Piezo surgery – a broad spectrum of applications in oral surgery

by Christian Kurz

* first published in PIP 5/2018, pages 90-91

In the age of minimally invasive treatment, dental surgeons and oral and maxillofacial surgeons are increasingly employing piezoelectric devices for the preparation of bone tissue. They allow particularly atraumatic preparation of hard tissue on the basis of ultrasonic surgery technology and the cavitation effect allows an almost blood-free operating field.

Doing away with prejudices

Whilst piezo surgery was formerly considered a slow procedure, the latest generation of devices performs significantly better and the cutting and ablation performance has been improved considerably.

The great advantage of piezo surgery in dentistry is that it is selectively effective for hard substances such as bone and teeth: while the surrounding soft tissue absorbs the vibration of the predominantly metallic instruments and “vibrates along”, calcified tissue is selectively ablated for specific preparation of bone. This offers significant advantages for various indications, which require atraumatic bone preparation in the immediate vicinity of important soft-tissue structures such as nerves, the gingiva and even the mucous membrane in the sinus cavity. Thin saws measuring just 0.25 mm in thickness allow very precise osteotomies without significant bone loss.

Alveolar management

One application, which is often underestimated is the atraumatic extraction of tooth roots or root fragments in the scope of alveolar management. The fine periotomes, which are currently available in two versions (EX1 and EX2 from W&H), can also be used to remove teeth which have previously undergone special endodontic treatment or ankylosed roots with ease. This results in extraction alveoli where both the hard and soft tissue are fully intact as it is generally possible to avoid reflection.

This establishes the optimal basis for subsequent or immediate implant treatment (Figures 1 and 2 included with the kind permission of Dr Torsten Conrad, Bingen a. Rhein).

Internal sinus lift

W&H also offers the perfect solution for the internal sinus lift.

Following preparation of the maxillary sinuses with the corresponding instrument set (Fig. 3), the new Z35P instrument (Fig. 4) is used to lift the membrane hydrodynamically. The same instrument set can also be used for piezosurgical preparation of the implant bed in increasing diameters (Figures 3 and 4 included with the kind permission of Dr Mario Kirste, Frankfurt/Oder).

Reduction of morbidity risk

Another important property of piezoelectric devices, which is an indication for the use of piezo technology, is the possibility of using instruments to redirect the preparation vibrations. The retrograde preparation can be done very elegantly using piezoelectric devices by redirecting the vibration energy within the instrument. The resulting reduced preparation of hard and soft tissue allows smaller accesses and thus reduces perioperative morbidity of patients following apical resection.

Detection of instruments

The development of the innovative Piezomed device by W&H incorporates significant advances in the instruments and the general transmission energy compared to conventional performance parameters. The system also improves handling with an automatic system for detecting instruments, which defines the ideal settings for the specific instrument. Piezomed also provides optimal illumination of the surgical site with a light LED ring integrated in the handpiece, facilitating a good view even into the posterior regions.

Conclusion

It is clear that the latest Piezomed generation represents a clear alternative to conventional rotary instruments with its optimal protection and preservation of the neighbouring soft tissue. The absolute indications are:

• Osteotomies in the hard tissue in the crestal and horizontal regions
  
• Preparation for bone spreading/splitting
  
• Lifting of retromolar bone blocks
  
• Harvesting of autologous bone with special scrapers
  
• Sinus lift with lateral window
  
• Internal sinus lift via transcrestal approach and hydrodynamic procedure
  
• Preparation of implant bed in anterior and posterior region
  
• Atraumatic extraction of tooth roots and fragments
  
• Surgical periodontal debridement
  
• Sterile retrograde endodontic procedures