piezosurgery in oral and maxillofacial surgery

1. Dr ARJUN SHENOY
DEPT OF OMFS
*

2. *HISTORY
*HOW PIEZOELECTRICITY WORKS
*PIEZOSURGERY EQUIPMENT
*DESIGN OF INSTRUMENTS
*APLLICATION IN MAXILLOFACIAL SURGERY
*ADVANTAGES AND FEATURES
*DISADVANTAGES
*LEARNING CURVE FOR A SURGEON
*REFERENCES

3. *Greek word- ‘squeeze’ or ‘press’
*Dscovered 1880 – Jacques and Pierre Curie
*The converse effect- mathematically
deduced by Gabriel Lippmann 1881

4. Charge that accumulates in certain solid
materials (notably crystals, certain ceramics) in
response to applied mechanical stress.
It is reversible

5. CRYSTALLINE SOLIDS WITH ELECTRIC DIPOLE
SENSITIVE TO ELASTIC STRAIN OR ELECTRIC FIELD

6. *
*DIRECT EFFECT
MECHANICAL STRESS
PIEZOELECTRIC MATERIAL
GENERATION OF ELECTRICITY

7. *
APPLICATION OF ELECTRICITY
PIEZOELECTRIC MATERIAL
PHYSICAL DEFORMATION
(RESTRAINED)
MECHANICAL FORCE GENERATED
(USEFFUL IN INSTRUMENTS)

8. *
*Application in surgery by Tomaso Varcellotti
*Patented ‘piezosurgery’
*Recent advancement- 13 years old
*40 publications

9. *
*Selective cutting of only hard tissues
- sparing the soft tissues
it does not cut soft tissues such as vessels, nerves and
mucosa

10. *Clean and precise micrometric osteotomy cuts
-limiting damage to osteocytes
Cut surfaces -
no imperfections or
pigmentation nor sign
of cellular suffering.
*
Due to the absence of macro-vibrations, patients feel
very comfortable during surgeries under local
anaesthesia

11. *Maintainance of a clean surgical site with higher visibility
-cavitation effect

12. *
*Cavitation disperses coolant fluid as an aerosol that
causes the blood to essentially be washed away.
*Brings about haemostasis, which results in a bloodless
surgery.
*fragments the cell walls of bacteria
- anti-bacterial efficiency (Walmsley et al)

13. *Oscillating tip drives cooling fluid
-Effective cooling
local bone necrosis would occur in cases where the
temperature exceeds 47°C for 1 min due to the contact
of rotating tools

14. *

15. CUTTING
longitudinal vibration 40 to 200 μm,
vertical vibration 20 and 60 μm
SMOOTHING
NON CUTTING

16. *
*In contrast to conventional micro saws or drills,
they require minimal pressure.
*Contact load of 150 gms gives the greatest
depth cut

17. *

18. cylindrical diamond-coated insert
with 2.4-mm diameter used for
differential preparation
cutting insert with 3-mm diameter
-final preparation
There is still a need of using the final drill of the selected
implant system in order to tightly accommodate the
implant into its socket.

19. *
Access window preparation -
diamond-coated square or ball-shaped
inserts
sinus membrane can be elevated
with rounded soft tissue inserts
Atraumatic dissection of a sinus membrane with a lateral
approach

20. *
*Dual-angled saw-shaped
piezosurgery insert.
*Clean-cut edges of the
harvested bone graft
* Bloodless and clear surgery
during osteotomies and fixation
of the bone graft

21. *
*Only a small number of
applications have been reported
in the literature
*careful removal of the thin bone
laminate that covers the cyst
*meticulous handling of the cyst
without tearing the epithelial
wall, reduced recurrence

22. *
*Dentoalveolar procedures
*Hemisection
*Apical resections
*Alveolar ridge splitting
*Mental nerve repositioning
*TMJ ankylosis resections
*Head and Neck
*Craniofacial

23. *
*the advantage of protection of vital structures
(e.g. neurovascular bundles) when surgery is
within a close vicinity to those structures .

24. *
* Lateral maxillary wall cuts can be performed
using a standard saw-shaped insert
*medial wall cuts require a specifically designed
insert

25. *Fifty patients had orthognathic surgery procedures in typical
distribution using piezosurgical osteotomy
* Controls were 86 patients with conventional saw and chisel
osteotomies
*Conclusions: reduced blood loss and inferior alveolar nerve
injury at no extra time investment. single cases require
auxiliary chiseling or sawing.
*J Oral Maxillofac Surg. 2008 Apr;66(4):657-74.

26. *
*Substantial amount of initial investment.
*The duration of the surgical procedure is longer with the
application of piezosurgery.

27. *
*The use of piezoelectric units on patients with pacemakers is
generally discouraged, although there is no empirical evidence
of the effects of current piezoelectric units on pacemaker
activity in vitro.

28. *
An important feature of the device is its good
manageability
This makes it easy for a well trained surgeon to create a
straight osteotomy cuts
No need for any learning period

29. *
* Piezosurgery, with its precision and intra-operatory safety,
today, seems to be the only evidence based alternative to
traditional bone surgical tools.
*Further research needs to be conducted to clarify any
misconception.

30. *
* Pavlikova G, Foltan R, Horka M, Hanzelka T, Borunska H, Sedy J.
Piezosurgery in oral and maxillofacial surgery. Int J Oral Maxillofac
Surg 2011 May;40(5):451-7.
* Landes CA, Stubinger S, Rieger J, Williger B, Ha TK, Sader R. Critical
evaluation of piezoelectric osteotomy in orthognathic surgery:
operative technique, blood loss, time requirement, nerve and vessel
integrity. J Oral Maxillofac Surg 2008 Apr;66(4):657-74.
* Kocyigit ID, Atil F, Alp YE, Tekin U, Tuz HH. Piezosurgery versus
conventional surgery in radicular cyst enucleation. J Craniofac Surg
2012 Nov;23(6):1805-8.
* Landes CA, Stübinger S, Laudemann K, Rieger J, Sader R. Bone
harvesting at the anterior iliac crest using piezo osteotomy versus
conventional open harvesting: a pilot study. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2008 Mar;105(3):e19-28.

31. * Horton JE, Tarpley TMJr, Jacoway JR. Clinical applications of
ultrasonic instrumentation in the surgical removal of bone. Oral Surg
Oral Med Oral Pathol 1981 Mar;51(3):236-42.
* Pekovits K, Wildburger A, Payer M, Hutter H, Jakse N, Dohr G.
Evaluation of graft cell viability-efficacy of piezoelectric versus
manual bone scraper technique. J Oral Maxillofac Surg 2012
Jan;70(1):154-62.
* Ueki K, Nakagawa K, Marukawa K, Yamamoto E. Le Fort I osteotomy
using an ultrasonic bone curette to fracture the pterygoid plates. J
Craniomaxillofac Surg 2004 Dec;32(6):381-6.
* Ultrasonic osteotomy as a new technique in craniomaxillofacial
surgery. Int J Oral Maxillofac Surg. 2007 Jun;36(6):493-500.