Objetivo: Informar y evaluar sobre la cirugia osea ultrasonica (USBS), tambien conocida como piezocirugia, para procedimientos de division de la cresta con colocacion inmediata de implantes a los 3 anos de seguimiento. Metodo y materiales: Se llevaron a cabo sesenta y un procedimientos de division de la cresta, y se colocaron 180 implantes en 43 pacientes. La anchura inicial de los rebordes vario entre 1,5 y 5,0 mm (media 3,3 ± 0,7 mm). La densidad del hueso era de tipo I (11,1%), de tipo II (27,8%), de tipo III (28,9%) y de tipo IV (32,2%). El aparato USBS trabajo con una frecuencia de vibracion de 20 a 32 kHz y un pico de potencia de 90 W. Resultados: La longitud media de la incision fue de 14,8 ± 10,8 mm; la anchura media final de los rebordes fue de 6,0 ± 0,4 mm. En la segunda fase de la cirugia se comprobo que habian fallado en su osteointegracion, cinco de los 180 implantes (2,8%), todos ellos en el maxilar superior, siendo la tasa de exito global de los implantes colocados de forma simultanea a la expansion del reborde mediante USBS del 97,2%, 95,1% en el maxilar superior y 100% en la mandibula. Durante el seguimiento de 3 anos no fallo ninguno de los implantes que habian recibido carga; las tasas de exito respectivas permanecieron sin cambios. Conclusiones: La USBS resulta predecible para llevar a cabo procedimientos de division de la cresta, sin riesgo de termonecrosis osea; ademas disminuye el riesgo de danos a los tejidos blandos. La eficiencia de corte de hueso con el presente aparato de USBS fue satisfactoria gracias a su elevada potencia de vibracion ultrasonica, sobretodo en el hueso blando tipo IV.

Purpose: The purpose of this study was to investigate and compare, in a randomized and controlled clinical trial, the use of ultrasound bone surgery devices and the use of rotary instruments in lower third molar extractions.Materials and Methods: We selected 26 patients (12 women and 14 men) for this study; the mean age was 31.2 years (range, 24-45 years). A randomized clinical trial was planned. Patients in the control group received treatment with the conventional rotary instruments; patients in the test group received treatment with the ultrasound bone surgery tools. Twenty-six third molars were allocated to the test and control groups according to a computer-generated randomization list. All the surgical procedures were performed by the same surgeon. Pain, trismus, cheek swelling, and number of analgesics taken were evaluated at baseline (before surgery) and at the first-, third-, fifth-, and seventh-day visits.Results: Pain levels (evaluated on a visual analog scale) were higher in the control group when compared with the ultrasonic group; however, no statistically significant differences were found. On the contrary, the number of analgesics taken in the test group was significantly lower when compared with the control group. The occurrence of trismus was significantly higher in the control group when compared with the test group. The clinical values of cheek swelling were higher in the rotary group when compared with the ultrasound group at the fifth-day visit.Conclusion: This study showed that the use of ultrasound bone surgery for third molar extraction significantly reduced the occurrence of postsurgical trismus, the occurrence of swelling, and the number of analgesics taken after surgery. (C) 2010 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 68:330-336, 2010

OBJECTIVE To report and evaluate ultrasonic bone surgery (USBS), also known as piezosurgery, in split-crest procedures with immediate implant placement at 3 years of follow-up. METHOD AND MATERIALS Sixty-one split-crest procedures were performed, and 180 implants were placed in 43 patients. Initial ridge width varied between 1.5 and 5.0 mm (mean 3.3 +/- 0.7 mm). Bone density was type I (11.1%), type II (27.8%), type III (28.9%), and type IV (32.2%). The USBS device worked with a 20 to 32 kHz vibrating frequency and 90 W peak power. RESULTS Mean split length was 14.8 +/- 10.8 mm; mean final ridge width was 6.0 +/- 0.4 mm. At second-stage surgery, five of 180 implants failed to osseointegrate (2.8%), all in the maxilla. Also at second-stage surgery, the success rate of the implants placed simultaneously to the split crest performed with USBS was 97.2% overall, 95.1% in the maxilla and 100% in the mandible. No loaded implant failed during the 3-year follow-up; respective success rates were unchanged. CONCLUSIONS USBS is predictable to perform split-crest procedures, without risk of bone thermonecrosis; it decreases the risk of soft tissue alteration. Bone-cutting efficiency was satisfactory with the present USBS device because of its elevated ultrasonic vibrating power, especially in soft type IV bone.

BACKGROUND:Some of the original surgical protocols for implant surgery have been reassessed to satisfy the patient's continuously increasing expectation for shorter rehabilitation time, improved esthetics, and increased comfort. The aim of this study was to evaluate the 12-month clinical success of 18 single-tooth implants inserted immediately after tooth extraction and restored the same day with non-functional loading.METHODS:A total of 18 patients (12 women and six men), 22 to 60 years old, were enrolled in this study. Eighteen single implants were inserted in fresh extraction sockets and immediately restored with temporary abutments and crowns. All experimental sites showed an absence of fenestrations or dehiscences of the bone walls and a residual gap between implant surfaces and surrounding bone walls < or =2 mm. All temporary prostheses were positioned the same day of surgery and were not in occlusal contact with opposing arches. The comparison between the baseline and 12-month visits was performed with the Student t test for paired data (statistically significant at a level of alpha = 0.05).RESULTS:During the 12-month follow-up period, one fixture was removed 4 weeks after implant placement following an abscess. All remaining implants healed uneventfully with no complications and were assessed as stable and successful at the 12-month checkup. No technical complications such as screw loosening, resin fracture, or pain during chewing were registered during the 12-month period.CONCLUSIONS:Within the limits of the data from this study, it can be suggested that immediate placement and restoration of a single implant can be a valid and successful option of treatment in the case of single compromised teeth. Moreover, this treatment protocol eliminates the need for removable provisional restoration and seems to maintain the preexisting architecture of soft and hard tissues in most cases. Nonetheless, further prospective and long-term studies are required to obtain a better insight into the limitations of this protocol.