Factors Affecting the Efficacy of Suction Curettage Using an Arthroscopic Shaver for Bromhidrosis.

BACKGROUND: Suction-curettage using an arthroscopic shaver is the most effective surgical treatment for bromhidrosis; however, information regarding the procedure is limited. This study investigated the factors that affect the efficacy of suction-curettage. PATIENTS AND METHODS: We retrospectively evaluated data for 215 patients (430 axillae) with bromhidrosis treated with suction-curettage using an arthroscopic shaver between 2011 and 2019. RESULTS: Excellent or good efficacy with improved malodor was achieved in 418 axillae (97.21%). Secondary suction-curettage was performed for 11 (2.56%), with excellent results. Efficacy and need for secondary suction-curettage were not associated with age, sex, shaving time, and tumescent infiltration use. Complications were observed in 52 (12.09%) axillae, including hematoma or seroma, epidermis decortication, skin necrosis, and infections; 10 (2.33%) required local debridement for wounds. Complications showed a significant difference with respect to age (p < .001). Pain scores on postoperative Day 2 were significantly lower for patients treated using tumescent infiltration than those for the others (1.65 ± 0.84 vs 4.57 ± 1.16; p < .001). CONCLUSION: The results suggest that 7 to 15 minutes of suction curettage using an arthroscopic shaver is sufficient to achieve good efficacy for bromhidrosis with few complications. Older age was a risk factor for complications, and tumescent infiltration use achieved good postoperative pain control. LEVELS OF EVIDENCE: II.

Use of a disposable ear speculum: An alternative technique for molluscum contagiosum curettage.

Molluscum contagiosum is a common contagious disease in children characterized by small skin-colored umbilicated papules. Although spontaneous resolution is common, many parents and patients seek treatment. Multiple therapeutic modalities have been described. We present an easy, safe, caregiver-friendly, modified curettage technique using an ear speculum.

Arthroscopic Cartilage Lesion Preparation in the Human Cadaveric Knee Using a Curette Technique Demonstrates Clinically Relevant Histologic Variation.

PURPOSE: To examine the quality of arthroscopic cartilage debridement using a curette technique by comparing regional and morphologic variations within cartilage lesions prepared in human cadaveric knee specimens for the purpose of cartilage repair procedures. A secondary aim was to compare the histologic properties of cartilage lesions prepared by surgeons of varying experience. METHODS: Standardized cartilage lesions (8 mm × 15 mm), located to the medial/lateral condyle and medial/lateral trochlea were created within 12 human cadaver knees by 40 orthopaedic surgeons. Participants were instructed to create full-thickness cartilage defects within the marked area, shouldered by uninjured vertical walls of cartilage, and to remove the calcified cartilage layer, without violating the subchondral plate. Histologic specimens were prepared to examine the verticality of surrounding cartilage walls at the front and rear aspects of the lesions, and to characterize the properties of the surrounding cartilage, the cartilage wall profile, the debrided lesion depth, bone sinusoid access, and the bone surface profile. Comparative analysis of cartilage wall verticality measured as deviation from perpendicular was performed, and Spearman's rank correlation analysis was used to examine associations between debrided wall verticality and surgeon experience. RESULTS: Mean cartilage wall verticality relative to the base of the lesion was superior at the rear aspect of the lesion compared to the front aspect (12.9° vs 29.2°, P < .001). Variability was identified in the morphology of the surrounding cartilage (P < .001), cartilage wall profile (P = .016), debrided lesion depth (P = .028), bone surface profile (P = .040), and bone sinusoid access (P = .009), with sinusoid access identified in 42% of cases. There was no significant association of cartilage lesion wall verticality and surgeon years in practice (rs = 0.161, P = .065) or arthroscopic caseload (rs = -0.071, P = .419). CONCLUSIONS: Arthroscopic cartilage lesion preparation using standard curette technique in a human cadaveric knee model results in inferior perpendicularity of the surrounding cartilage walls at the front aspect of the defect, compared to the rear aspect. This technique has shown significant variability in the depth of debridement, with debridement depths identified as either too superficial or too deep to the calcified cartilage layer in more than 60% of cases in this study. Surgeon experience does not appear to impact the morphologic properties of cartilage lesions prepared arthroscopically using ring curettes. CLINICAL RELEVANCE: To optimize restoration of hyaline-like cartilage tissue, careful attention to prepared cartilage lesion morphology is advised when arthroscopically performing cartilage repair, given the tendency for standard curette technique to create inferior verticality of cartilage walls at the front of the lesion, and the variable depth of debridement achieved.

Effects of Er,Cr:YSGG Laser Treatment on Human Gingival Fibroblast Attachment, Viability and Morphology of Root Surface: An In Vitro Study.

Rehabilitation of periodontal support is the main goal of therapies for periodontitis. Hand instrumentation with curettes, piezoelectric ultrasonic scalers and lasers, such as Er,Cr:YSGG, are used for this purpose. This study was designed to evaluate human gingival fibroblast viability attachment to root surfac after modification with the mentioned therapeutic alternatives. Lasers showed significantly lower cell viability after 72 hours compared to hand instrumentation and ultrasound, probably due to more irregular root surfaces after treatment.

Effect of root planing on surface topography: an in-vivo randomized experimental trial.

BACKGROUND AND OBJECTIVE: The root surface topography exerts a major influence on clinical attachment and bacterial recolonization after root planing. In-vitro topographic studies have yielded variable results, and clinical studies are necessary to compare root surface topography after planing with current ultrasonic devices and with traditional manual instrumentation. The aim of this study was to compare the topography of untreated single-rooted teeth planed in vivo with a curette, a piezoelectric ultrasonic (PU) scraper or a vertically oscillating ultrasonic (VOU) scraper. MATERIAL AND METHODS: In a randomized experimental trial of 19 patients, 44 single-rooted teeth were randomly assigned to one of four groups for: no treatment; manual root planing with a curette; root planing with a PU scraper; or root planing with a VOU scraper. Post-treatment, the teeth were extracted and their topography was analyzed in 124 observations with white-light confocal microscopy, measuring the roughness parameters arithmetic average height, root-mean-square roughness, maximum height of peaks, maximum depth of valleys, absolute height, skewness and kurtosis. RESULTS: The roughness values arithmetic average height and root-mean-square roughness were similar after each treatment and lower than after no treatment ( p < 0.05). Absolute height was lower in the VOU group than in the untreated ( p = 0.0026) and PU (p = 0.045) groups. Surface morphology was similar after the three treatments and was less irregular than in the untreated group. Values for the remaining roughness parameters were similar among all treatment groups ( p > 0.05). CONCLUSION: Both ultrasonic devices reduce the roughness, producing a similar topography to that observed after manual instrumentation with a curette, to which they appear to represent a valid alternative.

Microbiopsy a novel sampling technique to early detect dysplastic/malignant alterations in oral mucosal lesions: practicability by general dentists.

BACKGROUND: When used in oral medicine clinics, microbiopsy is able to obtain tissue fragments suitable for a highly sensitive first-level diagnosis of dysplastic/malignant alterations in oral mucosal lesions. If feasible by general dentists, this sampling technique could reduce the diagnostic delay for oral malignant and premalignant lesions. This study assesses the adequacy of microbiopsy samples when taken by general dentists. METHODS: Fifty dentists, without specific training on oral medicine, volunteered for enrolment. They were given brief training and asked to prospectively sample any mucosal lesion observed during their routine practice. The sample adequacy features were assessed. RESULTS: The dentists sampled 152 lesions; there were 92.1% of adequate samples (140/152), and the BMZ was visible in 78.6% of these (110/140). Neither the clinical aspect nor lesion site affected either the adequacy or the presence of BMZ. CONCLUSIONS: The high adequacy rate observed and the advantages histological specimens have over cytological ones go to support the feasibility of microbiopsy taken by general dentists for the characterization of oral mucosal lesions and in selecting those requiring further assessment in specialized oral medicine centres.

Risk of otitis externa following manual cerumen removal.

OBJECTIVES: Based on an interpretation of a recent Joint Commission protocol to sterilize instruments coming into contact with mucous membranes, there has been institutional interest in sterile packaging of cerumen curettes used for manual cerumen removal. To date, there are no studies that have assessed the risk of otitis externa (OE) following cerumen removal and the utility of sterile packaging is questionable. The objective of this study is to assess the incidence of OE following cerumen disimpaction prior to the implementation of sterile packaging at our institution. METHODS: This was a retrospective chart review. Over a I-year period, 1457 episodes of manual cerumen removal took place in the otolaryngology clinic. Charts were assessed for signs or symptoms of OE within 2 weeks of the procedure through follow-up phone calls and clinic visits in the otolaryngology division. RESULTS: There were no patients who followed up with symptoms or signs suggestive of OE in the 2-week postprocedure period. CONCLUSION: There is no evidence that OE is a complication of manual cerumen removal when performed by otolaryngologists using clean technique. Unnecessary sterilization of tools leads to increased cost and time for this common outpatient procedure performed by the otolaryngologist.

An investigation of the effect of scaling-induced surface roughness on bacterial adhesion in common fixed dental restorative materials.

STATEMENT OF PROBLEM: Bacterial plaque must be routinely removed from teeth, adjacent structures, and prostheses. However, the removal of this plaque can inadvertently increase the risk of future bacterial adhesion. PURPOSE: The purpose of this investigation was to assess the change in the surface roughness of 3 different surfaces after dental prophylactic instrumentation and how this influenced bacterial adhesion. MATERIAL AND METHODS: Forty specimens each of Type III gold alloy, lithium disilicate, and zirconia were fabricated in the same dimensions. The specimens were divided into 4 groups: ultrasonic scaler, stainless steel curette, prophylaxis cup, and control. Pretreatment surface roughness measurements were made with a profilometer. Surface treatments in each group were performed with a custom mechanical scaler. Posttreatment surface roughness values were measured. In turn, the specimens were inoculated with Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus. Bacterial adhesion was assessed by rinsing the specimens with sterile saline to remove unattached cells. The specimens were then placed in sterile tubes with 1 mL of sterile saline. The solution was plated and quantified. Scanning electron microscopy was performed. The statistical analysis of surface roughness was completed by using repeated-measures single-factor ANOVA with a Bonferroni correction. RESULTS: The surface roughness values for gold alloy specimens increased as a result of prophylaxis cup treatment (0.221 to 0.346 Ra) (P<.01) and stainless steel curette treatment (0.264 to 1.835 Ra) (P<.01). The results for bacterial adhesion to gold alloy proved inconclusive. A quantitative comparison indicated no statistically significant differences in pretreatment and posttreatment surface roughness values for lithium disilicate and zirconia specimens. In spite of these similarities, the overall bacterial adherence values for lithium disilicate were significantly greater than those recorded for gold alloy or zirconia (P<.05). Instrumentation of the lithium disilicate and zirconia with the stainless steel curette significantly increased bacterial adhesion compared with the control (P<.05). CONCLUSIONS: The results of this investigation indicate that Type III gold alloy exhibited increased surface roughness values after stainless steel curette and prophylaxis cup treatments. Zirconia was less susceptible to bacterial adhesion than lithium disilicate, and greater bacterial adhesion was found for the stainless steel curette than the other instrumentation methods.

Chemo-mechanical caries removal with Papacarie™: case series with 84 reports and 12 months of follow-up.

AIM: The aim of the present study was to determine the success rate after 12 months of follow-up in a series of cases in which chemo-mechanical caries removal (CMCR) was performed with Papacarie(TM), followed by restoration with glass ionomer cement. BACKGROUND: The development of conservative techniques for carious tissue removal and improvements in dental restoration materials have allowed better preservation of dental structures in the treatment of decayed teeth. Chemo-mechanical caries removal (CMCR) is a conservative atraumatic treatment option. Papacarie(TM) is a papain-based material developed to act only on the carious dentin, allowing its easy removal with a blunt curette. CASE REPORT: The study involved a total of 84 deciduous posterior teeth with occlusal dentinal caries. Only teeth without risk of pulp exposure were studied. After a period of 12 months, the restorations were evaluated based on criteria employed in previous studies. The radiographic evaluation revealed resorption and calcification of the affected teeth. The data were submitted to descriptive statistical analysis with the aid of the XLSTAT program. The success rate was 88.1% and 98.8% based on the clinical and radiographic evaluations, respectively. The difference between the success and failure rates was statistically significant (p < 0.0001). CONCLUSION: Papacarie(TM) is an effective product for CMCR on occlusal dentinal tissue in deciduous teeth, demonstrating a high clinical and radiographic success rate after 12 months of follow-up.

Outpatient endometrial biopsy with Pipelle vs diagnostic dilatation and curettage.

BACKGROUND: Pipelle is a silastic curette which does not require a tenaculum or straightening of the cervical fundus axis because of its flexibility and does not require general anaesthesia, whereas Dilatation and curettage (D&C) requires hospitalization and general anaesthesia along with the problem of postoperative pain. The objective of the study was to assess the effectiveness of Pipelle sampling in terms of adequate specimen collection and patients' knowledge and perception about Pipelle and compare it D&C. METHODS: In this randomized control trial, 203 women presenting with abnormal uterine bleeding were enrolled. The patients were randomly assigned to one of the two procedures. In group A 102 patients were subjected to Pipelle endometrial sampling and in group B 101 patients were enrolled for D&C. Frequencies of adequacy of histopathology reports and cost effectiveness of both groups were compared. Patient's knowledge, perception, pain and acceptability of the procedure of both groups were also assessed and compared. RESULTS: The mean age of the patients was 46.3 ± 4.45 years. Tissue obtained for histopathology was 100% adequate when the procedure was D&C while it was 98% in Pipelle group. In group-A 92% patients experienced no discomfort, with only 2% experiencing severe pain and 6% mild pain. On the other hand in group-B, 45% patients experienced moderate and 5% experienced severe pain up to 9 on visual analogue scale (VAS) postoperatively arid requiring post-operative analgesia. The acceptability for the Pipelle suction curette was 98% and for the D&C group was 34%. Regarding previous knowledge of procedure none of patients (100%) knew about Pipelle procedure but 98% patients were aware of D&C procedure. Pipelle was eight times more cost effective as compared to D&C. CONCLUSIONS: The results of obtained by endometrial sample by Pipelle and D&C are compareable. Pipelle significantly produced less pain than D&C.

Four-year follow-up of combined surgical therapy of advanced peri-implantitis evaluating two methods of surface decontamination.

OBJECTIVES: To investigate the impact of two surface decontamination methods on the long-term outcomes following combined surgical resective/regenerative therapy of advanced peri-implantitis lesions. MATERIAL AND METHODS: Seventeen patients (n = 17 combined supra- and intrabony-defects) completed the 48 months follow-up observation following access flap surgery, granulation tissue removal and implantoplasty at bucally and supracrestally exposed implant parts. The remaining unmodified implant surface areas were randomly treated using either (i) an Er:YAG laser (ERL), or (ii) plastic curets + cotton pellets + sterile saline (CPS), and augmented with a natural bone mineral + collagen membrane. RESULTS: At 48 months, CPS-treated sites tended to reveal higher reductions in mean BOP (CPS: 85.2 ± 16.4% versus ERL: 71.6 ± 24.9%) and CAL values (CPS: 1.5 ± 2.0 mm versus ERL: 1.2 ± 2.0 mm) when compared with the ERL group. In both groups, clinical outcomes were not directly influenced by the initial defect configuration. CONCLUSION: The 4-year clinical outcomes obtained following combined surgical resective/regenerative therapy of advanced peri-implantitis were not influenced by the method of surface decontamination.

In vitro evaluation of surface roughness, adhesion of periodontal ligament fibroblasts, and Streptococcus gordonii following root instrumentation with Gracey curettes and subsequent polishing with diamond-coated curettes.

OBJECTIVES: The objective of the study was to evaluate the efficacy of an additional usage of a diamond-coated curette on surface roughness, adhesion of periodontal ligament (PDL) fibroblasts, and of Streptococcus gordonii in vitro. MATERIALS AND METHODS: Test specimens were prepared from extracted teeth and exposed to instrumentation with conventional Gracey curettes with or without additional use of diamond-coated curettes. Surface roughness (Ra and Rz) was measured before and following treatment. In addition, the adhesion of PDL fibroblasts for 72 h and adhesion of S. gordonii ATCC 10558 for 2 h have been determined. RESULTS: Instrumentation with conventional Gracey curettes reduced surface roughness (median Ra before: 0.36 µm/after: 0.25 µm; p < 0.001; median Rz before: 2.34 µm/after: 1.61 µm; p < 0.001). The subsequent instrumentation with the diamond-coated curettes resulted in a median Ra of 0.31 µm/Rz of 2.06 µm (no significance in comparison to controls). The number of attached PDL fibroblasts did not change following scaling with Gracey curettes. The additional instrumentation with the diamond-coated curettes resulted in a two-fold increase in the number of attached PDL fibroblasts but not in the numbers of adhered bacteria. CONCLUSIONS: Treatment of root surfaces with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may result in a root surface which provides favorable conditions for the attachment of PDL fibroblasts without enhancing microbial adhesion. CLINICAL RELEVANCE: The improved attachment of PDL fibroblasts and the limited microbial adhesion on root surfaces treated with scaling with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may favor periodontal wound healing.

Effect of caries removal techniques on the bond strength of adhesives to caries-affected primary dentin in vitro.

AIM: The aim of this in vitro study is to evaluate the effects of three different caries removal techniques on the microtensile bond strength of adhesive materials to caries-affected dentin. MATERIALS AND METHODS: Thirty primary molar teeth were used. The teeth were randomly divided into three groups according to the caries removal technique employed: conventional steel bur (group 1); Er:YAG laser (group 2); chemomechanical method (group 3). Each group was divided into two subgroups according to bonding agents: one-step self-etch adhesive and etch-and-rinse adhesive. The teeth were restored with composite resin. Vertical sticks were obtained and subjected to tensile stress. Data were analyzed by two-way analysis of variance (ANOVA), Tukey's test and an independent samples t-test. RESULTS: The values for the laser groups were significantly lower than those of the bur groups for both bonding agents (p<0.05). There were no significant differences between the bur and chemomechanical groups (p > 0.05). CONCLUSION: Bur and chemomechanical techniques in primary teeth were found more successful. Similar results were found according to the adhesives used for each caries removal techniques.

Evaluation of root surface microtopography following the use of four instrumentation systems by confocal microscopy and scanning electron microscopy: an in vitro study.

BACKGROUND AND OBJECTIVE: The ideal instrument for initial periodontal therapy should enable the removal of all extraneous substances from the root surfaces without any iatrogenic effects. Because of that the objective of this study is to analyse and to compare the root surface roughness after using Gracey curettes, termination diamond burs (40 µm), a piezo-ceramic ultrasonic scaler and a piezosurgery ultrasonic scaler using confocal microscopy and scanning electron microscopy. MATERIAL AND METHODS: A 2 mm × 2 mm interproximal root area of 20 teeth (n = 40 surfaces) was evaluated by confocal microscopy (×20 magnification) and scanning electron microscopy (×50 to ×1000 magnification). Teeth were randomly assigned to the following four groups: Gracey curettes with 15 vertical strokes; termination diamond burs (40 µm) at 3000 r.p.m.; a piezo-ceramic ultrasonic scaler with a power of 11; and a piezosurgery ultrasonic scaler in mode ROOT with a power of two. RESULTS: Confocal microscopy revealed that curettes [mean changes in the value of surface roughness average reduced by 0.11 ± 0.3], piezo-ceramic ultrasonic scaler (roughness average reduced by 0.47 ± 0.93) and piezosurgery ultrasonic scaler (roughness average reduced by 0.62 ± 0.93) left a smoother surface than termination diamond burs (roughness average increased by 0.39 ± 0.18). Statistically significant differences were observed in roughness (p = 0.005) between piezosurgery and termination diamond burs (p = 0.005). No statistically significant differences were between piezosurgery and Gracey curettes (p = 0.140) and between piezosurgery and piezo-ceramic ultrasonic scalers (p = 0.745). Confocal microscopy and scanning electron microscopy showed that piezosurgery seems to leave the smoothest surface. Surfaces treated with termination burs appear to show more scratches and pits. CONCLUSION: Three of the four instruments tested for root planing reduced surface roughness; however, the piezosurgery ultrasonic scaler produced the smoothest surface. The termination diamond burs (40 µm) produced a rougher surface than the ultrasonic instruments and the hand curettes. Further clinical studies are needed.

Combined surgical therapy of peri-implantitis evaluating two methods of surface debridement and decontamination. A two-year clinical follow up report.

OBJECTIVES: The study aimed at evaluating the 2-year results obtained following combined surgical resective and regenerative treatment of advanced peri-implantitis defects comparing two methods of surface debridement/decontamination (DD). MATERIAL & METHODS: Twenty-four patients (n = 26 combined supra- and intrabony defects) completed the 24 months follow-up observation following access flap surgery, granulation tissue removal and implantoplasty at bucally and supracrestally exposed implant parts. The remaining aspects were randomly allocated to surface DD using either (i) an Er:YAG laser (ERL) device, or (ii) plastic curets + cotton pellets + sterile saline (CPS) were augmented with a natural bone mineral and covered with a collagen membrane. RESULTS: At 24 months, ERL treated sites failed to reveal significantly higher reductions in mean BOP (ERL: 75.0 ± 32.6% versus CPS: 54.9 ± 30.3%) and CAL values (ERL: 1.0 ± 2.2 mm versus CPS: 1.2 ± 2.2 mm) when compared with the CPS group. In both groups, mean CAL values were not significantly different when compared with baseline. CONCLUSION: The long-term stability of clinical outcomes obtained following combined surgical therapy of advanced peri-implantitis may be influenced by factors other than the method of surface debridement/decontamination.

Le Fort I osteotomy under navigational guidance for posterior repositioning of the maxilla.

Because navigational guidance can localize the operative site 3-dimensionally during maxillofacial surgery and provide precision, reliability, and safety for surgeons, we report Le Fort I osteotomy under navigational guidance for posterior repositioning of the maxilla.

Diode laser offers minimal benefit for periodontal therapy.

Current evidence indicates that use of diode lasers in the treatment of periodontitis--either as a monotherapy or adjunctive to traditional therapy--offers minimal benefit. Further, subgingival application of the diode laser during nonsurgical periodontal therapy can result in undesired outcomes, even when using manufacturer-recommended parameters.

Impact of the method of surface debridement and decontamination on the clinical outcome following combined surgical therapy of peri-implantitis: a randomized controlled clinical study.

OBJECTIVES: The study aimed at investigating the impact of two surface debridement/decontamination (DD) methods on the clinical outcomes of combined surgical treatment of peri-implantitis. MATERIAL AND METHODS: Thirty-two patients suffering from advanced peri-implantitis (n=38 combined supra- and intra-bony defects) were treated with flap surgery, granulation tissue removal, and implantoplasty at buccally and supracrestally exposed implant parts. The intra-bony aspects were randomly allocated to surface DD using either (i) an Er:YAG laser (ERL) device, or (ii) plastic curets+cotton pellets+sterile saline (CPS). In both groups, the intra-bony component was augmented with a natural bone mineral and covered with a collagen membrane. Clinical and radiographic parameters were recorded at baseline and after 6 months of non-submerged healing. RESULTS: Two patients were lost during follow-up. At 6 months, ERL-treated sites failed to reveal higher reductions in mean bleeding on probing (ERL: 47.8 ± 35.5 versus CPS: 55.0 ± 31.1%) and CAL values (ERL: 1.5 ± 1.4 versus CPS: 2.2 ± 1.4 mm) when compared with the CPS group. Both groups exhibited a comparable radiographic bone fill at the intra-bony defect component. CONCLUSION: The study failed to demonstrate a significant impact of the method of surface DD on the clinical outcome following combined surgical therapy of advanced peri-implantitis lesions.

The use of an ultrasonic bone curette in the surgery of jaw tumors involving the inferior alveolar nerve.

BACKGROUND: Preservation of lip sensation is crucial in ablative surgery of mandibular tumors. When tumor control does not necessitate sacrifice of the inferior alveolar nerve (IAN), as in some cases of benign tumors of the lower jaw, attempts may be made to spare the nerve. The authors present and discuss their experience with an ultrasonic device in the treatment of benign tumors of the jaw in correspondence of the IAN. MATERIALS AND METHODS: Five patients with tumoral lesions involving the IAN underwent surgery with an ultrasonic surgical device (Sonopet Omni Surgical System; Stryker, Kalamazoo, MI). RESULTS: Fine, delicate movements allowed the surgeon to remove bone without damage to surrounding tissue. Three of 5 patients did not present intraoperative or postoperative complications that could be attributed to the Sonopet. Two cases were partial failures. In 1 case, postoperative dysesthesia was encountered, and in the other case, intraoperative transection of the nerve occurred. CONCLUSION: The Sonopet ultrasonic bone curette proved to be highly useful in surgical procedures close to the IAN because it does not produce heat or cause mechanical injury to the neurovascular bundle. Application of this instrument may provide improved ability to preserve sensibility of the chin and lower lip in patients affected by lesions in proximity to the IAN.