Flapless Piezotome Crest Split Achieves Comparable Outcomes to Autologous Onlay Grafts With Significant Less Patient Morbidity and Complications-A Randomized Clinical Study.

PURPOSE: In the management of the narrow alveolar ridge, the flapless piezotome crest split (FPCS) technique with horizontal distraction was introduced as an alternative to lateral alveolar ridge augmentation using autologous bone block grafting (ABBG). The study purpose was to measure and compare the alveolar crest width and complications between FPCS and ABBG. MATERIALS AND METHODS: We implemented a nonblinded, randomized clinical trial. The sample included patients requiring lateral alveolar ridge augmentation before implant insertion. The predictor variable was lateral alveolar ridge augmentation performed using ABBG (control group) or FPCS using an ultrasonic surgical device (Piezotome II or Piezotome CUBE; Acteon, Norwich, UK) and specific crest split working tips (test group). The primary outcome variable was the overall coronal crest width achieved after completed healing measured at 6 months using 3-dimensional imaging studies. Other study variables included the postoperative morbidity, staged using the Universal Pain Assessment Scale, complications, and surgery duration. Descriptive and bivariate statistics were computed using SPSS, version 22.0 (IBM Corp, Armonk, NY), and P ≤ .05 was considered to indicate statistical significance. RESULTS: The sample included 567 patients treated with ABBG (56.1% female; age, 64.1 ± 20.2 years) and 562 treated with FPCS (57.2% female; age, 62.3 ± 18.2 years). The baseline crest width in the control and test groups was 2.1 ± 0.5 mm and 1.9 ± 0.4 mm, respectively. The final crest width achieved with ABBG and FPCS was 5.8 ± 0.8 mm and 6.5 ± 0.7 mm, respectively (P > .05). Statistically significant differences (P < .05) were found between the ABBG and FPCS groups in the postoperative complication rate, morbidity, and operative time, all in favor of FPCS. CONCLUSIONS: FPCS seems to be a significantly less traumatic alternative to buccal onlay grafting with autologous bone blocks, providing a comparable or better net gain in the alveolar crest width with a significantly shorter operative time and less postoperative morbidity.

Piezotome Genioplasty Reduces Postsurgical Morbidity and Enhances Patient Satisfaction: A Randomized Clinical Trial.

PURPOSE: Recent clinical studies have shown piezotomes might establish the new "state of the art" for osteotomies in maxillofacial surgery. The author hypothesized genioplasty surgery with piezotomes might decrease postsurgical morbidity and increase overall patient satisfaction compared with genioplasty with traditional instruments. MATERIALS AND METHODS: The author implemented a randomized clinical trial. The sample was composed of patients undergoing reductive genioplasty. The predictor variable was genioplasty performed with traditional instruments and a traditional sliding genioplasty protocol (control group) or ultrasonic surgical devices (Piezotome II and Piezotome SOLO M+) with a piezotome-adapted 3-dimensional curved osteotomy surgical protocol (test group). The primary outcome variable was overall long-term patient satisfaction determined by the Genioplasty Outcome Evaluation. Other study variables were postsurgical morbidity assessed by the Universal Pain Assessment Scale, analgesic intake, neurosensory 2-point discrimination test of the lip and chin, and surgery duration. Descriptive and bivariate statistics were computed by SPSS 22.0 and the P value was set at .05. RESULTS: The sample was composed of 48 patients undergoing reductive genioplasty with a piezotome (10 men and 13 women; age, 24 to 56 yr) or traditional sliding genioplasty (11 men and 14 women; age, 26 to 54 yr). No statistically relevant difference was found for surgery duration between the test and control groups. There was a statistically significant association between decreased postsurgical morbidity (P < .05) and higher overall long-term patient satisfaction with genioplasty outcome (P < .05) when piezotomes were used for performing the genioplasty. CONCLUSION: The results of this study suggest the use of piezotomes and piezotome-adapted surgical protocols is advantageous in genioplasty surgery compared with traditional surgical instruments and traditional surgical protocols.

Contemporary CBCT diagnostics-discovery of a new artery with possible impact on surgical planning: the anterior superior palatal alveolar artery.

PURPOSE: An ongoing clinical trial regarding intra- and post-surgical morbidity in maxillary apicoectomies showed significant higher morbidity for upper canines and palatal roots of upper 1st premolars. Analysis of available presurgical cone beam computed tomography (CBCT)-scans revealed the existence of an unknown bone-canal branching off from the bone-canal or groove of the anterior superior alveolar artery (asaa). Aim of the study was the determination of the contents of this newly found bone canal in human cadaver heads, its prevalence as possible standard anatomical structure and its automatized detection with a contemporary high-resolution TRIUM-CBCT-device in vivo. METHODS: 35 human cadaver heads were dissected, the prevalence of the bone-canal determined and its contents analyzed by histology. 835 consecutive routine high-resolution TRIUM-CBCT-scans from routine patients were analyzed by an automatized detection- and tracing-algorithm for in vivo-determination of prevalence of this bone canal. Automatized detection and additional manual tracing were statistically evaluated by SSPS 20.0 software. RESULTS: The bone-canal was found in 96% of the anatomical specimens, its content identified as artery not described until now and named after the first finder "Arteria Kurrekii". Automatized tracing of TRIUM-CBCT-scans with additional manual tracing revealed an in vivo prevalence of this newly found artery of 95% (p ≤ 0.05). CONCLUSIONS: The newly found anterior superior palatal alveolar artery (aspaa-"Arteria Kurrekii") might have the same clinical impact for surgical procedures in the maxilla as the posterior superior alveolar artery (psaa). Its first detection was enabled by high-resolution TRIUM-CBCT devices and prevalence as standard anatomical structure proven in vivo by automatized CBCT-scan analysis.

Piezotome Rhinoplasty Reduces Postsurgical Morbidity and Enhances Patient Satisfaction: A Multidisciplinary Clinical Study.

PURPOSE: Experimental and clinical studies in various fields of oral and maxillofacial surgery suggest the use of piezotomes to reduce postsurgical morbidity and enhance healing. The aim of the study was to investigate if rhinoplasty surgery with piezotomes might decrease postsurgical morbidity and increase overall patient satisfaction when compared with rhinoplasty with traditional instruments and protocols. MATERIALS AND METHODS: In this prospective clinical study, patients in a cosmetic surgery department, ear-nose-throat (ENT) department, and the department for maxillofacial surgery, scheduled for cosmetic reductive rhinoplasty, underwent rhinoplasty with traditional instruments or an ultrasonic surgical device called a "piezotome." Before rhinoplasty, all patients were evaluated by the Rhinoplasty Outcome Evaluation (ROE) questionnaire. Staging for ecchymosis/edema and for pain was performed on the seventh day after surgery, and at 6 months after surgery, patients were again evaluated by the ROE score. Female and male patients aged between 24 and 57 years were included; patients had to be free of functional impairments of nasal breathing. Data were anonymized and evaluated with SPSS software (version 22.0; IBM, Armonk, NY) (1-way analysis of variance, Games-Howell post hoc test for primary and secondary outcome evaluation, Levene test of equal variances, t test, and Pearson correlation of primary and secondary outcome evaluation). RESULTS: Eighty-four patients were fully documented by ecchymosis/edema staging, pain staging, and ROE; of these, 51 women and 12 men underwent cosmetic rhinoplasty in a department of plastic and reconstructive surgery; an ENT department; or a department for maxillofacial surgery. A piezotome rhinoplasty was performed in 16 female and 5 male patients. Statistical evaluation verified that there were no significant differences between the three surgical disciplines when a rhinoplasty was performed with traditional instruments (P > .7), but showed that the use of ultrasonic surgical instruments significantly improved immediate postsurgical morbidity in terms of ecchymosis/edema and pain (P < .05), as well as ROE score after 6 months (P < .05). Correlation of ecchymosis/edema and pain with ROE score showed a significant difference (P ≤ .01) in favor of the piezotome. CONCLUSIONS: The use of ultrasonic surgical devices in reductive rhinoplasty decreases postsurgical morbidity and increases overall patient satisfaction significantly. The results of this study suggest piezotomes to be the surgical instrument of choice not only for oral surgical procedures, but also for cosmetic surgery on facial bones.

Schneiderian membrane detachment using transcrestal hydrodynamic ultrasonic cavitational sinus lift: a human cadaver head study and histologic analysis.

PURPOSE: Recent studies have suggested the osteogenic layer of the periosteum at the base of the sinus membrane to play a key role in bone regeneration after sinus lift procedures. Thus, atraumatic detachment of the sinus membrane with an intact periosteum seems mandatory. The present histologic study of fresh human cadaver heads investigated the detachment behavior and histologic integrity of the detached periosteum after application of the transcrestal hydrodynamic ultrasonic cavitational sinus lift (tHUCSL-INTRALIFT). MATERIALS AND METHODS: A total of 15 sinuses in 8 fresh human cadaver heads were treated using tHUCSL-INTRALIFT. After surgery, they were checked macroscopically for damage to the sinus membrane and then processed for histologic inspection under light microscopy. A total of 150 histologic specimens, randomly selected from the core surgical sites, were investigated using hematoxylin-eosin (HE), Azan, and trichrome staining. RESULTS: None of the 150 inspected specimens showed any perforation or dissection of the periosteum from the subepithelial connective tissue and respiratory epithelium and were fully detached from the bony antrum floor. The connecting Sharpey fibers revealed to be cleanly separated from the sinus floor in all specimens. CONCLUSIONS: The results of the present study suggest tHUCSL-INTRALIFT should be used to perform predictable and safe detachment of the periosteum from the bony sinus floor as a prerequisite for undisturbed and successful physiologic subantral bone regeneration.

Hydrodynamic ultrasonic sinus floor elevation--an experimental study in sheep.

PURPOSE: The aim of the present study was to evaluate the pressure forces appearing to elevate the sinus membrane by comparing the hydraulic and pneumatic pressure. Also, the relation between the time and volume of the applied liquid and the achieved lift-volume were determined. MATERIALS AND METHODS: A total of 190 fresh, half sheep heads were used for the present investigation. An ultrasound surgical device (Piezotome; Acteon, Bordeaux, France) was tested to evaluate the pressure increase at different flow rates. The elevation volume at different flow rates and activation times of the ultrasound hand piece were measured. RESULTS: To detach the sinus membrane pneumatically from the sinus floor, a mean average pressure of 29.54 millibars was required. Using the hydraulic technique, a mean average pressure of 19.8 millibars was determined. Comparing the different flow rates, the elevated volume increased to 0.52 mL when a flow of 60 mL/minute was used. Using an activation time of 20 seconds, a lifted volume of 3.92 mL could be measured on average. If the flow was set to a maximum of 60 mL/minute, the created volume increased to 5.58 mL. A comparison using the chi(2) test showed a significant correlation (P = .03) between the application time and the created sinus lift volume. Even at high flow rates of 60 mL/minute of the activated Piezotome for a 20-second period, no rupture of the sinus membrane of the sheep heads occurred in 190 experiments. CONCLUSION: From these results, we have concluded that hydrodynamic ultrasound could be used as an alternative method for sinus floor elevations of any size and volume with a mere 3-mm-diameter transcrestal approach, if findings from clinical investigations confirm the results of the present animal study.

Primary implant stability in augmented sinuslift-sites after completed bone regeneration: a randomized controlled clinical study comparing four subantrally inserted biomaterials.

Implant-Insertion-Torque-Value (ITV) proved to be a significant clinical parameter to predict long term implant success-rates and to decide upon immediate loading. The study evaluated ITVs, when four different and commonly used biomaterials were used in sinuslift-procedures compared to natural subantral bone in two-stage-implant-procedures. The tHUCSL-INTRALIFT-method was chosen for sinuslifting in 155 sinuslift-sites for its minimal invasive transcrestal approach and scalable augmentation volume. Four different biomaterials were inserted randomly (easy-graft CRYSTAL n = 38, easy-graft CLASSIC n = 41, NanoBone n = 42, BioOss n = 34), 2 ccm in each case. After a mean healing period of 8,92 months uniform tapered screw Q2-implants were inserted and Drill-Torque-Values (DTV) and ITV were recorded and compared to a group of 36 subantral sites without need of sinuslifting. DTV/ITV were processed for statistics by ANOVA-tests. Mean DTV/ITV obtained in Ncm were: Control Group 10,2/22,2, Bio-Oss 12,7/26,2, NanoBone 17,5/33,3, easy-graft CLASSIC 20,3/45,9, easy-graft CRYSTAL 23,8/56,6 Ncm, significance-level of differences throughout p < 0,05. Within the limits of this study the results suggest self-hardening solid-block-like bone-graft-materials to achieve significantly better DTV/ITV than loose granulate biomaterials for its suspected improvement of vascularization and mineralization of the subantral scaffold by full immobilization of the augmentation site towards pressure changes in the human sinus at normal breathing.

Rupture length of the sinus membrane after 1.2 mm puncture and surgical sinus elevation: an experimental animal cadaver study.

OBJECTIVES: To evaluate the rupture length of the sinus membrane after applying a defined 1.2 mm defect comparing 3 different techniques: Summers lift, balloon-assisted technique (BASL), and hydrodynamic ultrasonic cavitational sinus lift (HUCSL). STUDY DESIGN: Thirty fresh sheep heads (60 maxillary sinuses) were investigated. The sinus membrane was ruptured using a 1.2 mm pilot drill. Then Summers lift, BASL, and HUCSL were each performed on 20 sinuses, creating a 5 mm vertical lift of the sinus membrane. The length of the ruptured sinus membrane was measured before and after the experiment. The results of the different sinus lift techniques were compared using t tests. RESULTS: The t test showed that the Summers lift leads to a significantly higher rupture length (P = .05) than BASL. The comparison between Summers lift and HUCSL showed a significantly higher rupture length with the Summers lift (P < .005). The same significance (P < .005) was found when BASL was compared with HUCSL. Comparing the increasing rupture length of the sinus membrane during the experiment, the t test showed a significantly greater rupture using BASL or the Summers lift compared with HUCSL. CONCLUSIONS: The HUCSL technique yielded the lowest increase of rupture length compared with BASL and Summers lift. The technique therefore shows the lowest risk of a growing rupture of the sinus membrane in case of an iatrogenic puncture during preparation of the transcrestal approach.