Interventional sonography describes the step from pure sonographic imaging diagnostics to sonographically controlled treatment that can be connected directly to sonographic imaging diagnostics instead of postponing it over a longer time interval with possibly further (X-ray, computed tomography, magnetic resonance imaging) diagnostics. The sonographically controlled interventional measures range from a simple puncture of fluid-filled spaces to infiltration of deeper lying areas, such as the labrum acetabulare, the dorsal knee joint capsule and facet joints up to infiltration of the sciatic nerve. The safety is guaranteed by adhering to clearly defined hygiene standards as well as by qualified training as part of the 3‑stage model of certification of the surgery section of the German Society of Ultrasound in Medicine (DEGUM). By using modern sonography devices, structures in the submillimeter range are visible even at close range, so that nowadays even splitting of the annular ligament of the finger has become possible under ultrasound control.
UNASSIGNED: Interventionelle Sonographie bezeichnet den Schritt von der reinen sonographischen Bilddiagnostik zur sonographisch kontrollierten Therapie. Diese kann direkt an die Sonographiebilddiagnostik angeschlossen werden, anstatt sie über ein längeres Zeitintervall mit evtl. weiterer Diagnostik (Röntgen, CT, MRT) aufzuschieben. Die sonokontrollierten Interventionsmaßnahmen reichen von einfacher Punktion flüssigkeitsgefüllter Räume über Infiltrationen tiefer gelegener Areale wie z. B. dem Labrum acetabulare, der dorsalen Kniegelenkkapsel, der Facettengelenke bis hin zu Infiltrationen am N. ischiadicus. Die Sicherheit wird sowohl durch Einhalten klar definierter hygienischer Standards als auch durch die qualifizierte Ausbildung im Rahmen des 3‑Stufen-Modells der Zertifizierung der Sektion Chirurgie der Deutschen Gesellschaft für Ultraschall in der Medizin (DEGUM) gewährleistet. Durch den Einsatz moderner Sonographiegeräte sind selbst im Nahbereich Strukturen im Submillimeterbereich sichtbar, sodass in der heutigen Zeit auch Ringbandspaltungen am Finger unter Ultraschallkontrolle möglich sind.

BACKGROUND: The purpose of this study was to evaluate the topographic anatomy of the tibial nerve and its medial calcaneal branches in relation to the tip of the medial malleolus and to the posterior superior tip of the calcaneal tuberosity using the ultrasound examination and to verify its preoperative usefulness in surgical treatment.
METHODS: Bilateral ultrasound examination was performed on 30 volunteers and the location of the tibial nerve bifurcation and medial calcaneal branches origin were measured. Medial calcaneal branches were analysed in reference to the amount and their respective nerves of origin.
RESULTS: In 77% of cases, tibial nerve bifurcation occurred below the tip of the medial malleolus with the average distance of 5.9 mm and in 48% of cases above the posterior superior tip of the calcaneal tuberosity with the average distance of 2.7 mm. In 73% of cases medial calcaneal branches occurred as a single branch originating from the tibial nerve (60%). The average distance of the first, second and third medial calcaneal branch was accordingly 9.3 mm above, 9.5 mm below and 11.6 mm below the tip of the medial malleolus and 17.7 mm above, 1.6 mm below and 4 mm below the posterior superior tip of the calcaneal tuberosity.
CONCLUSIONS: As the tibial nerve and its branches present a huge variability in the medial ankle area, in order to prevent the iatrogenic injuries, the preoperative or intraoperative ultrasound assessment (sonosurgery) of its localisation should be introduced into the clinic.

OBJECTIVE: To compare peri-implant soft- and hard-tissue integration at implants installed juxta- or sub-crestally. Furthermore, differences in the hard and soft peri-implant tissue dimensions at sites prepared with drills or sonic instruments were to be evaluated.
METHODS: Three months after tooth extraction in six dogs, recipient sites were prepared in both sides of the mandible using conventional drills or a sonic device (Sonosurgery(®)). Two implants with a 1.7-mm high-polished neck were installed, one with the rough/smooth surface interface placed at the level of the buccal bony crest (control) and the second placed 1.3 mm deeper (test). After 8 weeks of non-submerged healing, biopsies were harvested and ground sections prepared for histological evaluation.
RESULTS: The buccal distances between the abutment/fixture junction (AF) and the most coronal level of osseointegration (B) were 1.6 ± 0.6 and 2.4 ± 0.4 mm; between AF and the top of the bony crest (C), they were 1.4 ± 0.4 and 2.2 ± 0.2 mm at the test and control sites, respectively. The top of the peri-implant mucosa (PM) was located more coronally at the test (1.2 ± 0.6 mm) compared to the control sites (0.6 ± 0.5 mm). However, when the original position of the bony crest was taken into account, a higher bone loss and a more apical position of the peri-implant mucosa resulted at the test sites.
CONCLUSIONS: The placement of implants into a sub-crestal location resulted in a higher vertical buccal bone resorption and a more apical position of the peri-implant mucosa in relation to the level of the bony crest at implant installation. Moreover, peri-implant hard-tissue dimensions were similar at sites prepared with either drills or Sonosurgery(®).

OBJECTIVE: To compare peri-implant tissue healing at implants installed in sites prepared with conventional drills or a sonic device.
METHODS: In six Beagle dogs, the mandibular premolars and first molars were extracted bilaterally. After 3 months, full-thickness muco-periosteal flaps were elevated and recipient sites were prepared in both sides of the mandible. In the right side (control), the osteotomies were prepared using conventional drills, while, at the left side (test), a sonic device (Sonosurgery(®)) was used. Two implants were installed in each side of the mandible. After 8 weeks of non-submerged healing, biopsies were harvested and ground sections prepared for histological evaluation.
RESULTS: The time consumed for the osteotomies at the test was more than double compared to the conventional control sites. No statistically significant differences were found for any of the histological variables evaluated for hard and soft tissue dimensions. Although not statistically significant, slightly higher mineralized bone-to-implant contact was found at the test (65.4%) compared to the control (58.1) sites.
CONCLUSIONS: Similar healing characteristics in osseointegration and marginal hard tissue remodeling resulted at implants installed into osteotomies prepared with conventional drills or with the sonic instrument (Sonosurgery(®)).