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What is the Role of Piezo Devices in Oral Surgery?

This content is based on the article "Role of Piezo Surgery and Lasers in the Oral Surgery Office" published in Dental Clinics of North America (April 2020)

  • Piezo surgery is a useful adjunct in oral surgical procedures because it helps limit any soft tissue damage secondary to bony surgery.
  • Piezo surgery may limit the amount of sinus membrane perforations during the performance of lateral sinus bone augmentation procedures.
  • Laser surgery has a place in soft tissue and hard tissue cutting procedures, and may also have value in the treatment of nerve injuries and periodontal regenerative procedures.

The term piezo is derived from the Greek word piezein, which means pressure. The process consists of crystals and ceramics that become deformed when exposed to electric flows resulting in oscillating movements with ultrasound frequency that has the power to precisely cut bone structures without causing injuries to soft tissue.

ADVANTAGES OF THE PIEZO TECHNIQUE RELATIVE TO DRILLS AND SAWS

  • Greater precision and safety in bone surgery.
  • Less adverse damages to soft tissues.
  • Less potential for associated bone necrosis.
  • A link flood system that ensures work and comfort of the surgeon by increasing visibility through the cavitation effect—physical effect resulting from ultrasound vibration with water that removes debris from the cutting area.
  • Better healing and reduced postoperative swelling of patients.
  • Different angles permit it to be used in areas where it is difficult to see and reach.
  • The absence of macrovibrations make patients feel comfortable during oral surgery procedures under local anesthesia and intravenous sedation.

DISADVANTAGES OF PIEZO SURGERY

  • This procedure should not be used in patients with pacemakers.
  • The financial cost is a consideration.
  • The duration for procedures tends to be longer.
  • There is a learning curve with its use.

Piezo Uses in Oral Surgery

Dentolalveolar surgery

The Piezo device can be used to assist in all types of dentoalveolar surgery, including endodontic and periodontal surgeries.

A systematic review and meta-analysis of randomized controlled trials comparing the piezo versus conventional rotary instruments for third molar surgery showed a lower postoperative pain score, less swelling, and greater mouth opening relative to the conventional group. However, more operation time was needed with the piezo and there was no statistically significant difference in postoperative analgesic use by either group.

  1. Pavlikova G, Folta´n R, Horka´ M, et al. Piezosurgery in oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2011;40:451–7.
  2. De Azevedo ET, Costa DL, Pryzysiezny PE, et al. Using Piezoelectric Sysmte in Oral and Maxillofacial Surgery. Int J Med Surg Sci 2015;2(3):551–5.
  3. Liu J, Hua C, Pan J, et al. Piezosurgery vs conventional rotary instrument in the third molar surgery: a systematic review and meta-analysis of randomized controlled trials. J Dent Sci 2018;13:342–9.
  4. Stu¨binger S, Kuttenberger J, Filippi A, et al. Intraoral piezosurgery: preliminary results of a new technique. J Oral Maxillofac Surg 2005;63:1283–7.
  5. Tsai SJ, Chen YL, Chang HH, et al. Effect of piezoelectric instruments on healing propensity of alveolar sockets following mandibular third molar extraction. J Dent Sci 2012;7:296–300.

Dental implantology

Implant site preparation could allow for the enlargement of only 1 socket wall by using specially designed inserts.

Ridge splitting techniques

Classic ridge splitting involved using chisels with rotation and oscillating saws which was time consuming, technically more difficult, and carried a higher risk of damage to adjacent soft tissues and teeth. The piezo has made this procedure easier and safer to perform with lower risk of thermal necrosis and vertical cusp can be made without damaging adjacent soft tissues and teeth.

Maxillary sinus lifts

This procedure can be accomplished via a lateral window approach with less risk of perforation of the Schneiderian membrane. Reports
show perforation is reduced to as low as 5% with the piezo in the literature. The bony access window can be created with a diamond-coated square or ball insert, and the sinus membrane can be elevated with rounded and soft tissues inserts.

  1. Schaeren S, Jaquie´ ry C, Heberer M, et al. Assessment of nerve damage using a novel ultrasonic device for bone cutting. J Oral Maxillofac Surg 2008;66:593–6.

Inferior alveolar nerve lateralization technique

These are an alternative to augmentation techniques if implants are planned in edentulous jaws. This decreases the risk of damage to the nerve at the osteotomy lines. Schaeren and colleagues showed that direct exposure of a nerve to piezosurgery does not dissect the nerve, but only induces some structural or functional damage. In most cases, the nerve is able to regenerate with the perineurium intact, in contrast with conventional drills or oscillating saws.

  1. chaeren S, Jaquie´ ry C, Heberer M, et al. Assessment of nerve damage using a novel ultrasonic device for bone cutting. J Oral Maxillofac Surg 2008;66:593–6.

Maxillary and mandibular osteotomies in orthognathic surgery

This technique is particularly useful when doing a multiple piece maxillary surgery and maintaining vitality of the teeth in the line of osteotomy. The conclusion from on large study was that the piezo allows for precise cutting and spares soft tissue, such as the brain, dura mater, and palatal mucosa.

  1. Aly LAA. Piezoelectric Surgery: Applications in oral & Maxillofacial Surgery. Future Dental Journal 2018;4:105–11.

Aesthetic facial surgery

This technique is particularly useful for lateral osteotomies in rhinoplasty procedures with less likelihood of lacerating the nasal tissues
and damaging associated vessels. It can also be used in otologic procedures.

Distraction osteogenesis

The piezo creates precise osteotomies owing to micrometric and linear vibrations. There is also less flap damage, which means better vascularization that leads to more successful bone formation by this process.

Enucleation of maxillofacial cysts/resecting odontogenic tumors

This procedure allows for careful removal of thin bone overlying the cyst to reduce damage to the epithelial wall. This technique could mean a reduction in the rate of recurrence of the pathology.

Temporomandibular joint surgery

The piezo device is particularly useful for temporomandibular joint ankylosis cases when performing condylectomies. The LED illumination, continuous irrigation, precise cutting, and preservation of vascular structures, such as the maxillary artery located medially, makes this procedure more effective and safer with a piezo device.

Bone graft harvesting

The piezo device makes it easier to harvest grafts of optimum dimensions. This technique can involve lateral ramus block grafts or symphysis block grafts. The different angled inserts also help with the osteotomy angulations needed for such harvest. A study highlighted the ability of the piezo to provide precise, clean, and smooth cutting with excellent visibility. All grafts integrated without complication, provided enough bone for implant placement with less resorption of the grafts than those harvested by conventional techniques.

  1. Happe A. Use of piezoelectric surgical device to harvest bone grafts from the mandibular ramus, report of 40 cases. Int J Periodontics Restorative Dent 2007;27:241–9.

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Until next time!
CDA Oasis Team

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