Evaluation of user impressions, micromorphological bone surface properties and material attrition by three generations of osteotomy methods

Abstract

Background: Ultrasonic-driven osteotomy is associated with a safe processing method and has broadened the daily used armamentarium of maxillofacial surgeons. As further development, sonic-based osteotomy method was newly introduced. Objectives: To analyse user impressions micromorphological bone changes and material attrition by sound-, ultrasound and conventionally driven osteotomy. Methods: In fresh bovine ribs conventional — (Lindemann-drill H254E, Brasseler GmbH and Co. KG, Lemgo, Germany), sound – (saw SFS 101 Brasseler GmbH and Co. KG, Lemgo, Germany) and ultrasound (saw OT7S-4, Piezosurgery, Mectron Medical Technology, Carasco, Italy) guided osteotomies were performed by novice (N) and expert (E) practitioners with different irrigation volumes. Bone surfaces were analysed by (environmental) scanning electron microscopy. Energy dispersive spectroscopy was carried out to detect possible material attrition. Findings: Sonic system was significantly slowest with worst noise impact subjectively (N: 2.9, E: 3.2) and objectively (92.9 dB; SD 7.1). However, both user groups improved significantly in a second run (N: 7.9, E: 7.6). Bone structure was mostly preserved after sonic and ultrasonic assisted preparation. By contrast, using the conventional technique showed significant changes especially with regard to the cancellous layer of the bone with incorporation of abundant bone debris. None of the tested treatment procedures resulted in relevant attrition of drill materials. Conclusion: The practitioners had a promising experience with ultrasonic and specially the sonic system. In contrast to conventional osteotomy, osseous micromorphology was mostly preserved by sonic and the piezoelectric method. This could have a positive effect on bone healing and osseointegration and should be investigated in future studies.