Mauro Ferri Niklaus P. Lang Edwin El  ıas Angarita Alfonso Iv an Dar  ıo Bedoya Quintero Enrique Mej  ıa Burgos Daniele Botticelli Use of sonic instruments for implant biopsy retrieval Authors’ affiliations: Mauro Ferri, Edwin El  ıas Angarita Alfonso, Iv an Dar  ıo Bedoya Quintero, Enrique Mej  ıa Burgos, Universidad Militar Nueva Granada, Fundaci on CIEO, Bogot a, Colombia Niklaus P. Lang, Universities of Berne and Zurich, Switzerland Daniele Botticelli, ARDEC, Ariminum Odontologica, Rimini (Italy) and Faculty of Dentistry, University of Medical Science, La Habana, Cuba Corresponding author: Daniele Botticelli Division of Oral Surgery, ARDEC, Ariminum Odontologica, Rimini, Italy Tel.: +39 0541 393444 Fax: +39 0541 397044 e-mail: daniele.botticelli@ardec.it Key words: biopsy, dental implants, histology, in vitro study , sonosurgery â , sonic instrument, trephine Abstract Objective: To evaluate in vitro the quality of dental implant biopsies collected using trephines or a sonic instrument. Method: Sixty implants, 4 mm long and 2.4 mm in diameter, were installed in twelve fresh bovine ribs. Biopsies were collected after using three different methods for retrieval, 20 biopsies representing each group: (A) A trephine used concentrically; (B) a trephine used eccentrically; and (C) a sonic device (Sonosurgery â ). The time used for biopsy collection was recorded, and an evaluation of the quality of the biopsies obtained was performed. The specimens were subsequently prepared for ground sections, and tissue-to-implant contact percentages (TIC%) were evaluated in a stereomicroscope. Results: Time needed for biopsy collection in Groups A and B was between 2 and 3 min, while in C, it amounted to 10–11 min. The differences between Group C and the other two groups were statistically significant (P < 0.00006). Group C showed significantly greater volumes of tissue around the apex of the implants compared with the other two groups (P < 0.027). Groups A and C showed biopsies with higher quality compared with Group B (P < 0.05). Group C presented a higher TIC% compared with the other two groups (P < 0.008). Conclusion: Compared with the use of trephines, the use of a sonic device for harvesting biopsies resulted in higher-quality biopsies and generated smaller residual defects. However, the harvesting was more time-consuming and was limited to one aspect of the implants. Human bone biopsies are usually collected with trephines. Nevertheless, this method may potentially damage the biopsy, espe- cially when soft tissues are to be harvested (Bosshardt et al. 2011; Lang et al. 2011). In fact, in a human study in which osseointe- gration of implants with different surfaces was evaluated (Lang et al. 2011), of 49 implants installed, only 30 biopsies (61%) were available for histological analysis. To obtain high-quality biopsies, it may be necessary to increase their dimensions. In a human study (Donati et al. 2013), 8-mm-long and 3.5-mm-diameter implants were used and retrieved after healing using trephines with an internal diameter of 5 mm. Three implants failed to integrate, but all the collected biop- sies were available for histological analyses. Soft tissue biopsy harvesting is also associ- ated with difficulties. To overcome such problems, punch biopsies of peri-implant soft tissues were successfully harvested (Tomasi et al. 2014). However, this method was lim- ited to the interpretation of the soft tissue. The surrounding marginal bone tissue could not be evaluated. Another important issue to be considered, if human biopsies have to be harvested, is the volume of the residual defect at the donor sites. The trephine has limitations in flexibility in usage. In fact, the use of a tre- phine with a larger diameter, aiming to increase the volume of the biopsy, will also increase the size of the residual defect expo- nentially, because all the circumferential tis- sues will be included. The total volume of tissues around implant may not be needed to answer a well-defined research question. The limitations mentioned for the use of trephines lead to the exploration of other devices more versatile in usage and less traumatic for the collection. Date: Accepted 25 June 2014 To cite this article: Ferri M, Lang NP, Angarita Alfonso EE, Bedoya Quintero ID, Burgos EM, Botticelli D. Use of sonic instruments for implant biopsy retrieval. Clin. Oral Impl. Res. 26, 2015, 1237–1243 doi: 10.1111/clr.12466 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1237