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Piezosurgery (piezoelectric bone surgery) is a technique of bone surgery which is gaining popularity in the field of dentistry in the recent years. This device is being used in osteotomies, periodontology and implantology, and oral surgical procedures. Piezoelectric ultrasonic vibrations are utilized to perform precise and safe osteotomies. This article discusses the equipment, biological effects on bone, and advantages and disadvantages of this technology.
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Journal of
Oral Research
and Review
Journal of Oral Research and Review . Volume 8 . Issue 1 . January-June 2016 . Pages 1-48
ISSN 2249-4987
Volume 8 | Issue 1 | January-June 2016
Official Publication of
Panineeya Mahavidyalaya Institute of Dental Sciences & Research Center
www.pmids.org
27
© 2016 Journal of Oral Research and Review | Published by Wolters Kluwer ‑ Medknow
cutting zone that must be minimized by water irrigation.
Overheating of adjacent tissue may alter or delay the healing
response. Reduced rotational speed decreases not only
frictional heat but also cutting efciency. Motorized cutting
tools also decrease tactile sensitivity. Slower rotational speed
necessitates increased manual pressure, which increases the
macrovibration of the cutting tool and further diminishes
sensitivity.[1] Microultrasonic instruments have been developed
with the aim of improving root surface debridement.[2]
Piezosurgery (PS) (Mectron Medical Technology, Carasco, Italy)
uses piezoelectric ultrasonic vibrations to perform precise and
safe osteotomies.[2] Moreover, it reduces damage to osteocytes
and permits good survival of bony cells during harvesting of
bone.[3]
Historical Background
In 1880, piezoelectric effect was discovered by Jacques
and Pierre Curie. In 1953, within the field of dentistry,
ultrasonics established itself mainly in periodontology and
endodontics when Catuna rst reported the cutting effects
of high‑frequency sound waves on the dental hard tissue.[4,5]
In 1955, Zinner rst introduced ultrasound in the periodontal
procedure as ultrasonic scalers introducing a single, bulky
universal tip which now has been replaced by a variety of
site‑specic, slimmer tips.[2] Although ultrasonic osteotomies
Introduction
Periodontitis is a chronic inammatory disease of the supporting
tissues of the teeth. This disease is associated with crestal bone
resorption which alters the morphology of the alveolar process
and also produces reverse osseous architecture at times, which
significantly hinders the removal of bacterial plaque. The
treatment is largely based on the removal of local factors and
restoration of the bony architecture. Traditionally, osseous
surgery has been performed by either manual or motor‑driven
instruments. However, both these methods have their own
advantages and disadvantages.
Manual instruments offer good control when used to remove
small amounts of bone in areas with relatively less dense
mineralization. However, they are difcult to control in
cortical bone, particularly where precise osteotomies are
essential. As a consequence, they are mostly applied for gross
cutting of larger bone segments. Motor‑driven instruments
are often used when bone is very dense. They transform
electric or pneumatic energy into mechanical cutting action
using the sharpened edge of burs or saw blades. These
instruments generate a signicant amount of heat in the
REVIEW ARTICLE
Piezosurgery in dentistry
Dhruvakumar Deepa, Gazal Jain, Tushika Bansal1
Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, 1Department of Periodontology,
Uttaranchal Dental and Medical Research Institute, Dehradun, Uttarakhand, India
Piezosurgery (piezoelectric bone surgery) is a technique of bone surgery which is gaining popularity in the field of dentistry in the recent
years. This device is being used in osteotomies, periodontology and implantology, and oral surgical procedures. Piezoelectric ultrasonic
vibrations are utilized to perform precise and safe osteotomies. This article discusses the equipment, biological effects on bone, and
advantages and disadvantages of this technology.
Key words: Dentistry, implantology, osteotomies, periodontal surgery, piezosurgery, ultrasonic vibration
ABSTRACT
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DOI:
10.4103/2249-4987.182487
How to cite this article: Deepa D, Jain G, Bansal T. Piezosurgery in
dentistry. J Oral Res Rev 2016;8:27-31.
This is an open access article distributed under the terms of the
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License, which allows others to remix, tweak, and build upon the
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For reprints contact: reprints@medknow.com
Address for correspondence:
Dr. Dhruvakumar Deepa,
Department of Periodontology, Subharti Dental College and
Hospital, Meerut - 250 005, Uttar Pradesh, India.
E-mail: deepa_arun@rediffmail.com
Deepa, et al.: Applications of piezosurgery in dentistry
28
Journal of Oral Research and Review
Vol. 8, Issue 1, | January-June 2016
were rst described more than 20 years ago by Horton and
co‑workers, this approach was not pursued for many years. In
2000, Vercellotti et al. renewed this approach for nerve and
soft tissue protecting surgery which overcame the limitations
of traditional instruments in oral bone surgery. It was rst
reported for preprosthetic surgery, alveolar crest expansion,
and sinus grafting.[2,5]
Ultrasonic osteotomy was rst used to reposition the inferior
alveolar nerve (IAN) in 2005 by Bovi, whose case report mentions
better surgical approach, lower risk of damage to the nerve, and
the reduction of mental nerve stretching through the use of a
smaller window and apico‑coronal instrument inclination to
capture the neurovascular bundle, a method that is impossible
with conventional instruments. In subsequent case series,
ultrasonic osteotomy has been described as minimally harmful
in IAN lateralization and transposition, which was referred to as
one of the major indications for this technology.[4] Stübinger et al.
not only reported excellent postoperative healing of ultrasonically
harvested canine eminence bone used for sinus lift but also
noted the need for a longer surgical time.[5] Good average graft
size and healing were also observed in a series of forty cases of
ultrasonic bone harvesting from the mandibular ramus. Cases
have been reported in which ultrasonic osteotomy has been used
successfully for impacted canine exposure, the removal of tissue
in the vicinity of the IAN, periodontal surgery, and the removal
of osseointegrated implants.[4,5]
Recently, autologous bone that had been harvested by different
methods (round bur on low and high‑speed handpiece, spiral
implant bur on low‑speed handpiece, safe scraper, Rhodes back
action chisel, rongeur pliers, gouge‑shaped bone chisel, and
piezoelectric surgery) was examined using microphotography
and histomorphometric analysis that evaluated particle size,
percentage of vital and necrotic bone, and the number of
osteocytes/unit of surface area. The results showed that the best
methods for harvesting vital bone are gouge‑shaped bone chisel,
back action, en block harvesting, rongeur pliers, and piezoelectric
surgery. Bone that has been harvested with a round bur on
low‑ and high‑speed handpieces, a spiral implant bur, or safe
scrapers, is not suitable for grafting because of the absence of
osteocytes and the predominance of nonvital bone.
Recently, Stübinger et al. showed that autologous bone from
the zygomaticomaxillary region that had been harvested with
a piezoelectric device could be used in augmentation for stable
and esthetic placements of oral implants after a 5‑month healing
period.[3,5]
Equipment
Piezoelectric devices usually consist of handpiece and foot
switch that are connected to the main power unit. This has
a holder for the handpiece and contains irrigation uids that
create an adjustable jet of 0–60 ml/min through a peristaltic
pump removing debris from the cutting area and maintains a
blood‑free operating area because of cavitation (production
of imploding bubbles) of the irrigation solution giving greater
visibility particularly in complex anatomical areas by dispersing
coolant uid as an aerosol [Figure 1].[3,4] The instantaneous
frequency is generally automatically controlled in response to the
pressure load on the tip. The parameters under the control of the
operator, apart from the pressure applied, are the pulse frequency
(when available), the rate of delivery of coolant uid, and the
applied power, which in some instruments is limited to 3–16
W and in others has a maximum of as much as 90 W. In most
instruments, power is controlled by selecting the type of bone
to be cut or the procedure to be performed. The peak‑to‑peak
amplitude of tip oscillations, typically in the range of 30–200
mm in the plane perpendicular to the shaft of the working piece
(some instruments also or exclusively oscillate along the shaft),
ensures precise microabrasive incision.[4]
The piezoelectric system is based on the fact that certain
crystalline structures such as quartz will be subject to a change
in shape when placed within an electric eld. If an alternating
voltage at an ultrasonic frequency is applied across a piezoelectric
crystal, it will result in an oscillating shape change of the crystal
at the frequency applied. The resultant vibration produces tip
movement that is primarily linear in direction and generally
allows only 2 sides of the tip to be active at any time [Figure 2].
At present, the most widely used piezoelectric material is lead
zirconate titanate.[6,7] The piezoelectric unit operates in the 25–50
kHz range and is activated by dimensional changes in crystals
housed within the handpiece, as electricity is passed over the
surface of the crystals resulting in more favorable osseous repair
and remodeling in comparison with carbide and diamond burs.
Applications in Dentistry
Piezoelectric equipment can be used for endodontic surgery
(removing root canal fillings and fractured instruments
Figure 1: Piezoelectric Equipment (Courtesy: Mectron Dental India
Pvt. Ltd.)
Deepa, et al.: Applications of piezosurgery in dentistry
29
Journal of Oral Research and Review
Vol. 8, Issue 1, | January-June 2016
from root canals), periodontology and implantology (scaling
subgingival plaque, ostectomy and osteoplasty procedures to
create positive physiologic architecture of bone support of
the involved teeth, bone grafting of an infrabony periodontal
defect, implant site preparation, implant removal, crestal bone
splitting, bone osteotomy or corticotomy, harvesting bone blocks
and bone grafting, sinus lift procedure, ridge augmentation, and
ridge expansion), tooth extraction, cystectomy, maxillofacial
surgery, surgical orthodontic surgery, otological surgery,
neurosurgery, orthopedic, and hand surgery. The advantages of
the piezo‑osteotomy can also be applied to preimplantologic
surgery for augmentative purposes, for example, sinus oor
elevation carries a much lower risk of perforation or injury to
the mucous membrane since soft tissues cannot be damaged
with this method.[3,4,8] and also auto transportation of unerupted
third molars.[9]
Clinical benefits
Unlike traditional cutting instruments, PS offers the possibility
of a cut with the following characteristics:
Micrometric, in as much as the insert, vibrates with a range
of 60–200 μm at a modulated ultrasonic frequency, which,
while cutting, maintains the bone constantly clean, thus
avoiding excessive temperatures
Selective cutting, in as much as the vibration frequency, is
optimal for the mineralized tissues (in fact, to cut the soft
tissues, different frequencies are required)
Safe, in as much as the reduced range of the micrometric
vibrations, offers the possibility to perform surgery with
very great precision. The cut, in fact, could be controlled
as easily as if drawing an outline. This enables osteotomy to
be performed even in close proximity to delicate structures,
such as vasculo‑nervous structures, in general, without
damaging them.[10]
Surgical control with PS is maximum as the strength required
by the surgeon to effect a cut is far less compared to that with
a drill or with oscillating saws. In fact, burs controlled by a
micromotor require greater strength, against the rotating couple
of the instrument, obtained by applying increased pressure of
the hand. As a result, surgical sensitivity is reduced, especially
when there are structures presenting different mineralization or
even more complex soft tissues, where one runs the risk of losing
control of the latter on the drill’s stem. Furthermore, oscillating
saws, with macrovibrations, require a contrast action which is
necessary to perform a cut; even though guaranteeing excellent
linearity, they do not allow control of the depth of the cutting, at
the sides or in the center, and, therefore, it is often necessary to
complete the incision with a scalpel and hammer. From a clinical
point of view, the PS system offers three different power levels:
Low mode indicated for apical endocanal cleaning in
orthodontic surgery
High mode useful for cleaning and smoothing the radicular
surface
Boosted‑mode indicated in bone surgery, necessary in
performing osteotomy and osteoplasty.[11]
Ergonomics
Experience and repeating of the movements form the basis
of surgical movements and this is the principal element to be
taken into consideration when starting to use PS. In fact, in
piezoelectric surgery, the surgical handling required is completely
different from that used with the drills and oscillating saws, as
the piezoelectric cutting employs microvibrations. It thus follows
that in order to increase the capacity of cutting, pressure of
the hand should not be increased (as with bone drills or saws),
since above certain limits, an increase in pressure prevents the
microvibration of the insert; the energy not used for cutting
is thus transformed into heat which, if prolonged, can cause
damage to the tissue. Thus, in order to avoid a surgical obstacle,
it is necessary to calculate the pressure according to the speed
of the insert.[12]
Advantages
1. Piezoelectric bone surgery seems to be more efcient in the
rst phases of bony healing; it induces an earlier increase
in bone morphogenetic proteins, controls the inammatory
process better, and stimulates remodeling of bone as early
as 56 days after treatment[13]
2. It provides faster bone regeneration and healing process
3. Great control of surgical device
4. Selective cutting and minimal operative invasion
5. Reduced traumatic stress
6. Decreased postintervention pain, and
7. No risk of emphysema.[3,8]
Disadvantages
1. The main disadvantage is its slowness. Cutting very dense
bone with ultrasound can take up to 4 times longer than
with a rotary bur
2. Tip breakage can be frequent which makes it necessary to
maintain a stock of tips
3. The cost of ultrasonic osteotomy equipment is more than
mechanical osteotomes
Figure 2: Diagrammatic representation of piezoelectric effect
Deepa, et al.: Applications of piezosurgery in dentistry
30
Journal of Oral Research and Review
Vol. 8, Issue 1, | January-June 2016
4. Longer operating time and increasing the working pressure
impedes the vibration of device that transforms the
vibrational energy into heat, so tissues can be damaged,
therefore, the use of irrigation is essential not only for the
effect of cavitation but also to avoid overheating
5. Moreover, the technique is difcult to learn.[4]
Biological effects on bone
The effects of mechanical instruments on the structure of
bone and the viability of cells are important in regenerative
surgery. Relatively high temperatures, applied even for a short
time, are dangerous to cells and cause necrosis of tissue. There
have been studies about the effect of piezoelectric surgery on
bone and the viability of cells.[14,15] Not only is this technique
clinically effective, but also histological and histomorphometric
observation of postoperative wound healing and formation
of bone in experimental animal models has indicated that
the response of tissue is more favorable after PS than after
conventional bone‑cutting techniques with diamond or carbide
rotary instruments.
The result of a histologic comparison of the effect of a standard
ultrasonic insert to a rotary bur and a surgical chisel was published
in 1975.[16] The ultrasonic insert, like the surgical chisel, was
found to cut and not burnish bone. While the rotary bur was
observed to produce the smoothest surface of bone, the rate of
bone healing proceeded best when the bone was removed by a
surgical chisel or ultrasonic insert. In a follow‑up study, 17 of
clinical and histologic observations using ultrasonic instruments
in the surgical removal of teeth and osseous surgery, ultrasonic
inserts were found to remove bone with ease and preciseness.
There was no evidence of detrimental histologic changes.[17]
In a study by Vercellotti et al., a modulated‑frequency piezoelectric
knife was investigated as a means of performing ostectomy and
osteoplasty.[18] The rate of postoperative level of bone change
was used to compare the effectiveness of this instrument with
a standard carbide bur and a standard diamond bur and the
results indicated that PS provided a more favorable osseous
response than traditional carbide and diamond burs when
surgical ostectomy and osteoplasty procedures were performed.
Because the PS insert vibrated within a width of 60–200 mm
at a modulated ultrasonic frequency, an increase in temperature
was avoided that eliminated bone damage. Ultrasonic osteotomy
preserves the bone microstructure which facilitates bone healing
and, in turn, osseointegration, which is the key to implant
success.[19]
Research has shown that the healing process after the surgical
procedure is facilitated with the use of piezoelectric surgery and
reduces inammatory reaction when the graft is healing, which
helps in stabilizing the live bone tissue after it has been grafted.[20]
Bone block grafting performed with piezoelectric surgery is
a more precise and gentle technique compared with the same
procedure carried out with rotary instruments. Studies conducted
by Majewski have shown that, with the use of piezoelectric
surgery, it was possible to more accurately harvest the correct
shape of block for a ridge defect and to stabilize it in the recipient
site, nally allowing the shaping and contouring of the cortical
part of the graft. Majewski also observed that piezoelectric
surgery was used to delicately shape and thin a layer of cortical
block that could serve as an element supporting the shape of the
reconstructed alveolar process. Another hypotheses stated by the
author includes PS tips do not generate pressure and vibrations
in the bone when it is being prepared whereas it is difcult to
perform with the rotary instruments.[21]
The piezoelectric knife is effective in removing mineralized
tissues. Studies have shown its use in ridge expansion to place
dental implants and also to perform sinus lift procedures.[11]
The advantage of this technique is the ability to cut the bony
window with simplicity and precision, thereby avoiding the risk
of perforating the membrane as a result of the shape of the bone
scalpels working with ultrasonic modulating vibrations. Further
use of piezoelectric elevators lifted the membrane without
heightened risk of perforation even in anatomically complex
situations.[11] Piezosurgical site preparation provides similar
primary stability and short‑term survival rate of an implant
when compared with conventional site preparation techniques.
Stelzle et al. emphasized that the applied load on the handpiece
may increase the preparation speed but it may also increase the
negative thermal effect on the bone.[22]
Wallace et al. conducted a study in which one hundred maxillary
sinus surgeries were performed using the piezoelectric device.
Only seven cases of perforation of the sinus mucosa were
observed. None of these perforations occurred because of the
inserts of the piezoelectric unit and all of them were caused by
the subsequent elevation of the Schneiderian membrane with
hand tools. Perforations occurred due to the presence of bony
septum (four cases) and by manipulation of extremely thin
membranes (three cases).[23] PS is suitable to collect the bone
particles with optimal size and low heat generation, thereby
minimizing the possibility of thermal necrosis. A feature of the
use of PS is the signicant amount of surviving osteoblasts and
osteocytes in bone blocks removed by ultrasonic surgery, besides
that the clinical outcomes sometimes cannot be seem when
compared to surgery with rotary instruments.[24] Gonzalez‑Garcia
et al. conducted a study of 17 vertical alveolar distractions in
the posterior region of the mandible, seven in the right side
and ten in the left side. The results were compared between
two approaches: Conventional technique and piezoelectric
technique. After analyzing several criteria, the authors concluded
that the use of piezoelectric osteotomy in osteogenic distraction
to increase the alveolar ridge height prior to the installation
of dental implants is easier for the surgeon and less prone
to intraoperative complications compared with conventional
osteotomy procedures.[25]
Deepa, et al.: Applications of piezosurgery in dentistry
31
Journal of Oral Research and Review
Vol. 8, Issue 1, | January-June 2016
Overall, the patient’s response is signicantly improved as
compared to traditional instrumentation also piezoelectric
surgery resulting in favorable osseous repair and remodeling
which encourages the clinicians to include this method to their
armamentarium.
Conclusion
PS is a promising, highly precise, and safe bone‑cutting system
that is based on ultrasonic microvibrations which are optimally
adjusted to target only mineralized tissue and spares soft tissue,
nerves, and vessels. The precise nature of the instrument allows
exact, clean, and smooth cut geometries during surgery. If used
judiciously, this could be of great help in performing precise
bone surgeries.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conicts of interest.
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... Unlike implanted devices, piezoelectric devices needed for surgery do not need to be biocompatible, because they do not come in contact with human cells. Therefore, many external devices will make use of lead zirconate titanate (PZT), as it is easier to produce [86]. The typical piezosurgical devices will consist of stacked rings which are given an applied voltage. ...
... There are no macrovibrations which may cause discomfort to the patient or disturbance of surrounding tissue [90]. The tip oscillates in a linear direction, and can span the distance of 60-200 ?m [86]. ...
... Piezosurgery has some other applications in neurosurgery and orthopedic surgery; however, it is limited in equipment fragility and associated expenses [86,90]. The tip of the device frac- tures, creating the need for replacements [88]. ...
... [13] APPLICATIONS IN DENTISTRY Periodontics 1. Supra and subgingival scaling and root planing [8] 2. Curettage of periodontal pockets [8] 3. Crown-lengthening procedures [8] 4. Procuring bone chips/block grafting for periodontal regeneration [8] 5. Osteoplasty and ostectomy to obtain positive bony architecture of bony defects. [15] Oral and maxillofacial surgery 1. Craniomaxillofacial surgeries [11] 2. Enucleation of cyst and tumors [7] 3. Jaw resection [1] 4. Exostoses treatment [14] 5. Removal of osteosynthetic materials [11] 6. Atraumatic extraction of 3 rd molars. [7] Implant surgeries 1. Implant site preparation [8] 2. Extraction for immediate implant placement [1] 3. Bone graft harvesting [1] 4. Alveolar ridge expansion [7] 5. Distraction osteogenesis [11] 6. Sinus lift procedures [1] 7. Nerve mobilization for implant prosthetic issues [14] 8. Removal of implants. ...
... PS can be safely performed in pediatric and medically compromised patients. [7] Disadvantages • Increased operating time required for bone preparation using PS is the main disadvantage [1] • PS needs a different learning curve to acquire both adequate dexterity and a gentle touch [7] • Unavailability of PS inserts with appropriate dimensions makes it is difficult or impossible to perform deeper osteotomies [8] • Tip breakage can be frequent necessitating to maintain a stock of tips [15] • PS device is not as cost effective as the conventional instruments [15] • PS is not advisable in patients and operator using pacemakers. ...
... PS can be safely performed in pediatric and medically compromised patients. [7] Disadvantages • Increased operating time required for bone preparation using PS is the main disadvantage [1] • PS needs a different learning curve to acquire both adequate dexterity and a gentle touch [7] • Unavailability of PS inserts with appropriate dimensions makes it is difficult or impossible to perform deeper osteotomies [8] • Tip breakage can be frequent necessitating to maintain a stock of tips [15] • PS device is not as cost effective as the conventional instruments [15] • PS is not advisable in patients and operator using pacemakers. ...
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Dentistry has undergone significant improvement with a lot of changing concepts involving novel surgical tools over the past two decades. Piezoelectric surgery, also popularly called as piezosurgery (PS), is a rapidly evolving technique of bone surgery which is gaining importance because of its ability to place osteotomy cuts with absolute precision and confidence, especially near the vital structures. Piezosurgical device functions with an ultrasonic frequency (25–29 KHz) resulting in microvibrations in the range of 60–200 µm/s enabling bone cutting that is secured and accurate preserving the underlying neurovascular elements along with improved visibility through bloodless surgical site and thorough debridement using internal irrigation system. Till date, PS has seen wide applications in various disciplines of medicine. In the field of dentistry, PS has emerged as a promising technical modality in bone graft harvesting, alveolar ridge expansion, sinus lift procedures, osteogenic distraction, and endodontic and periodontal surgeries. The present review addresses the efficiency of PS comparing it with the traditional dental surgical equipment. The advantages, limitations, and biological effects of PS as well its various applications in dentistry have also been discussed.
... W HEN it comes to high precision positioning applications, piezoelectric actuators are one of the widely employed. For example, they are used in scanning images based on scanning probe microscopy, diesel injectors, medical micro-robotics, or hard disk drivers [1], [2]. The reason for this recognition is the performances they can offer. ...
... The signum function sgn (·) is defined as in [13] pp. 553. The output equation y h links the hysteresis dynamics with the actuator dynamics, as can be seen in (2). On the other hand, subsystem Ω models the linear actuator dynamics characterized by an internal state x ∈ R n and described by the realization (A, B, C, 0), where A ∈ R n×n < 0, B ∈ R n×1 and C ∈ R 1×n ; parameter d p provides a general slope of the hysteresis; external disturbances (δ h , δ x ) are considered acting on the system. ...
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When designing controllers for piezoelectric systems with hysteresis, usually simplified models are used. This can lead to inaccuracies in the closed-loop system response. In this letter, we pose the problem of tracking stabilization of piezoelectric systems using the generalized Bouc-Wen model, a highly non-linear system rarely used to design controllers. Besides, we consider only partially knowledge of one hysteresis system parameter and external disturbances in all the system states. We propose an interconnected control composed of three parts for the solution: an observer, a virtual hysteresis control, and actuator control. It is demonstrated that the closed-loop system converges in finite time. Simulation experiments were carried out, demonstrating the effectiveness of our approach despite exogenous and unknown disturbances.
... • Piezoelectric bone surgery seems to be more efficient in the first phases of bony healing; it induces an earlier increase in bone morphogenetic proteins, controls the inflammatory process better, and stimulates remodelling of bone as early as 56 days after treatment [25] • It provides faster bone regeneration and healing process • Greater control of surgical device • Selective cutting and minimal operative invasion • Reduced traumatic stress • Decreased post-intervention pain • No risk of emphysema [26]. ...
... • Increased operating time required for bone preparation • Increased cost of the PS equipment as compared with the motor-driven or manual instruments • Longer operating time and increasing the working pressure impedes the vibration of device that transforms the vibrational energy into heat, so tissues can be damaged, therefore, the use of irrigation is essential not only for the effect of cavitation but also to avoid overheating • Moreover, the technique is difficult to learn [26]. ...
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Full-text available
Introduction Dentistry over the past few years has seen a lot of innovations. Recent advances in dentistry include latest diagnostic imaging techniques like ultrasonography, cone beam computed tomography and procedures like microsurgery, implants, lasers and nanotechnology. Ultrasonic vibrations have been used to cut tissues for last two decades [1]. These innovations have made dentistry, as one of the forerunners in medical fraternity. One such novel innovation is piezosurgery (PS) invented by Tomaso Vercellotti and developed by Mectron Medical Technology. It is a true revolution in the field of periodontology and oral implantology [2].
... • Piezoelectric bone surgery seems to be more efficient in the first phases of bony healing; it induces an earlier increase in bone morphogenetic proteins, controls the inflammatory process better, and stimulates remodelling of bone as early as 56 days after treatment [25] • It provides faster bone regeneration and healing process • Greater control of surgical device • Selective cutting and minimal operative invasion • Reduced traumatic stress • Decreased post-intervention pain • No risk of emphysema [26]. ...
... • Increased operating time required for bone preparation • Increased cost of the PS equipment as compared with the motor-driven or manual instruments • Longer operating time and increasing the working pressure impedes the vibration of device that transforms the vibrational energy into heat, so tissues can be damaged, therefore, the use of irrigation is essential not only for the effect of cavitation but also to avoid overheating • Moreover, the technique is difficult to learn [26]. ...
... The use of piezosurgery permits the initial osteotomy to be made delicately and accurately while minimizing injury to the soft-tissue flap and surrounding hard tissue, preserving the vascularity which is the prerequisite for successful new bone formation. 17 It also preserves the original bone structure, especially while performing surgeries on the cancellous bone, which promotes bone healing. Distraction Osteogenesis using piezoelectric osteotomy for Pierre Robin Sequence has shown improved results with precise placement of micro-distractors. ...
Article
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Piezosurgery is an excellent way of performing effective osteotomies, sparing the adjacent soft tissues as well as protecting the adjacent nerves and blood vessels. Improved wound healing and better bone formation have also been reportedusing several experimental studies. This revolutionary tool preserves osteocyte cells, which in turn complement the whole bone healing process. The most wonderful features of piezosurgery is its soft tissue sparing capability, controlled blood loss and better patient comfort, which helped to make this technique an exceptional one in the surgical branches of medicine and dentistry.
... Distraction osteogenesis (DO) is indicated when there is a need for significant amounts of bone augmentation or lengthening, or when the soft tissues that cover the bone will not allow for osseous augmentation. The use of piezosurgery permits the initial osteotomy to be made delicately and accurately while minimizing injury to the soft-tissue flap and surrounding hard tissue, allowing maintenance of the vascularity needed for successful new bone formation [31]. Distraction Osteogenesis (DO) can be used for distraction of either the alveolar bone or the basal jawbone. ...
Chapter
Full-text available
Piezoelectric devices are a revolutionary surgical tool with original application in Oral and Maxillofacial Surgery and then adapted to multiple other surgical specialties, including orthopedic surgery, neurosurgery, and otorhinolaryngology. The major advantage for the surgeon is protection of the soft tissues, which are vital for the outcome and patient’s quality of life. This chapter deals with a description of the equipment, principles of use, advantages/disadvantages, and some common clinical applications. With time, the device and its applications have evolved and continue to diversify.
... Conversely, a known disadvantage of the piezosurgery is that it is time-consuming [1,60,61]. However, in the authors' experience, the slight increase in the overall operative time was largely counterbalanced by the safety of the technique. ...
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Objective: To report the physical and technical principles, clinical applications, and outcomes of the minimal invasive piezoelectric osteotomy in a consecutive veterinary neurosurgical series. Methods: A series of 292 dogs and 32 cats underwent an osteotomy because a neurosurgical pathology performed with a Mectron Piezosurgery® bone scalpel (Mectron Medical Technology, Genoa, Italy) was retrospectively reviewed. Efficacy, precision, safety, and blood loss were evaluated intraoperatively by two different surgeons, on a case-by-case basis. Postoperative Rx and CT scans were used to assess the selectivity and precision of the osteotomy. A histological study on bony specimens at the osteotomized surface was carried out to evaluate the effects of piezoelectric cutting on the osteocytes and osteoblasts. All the patients underwent a six-months follow-up. A series of illustrative cases was reported. Results: All the osteotomies were clear-cut and precise. A complete sparing of soft and nervous tissues and vasculature was observed. The operative field was blood- and heat-free in all cases. A range of inserts, largely different in shape and length, were allowed to treat deep and difficult-to-reach sites. Two mechanical complications occurred. Average blood loss in dogs' group was 52, 47, and 56 mL for traumatic, degenerative, and neoplastic lesions, respectively, whereas it was 25 mL for traumatized cats. A fast recovery of functions was observed in most of the treated cases, early on, at the first sixth-month evaluation. Histology on bone flaps showed the presence of live osteocytes and osteoblasts at the osteotomized surface in 92% of cases. Conclusions: Piezosurgery is based on the physical principle of the indirect piezo effect. Piezoelectric osteotomy is selective, effective, and safe in bone cutting during neurosurgical veterinary procedures. It can be considered a minimal invasive technique, as it is able to spare the neighboring soft tissues and neurovascular structures.
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Piezosurgery is a relatively a new technique of bone surgery, that is recently gaining popularity in implantology, periodontics and oral surgery. Piezoelectric ultrasonic vibrations are utilized to perform precise and safe osteotomies. Becauseof its highly selective and accurate nature, with its cutting effect exclusively targeting hard tissue, its use may be extended to more complex oral surgical procedures, as well as to other interdisciplinary problems. It can be used for selective cutting of bone depending on bone mineralization, without damaging the adjacent soft tissue (e.g. vessels, nerves or mucosa), providing a clear visibility in the operating field, and cutting with sensitivity without the generation of heat. So this review discusses the equipment, mechanism of action biological effects on bone, indications, contraindications, advantages and disadvantages of this new technology.
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Piezosurgery is a relatively new technique of bone surgery that is recently gaining popularity in implantology, periodontics and oral surgery. The piezosurgery device produces specific ultrasound frequency modulation (22 000-35 000 Hz). The unit provides extreme precision and safety as well as micrometric cutting, thus allowing one to selectively section the mineralized bone structures. Moreover, the device causes less bleeding during and after the operation and the healing process is shorter. Due to the aforementioned advantages, an ultrasound device could be utilized in a wide range of surgical procedures, e.g. impacted tooth extraction, elevation of the Schneiderian membrane, bone splitting or expansion of the ridge, preparing bone bed and bone sampling, and corticotomy, not to menton cystectomy.
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Most dental implants are positioned using a drilling surgery technique. However, dentistry recently experienced the implementation of piezoelectric surgery. This technique was introduced to overcome some of the limitations involving rotating instruments in bone surgery. This study used biomolecular and histologic analyses to compare the osseointegration of porous implants positioned using traditional drills versus the piezoelectric bone surgery technique. Porous titanium implants were inserted into minipig tibias. Histomorphology and levels of bone morphogenetic protein (BMP)-4, transforming growth factor (TGF)-beta2, tumor necrosis factor-alpha, and interleukin-1beta and -10 were evaluated in the peri-implant osseous samples. Histomorphological analyses demonstrated that more inflammatory cells were present in samples from drilled sites. Also, neo-osteogenesis was consistently more active in bone samples from the implant sites that were prepared using piezoelectric bone surgery. Moreover, bone around the implants treated with the piezoelectric bone surgery technique showed an earlier increase in BMP-4 and TGF-beta2 proteins as well as a reduction in proinflammatory cytokines. Piezoelectric bone surgery appears to be more efficient in the first phases of bone healing; it induced an earlier increase in BMPs, controlled the inflammatory process better, and stimulated bone remodeling as early as 56 days post-treatment.
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Periodontitis is a chronic inflammatory disease of the tooth-supporting structures. The treatment of this condition is largely based on the removal of local factors and restoration of the bony architecture. Moreover, in the era of modern dentistry, successful implant therapy often requires sound osseous support. Traditionally, osseous surgery has been performed by either manual or motor-driven instruments. However, both these methods have their own advantages and disadvantages. Recently, a novel surgical approach using piezoelectric device has been introduced in the field of periodontology and oral implantology. This article discusses about the wide range of application of this novel technique in periodontology.
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This article describes alveolar ridge reconstruction in the esthetic zone using autogenous bone blocks harvested from the chin, taking into account the way the bone block is harvested, stabilized, and contoured in the recipient site. The 38 procedures were divided into two groups: group 1, using piezoelectric surgery, and group 2, using rotary instruments. The piezoelectric surgery technique made it possible to introduce surgical modifications. An observation of bone regeneration and follow-up clinical observations 5 to 7 years after the procedure revealed that the piezoelectric surgery technique provides better and more predictable clinical results for bone regeneration.
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We used resonance frequency analysis to evaluate the implant stability quotient (ISQ) of dental implants that were installed in sites prepared by either conventional drilling or piezoelectric tips. We studied 30 patients with bilateral edentulous areas in the maxillary premolar region who were randomised to have the implant inserted with conventional drilling, or with piezoelectric surgery. The stability of each implant was measured by resonance frequency analysis immediately after placement to assess the immediate stability (time 1) and again at 90 days (time 2) and 150 days (time 3). In the conventional group the mean (SD) ISQ for time 1 was 69.1 (6.1) (95% CI 52.4-77.3); for time 2, 70.7 (5.7) (95% CI 60.4-82.8); and for time 3, 71.7 (4.5) (95% CI 64.2-79.2). In the piezosurgery group the corresponding values were: 77.5 (4.6) (95% CI 71.1-84.3) for time 1, 77.0 (4.2) (95% CI, 69.7-85.2) for time 2, and 79.1 (3.1) (95% CI 74.5-87.3) for time 3. The results showed significant increases in the ISQ values for the piezosurgery group at each time point (p=0.04). The stability of implants placed using the piezoelectric method was greater than that of implants placed using the conventional technique.
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Autotransplantation is a well-known method used in oral surgery. However, risk of failure, most commonly resulting from root resorption of the transplanted tooth or ankylosis, is quite high. Piezosurgery with specific device tip vibration frequencies enables selective tissue cutting, and therefore, tooth buds or teeth can easily be removed from bones with little injury to periodontal fibers or bud follicles.
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Objectives Piezoelectric surgery (PS) is meant to be a gentle osteotomy method. The aim of this study was to compare piezosurgical vs. conventional drilling methods for implant site preparation (ISP) - focusing on load-dependent thermal effect on hard tissue and the expenditure of ISP time. Materials and methodsThree hundred and sixty ISP were performed on ex vivo pig heads using piezosurgery, spiral burs (SB) and trephine burs (TB). The load applied was increased from 0 to 1000g in 100-g intervals. Temperature within the bone was measured with a thermocouple, and duration was recorded with a stop watch. Thermal effects were histomorphometrically analysed. Twelve ISPs per technique were performed at the lateral wall of the maxillary sinus. ResultsPS yields the highest mean temperatures (48.63.4 degrees C) and thermal effects (200.7 +/- 44.4m), both at 900-1000g. Duration is reduced with a plus of load and significantly longer in either case for PS (P<0.05). There is a correlation of the applied load with all other examined factors for PS and TB. Temperature and histological effects decrease for SB beyond 500g. ConclusionsPS yields significantly higher temperatures and thermal tissue alterations on load levels higher than 500g and is significantly slower for ISP compared to SB and TB. For ISP with PS, a maximum load of 400g should be maintained.
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Little is known about the recently introduced ultrasonic implant site preparation. The purpose of this study was to compare material attrition and micromorphological changes after ultrasonic and conventional implant site preparations. Implant site preparations were performed on fresh bovine ribs using one conventional (Straumann, Freiburg, Germany) and two ultrasonic (Piezosurgery®; Mectron Medical Technology, Carasco, Italy and Variosurg®; NSK, Tochigi, Japan) systems with sufficient saline irrigation. Sections were examined by environmental scanning electron microscopy (ESEM). Energy-dispersive X-ray spectroscopy (EDX) was performed to evaluate the metal attrition within the bone and the irrigation fluid. ESEM: After conventional osteotomy, partially destroyed trabecular structures of the cancellous bone that were loaded with debris were observed, whereas after ultrasonic implant site preparations, the anatomic structures were preserved. EDX: None of the implant site preparation methods resulted in metal deposits in the adjacent bone structures. However, within the irrigation liquid, there was significantly higher metal attrition with ultrasonic osteotomy (P < 0.0001 and P < 0.0001 for Mectron and NSK, respectively). Whereas for Straumann system used, 15.5% of the SEM/EDX findings were drill-origin metals, this percentage increased to 37.3% and 37.9% with the application of Mectron and NSK, respectively. Ultrasonic implant site preparation is associated with the preservation of bone microarchitecture and with the increased attrition of metal particles. Therefore, copious irrigation seems to be even more essential for ultrasonic implant site preparation than for the conventional method.