Dynamics of bone healing after osteotomy with piezosurgery or conventional drilling – histomorphometrical, immunohistochemical, and molecular analysis

Journal of Translational Medicine

Giuseppe Intini⁵  Katarzyna Wilk³  Rosemary Adriana Marcantonio⁴  Fernanda Regina Godoy Rocha⁴  Ana Paula de Souza Faloni²  Elcio Marcantonio Jr¹  Jônatas Caldeira Esteves³ 

[1] Department of Diagnosis and Surgery - Periodontics, UNESP - Univ EstadualPaulista, Araraquara Dental School, Araraquara, SP, Brazil;Implantology Post Graduation Course, University Center of Araraquara–UNIARA,Araraquara, São Paulo, Brazil;Department of Oral Medicine, Infection, and Immunity, Harvard School of DentalMedicine – Harvard University, 188 Longwood Avenue, Boston, MA 02115 –REB 403, USA;Department of Diagnostic and Sugery, Araraquara Dental School, Univ EstadualPaulista – UNESP, Araraquara, São Paulo, Brazil;Harvard Stem Cell Institute, Cambridge, MA, USA

关键词: Bone drilling;    Bone surgery;    Osteotomy system;    Bone healing;    Piezosurgery;   

Others  :  826430
DOI  :  10.1186/1479-5876-11-221

 received in 2013-08-04, accepted in 2013-09-10,  发布年份 2013

【 摘 要 】

Background

Piezosurgery is an osteotomy system used in medical and dental surgery. Many studies have proven clinical advantages of piezosurgery in terms of quality of cut, maneuverability, ease of use, and safety. However, few investigations have tested its superiority over the traditional osteotomy systems in terms of dynamics of bone healing. Therefore, the aim of this study was to evaluate the dynamics of bone healing after osteotomies with piezosurgery and to compare them with those associated to traditional bone drilling.

Methods

One hundred and ten rats were divided into two groups with 55 animals each. The animals were anesthetized and the tibiae were surgically exposed to create defects 2 mm in diameter by using piezosurgery (Piezo group) and conventional drilling (Drill group). Animals were sacrificed at 3, 7, 14, 30 and 60 days post-surgery. Bone samples were collected and processed for histological, histomorphometrical, immunohistochemical, and molecular analysis. The histological analysis was performed at all time points (n = 8) whereas the histomorphometrical analysis was performed at 7, 14, 30 and 60 days post-surgery (n = 8). The immunolabeling was performed to detect Vascular Endothelial Growth Factor (VEGF), Caspase-3 (CAS-3), Osteoprotegerin (OPG), Receptor Activator of Nuclear Factor kappa-B Ligand (RANKL), and Osteocalcin (OC) at 3, 7, and 14 days (n = 3). For the molecular analysis, animals were sacrificed at 3, 7 and 14 days, total RNA was collected, and quantification of the expression of 21 genes related to BMP signaling, Wnt signaling, inflammation, osteogenenic and apoptotic pathways was performed by qRT-PCR (n = 5).

Results

Histologically and histomorphometrically, bone healing was similar in both groups with the exception of a slightly higher amount of newly formed bone observed at 30 days after piezosurgery (p < 0.05). Immunohistochemical and qRT-PCR analyses didn’t detect significant differences in expression of all the proteins and most of the genes tested.

Conclusions

Based on the results of our study we conclude that in a rat tibial bone defect model the bone healing dynamics after piezosurgery are comparable to those observed with conventional drilling.

【 授权许可】

   
2013 Esteves et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Chacon GE, Bower DL, Larsen PE, McGlumphy EA, Beck FM: Heat production by 3 implant drill systems after repeated drilling and sterilization. J Oral Maxillofac Surg 2006, 64:265-269.
• [2]Queiroz TP, Souza FA, Okamoto R, Margonar R, Pereira-Filho VA, Garcia IR Jr, Vieira EH: Evaluation of immediate bone-cell viability and of drill wear after implant osteotomies: immunohistochemistry and scanning electron microscopy analysis. J Oral Maxillofac Surg 2008, 66:1233-1240.
• [3]Eggers G, Klein J, Blank J, Hassfeld S: Piezosurgery: an ultrasound device for cutting bone and its use and limitations in maxillofacial surgery. Br J Oral Maxillofac Surg 2004, 42:451-453.
• [4]Leclercq P, Zenati C, Amr S, Dohan DM: Ultrasonic bone cut part 1: State-of-the-art technologies and common applications. J Oral Maxillofac Surg 2008, 66:177-182.
• [5]Schlee M, Steigmann M, Bratu E, Garg AK: Piezosurgery: basics and possibilities. Implant Dent 2006, 15:334-340.
• [6]Barone A, Santini S, Marconcini S, Giacomelli L, Gherlone E, Covani U: Osteotomy and membrane elevation during the maxillary sinus augmentation procedure. A comparative study: piezoelectric device vs. conventional rotative instruments. Clin Oral Implants Res 2008, 19:511-515.
• [7]Happe A: Use of a piezoelectric surgical device to harvest bone grafts from the mandibular ramus: report of 40 cases. Int J Periodontics Restor Dent 2007, 27:241-249.
• [8]Danza M, Guidi R, Carinci F: Comparison between implants inserted into piezo split and unsplit alveolar crests. J Oral Maxillofac Surg 2009, 67:2460-2465.
• [9]Bovi M, Manni A, Mavriqi L, Bianco G, Celletti R: The use of piezosurgery to mobilize the mandibular alveolar nerve followed immediately by implant insertion: a case series evaluating neurosensory disturbance. Int J Periodontics Restor Dent 2010, 30:73-81.
• [10]Landes CA, Stubinger S, Rieger J, Williger B, Ha TK, Sader R: Critical evaluation of piezoelectric osteotomy in orthognathic surgery: operative technique, blood loss, time requirement, nerve and vessel integrity. J Oral Maxillofac Surg 2008, 66:657-674.
• [11]Kramer FJ, Ludwig HC, Materna T, Gruber R, Merten HA, Schliephake H: Piezoelectric osteotomies in craniofacial procedures: a series of 15 pediatric patients. Technical note. J Neurosurg 2006, 104:68-71.
• [12]Claire S, Lea SC, Walmsley AD: Characterisation of bone following ultrasonic cutting. Clin Oral Investig 2013, 17:905-912.
• [13]Sortino F, Pedulla E, Masoli V: The piezoelectric and rotatory osteotomy technique in impacted third molar surgery: comparison of postoperative recovery. J Oral Maxillofac Surg 2008, 66:2444-2448.
• [14]Maurer P, Kriwalsky MS, Block Veras R, Vogel J, Syrowatka F, Heiss C: Micromorphometrical analysis of conventional osteotomy techniques and ultrasonic osteotomy at the rabbit skull. Clin Oral Implants Res 2008, 19:570-575.
• [15]Horton JE, Tarpley TM Jr, Wood LD: The healing of surgical defects in alveolar bone produced with ultrasonic instrumentation, chisel, and rotary bur. Oral Surg Oral Med Oral Pathol 1975, 39:536-546.
• [16]Vercellotti T, Nevins ML, Kim DM, Nevins M, Wada K, Schenk RK, Fiorellini JP: Osseous response following resective therapy with piezosurgery. Int J Periodontics Restor Dent 2005, 25:543-549.
• [17]Ma L, Stubinger S, Liu XL, Schneider UA, Lang NP: Healing of osteotomy sites applying either piezosurgery or two conventional saw blades: a pilot study in rabbits. Int Orthop 2013, 37(8):1597-1603.
• [18]Preti G, Martinasso G, Peirone B, Navone R, Manzella C, Muzio G, Russo C, Canuto RA, Schierano G: Cytokines and growth factors involved in the osseointegration of oral titanium implants positioned using piezoelectric bone surgery versus a drill technique: a pilot study in minipigs. J Periodontol 2007, 78:716-722.
• [19]Schneider CA, Rasband WS, Eliceiri KW: NIH Image to ImageJ: 25 years of image analysis. Nat Meth 2012, 9:671-675.
• [20]dos Santos PL, Queiroz TP, Margonar R, Gomes de Souza Carvalho AC, Okamoto R, de Souza Faloni AP, Garcia IR Jr: Guided implant surgery: what is the influence of this new technique on bone cell viability? J Oral Maxillofac Surg 2013, 71:505-512.
• [21]Livak KJ, Schmittgen TD: Analysis of relative gene expression data using real-time quantitative PCR and the 2(−Delta Delta C(T)) Method. Methods 2001, 25:402-408.
• [22]Miura M, Chen XD, Allen MR, Bi Y, Gronthos S, Seo BM, Lakhani S, Flavell RA, Feng XH, Robey PG, et al.: A crucial role of caspase-3 in osteogenic differentiation of bone marrow stromal stem cells. J Clin Invest 2004, 114:1704-1713.
• [23]Chim SM, Tickner J, Chow ST, Kuek V, Guo B, Zhang G, Rosen V, Erber W, Xu J: Angiogenic factors in bone local environment. Cytokine Growth Factor Rev 2013, 24:297-310.
• [24]Hollinger JO, Kleinschmidt JC: The critical size defect as an experimental model to test bone repair materials. J Craniofac Surg 1990, 1:60-68.
• [25]Lowery JW, Pazin D, Intini G, Kokabu S, Chappuis V, Capelo LP, Rosen V: The role of BMP2 signaling in the skeleton. Crit Rev Eukaryot Gene Expr 2011, 21:177-185.
• [26]Baron R, Kneissel M: WNT signaling in bone homeostasis and disease: from human mutations to treatments. Nat Med 2013, 19:179-192.