Piezosurgery – A novel tool in modern dentistry

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.

Different techniques in transalveolar maxillary sinus elevation: A literature review

Dental implant treatment in the posterior maxilla encounters bone quality and quantity problems. Sinus elevation is a predictable technique to overcome height deficiency in this area. Transalveolar sinus elevation is a technique that is less invasive and less time-consuming, first introduced for ridges with at least 5 mm of bone height. Many modifications and innovative equipment have been introduced for this technique. This review aimed to explain the modifications of this technique with their indications and benefits. An exhaustive search in PubMed Central and Scopus electronic databases was performed until December 2020. Articles were selected that introduced new techniques for the transalveolar maxillary sinus approach that had clinical cases with full texts available in the English language. Finally, twenty-six articles were included. The data were categorized and discussed in five groups, including expansion-based techniques, drill-based techniques, hydraulic pressure techniques, piezoelectric surgery, and balloon techniques. The operator’s choice for transalveolar approach techniques for sinus floor elevation can be based on the clinician’s skill, bone volume, and access to equipment. If possible, a technique with simultaneous implant placement should be preferred.

Comparison of Implant Stability Between Conventional Drills and Piezosurgical Implant Bed Preparation Techniques

This prospective study compared the stability of implants placed using piezoelectric surgery (piezo group) and those placed using conventional rotary drills (bur group) during the first 90 days postoperatively. Teeth in the posterior maxillary regions of twenty-one patients were randomly assigned to two groups. The implant stability quotient (ISQ) was measured at days 0, 7, 14, 21, 28, 42, 56 and 90 postoperatively. Twenty eight out of 29 implants were successfully integrated at day 90 (one implant in the test group was lost). Although both groups showed a significant overall increase in implant stability with time (p< 0.0001) and a high final mean ISQ value, no statistically significant difference in stability was seen between groups. The bur group showed greater variance in ISQ values than the piezo group (p< 0.001) at all time points. Long-term studies with larger samples are needed to investigate the bone response to the use of piezoelectric surgery for implant preparation.

Thermal Evaluation by Infrared Thermography Measurement of Osteotomies Performed with Er:YAG Laser, Piezosurgery and Surgical Drill—An Animal Study

The bone healing process following osteotomy may vary according to the type of surgical instrumentation. The aim of the present in vivo study was to determine thermal changes of the bone tissue following osteotomies performed by Er:YAG laser ablation in contact and non-contact modes, piezoelectric surgery, and surgical drill using an infrared thermographic camera. For each measurement, the temperature before the osteotomy-baseline (Tbase) and the maximal temperature measured during osteotomy (Tmax) were determined. Mean temperature (ΔT) values were calculated for each osteotomy technique. The significance of the difference of the registered temperature between groups was assessed by the ANOVA test for repeated measures. Mean baseline temperature (Tbase) was 27.9 ± 0.3 °C for contact Er:YAG laser, 29.9 ± 0.3 °C for non-contact Er:YAG laser, 29.4 ± 0.3 °C for piezosurgery, and 28.3 ± 0.3 °C for surgical drill. Mean maximum temperature (Tmax) was 29.9 ± 0.5 °C (ΔT = 1.9 ± 0.3 °C) for contact Er:YAG laser, 79.1 ± 4.6 °C (ΔT = 49.1 ± 4.4 °C) for non-contact Er:YAG laser, 29.1 ± 0.2 °C (ΔT = −0.2 ± 0.3 °C) for piezosurgery, and 27.3 ± 0.4 °C (ΔT = −0.9 ± 0.4 °C) for surgical drill. Statistically significant temperature changes were observed for the non-contact laser. The results of the study showed beneficial effects of the osteotomy performed by the Er:YAG laser used in the contact mode of working as well as for piezosurgery, reducing the potential overheating of the bone tissue as determined by means of infrared thermography.

Mandibular dentigerous cyst: Enucleation and bone reconstruction – Case report

Purpose: The dentigerous cyst is the second most common odontogenic cyst in the jaws. These lesions are observed in routine examinations. The third molars and maxillary canines are the most affected teeth. Definition of marsupialization and enucleation techniques as well as consideration of important objective criteria for the treatment plan like cyst size, age, and proximity to anatomical structures, clinical importance of the tooth or teeth associated with the lesion and risk of bone fracture. This paper will present a case report treated by maneuver of decompression followed by enucleation and bone reconstruction. Case report: A 43-year-old female patient, Caucasian, attended the Oral-Maxillofacial Surgery consultation at Clitrofa - Centro Médico, Dentário e Cirúrgico, in Trofa - Portugal, to assess extraction of 3.8 and 4.8. On intraoral physical examination, a slight bulging of the cortical bone was noted in the region of the left external oblique line. Aspiration puncture was performed and a small amount of light-yellow liquid confirmed the cystic nature of the lesion. In a second stage, osteotomy through piezoelectric surgery was performed. The cystic capsule was excised together with the extraction of tooth 3.8 included and tooth 3.7. Bone regeneration was performed. The material obtained from the cystic cavity was sent for pathological examination, confirming the diagnosis of dentigerous cyst. During observation of the patient for twelve months, no hypoesthesia or any sign of recurrence of the lesion was observed. Conclusion: The technique preserved the neurosensory function and was effective for the enucleation and reconstruction of the lesion. Despite the clinical peculiarities of each case and the chosen treatment method, the prognosis of these lesions is favourable when appropriate therapy is used.