Bone characteristics following osteotomy surgery: an in vitro SEM study comparing traditional Lindemann drill with sonic and ultrasonic instruments

Osteotomy surgery is widely used in dental surgery for implant site preparation, bone grafting and GBR. In this study, the characteristics of bone surfaces were examined after bone osteotomy surgery performed with the Lindemann bur, sonic (Komet Sonosurgery) and ultrasonic (Mectron Piezosurgery) instruments. Materials and Methods. Anatomic integrity and osteotomic precision were analyzed using Scanning Electron Microscopy (SEM) to observe vascular canals, microfractures, exfoliations and bone debris on cortical and cancellous surfaces cut with the 3 types of instruments. Results. The use of ultrasonic instruments resulted in extremely precise cuts and reduced bone damage. The sonic instrument was precise in cortical bone but showed minor signs of bone damage in cancellous bone. Lindemann bur showed less precision and higher bone damage both in cortical and in cancellous bone. In cortical bone, ultrasonic and sonic cuts showed nicely opened bone vascular canals, while Lindemann bur showed many canals closed by abrasions, exfoliation and cracks by dragging attrition. In cancellous bone, ultrasonic cut showed intact trabeculae and trabecular spaces free of debris, while sonic cut showed more debris accumulation in trabecular spaces. Lindemann bur showed huge quantity of bone debris that filled trabecular spaces. Discussion and Conclusion. For all parameters, the ultrasonic cut offered the most precise and atraumatic bone cut. Ultrasonic and sonic instruments both showed more precise and less traumatic results than the Lindemann bur.