Introduction: In 2006 an ultrasound-surgery-based method to hydrodynamically detach the sinus-membrane utilizing the ultrasonic cavitation effect—the tHUCSL—was developed and a surgical protocol established. The aim...Introduction: In 2006 an ultrasound-surgery-based method to hydrodynamically detach the sinus-membrane utilizing the ultrasonic cavitation effect—the tHUCSL—was developed and a surgical protocol established. The aim of the study was to determine the indication-range and success-rate of this novelty procedure. Materials & Methods: Between 2007 and 2009, 404 patients were treated by 6 oral surgeons of different experience-levels with the tHUCSL in 446 sinussites. 637 implants were inserted and then prosthodontically treated and observed and documented until December 2011. The subantral space was augmented via the 3 mm transcrestal approach with an augmentation volume of 1.9 ccm (+/? 0.988 ccm) and an augmentation height of 10.7 mm (+/? 2.85 mm). Results: Within the survey-period 15 (2.35%) of the 637 inserted implants were lost, mostly before implant loading due to postsurgical infection and nonosseointegration in the augmentation site. 1 implant was lost after implant loading and prosthetic treatment within 1 year after loading. The overall success rate with functional implants in site is 97.65% evenly distributed among the participating surgeons. 86% of the patients were observed with no postsurgical swelling and 87% no postsurgical pain. Discussion: The results suggest the tHUCSL to be a safe minimal-invasive alternative to traditional lateral approach and transcrestal osteotome sinuslift-procedures applicable to all anatomical situations.展开更多
Aim of the study was to evaluate if there is a constant and significant reduction in traumaticity when mas- sively traumatic oral surgical procedures such as the removal of third molars are conducted with only ul- tra...Aim of the study was to evaluate if there is a constant and significant reduction in traumaticity when mas- sively traumatic oral surgical procedures such as the removal of third molars are conducted with only ul- trasonic surgical devices (Piezotomes) expressed in a reduction of postsurgical pain and swelling on the patient’s side since such clinical experiences by the authors suggested this. Since oral surgeons criticize a higher time consumption for surgeries with Piezoto- mes also the objective time consumption was evalu- ated and compared to the traditional methods. Mate- rial and Methods: 56 female and male patients were selected that already underwent a removal of an im- pacted third mandibular molar on one side with rota- ry instruments by bone destructive burring with a still persisting comparable third mandibular molar on the contralateral side complaining about recur- rent pain episodes and were already documented for pain and swelling before. The ultrasonic surgical re- moval with the Piezotome was conducted with a buc- cal osteotomy of the compacta lateral to the impacted third molar, preservation of the resected compacta in saline solution, removal of the third molar by single or multiple dentotomy and full anatomical restitution of the surgical site with the preserved buccal com- pacta. The swelling was documented by kephalome- try 24/48/72 hours and 1 week post surgery, the pain index by the total consumption of ibuprofen-400 mg—tablets. Lesions of the mandible nerve were documented. Netto surgery time was taken from the first incision to the last suture of the procedure. Re-sults: 6 patients had to be excluded from evaluation due to incomplete post surgical follow up. A signify-cant (***, p > 0.999) decrease in pain and swelling of 50% was detected both for the parameters swelling and pain with Piezotome-surgery. No lesions of the mandible nerve were detected with Piezotome sur- gery whereas surgery with rotary instruments re- sulted in 16% hypesthesia at least up to one week. Although netto surgery time was approximately 50% longer when done with the Piezotome at the begin-ning the time consumption normalized with the growing experience of the surgeons back to the time schedule when surgery was performed with rotary instruments revealing no significant differences (-, p < 0.73). Conclusions: The results of this retrospective study suggest that Piezotome-surgery is superior in atraumaticity and soft-tissue safety compared to tra- ditional procedures with burs and grants the patients significantly less post surgical pain and swelling. Al- though—as it is with all new surgical tools and pro- tocols—surgery time is longer at the beginning when purely working with ultrasonic surgical devices time consumption reduces to normal values after a learn- ing curve.展开更多
Alveolar crest-splitting and horizontal distraction is an established surgical technique to enable implant insertion into the narrow, lateral atrophic alveolar crest. This surgical technique is challenging for the ora...Alveolar crest-splitting and horizontal distraction is an established surgical technique to enable implant insertion into the narrow, lateral atrophic alveolar crest. This surgical technique is challenging for the oral surgeon and restricted to crest-widths of 3 - 5 mm: significant procedural bone loss at osteotomy, the need to prepare a full thickness mucoperiostal flap and milling a baseline-osteotomy to weaken the bone for distraction inhere significant risks of accidental fractures. Aim of the study was to investigate if the recently developed novel Flapless Piezotome enhanced Crest-Splitting and Widening Technique (FPeCSWT) could safely narrow down the indication for this procedure to narrow alveolar crests of widths of even less than 2 mm in a three-year survey-period. 239 patients underwent 261 FPeCSWT-surgeries and 488 implants were inserted simultaneously in the upper and the lower jaw and clinical parameters such as intrasurgical complications, patient morbidity, implant loss and vertical bone loss (VBL) in the first three years after surgeries were recorded comparing sites with less than 2 mm width with sites of more than 2 mm. After three years a significant difference (p = 0.24) of VBL could be observed between the group with less than 2 mm crest-width (mean: 0.97 mm, max: 2.0 mm/min: 0.0 mm;SD: 0.41) compared with the group with more than 2 mm crest-width (mean: 0.69 mm, max: 1.5 mm/min: 0.0 mm;SD: 0.36) but was still significant lower when compared with the results of similar studies published with a mucoperiostal-flap approach and baseline bone-cut. The cumulative 3-year-implant-survival-rate was 98.8%, no accidental fracture of the distracted buccal bone-plate occurred. The re-sults of the study suggest that the FPeCSWT narrows safely down the indication for crest-splitting to also crest-widths of only 1 mm. The procedure is highly predictable and significantly reduces the challenge of surgical skills and leads to negligible patient-morbidity. The higher VBL in crest-widths of less than 2 mm can easily be compensated by subcrestal placement of implants.展开更多
文摘Introduction: In 2006 an ultrasound-surgery-based method to hydrodynamically detach the sinus-membrane utilizing the ultrasonic cavitation effect—the tHUCSL—was developed and a surgical protocol established. The aim of the study was to determine the indication-range and success-rate of this novelty procedure. Materials & Methods: Between 2007 and 2009, 404 patients were treated by 6 oral surgeons of different experience-levels with the tHUCSL in 446 sinussites. 637 implants were inserted and then prosthodontically treated and observed and documented until December 2011. The subantral space was augmented via the 3 mm transcrestal approach with an augmentation volume of 1.9 ccm (+/? 0.988 ccm) and an augmentation height of 10.7 mm (+/? 2.85 mm). Results: Within the survey-period 15 (2.35%) of the 637 inserted implants were lost, mostly before implant loading due to postsurgical infection and nonosseointegration in the augmentation site. 1 implant was lost after implant loading and prosthetic treatment within 1 year after loading. The overall success rate with functional implants in site is 97.65% evenly distributed among the participating surgeons. 86% of the patients were observed with no postsurgical swelling and 87% no postsurgical pain. Discussion: The results suggest the tHUCSL to be a safe minimal-invasive alternative to traditional lateral approach and transcrestal osteotome sinuslift-procedures applicable to all anatomical situations.
文摘Aim of the study was to evaluate if there is a constant and significant reduction in traumaticity when mas- sively traumatic oral surgical procedures such as the removal of third molars are conducted with only ul- trasonic surgical devices (Piezotomes) expressed in a reduction of postsurgical pain and swelling on the patient’s side since such clinical experiences by the authors suggested this. Since oral surgeons criticize a higher time consumption for surgeries with Piezoto- mes also the objective time consumption was evalu- ated and compared to the traditional methods. Mate- rial and Methods: 56 female and male patients were selected that already underwent a removal of an im- pacted third mandibular molar on one side with rota- ry instruments by bone destructive burring with a still persisting comparable third mandibular molar on the contralateral side complaining about recur- rent pain episodes and were already documented for pain and swelling before. The ultrasonic surgical re- moval with the Piezotome was conducted with a buc- cal osteotomy of the compacta lateral to the impacted third molar, preservation of the resected compacta in saline solution, removal of the third molar by single or multiple dentotomy and full anatomical restitution of the surgical site with the preserved buccal com- pacta. The swelling was documented by kephalome- try 24/48/72 hours and 1 week post surgery, the pain index by the total consumption of ibuprofen-400 mg—tablets. Lesions of the mandible nerve were documented. Netto surgery time was taken from the first incision to the last suture of the procedure. Re-sults: 6 patients had to be excluded from evaluation due to incomplete post surgical follow up. A signify-cant (***, p > 0.999) decrease in pain and swelling of 50% was detected both for the parameters swelling and pain with Piezotome-surgery. No lesions of the mandible nerve were detected with Piezotome sur- gery whereas surgery with rotary instruments re- sulted in 16% hypesthesia at least up to one week. Although netto surgery time was approximately 50% longer when done with the Piezotome at the begin-ning the time consumption normalized with the growing experience of the surgeons back to the time schedule when surgery was performed with rotary instruments revealing no significant differences (-, p < 0.73). Conclusions: The results of this retrospective study suggest that Piezotome-surgery is superior in atraumaticity and soft-tissue safety compared to tra- ditional procedures with burs and grants the patients significantly less post surgical pain and swelling. Al- though—as it is with all new surgical tools and pro- tocols—surgery time is longer at the beginning when purely working with ultrasonic surgical devices time consumption reduces to normal values after a learn- ing curve.
文摘Alveolar crest-splitting and horizontal distraction is an established surgical technique to enable implant insertion into the narrow, lateral atrophic alveolar crest. This surgical technique is challenging for the oral surgeon and restricted to crest-widths of 3 - 5 mm: significant procedural bone loss at osteotomy, the need to prepare a full thickness mucoperiostal flap and milling a baseline-osteotomy to weaken the bone for distraction inhere significant risks of accidental fractures. Aim of the study was to investigate if the recently developed novel Flapless Piezotome enhanced Crest-Splitting and Widening Technique (FPeCSWT) could safely narrow down the indication for this procedure to narrow alveolar crests of widths of even less than 2 mm in a three-year survey-period. 239 patients underwent 261 FPeCSWT-surgeries and 488 implants were inserted simultaneously in the upper and the lower jaw and clinical parameters such as intrasurgical complications, patient morbidity, implant loss and vertical bone loss (VBL) in the first three years after surgeries were recorded comparing sites with less than 2 mm width with sites of more than 2 mm. After three years a significant difference (p = 0.24) of VBL could be observed between the group with less than 2 mm crest-width (mean: 0.97 mm, max: 2.0 mm/min: 0.0 mm;SD: 0.41) compared with the group with more than 2 mm crest-width (mean: 0.69 mm, max: 1.5 mm/min: 0.0 mm;SD: 0.36) but was still significant lower when compared with the results of similar studies published with a mucoperiostal-flap approach and baseline bone-cut. The cumulative 3-year-implant-survival-rate was 98.8%, no accidental fracture of the distracted buccal bone-plate occurred. The re-sults of the study suggest that the FPeCSWT narrows safely down the indication for crest-splitting to also crest-widths of only 1 mm. The procedure is highly predictable and significantly reduces the challenge of surgical skills and leads to negligible patient-morbidity. The higher VBL in crest-widths of less than 2 mm can easily be compensated by subcrestal placement of implants.
