Ultra-sonic bone surgery (USBS) has been recently introduced as a novel osteotomic technique. This clinical study reports on the application of this new technique to perform ridge-split procedures. Over a period of 3.5 years, 57 patients underwent a split-crest procedure with the aim to place 230 implants, 78 in the mandible and 152 in the maxilla, in order to rehabilitate nine full arches, three hemi-arcades, 43 partial bridges and 24 single crowns. The initial ridge width varied between 1.5 and 5 mm, average was 3.2 mm. The final width of the ridge ranged from 4 to 9 mm, average was 6 mm. The split length varied between 4.5 and 40 mm, average was 15 mm. Inserted implants were 3.25-5 mm in diameter however most of them (82.4%) were standard implants of 3.75 mm; implant length was classically 10-13 mm. Two hundred and twenty-eight (99.1%) out of the 230 planned implants were placed, the two non-suitable sites were in the maxilla. In the mandible, the ridge augmentation procedure was drastically eased by performing a basal longitudinal discharge notch. At second stage surgery, eight implants failed to osseointegrate; the success rate for the placed implants was 96.5%. All implants have been loaded for at least 2 months and no implant was lost after loading. One hundred and eighty-one and 77 implants have been loaded for at least 6 and 12 months, respectively. The 3-year life-table analysis of loaded implants showed a cumulative survival rate of 100%. The split-crest procedure performed with USBS showed to be safe and comfortable.

Biofilm elimination is often necessary during antimicrobial therapy or industrial medical manufacturing decontamination. In this context, ultrasound treatment has been frequently described in the literature for its antibiofilm effectiveness, but at the same time, various authors have described ultrasound as a formidable enhancer of bacterial viability. This discrepancy has found no solution in the current literature for around 9 years; some works have shown that every time bacteria are exposed to an ultrasonic field, both destruction and stimulation phenomena co-exist. This co-existence proves to have different final effects based on various factors such as: ultrasound frequency and intensity, the bacterial species involved, the material used for ultrasound diffusion, the presence of cavitation effects and the forms of bacterial planktonic or biofilm. The aim of this work is to analyze current concepts regarding ultrasound effect on prokaryotic cells, and in particular ultrasound activity on bacterial biofilm.

Implant survival rates might be similar in infected and noninfected sites when infected sites receive standard medical and surgical treatment and are ultrasonicated. Atraumatic tooth/root extraction and implant placement can be reliably performed with piezoelectric surgery.

We hypothesize that healing of all treated sites might have resulted from the synergic effect of bone ablation, biofilm alteration, and antibiotic administration. Biofilm alteration might have permitted a better access of antibiotics to the involved germs. These encouraging results warrant further studies on the use of ultrasonic surgery to treat MRONJ patients in order to confirm or refute the hypothesized effect.

This preliminary work documents the use of a powerful piezosurgery device to treat biphosphonate-related osteonecrosis of the jaw (BRONJ) in combination with classical medication therapy. Eight patients presenting 9 BRONJ sites were treated, 2 in the maxilla and 7 in the mandible. Reason for biphosphonate (BiP) intake was treatment of an oncologic disease for 5 patients and osteoporosis for 3. The oncologic and osteoporosis patients were diagnosed with BRONJ after 35-110 months and 80-183 months of BiP treatment, respectively. BRONJ 2 and 3 was found in 4 patients. Resection of the bone sequestrae was performed with a high power ultrasonic (piezo) surgery and antibiotics were administrated for 2 weeks. Soft tissue healing was incomplete at the 2-week control but it was achieved within 1 month. At the 1-year control, soft tissue healing was maintained at all patients, without symptom recurrence. One patient with paraesthesia had abated; of the 2 pa-tients with trismus, one was healed, severity of the second trismus abated. This case report series suggests that bone resection performed with a high power ultrasonic surgery device combined with antibiotics might lead to BRONJ healing. More patients are warranted to confirm the present findings and assess this treatment approach.