Reciprocating Rasp for Use in Mandibular Anterior Subapical Osteotomy

Abstract

The article describes a reciprocating rasp used in the mandibular anterior subapical osteotomy. Over the past 2 years, reciprocating rasp osteotomy was introduced in the Oral and Craniomaxillofacial Surgery Department of Shanghai Ninth People’s Hospital. No complication such as bleeding, wound infection, or tissue necrosis has been encountered. The use of reciprocating rasp avoids iatrogenic damage to adjacent structures and reduces the time spent operating mandibular anterior subapical osteotomy. Therefore, it is recommended for mandibular anterior subapical osteotomy.

The mandibular anterior subapical osteotomy is a reliable technique to move the alveolus and teeth.1–4 It is now popularly used in the “surgery first” or “surgery early” approach.5,6

Traditionally mandibular anterior subapical osteotomy is performed using a reciprocating saw or piezo device. However, 2 parallel osteotomies are needed, double the time spent for subapical osteotomy. Furthermore, the osteotomy access to the alveolar crest can be hazardous to mucoperiosteal tissue. The mucoperiosteal integrity is essential for the blood supplies of the segmental block of the mandible. Therefore, we use a reciprocator rasp (ConMed Linvatec, Largo, FL) to avoid damage to the soft tissue and reduce the time spent. Here, we demonstrate the sequence of reciprocating rasp for a segmental osteotomy.

TECHNIQUE

The first bicuspids are removed to provide space for the planned alveolar movement, then the attached tissue at the vertical osteotomy sites is elevated. The horizontal incision is designed 5 mm below the first bicuspid root tip. The periosteum is elevated with care about the mental nerve. A hole with a 3 mm diameter is made at the corner of the planned vertical and horizontal osteotomy. Then reciprocating rasp removes the buccolingual socket and the subapical bone. The reciprocating speed is set at 6000 to 8000 strokes per minute. The cone-shape working surface in the extraction socket removes the alveolar crest bone (Fig. 1). The side working surface removes the mesial and distal alveolar fossa bone. At the same time, the osteotomy area is continuously irrigated with saline solution. After ensuring an accessible seating of the teeth into the surgical splint, the segment is stabilized by wiring the teeth and rigid internal fixation of the bone block. Then, the mucoperiosteal incision is stitched using an antibacterial synthetic absorbable suture（Johnson & Johnson, New JerseyNew JerseyJ). There are no complications, such as bleeding, wound infection, or tissue necrosis.

FIGURE 1.

The osteotomy being completed using the reciprocating rasp.

DISCUSSION

The powered rasp is gradually in popularity in orthopedic surgery. This study introduces the reciprocating rasp for use in the mandibular anterior subapical osteotomy. Our technique has the following key points. First, it is necessary to irrigate the osteotomy area with continuous saline solution. Second, the reciprocating speed should be controlled to minimize the risk of thermal damage. Third, the axis of the reciprocating rasp should be parallel to the long axis of adjacent teeth. The advantages of our technique can be summarized as follows. First, other than the sharp edge or tips of power-assisted saw and piezo device, the cone-shape working surface, and flat tip minimizes iatrogenic damage of adjacent teeth root and mucoperiosteal tissue. Second, compared with the traditional technique to remove the bone block with the distal and mesial osteotomy, this technique with the reciprocating rasp removes the bone one-offs, which helps shorten the operation’s time spent and reduce the risk of hemorrhage and perforation. Moreover, osteotomy with reciprocating rasp yields less ecchymosis, edema, and pain in the postoperative period than conventional osteotomy.

In summary, the use of reciprocating rasp avoids iatrogenic damage to adjacent structures and reduces the time spent on the operation. This modified technique is safe, efficient, and minimally invasive. Therefore, it is recommended for mandibular anterior subapical osteotomy.