Low-Intensity Pulsed Ultrasound in Maxillofacial Bone Healing: A Systematic Review

Abstract

Background: Low-intensity pulsed ultrasound (LIPUS) is a non-invasive biophysical modality shown to enhance bone healing through mechanotransduction. Its role in maxillofacial bone regeneration remains less clearly defined compared with orthopaedic applications. Methods: This systematic review was conducted in accordance with PRISMA guidelines, synthesizing clinical and translational evidence on the use of LIPUS in maxillofacial bone healing. Electronic databases were searched for studies published between 2000 and 2025 evaluating mandibular fractures, distraction osteogenesis, orthognathic surgery, and dental implant osseointegration treated with LIPUS. Outcomes relevant to bone union, mineralization, pain reduction, and functional recovery were narratively analyzed, and risk of bias was assessed using appropriate standardized tools. Results: Included studies demonstrated accelerated radiographic union, increased early bone density, enhanced callus maturation, improved peri-implant bone preservation, and reduced postoperative pain with LIPUS therapy.Several studies also reported earlier functional recovery and improved clinical stability compared with conventional treatment protocols. However, heterogeneity in study design, outcome measures, and treatment parameters was noted, highlighting the need for standardized protocols and high-quality randomized controlled trials. Conclusion: LIPUS appears to be a safe and promising adjunct for maxillofacial bone healing, although further high-quality randomized trials are required to establish standardized protocols and definitive clinical guidelines.

Introduction

Low-intensity pulsed ultrasound (LIPUS) is a non-invasive therapy that enhances bone healing through mechanotransduction, delivering acoustic waves (~1.5 MHz, 30 mW/cm², ~20 min/day) that stimulate cells without thermal damage. LIPUS activates integrin-mediated focal adhesion kinase (FAK) and downstream ERK/MAPK pathways, upregulates osteogenic transcription factors (BMP-2, Runx2), modulates RANK/RANKL/OPG signaling, and promotes angiogenesis via VEGF and eNOS, thereby supporting the inflammatory, reparative, and remodeling phases of bone repair.

In the maxillofacial region, healing is challenged by complex anatomy, high vascularity demands, and functional loading. Clinical and preclinical evidence demonstrates that LIPUS:

• Accelerates fracture union and callus maturation in mandibular fractures, including condylar fractures.

• Enhances bone density and consolidation in orthognathic surgery and distraction osteogenesis.

• Improves osseointegration and peri-implant bone formation in dental implant procedures.

• Reduces postoperative pain and improves functional recovery.

Systematic review findings, though limited by small sample sizes and heterogeneous protocols, support LIPUS as a safe, adjunctive therapy that can reduce healing time, improve bone quality, and aid non-invasive management in selected craniofacial cases. Standardization of clinical protocols and larger trials are needed to confirm routine adoption.

Conclusion

LIPUS therapy holds substantial promise as a safe, non-invasive, and effective adjunct to enhance bone healing in the maxillofacial region. Its mechanism, which centers on accelerating the cellular and molecular events of osteogenesis, is well-established. Clinical evidence, particularly for mandibular fractures, suggests a reduction in healing time. However, to firmly establish LIPUS as a standard of care in maxillofacial trauma and reconstructive surgery, more robust and consistent evidence is required

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Copyright

Copyright © 2026 Dr. Gayathri G., Dr. Fiona Vijay, Dr. Mohammed Afradh K., Dr. Yeshwanth Krishna L.. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.