Ultrasonic Surgical Aspirator to Treat Deep Infrabony Defects: A New Flapless Minimally Invasive Approach

Abstract

The primary outcome of the present study was to assess the percentage of pocket closure, and the secondary aim was to evaluate the clinical performance in terms of clinical attachment level (CAL) gain, probing pocket depth (PPD) reduction, and gingival recession (REC) after the use of cavitron ultrasonic surgical aspirator (CUSA) in deep infrabony defects. Fourteen deep infrabony defects in 11 patients who were previously treated with active periodontal therapy followed by one year of supportive periodontal therapy (at least three sessions) were additionally treated by the aid of CUSA. Eighty-six percent of the initial defects (12 out of 14) resulted in a PD < 5 mm, showing complete resolution six months after CUSA treatment, without any adverse event and with negligible pain (VAS from 0 to 3). CUSA showed potential as a method to promote pocket healing, reduce PPD, and increase clinical attachment (P < 0.001) in deep infrabony defects. This trial is registered with ClinicalTrials.gov NCT03567161.

Figures

Figure 1

In the case of one or two wall defects, it was possible to use the transgingival approach through the very small access cavity on the basis of the papilla. (a) The sonotrode tip contacting the mucosa surface; (b) the small access after the CUSA treatment.

Figure 2

Ultrasound generator: hand-piece recognition and automatic adaptation; three frequencies: 25, 35, and 55 kHz; automatic self-test of all of the important functions predefined power steps or direct adjustment; and optical and acoustical indicator.

Figure 3

The stack of piezoelectric quartzes transforms the electrical energy of the generator into a longitudinal, mechanical vibration of the sonotrode tip.

Figure 4

Example of handpieces and sonostrodes.

Figure 5

This sequence shows an infrasulcular approach to fragment the tissue. The sonotrode was inserted in a periodontal pocket (a). The tip of the device, placed in contact with the tissues, destroys and emulsifies cells that are irrigated and removed through a built-in suction tube (b). After CUSA treatment, a blood clot fills the target area (c, d).

Figure 6

Progression of X-rays showing bone remineralization. Baseline is 12 months after (a) T0. In this case, the PD decreased from 10 mm ((b) baseline) to 4 mm (6 months (c) after CUSA treatment). The CAL gain was 7 mm (from 15 mm to 8 mm).

Figure 7

Progression of X-rays showing bone remineralization. Baseline is 12 months after (a) T0. In this case, the PD decreased from 8 mm ((b) baseline) to 3 mm (6 months (c) after CUSA). The CAL gain was 4 mm (from 10 mm to 6 mm).

Figure 8

Progression of X-rays showing bone remineralization. Baseline is 12 months after (a) T0. In this case, the PD decreased from 9 mm ((b) baseline) to 4 mm (6 months (c) after CUSA). The CAL gain was 6 mm (from 15 mm to 9 mm).

Figure 9

Progression of X-rays showing bone remineralization. Baseline is 12 months after (a) T0. In this case, the PD decreased from 10 mm ((b) baseline) to 4 mm (6 months (c) after CUSA). The CAL gain was 6 mm (from 14 mm to 8 mm).

Figure 10

Distribution of the 11 patients by the VAS score after CUSA treatment.