Stübinger S, Landes C, Seitz O, Zeilhofer H-F, Sader R
Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, J.-W.-Goethe-Universität Frankfurt.
Ultraschall Med. 2008 Feb;29(1):66-71. doi: 10.1055/s-2007-963507.
Surgical reconstruction of bony defects in the oral cavity can often be challenging since thin and fragile bony structures are especially prone to fracture cased by bulky cutting tips or the application of significant pressure by conventional mechanical instruments. The risk of accidental damage to adjacent soft tissue structures, such as nerves, by a dental drill or saw is also extremely high. The use of modulated ultrasound (piezosurgery) makes it possible to overcome such complications as a result of the precise and minimally invasive surgery technique which is limited to mineralized hard tissue.
In 60 patients (38 male, 22 female) a piezosurgery device was used for different bone augmentation procedures before dental implant placement. The instrument uses modulated ultrasound (25 - 30 kHz) and the amplitude of the working tip ranges from 60 mum to 200 mum. The device was employed for sinus floor elevation (25), alveolar ridge augmentation using an autogenous block graft (25), alveolar ridge splitting (5) or lateralization of the alveolar nerve (5). Physiological sodium chloride was used as a cooling solution. For all osteotomies mode boosted burst c and pump 5 were used.
Piezoelectric osteotomy permitted micrometric selective cutting and a clear surgical site due to the cavitation effect created by the cooling solution and the oscillating tip. No excessive bleeding was encountered. The risk of accidental soft tissue harm, such as perforating the sinus membrane or damaging adjacent nerves, was definitely lower than in the case of a conventional bur. No serious complications were encountered in the postoperative wound healing process after 2, 14, 30 and 90 days. However, the surgical procedures were time-consuming.
Piezosurgery is an advantageous osteotomy technique for delicate structures in the oral and maxillofacial region. With respect to osteotomies of thin and fragile bones, the application of ultrasound is superior to other mechanical instruments because of the extremely precise and virtually arbitrary cut geometries, easy handling, efficient bone ablation and minimal accidental damage to adjacent soft tissue structures.
口腔内骨缺损的外科重建往往具有挑战性，因为薄而脆弱的骨结构特别容易因粗大的切割头或传统机械器械施加的巨大压力而骨折。牙科钻或锯意外损伤相邻软组织结构（如神经）的风险也极高。调制超声（压电手术）的使用使得通过精确且微创的手术技术克服此类并发症成为可能，该技术仅限于矿化硬组织。
在60例患者（38例男性，22例女性）中，在种植牙植入前使用压电手术设备进行不同的骨增量手术。该器械使用调制超声（25 - 30千赫），工作头的振幅范围为60微米至200微米。该设备用于上颌窦底提升（25例）、使用自体块状骨移植进行牙槽嵴增高（25例）、牙槽嵴劈开（5例）或牙槽神经移位（5例）。使用生理氯化钠作为冷却液。所有截骨术均采用模式增强爆发c和泵5。
由于冷却液和振荡头产生的空化效应，压电截骨术允许进行微米级的选择性切割并使手术部位清晰。未出现过多出血。意外软组织损伤的风险，如穿透上颌窦黏膜或损伤相邻神经，肯定低于使用传统牙钻的情况。在术后2天、14天、30天和90天的伤口愈合过程中未出现严重并发症。然而，手术过程耗时较长。
压电手术是口腔颌面部精细结构的一种有利截骨技术。对于薄而脆弱骨骼的截骨术，超声的应用优于其他机械器械，因为其切割几何形状极其精确且几乎可任意设定，操作简便，骨消融效率高，对相邻软组织结构的意外损伤最小。
