Bone Scraper Research Articles

Maxillary Sinus Floor Augmentation and Simultaneous Implant Placement Using Locally Harvested Autogenous Bone Chips and Bone Debris: A Prospective Clinical Study

The aim of this study was to prospectively evaluate the status of implants, marginal bone loss, and outcome of maxillary sinus floor augmentation in patients undergoing maxillary sinus lift and simultaneous implant placement with the use of bone grafts harvested adjacent to the actual surgical site. Patients in need of maxillary sinus floor augmentation to enable implant placement were enrolled in 2 different groups. In group A, a "bone trap" was used to harvest bone debris during implant preparation with additional bone collected by further drilling adjacent to the implant sites. In group B, a "bone scraper" was used to harvest cortical bone chips from the zygomatic buttress and from the lateral sinus wall before opening of a bony window. All patients were provided a fixed partial denture after a healing period of 3 to 6 months. A total of 61 patients with 81 Straumann implants (Institut Straumann AG, Basel, Switzerland) were assessed, with 17 patients (20 implants) in group A and 44 patients (61 implants) in group B. One implant was lost (in group B) before loading. The survival rate after a follow-up of 12 to 60 months was 98.8%. There was no significant difference in marginal bone loss on the mesial and distal sides of the implant when baseline to 1-year registration was compared with baseline to final registration. During the same time, graft height decreased significantly on the distal apical side of the implants. Bone grafts can be locally harvested at the site of the maxillary sinus augmentation procedure to enable placement, successful healing, and loading of 1 to 3 implants.

Histomorphometric analysis of intraoral bone grafts harvested by different methods

Autogenous bone is considered the “gold standard” among graft materials for alveolar ridge augmentation, because of its osteogenic, osteconductive and osteoinductive features. In clinical practice, autogenous bone chips can be obtained by using different methods, and several studies demonstrated the influence of devices used for tissue harvesting on bone chip morphology and vitality. Aim of the present study was to compare histologically and histomophometrically the morphological features and the vitality of bone chips harvested intraorally with five different methods. Material and Methods Five young adult men were recruited for this study. Five bone samples were harvested from the alveolar process of each patient by means of different methods: 1) bone scraper, 2) stainless steel round bur, 3) stainless steel implant spiral bur, 4) piezoelectric device, 5) trephine bur+manual mill. Samples were processed for undecalcified histology and stained with toluidine blue/ pyronine G (Sigma-Aldrich, St Louis, MO). The sections were photographed in a Nikon light microscope (Eclipse E600) equipped with a calibrated digital camera (DXM1200, Nikon, Tokyo, Japan). Histomorphometric analyses were performed to evaluate bone fragment dimensions: fragments with dimensions comprised between 100μm and 1000μm (medium size fragments = MF), fragments smaller than 100μm (small size fragments = SF) and those greater than 1000μm (large size fragments = LF) were differentiated. Total area and percentage area were also evaluated. A stereologic method was used to calculate the percentage of vital bone. Results Five samples for each harvesting procedure were analyzed. Bone fragments harvested using Trephine bur mostly resulted vital and of large dimensions. Spiral and implant bur produced only small and medium fragments but the percentage of nonvital bone was higher than in the other groups. Bone scraper and piezoelectric device produced vital bone fragments with medium-large dimensions. Conclusions Within the limited number of samples evaluated, results of the present study claim that bone scraper and piezoelectric device are the most efficacious procedure on harvesting vital bone fragments.

Les petits moyens en chirurgie préimplantaire

Osteotomes, the bone scraper, and the bone trap are simple tools used for preprosthetic surgery. They are not very invasive, present little risks, and they can be used in private surgical practice with local anaesthesia. The osteotome preserves, dilates, and condenses the alveolar bone instead of eliminating it like drilling does. It does not require any motor or irrigation. It increases the width and the height of the alveolar crest. It allows the localized expansion of narrow or misshapen alveolar crest when its width ranges between 3 and 4.5mm. It also allows performing a localized sinus lift, when the sinus floor height ranges between 4 and 8mm. The bone scraper is used to retrieve cortical chips of parietal bone for sinus lift. The bone trap is connected to the suction tube. It is used to collect bone powder after milling or bone drilling. These simple tools should be available for all maxillofacial surgeons in specific indications.

O.097 Indications and results of oral and maxillofacial piezosurgery

The aim of the present study was to compare the influence of 2 different bone scrapers with respect to graft quality.The study was conducted as a prospective, controlled experimental study of patients selected from the outpatient unit of the Department of Oral Surgery and Radiology (Dental Clinic, Medical University, Graz, Austria). Bone samples were obtained during routine lower third molar removal. Both a manual bone scraper (MS) and a piezoelectric device (PD) were used in directly adjacent regions in each case. As variables, the chip morphology, cell viability, and osteogenic differentiation were investigated. For statistical analysis, the Student t test and Fisher's exact test (P < .05) were applied.A total of 20 patients (12 women and 8 men, mean age 28.15 ± 5.8 years) were included in the study. A series of 40 bone samples was obtained during lower third molar removal. MS and PD enabled similar intraoral harvest of bone chips. In vitro outgrowth of adherent cells was found in 90% of the MS and 80% of the PD samples after 7 to 18 days, without statistical significance (P = .67). Similar cell viability of outgrowing cells in both groups was observed (94.7% ± 2.2% in the MS group and 94.1% ± 1.6% in the PD group). Reverse transcriptase-polymerase chain reaction analysis and the staining pattern verified osteopotent cells in both groups.Both manual and piezoelectric techniques are adequate harvesting technologies for limited intraoral augmentations. Our results did not show an advantage for the piezoelectric device.

A novel bone scraper for intraoral harvesting: a device for filling small bone defects

To evaluate histologically the morphology and characteristics of bone chips harvested intraorally by Safescraper, a specially designed cortical bone collector. Bone chips harvested near a bone defect or in other intraoral sites were grafted into a post-extractive socket or applied in procedures for maxillary sinus floor augmentation or guided bone regeneration. Core biopsies were performed at implant insertion. Undecalcified specimens embedded in PMMA were studied by histology, histochemistry and SEM. Intraoral harvesting by Safescraper provided a simple, clinically effective regenerative procedure with low morbidity for collecting cortical bone chips (0.9-1.7 mm in length, roughly 100 microm thick). Chips had an oblong or quadrangular shape and contained live osteocytes (mean viability: 45-72%). Bone chip grafting produced newly formed bone tissue suitable for implant insertion. Trabecular bone volume measured on biopsies decreased with time (from 45-55% to 23%). Grafted chips made up 50% or less of the calcified tissue in biopsies. Biopsies presented remodeling activities, new bone formation by apposition and live osteocytes (35% or higher). In conclusion, Safescraper is capable of collecting adequate amounts of cortical bone chips from different intraoral sites. The procedure is effective for treating alveolar defects for endosseous implant insertion and provides good healing of small bone defects after grafting with bone chips. The study indicates that Safescraper is a very useful device for in-office bone harvesting procedures in routine peri-implant bone regeneration.

Prevention of amputation caused by rheumatic diseases following a novel therapy of exposing bone marrow, occlusive dressing and subsequent epidermal grafting

Wounds with exposed bones caused by rheumatic diseases commonly result in amputation despite progress in our understanding of wound-healing mechanisms. To determine whether an experimental therapy of bone marrow exposure, an occlusive dressing and subsequent grafting of epidermal sheets accelerates healing and reduces the need for amputation in patients with rheumatic diseases. Fifteen patients, including those with rheumatoid arthritis or systemic sclerosis, who had wounds with exposed bones were treated either with the standard procedure, consisting of local wound care, debridement with a scalpel, bed rest and parenteral antibiotics (n = 8), or with a newly developed experimental procedure (n = 7). In that new procedure, the affected bone was initially exposed by debridement with a scalpel, followed by partial excision with a bone scraper until bleeding was observed from the exposed bone. The lesions were immediately covered with an occlusive dressing, and were eventually treated with epidermal grafts obtained from suction blisters. A comparison with standard therapy demonstrated that the time needed for wound healing was similar, but that the newly developed combination therapy reduced the risk of amputation (P = 0.020). No skin ulcers or erosions were observed for at least 1 year in five of seven patients (72%) due to the adoption of stable palmoplantar-type characteristics in grafts derived from the trunk epidermis. Our study indicates that exposure of bone marrow cells plus an occlusive dressing accelerates the healing of skin ulcers at least partly through the preparation of a healthy well-granulated wound bed and that subsequent epidermal grafting achieves site-specific differentiation through epithelial-mesenchymal interactions.

Rapid healing of intractable diabetic foot ulcers with exposed bones following a novel therapy of exposing bone marrow cells and then grafting epidermal sheets

Diabetic foot ulcers with exposed bones commonly result in amputation. To determine whether exposure of bone marrow cells and subsequent grafting of epidermal sheets accelerates healing and reduces the need for amputation. Thirty-eight patients with chronic wounds caused by diabetes mellitus were enrolled in this study. Epidermal sheets obtained from suction blisters of each patient were grafted on to diabetic foot ulcers without exposed bones (n = 10) and were compared with the standard treatment of local wound care, debridement with a scalpel when indicated, bed rest and parenteral antibiotics (n = 8). In another group of patients, diabetic wounds with exposed bones were treated either with the standard procedure (n = 9) or with a newly developed experimental procedure (n = 11). In that new procedure, the affected bone was initially exposed by debridement with a scalpel, followed by partial excision with a bone scraper until fresh bleeding was observed from the exposed bone. The lesions were then immediately covered with an occlusive dressing, and finally the wound was covered with an epidermal graft of skin harvested from suction blisters. Patients in each group were matched with their counterparts by age, sex, wound size, wound infection and wound duration, to compare the time needed for total skin repair and rates of amputation. Epidermal grafting significantly accelerated the healing of diabetic foot ulcers (P = 0.042) without exposed bones, with site-specific differentiation. The newly developed combination therapy resulted in the healing of all diabetic ulcers with exposed bones without the occurrence of osteomyelitis or the necessity for amputation (P < 0.0001). Our study indicates that early aggressive debridement of diabetic foot ulcers with exposed bones down to a bleeding vascularized base and then grafting epidermal sheets significantly improves healing and reduces the rate of amputation.

A Bone Scraper Excavated from Tategahana, Lake Nojiri, Central Japan

Since 1962, excavations at Tategahana site which is located on the west coast of Lake Nojiri, Central Japan, have been carried out by the Nojiri-ko Excavation Research Group. On the occasion of the 8th excavation in 1981, 1, 064 materials were excavated in total. They include 234 stone artifacts, 19 wooden tools or man-made wooden flakes and 13 bone artifacts which were mainly made of Naumann elephant (Palaeoloxodon naumanni) and Yabe giant deer (Sinomegaceros yabei).Palaeolithic bone tools are, presently, available only in a few archaeological sites such as Hanaizumi, Iwate Pref., the First Cave of Yamashita-cho and Gohezu Cave, Okinawa Pref.; but the bone materials from the latter two caves are in controversy whether they belong to man-made tools or materials made by non-human agencies. In any case, there is not a single artifact in Japan comparable to the bone scraper from Tategahana. A portion of the bone scraper which is flaked off by a single side-blow percussion is identified with a left tibia of Naumann elephant. The shape is oval and it measures 18.5×6.2×1.7cm, and the scraper-edge is retouched from dorsal surface along the sharp margin of the primary flaking. Use-wear and abrasion on the edge surface have also been examined with a binocular microscope.The stratigraphic units of the Lower Nojiri-ko Member are divided into Members I, II and III in ascending order, and the bone scraper has been discovered on the bottom of Section IIIBl. A radiocarbon date of Section IIIA formed right under Section IIIBl indicates 36, 320±1, 130y.B.P. (GaK7792). This suggests that the age of the bone scraper belongs to a little bit younger range than this date.Berelekh is an archaeological site in the U.S.S.R. which reveals some bone scrapers morphologically related to that of Tategahana. But they represent a later stage of Upper Palaeolithic. The Section III of the Lower Nojiri-ko Member includes both stone and bone tools, and the stone industry is less developed than the bone industry.The age of the bone scraper, beyond dispute, coincides with the transitional phase from Neanderthal Man to Modern Man. The present paper focuses on a description of the bone scraper and its related problems. But this will provide some fundamental information for the elucidation of the bone tool manufacturing technology in the East Asian later Pleistocene.