Piezosurgery: Basics and Possibilities

Abstract

Useful in a variety of oral surgery procedures, piezosurgery has therapeutic features that include a micrometric cut (precise and secure action to limit tissue damage, especially to osteocytes), a selective cut (affecting mineralized tissues, but not surrounding soft tissues), and a clear surgical site (the result of the cavitation effect created by an irrigation/cooling solution and oscillating tip). Because the instrument's tip vibrates at different ultrasonic frequencies, since hard and soft tissues are cut at different frequencies, a "selective cut" enables the clinician to cut hard tissues while sparing fine anatomical structures (e.g., schneiderian membrane, nerve tissue). An oscillating tip drives the cooling-irrigation fluid, making it possible to obtain effective cooling as well as higher visibility (via cavitation effect) compared to conventional surgical instruments (rotating burs and oscillating saws), even in deep spaces. As a result, implantology surgical techniques such as bone harvesting (chips and blocks), crestal bone splitting, and sinus floor elevation can be performed with greater ease and safety.

Comparison of piezosurgery and traditional saw in bimaxillary orthognathic surgery

“…In the following decades, it has been applied to the following more challenging oral surgical procedures: alveolar ridge expansion (Blus and Szmukler-Moncler, 2006;Schlee et al, 2006) exposure of impacted canines (Grenga and Bovi, 2004), lateralisation of the inferior alveolar nerve (Bovi, 2005), sinus lifts for the placement of implants (Eggers et al, 2004;Stübinger et al, 2005;Barone et al, 2008), endodontic and periodontal surgery (Vercellotti and Pollack, 2006;Peñarrocha et al, 2007), and to harvest autologous bone grafts (Sohn et al, 2007). The end of the second millennium saw the growing clinical introduction of the ultrasonic scalpel (Shelley and Shelley, 1986;Lee and Park, 1999;Gonzalez-Garcia et al, 2009), and it has become competitive with conventional instruments in maxillo-facial surgery for orthognathic operations in certain frameworks (Stübinger et al, 2005;Kotrikova et al, 2006;Landes et al, 2008aLandes et al, , 2008bBeziat et al, 2009;Gilles et al, 2013;Hoffmann et al, 2013).…”

Piezosurgical Mandibular Ridge Expansion for Immediate Implant Placement

“…It facilitates maintenance of a clear surgical site as a result of the cavitation effect created by irrigation and oscillation of the tip. 23 Also, the piezosurgical system can split a very narrow ridge with minimal loss or perforation of bone. 6,24 Finally, the piezosurgery can be used in dense mineralized bone because the vertical dimension of the bone is maintained while the width permits no implant insertion.…”

Escalating Role of Piezosurgery in Dental Therapeutics

“…The ultrasonic tip vibrates at a controlled speed of 60-200mm/sec which is targeted to cut only mineralized tissue without damaging adjacent soft tissues [12]. Frequency above 50khz is only capable of cutting neurovascular tissues and other soft tissues [13]. The vibration amplitude is also adjustable in the range of 30-60 micro meter.This allows constant and instantaneous adaptation of the power required depending on the resistance encountered by the tip.The power of the device is adjusted at 5W.…”