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Recently, the terms sugosteogenesis and distraction sugosteogenesis have been introduced to the scientific literature. While the former describes a biologic phenomenon, the latter refers to the clinical technique which relies on the accelerated normal bone healing process that takes place at the osseous walls surrounding a cystic cavity when active negative pressure is applied. The purpose of this study is to provide the biologic bases and the therapeutic principles of this emerging technique. Employing well-stablished biologic principles, clinical evidence from analogous techniques, emerging experimental data, and circumstantial evidence, this study presents the possible mechanism of action of the evacuator for odontogenic cysts (Evocyst), a closed, vacuum-like drain system intended to treat cystic conditions using negative pressure.A review of the literature was done. Keywords for the Medline search were: marsupialization, decompression, odontogenic cysts, effects of negative pressure on bone, and negative pressure wound therapy. In addition, relevant publications from the reference list of the retrieved studies were considered. The matches were evaluated for relevance and analyzed accordingly. Clinical reports used to illustrate the concept of distraction sugosteogenesis were performed following the Declaration of Helsinki on medical protocol and ethics.Currently, the standard of care to manage odontogenic cystic lesions includes marsupialization, enucleation and curettage, decompression, and surgical resection. However, there is a need for an alternative option in which the entity could be treated while promoting bone formation. With large odontogenic cystic conditions treated in a short period of time, distraction sugosteogenesis appears to be a choice.The application of negative pressure to osseous cells produces a stretching that creates mechanical cues that trigger signaling pathways, promotes fluid flow, and enhances angiogenesis. All of them, combined, may explain sugosteogenesis. The clinical application of such parameters may explain the good clinical results obtained with the Evocyst.