®). Methods: The CARLO® device employs a stand-alone 2.94-µm erbium-doped yttrium aluminum garnet (Er:YAG) laser mounted on a robotic arm. A 19-year-old patient provided informed consent to undergo bimaxillary orthognathic surgery. A linear Le Fort I midface osteotomy was digitally planned and transferred to the CARLO® device. The linear part of the Le Fort I osteotomy was performed autonomously by the CARLO® device under direct visual control. All pre-, intra-, and postoperative technical difficulties and safety issues were documented. Accuracy was analyzed by superimposing pre- and postoperative computed tomography images. Results: The CARLO® device performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 0.8 mm between the planned and performed osteotomies, with a root-mean-square error of 1.0 mm. The patient showed normal postoperative healing with no complications. Conclusion: The newly developed stand-alone CARLO® device could be a useful alternative to conventional burs, drills, and piezosurgery instruments for performing osteotomies. However, the technical workflow concerning the positioning and fixation of the target marker and the implementation of active depth control still need to be improved. Further research to assess safety and accuracy is also necessary, especially at osteotomy sites where direct visual control is not possible. Finally, cost-effectiveness analysis comparing the use of the CARLO® device with gold-standard surgery protocols will help to define the role of the CARLO® device in the surgical landscape.
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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: 15] [Impact Index Per Article: 3.8] [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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Temperature Threshold Values of Bone Necrosis for Thermo-Explantation of Dental Implants-A Systematic Review on Preclinical In Vivo Research. MATERIALS 2020; 13:ma13163461. [PMID: 32781597 PMCID: PMC7476012 DOI: 10.3390/ma13163461] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Very high or low temperatures will lead to bone damage. The objective of this review was to analyze threshold values for thermal bone necrosis. METHODS Histological animal studies evaluating thermal effects on bone necrosis were selected via electronic and hand searches in English and German language journals until 1 November 2019. The outcome measures were temperature-exposure intervals and laser settings effecting bone damage. Furthermore, investigated parameters were the bone-to-implant contact ratios (BIC) and infrabony pockets around dental implants after thermal treatment. For quality assessment of studies, the CAMARADES study quality checklist was applied. RESULTS A total of 455 animals in 25 animal studies were included for data extraction after screening of 45 titles from 957 selected titles of the MEDLINE (PubMed), The Cochrane Library, Embase and Web of Science search. The threshold values for bone necrosis ranged between 47 °C and 55 °C for 1 min. A threshold value for cryoinsult and laser treatment has not yet been defined. However, temperatures in the vicinity of 3.5 °C produce a histologically proven effect on the bone and in the surrounding tissue. At 50 °C for 1 min, BIC values significantly decreased and infrabony pockets increased. Bone quality had an influence on the outcome, as cancellous bone suffered higher bone damage from thermal treatment compared to cortical bone. CONCLUSION No clear threshold value for bone necrosis is available according to the current literature for warm and cold stimuli. More in-depth and clinical studies are required to provide further insights in assessing the potential of thermal necrosis for implant removal.
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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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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: 195] [Impact Index Per Article: 27.9] [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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Effects on Bone Tissue After Osteotomy with Different High-Energy Lasers: AnEx VivoStudy. Photomed Laser Surg 2016; 34:291-6. [DOI: 10.1089/pho.2015.3917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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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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Morphological characteristics of osteotomies using different piezosurgical devices. A scanning electron microscopic evaluation. IMPLANT DENT 2015; 23:334-42. [PMID: 24819806 DOI: 10.1097/id.0000000000000077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to compare morphological characteristics of osteotomies performed by 6 Piezosurgical devices. MATERIALS AND METHODS The 6 Piezosurgical units were: (a) Piezotom, (b) SurgySonic, (c) Piezon Master Surgery, (d) VarioSurg, (e) Surgybone, and (f) Piezosurgery 3. Osteotomies on 9 freshly slaughtered cattle ribs (2 cuts by each unit, per rib) from the cortical (first cut at 5 mm) to the cancellous (second cut at 3 mm) bone layer were performed. The osteotomy margins were compared using scanning electron microscopy analysis. The cutting areas, osteotomy bottoms, and osteotomy margins were analyzed morphologically. Statistical evaluation of the 2 cuts regarding the design of the tips (a-d: tapered tool shanks, f: parallel tool shank) was performed by an unpaired t test. RESULTS Morphological characteristics were different for each Piezosurgical unit and each examined area. A significant difference (P = 0.0209) of the upper width of the first cut between tapered and parallel tips was shown. CONCLUSIONS The morphological characteristics of the produced Piezosurgical osteotomies vary and depend on the Piezosurgical unit and tip.
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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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Hennet P. Piezoelectric Bone Surgery: A Review of the Literature and Potential Applications in Veterinary Oromaxillofacial Surgery. Front Vet Sci 2015; 2:8. [PMID: 26664937 PMCID: PMC4672167 DOI: 10.3389/fvets.2015.00008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/10/2015] [Indexed: 12/21/2022] Open
Abstract
Piezoelectric bone surgery is a recent and innovative technology, permitting a selective cut of mineralized tissue while sparing soft tissue. Similar to a dental scaler, a high frequency vibration, in the range of 25-35 kHz, is transmitted to a metallic tip. However, the power of the piezosurgical instrument is three to six times higher than that of a dental scaler. The major advantages of this technology include high precision, a design that increases ease of curvilinear osteotomy, less trauma to soft tissue, preservation of neurological and vascular structures, reduced hemorrhage, minimal thermal damage to the bone, as well as overall improvement of healing. The handpiece of the instrument is equipped with a sterile irrigation system and light-emitting diode (LED) light, which improves visibility and overall safety. Piezoelectric surgery is particularly useful when performing delicate bone procedures such as periodontal or endodontic surgery. It is also indicated when performing more invasive bone surgery such as maxillectomy, mandibulectomy, and condylectomy, where preservation of neurovascular structures is important. Piezoelectric instruments are different from rotary instrumentation or oscillating saws, they require light pressure with constant motion of the tip. Training is required to master the technique.
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Rachmanis N, McGuinness GB, McGeough JA. Characterisation of debris from laser and mechanical cutting of bone. Proc Inst Mech Eng H 2014; 228:735-9. [PMID: 24951627 DOI: 10.1177/0954411914541089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laser cutting of bones has been proposed as a technology in orthopaedic surgery. In this short study, the laser-bone interaction was examined using a pulsed erbium-doped yttrium aluminium garnet laser and compared to a conventional cutting technique. Microscopic analysis revealed the nature of waste debris and showed higher proportions of finer particles for conventional sagittal sawing compared to laser cutting.
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Affiliation(s)
| | - Garrett B McGuinness
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin, Ireland
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Abstract
PURPOSE Orbital osteotomy risks injury to the eyeball and orbit soft tissues. Used extensively in oral and maxillofacial surgery, piezoelectric technology offers a greater margin of safety than traditional bone cutting instruments. The authors describe the novel use of this system in a variety of orbital surgeries. METHODS This interventional case series was performed in accordance with institutional review board regulations. The medical records of all patients who had undergone orbital surgery using the piezoelectric blade at 3 institutions were reviewed. Indication for surgery, gender, age, duration of follow up, intraoperative complications, surgical result, and postoperative course was recorded. RESULTS Sixteen patients underwent surgery on 18 orbits using the piezoelectric system between August 2011 and June 2012. Surgeries performed included orbital decompression (8), lateral orbitotomy (5), cranio-orbitotomy (4), and external dacryocystorhinostomy (1). Eight were female and 8 were male patients. Mean age was 55 years old (standard deviation 15 years). Mean follow up was 82 days. The osteotomy created by the blade was narrow and smooth in every case. The surgeons uniformly appreciated the precision and safety of the instrument compared with traditional electric saw blades. There were no soft tissue lacerations or intraoperative complications and reconstructions were uniformly uneventful. Postoperative healing was rapid with no unexpected inflammation, and no palpable bony defects were appreciated in the reconstructed cases. CONCLUSIONS Because it does not cut soft tissue and cuts a narrow trough, the self-irrigating piezoelectric saw blade appears safer and more precise than traditional electric saw blades in and around the orbit.
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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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Healing of osteotomy sites applying either piezosurgery or two conventional saw blades: a pilot study in rabbits. INTERNATIONAL ORTHOPAEDICS 2013; 37:1597-603. [PMID: 23793460 DOI: 10.1007/s00264-013-1908-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to compare bone healing of experimental osteotomies applying either piezosurgery or two different oscillating saw blades in a rabbit model. METHODS The 16 rabbits were randomly assigned into four groups to comply with observation periods of one, two, three and five weeks. In all animals, four osteotomy lines were performed on the left and right nasal bone using a conventional saw blade, a novel saw blade and piezosurgery. RESULTS All three osteotomy techniques revealed an advanced gap healing starting after one week. The most pronounced new bone formation took place between two and three weeks, whereby piezoelectric surgery revealed a tendency to faster bone formation and remodelling. Yet, there were no significant differences between the three modalities. CONCLUSIONS The use of a novel as well as the piezoelectric bone-cutting instrument revealed advanced bone healing with a favourable surgical performance compared to a traditional saw.
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Plecko M, Lagerpusch N, Pegel B, Andermatt D, Frigg R, Koch R, Sidler M, Kronen P, Klein K, Nuss K, Gedet P, Bürki A, Ferguson SJ, Stoeckle U, Auer JA, von Rechenberg B. The influence of different osteosynthesis configurations with locking compression plates (LCP) on stability and fracture healing after an oblique 45° angle osteotomy. Injury 2012; 43:1041-51. [PMID: 22284334 DOI: 10.1016/j.injury.2011.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 12/08/2011] [Accepted: 12/17/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Locking compression plates are used in various configurations with lack of detailed information on consequent bone healing. STUDY DESIGN In this in vivo study in sheep 5 different applications of locking compression plate (LCP) were tested using a 45° oblique osteotomy simulating simple fracture pattern. 60 Swiss Alpine sheep where assigned to 5 different groups with 12 sheep each (Group 1: interfragmentary lag screw and an LCP fixed with standard cortex screws as neutralisation plate; Group 2: interfragmentary lag screw and LCP with locking head screws; Group 3: compression plate technique (hybrid construct); Group 4: internal fixator without fracture gap; Group 5: internal fixator with 3mm gap at the osteotomy site). One half of each group (6 sheep) was monitored for 6 weeks, and the other half (6 sheep) where followed for 12 weeks. METHODS X-rays at 3, 6, 9 and 12 weeks were performed to monitor the healing process. After sacrifice operated tibiae were tested biomechanically for nondestructive torsion and compared to the tibia of the healthy opposite side. After testing specimens were processed for microradiography, histology, histomorphometry and assessment of calcium deposition by fluorescence microscopy. RESULTS In all groups bone healing occurred without complications. Stiffness in biomechanical testing showed a tendency for higher values in G2 but results were not statistically significant. Values for G5 were significantly lower after 6 weeks, but after 12 weeks values had improved to comparable results. For all groups, except G3, stiffness values improved between 6 and 12 weeks. Histomorphometrical data demonstrate endosteal callus to be more marked in G2 at 6 weeks. DISCUSSION AND CONCLUSION All five configurations resulted in undisturbed bone healing and are considered safe for clinical application.
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