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

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

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

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

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PURPOSE: The objective of this study was to evaluate the immediate bone damage and bone repair after osteotomy for implants using conventional drills and drills powered by piezoelectric motor. MATERIALS AND METHODS: Twelve rabbits received a tibial osteotomy with a conventional drill (control), with a diamond like carbon drill (DLC) and with a piezoelectric drill (Piezo). The animals were euthanized immediately, 30 and 60 days postoperatively. The tibias were removed and analyzed by means of histomorphometry, immunohistochemistry and microtomography. RESULTS: The immediate damage to the tissue at the cavity margins was similar (P > .05). At 30 and 60 days, the amount of newly formed bone tissue was similar (P > .05). Osteocalcin was intense score at 60 days in Piezo group. Microtomography revealed that bone volume at 30 days (control 3.8; DLC 4.3; and Piezo 2.4) and 60 days (control 4.9; DLC 4.82; and Piezo 3.95) were similar. There was a significant difference in bone formation between 30 (2.4) and 60 days (3.95) for the Piezo group (P = .016). CONCLUSION: The immediate effects and repair of cavities made using conventional, DLC coated, or ultrasound drills were similar.

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The objective of this study was to evaluate the use of piezosurgery for osteotomy and odontosection in the repair of the alveoli four months after exodontia. Fifteen young patients who needed third molars extracted were included. During the extractions, one of the teeth was included in the Piezo group, in which ultrasound motor tips were used in both procedures. The other tooth was removed with a conventional rotary instrument. The values of density of the repair regions of the right and left third molars were compared using digital panoramic radiographs. There were no significant differences (p>0.05): piezo group mean (SD) 125.7 (15.4) and control group 126.7 (21.2). The bone density of the alveoli after extraction of the lower third molars with rotary instruments and surgical ultrasound was similar in both groups.

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INTRODUCTION: The peripheral ossifying fibroma (POF) is a benign reactive lesion that exclusively arises from gingiva. The lesion may gain considerably large sizes and present peculiar clinical and radiographic features that would then allow it to be called a giant POF; in that case, its otherwise simple surgical extraction could create a challenge. Thus, we elect here, for the very first time, a plausible alternative for treating giant POF: piezosurgery followed by placement of platelet-rich fibrin (PRF). CASE PRESENTATION: A 31-year-old black male presented a large asymptomatic nodule on the lower gingiva; the lesion had caused vestibular displacement of teeth and had been present for 18 years. Following the diagnostic hypothesis of a giant POF, an excisional biopsy was performed under local anesthesia using piezosurgery (microvibration of 36,000 times/sec was used in a bone cortical working mode), which confirmed the diagnosis. The surgical procedure was facilitated with the use of piezosurgery followed by placement of PRF, being the trans- and postoperative periods occurred with no complications. One year after the treatment, the patient shows no signs of disease recurrence and remains under follow-up. CONCLUSIONS: Giant POF is a rare gingival reactive lesion that can reach large dimensions, causing teeth displacement, functional, and esthetic impairments. The lesion can be successfully managed with piezosurgery and PRF, as illustrated herein, avoiding extensive bone loss and damage to the surrounding soft tissues.

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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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Introducción: la rehabilitación de pacientes desdentados mandibulares posteriores con implantes osteointegrados, se vuelve difícil cuando la cresta alveolar presenta una atrofia severa debido al recorrido superficial del canal mandibular. La lateralización del nervio dentario inferior es una alternativa terapéutica que posibilita la colocación de implantes convencionales y cortos en esta región. Objetivo: comparar la facilidad, efectividad y seguridad de la técnica quirúrgica convencional, realizada con fresas quirúrgicas, y la piezocirugía en la lateralización del nervio dentario inferior. Presentación del caso: paciente con ausencia bilateral de los molares inferiores y cresta alveolar atrófica fue tratada mediante lateralización del nervio dentario inferior y colocación simultánea de implantes. En el lado izquierdo, la lateralización fue realizada con fresas y en el lado derecho, con motor piezoeléctrico. Fue posible observar que la piezocirugía facilitó la técnica quirúrgica, y consecuentemente disminuyó el tiempo operatorio. A la vez, produjo una osteotomía más regular y con menos sangrado, lo cual mejoró la visualización del campo operatorio. Finalmente, el daño neural inmediato fue menor en el lado tratado con motor piezoeléctrico y con recuperación más rápida. Después de 3 meses de seguimiento, los implantes en ambos lados no presentaban pérdida ósea. Conclusiones: el uso del motor piezoeléctrico trajo más beneficios durante la lateralización del nervio dentario inferior, por la simplificación de la técnica quirúrgica y la reducción del sangrado y del daño neural en comparación con el uso de fresas convencionales(AU)

Introduction: the rehabilitation of edentulous posterior mandibular patients with bone-integrated implants becomes difficult when the alveolar crest presents a severe atrophy due to the superficial course of the mandibular canal. The inferior alveolar nerve lateralization is a therapeutic alternative that allows the placement of conventional and short implants in this region. Objective: to compare the easiness, effectiveness, and safety of the conventional surgical technique, performed with surgical drills, and piezosurgery in the lateralization of the inferior alveolar nerve. Case presentation: a patient with bilateral absence of the lower molars and atrophic alveolar crest was treated by lateralization of the inferior alveolar nerve and simultaneous implant placement. On the left side, the lateralization was made with drills and on the right side, with an electric piezotome. It was possible to observe that the piezosurgery facilitated the surgical technique, and consequently decreased the operative time. At the same time, it produced a more regular osteotomy and with less bleeding, which improved the visualization of the operative field. Finally, the immediate neural damage was lower on the side treated with the electric piezotome and with faster recovery. After 3 months of follow-up, the implants on both sides did not show bone loss. Conclusions: the use of the electric piezotome brought more benefits during the lateralization of the inferior alveolar nerve, by the simplification of the surgical technique and the reduction of bleeding and neural damage in comparison with the use of conventional drills(AU)

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

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

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A instalação de implantes osseointegráveis na região posterior da mandíbula ainda pode ser considerada um grande desafio, principalmente em casos que envolvam reabsorção óssea vertical avançada. A técnica de aumento ósseo vertical por meio de enxerto interposto é uma alternativa interessante para a reconstrução desses defeitos. Por meio desta técnica, é possível um ganho vertical variando de 6 a 12 mm, possibilitando a instalação dos implantes com segurança. Este relato tem como objetivo demonstrar o passo a passo para a realização da técnica de aumento vertical por meio de enxerto de bloco ósseo interposto, fixado por meio de placa e parafuso de titânio (AU).

The installation of dental in implants the posterior mandible is still considered a major challenge, especially in cases with advanced vertical bone resorption. The vertical bone augmentation technique by means of interpositional bone grafts is an interesting alternative for the reconstruction of these defects. Through this technique, a vertical gain ranging from 6 to 12 mm is possible, allowing the placement of the implant safely. This report aims to demonstrate the step-by-step towards vertical bone augmentation technique through interposed bone block graft fixed by miniplate osteosynthesis (AU).

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

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

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

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

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A estabilidade primária de implantes dentários corresponde a um fenômeno mecânico relativo à qualidade ou quantidade óssea, ao tipo de implante e a técnica de instalação. O objetivo deste trabalho foi avaliar o tempo de fresagem, aquecimento dos sítios fresados e a estabilidade dos implantes instalados em cavidades realizadas com ultrassom cirúrgico e instrumentos rotatórios. Foram realizadas 64 cavidades em 04 blocos de poliuretano simulando as densidades de ossos tipo I, II, III e IV. A temperatura da superfície do bloco nos leitos foi medida durante a fresagem. A estabilidade dos implantes foi mensurada por meio do torque de inserção, de remoção e frequência de ressonância. O implante cilíndrico TitaOss 3,75 x 11 mm foi instalado em todas as cavidades. Os resultados mostraram maior tempo e temperatura para o grupo em que foi usado o ultrassom. Quanto à estabilidade primária não houve diferença significante entre os grupos estudados. Pôde-se concluir que a estabilidade primária dos implantes não foi influenciada pelos métodos de fresagem utilizados e que o ultrassom cirúrgico necessitou de mais tempo e gerou mais calor do que o instrumento rotatório para o preparo das cavidades(AU)

The primary stability of dental implants corresponds to a mechanical phenomenon related to bone quality or quantity, type of implant and installation technique. The objective of this study was to evaluate the time of drilling, heating drilled sites and stability of implants placed in cavities made with piezosurgery and rotary instruments. Polyurethane blocks were used simulating the densities of bone type I, II, III and IV. The surface temperature of the block was measured in the cavity during drilling, and recorded the highest temperature variation. The stability of the implants was measured with a torque insertion, torque of removal and resonance frequency. The cylindrical implant TitaOss 3.75 x 11 mm was used in all cavities. The results showed greater time and temperature for the group that was used piezosurgery. The primary stability was no significant difference between groups. It could be concluded that implant primary stability was not influenced by the used methods and piezosurgery took more time and generated more heat than the conventional rotatory instruments to prepare the cavities(AU)

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

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

RESUMO

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

La pérdida de piezas dentarias conlleva la disminución volumétrica del hueso alveolar y la necesidad de recurrir a técnicas de regeneración ósea guiada (ROG) para restablecer las condiciones anatómicas y aplicar las terapéuticas adecuadas. La membrana de fascia lata (MFL) ha sido utilizada en intervenciones quirúrgicas del área neurológica, ortopédica, otorrinolaringológica, cardiológica, vascular, ginecológica y odontológica para regeneración tisular guiada. El objetivo de este trabajo preliminar fue evaluar la respuesta tisular de defectos óseos en calota de rata recubiertos con MFL. Se utilizaron 8 ratas Wistar de 230 gr de peso, a las que se les realizó en la calota 2 defectos óseos de 5 x 5 mm de lado por 1 mm de profundidad, con bisturí piezoeléctrico e irrigación, a ambos lados de la línea media, según técnica estandarizada. Se realizó el siguiente protocolo: Grupo I (G I): colocación de una sola capa de MFL (Biotar, Rosario, Prov. de Santa Fe, Argentina) para cubrir el defecto; Grupo II (G II): colocación de MFL en doble capa para cubrir el defecto; Grupo III (G III): sin membrana; Grupo IV (G IV): control. Se les provocó la eutanasia a los 60 días. Las calotas fueron resecadas, radiografiadas y procesadas, previa descalcificación, para su inclusión en parafina y coloración con Hematoxilina-Eosina y Tricrómico de Masson. En todos los defectos óseos recubiertos con MFL simple o doble se evidenció una adecuada osteogénesis y ausencia de respuesta inflamatoria y macrófagos. El G III y el G Sham evidenciaron escasa osteogénesis y no mostraron alteraciones en el tejido blando. La MFL en el modelo experimental utilizado evidenció una respuesta compatible con el tejido circundante en los períodos estudiados. El tejido óseo remanente a la osteotomía con bisturí piezoeléctrico presentó las lagunas osteocíticas ocupadas con osteocitos y sin alteraciones. En estudios futuros se evaluará la respuesta tisular con MFL y utilizando un sustituto óseo.

Assuntos

RESUMO

The piezosurgery has been used with increasing frequency and applicability by health professionals, especially those who deal with dental implants. The concept of piezoelectricity has emerged in the nineteenth century, but it was applied in oral surgery from 1988 by Tomaso Vercellotti. It consists of an ultrasonic device able to cut mineralized bone tissue, without injuring the adjacent soft tissue. It also has several advantages when compared to conventional techniques with drills and saws, such as the production of a precise, clean and low bleed bone cut that shows positive biological results. In dental implants surgery, it has been used for maxillary sinus lifting, removal of bone blocks, distraction osteogenesis, lateralization of the inferior alveolar nerve, split crest of alveolar ridge and even for dental implants placement. The purpose of this paper is to discuss the use of piezosurgery in bone augmentation procedures used previously to dental implants placement.

RESUMO

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

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

Assuntos

RESUMO

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

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

Assuntos

RESUMO

Piezosurgery is a new and modern technique of bone surgery in implantology. Selective cutting is possible for different ultrasonic frequencies acting only in hard tissues (mineralized), saving vital anatomical structures. With the piezoelectric osteotomy technique, receptor site preparation for implants, autogenous bone graft acquistition (particles and blocks), osteotomy for alveolar bone crest expansion, maxillary sinus lifting, and dental implant removal can be performed accurately and safely, providing excellent clinical and biological results, especially for osteocyte viability. The aim of this review was, through literature review, to present clinical applications of piezosurgery in implant dentistry and outline their advantages and disadvantages over conventional surgical systems. Moreover, this study addressed the biological aspects related to piezosurgery that differentiate it from those of bone tissue approaches. Overall, piezosurgery enables critical operations in simple and fully executable procedures; and effectively, areas that are difficult to access have less risk of soft tissue and neurovascular tissue damage via piezosurgery.

Assuntos

RESUMO

OBJECTIVE: To evaluate bone remodeling around dental implants inserted into recipient sites prepared using either the piezoelectric or the conventional drilling technique. MATERIAL AND METHODS: Twenty-four male New Zealand white rabbits (4 months, 2.70 kg) received dental implants (3.3 mm diameter and 6 mm length) on the medial surface of the tibia and were divided into 3 groups (n = 8). Group I was euthanized at 7 days; group II, at 14; and group III, at 28 days. Each animal received four implants, two in the right and two in the left tibia (96 implants were installed). Each tibia was operated by the same technique, and there are therefore neighbor's implants installed by different techniques. Histomorphometric parameters were used: the volume occupied by trabecular bone around the implants (BV/TV), media thickness, separation and number of trabeculae around the loops, and the contact area (interface) directly between the bone and implant (BIC). RESULTS: BV/TV was similar for both techniques (P = 0.291). Reduction in trabecular thickness was observed for both techniques (P < 0.05), but then returned to prior levels, with no significant difference between techniques (P = 0.217). Trabecular number increased from day 7 to day 14 (P < 0.001) and remained constant afterward for both techniques. No difference in BIC was observed between techniques on day 28 (P = 0.961). CONCLUSIONS: Piezoelectric osteotomy allowed bone formation for osseointegration of titanium implants, was not associated with bone necrosis, and provided results similar to those of the conventional technique. The piezoelectric technique can be considered a viable alternative in dental implantology.

Assuntos