Enhancing precision and safety in dental surgery - the advantages of piezosurgery.

Piezosurgery in dentistry is an innovative surgical technique utilizing ultrasonic vibrations to precisely cut bone tissue while minimizing damage to surrounding soft tissues. This method is particularly advantageous for delicate procedures in oral and maxillofacial surgery, including bone graft harvesting, sinus lifts, and tooth extractions. Piezosurgery operates on the principle of piezoelectricity, discovered by Jacques and Pierre Curie in the 19th century, where a piezoelectric crystal converts oscillating electric fields into mechanical vibrations. Devices used in piezosurgery generate ultrasonic frequencies (25-30 kHz) that enable linear vibrations and controlled cutting, selective for mineralized tissues.The technology offers significant benefits over conventional surgical methods, including improved visibility, precise and smooth cuts, and a reduced risk of soft tissue damage. Clinical applications of piezosurgery demonstrate its effectiveness in preserving vital cells such as osteoblasts and osteocytes, promoting faster healing, and better osseointegration of implants. Specialized inserts and operating modes enhance its versatility for various surgical needs. Piezosurgery has shown to lower postoperative complications and enhance patient safety in complex procedures like sinus lifts and bone splitting. This advanced surgical technique represents a significant improvement in dental and oral surgery, offering enhanced precision, safety, and clinical outcomes, ultimately improving the standard of care and patient satisfaction.

Histological assessment of potential inferior alveolar nerve injury following osteotomy of the mandibular buccal cortex using a piezoelectric saw.

The present study aimed to evaluate the effect of Piezosurgery on histopathologic features of the inferior alveolar nerve (IAN) damage after osteotomy of the buccal cortex of the mandible using piezoelectric devices in Hamdani sheep. A total of ten healthy mature female sheep were included. Each side of the mandible underwent two different experiments: the first experiment operated directly on the mental nerve by touching and activating the piezo tip on the nerve for ten seconds for the left side and thirty seconds for the right side. In the second experiment, the inferior alveolar nerve was touched by an activated piezo tip inside the mandibular canal for ten seconds on the left side and thirty seconds on the right side. All the nerve samples underwent histopathological evaluation, and the scoring system was performed to assess the nerve structures. Mental nerves exposed to piezo tip for 10 seconds showed mild abnormality including disruption of the perineurium with the endoneurium remaining intact. Mental nerves exposed for 30 seconds showed moderate injury with destruction of the perineurium and moderate degeneration of nerve fibers, nevertheless, the endoneurium remained continuous with normal node of Ranvier. Severe damage of the inferior alveolar nerve was seen after exposure to piezo tip for 10 seconds, which showed sloughing of the perineurium and severe vacuolar degeneration of nerve fibers, partial disruption of the endoneurium; however, the axons were still intact. Inferior alveolar nerves exposed for 30 seconds revealed destruction of the perineurium, marked vacuolar degeneration of nerve fibers, focal damage of axon and loss of endoneurium (axonotmesis). Piezosurgery devices have the potential to cause severe nerve damage during surgery and should be used very carefully.

A comparative analysis of postoperative morbidity and alveolar bone regeneration following surgical extraction of impacted lower third molar teeth using piezosurgery and conventional instruments: a split-mouth clinical investigation.

BACKGROUND-OBJECTIVE(S): This randomized, split-mouth study aimed to compare postoperative complications following the surgical extraction of impacted lower third molars using piezosurgery versus conventional rotary instruments. MATERIALS AND METHODS: Twenty-one patients, aged 18-35 years, with bilaterally and symmetrically impacted lower third molars, were randomly assigned to undergo extraction using piezosurgery on one side and conventional rotary instruments on the other. RESULTS: The piezosurgery method required a longer operation time. However, it resulted in quicker resolution of postoperative swelling by the 7th day compared to the conventional method, where swelling persisted longer. Mandibular angle-tragus measurements were significantly higher with the conventional method on the 1st, 3rd, and 7th postoperative days. Although mouth opening decreased significantly after piezosurgery, it returned to preoperative levels by the 7th day, outperforming the conventional method. Postoperative pain was notably higher with the conventional method during the first four days but showed no significant difference from the 5th day onward. Alveolar bone healing was significantly better with piezosurgery at the 3rd and 6th months. Temporary paresthesia occurred in one patient from the conventional group, resolving within four weeks. Neither method resulted in alveolar osteitis. CONCLUSION(S): Within the study's limitations, piezosurgery demonstrated a reduction in postoperative discomfort, suggesting its advantage in enhancing patient recovery following lower third molar extractions. CLINICAL SIGNIFICANCE: Piezosurgery, when used appropriately, can reduce postoperative complications compared to conventional methods. Clinicians should be aware of its indications, benefits, and potential challenges. Trial registration This study was registered as a clinical trial to the ClinicalTrials.gov, and the registration ID is NCT06262841 ( https://clinicaltrials.gov/study/NCT06262841 ).

The effect of single versus multiple piezocisions on the rate of canine retraction: a randomized controlled trial.

BACKGROUND: Piezocision is a minimally invasive surgical method aiming to accelerate tooth movement. However, its effect was found to be transient, appertaining to the regional acceleratory phenomenon (RAP). Hence, the aim of the study was to evaluate the effect of single and multiple piezocisions on the rate of orthodontic tooth movement (OTM). Moreover, the impact of both protocols on canine tipping and orthodontically induced inflammatory root resorption (OIIRR) has been assessed. METHODS: Thirty indicated patients for the therapeutic extraction of maxillary first premolars were enlisted in this split-mouth study, and they were randomly split into two equal groups, each including 15 subjects. In the Single Application Group (SAG), one side of the maxillary arch arbitrarily received a single piezocision before the onset of canine retraction, whereas in the Multiple Application Group (MAG), piezocisions were randomly performed on one side, three times on a monthly basis, over the 12-week study period. The contralateral sides of both groups served as the controls. Canine retraction was carried out bilaterally using nickel-titanium closed-coil springs, delivering 150 g of force, and the rate of tooth movement, as well as canine tipping were evaluated on a monthly basis, over a 3-month period. Cone-bean computed tomography scans were also conducted pre- and post- canine retraction, and OIIRR was assessed using Malmgren Index. RESULTS: The reported outcomes revealed a significant increase in the amount of canine retraction, canine tipping, as well as root resorption scores on the experimental sides in both groups SAG and MAG post-retraction (p < 0.001). However, upon comparing the experimental sides in both groups, non-significant differences have been observed between them regarding all the assessed outcomes (p > 0.05). CONCLUSIONS: Single and multiple piezocisions effectively accelerate OTM in comparison to conventional orthodontic treatment, with relative outcomes reported by both intervention frequencies. Accordingly, single piezocision is recommended as an adjunct to OTM. Furthermore, significant tooth tipping as well as a significantly higher root resorption risk accompanies both single and multiple piezocision applications in conjunction with OTM. NAME OF THE REGISTRY: Clinicaltrials.gov TRIAL REGISTRATION NUMBER: NCT05782088 DATE OF REGISTRATION: 23/03/2023 "Retrospectively registered". URL: https://clinicaltrials.gov/ct2/show/NCT05782088.

Bone lid technique versus standard technique for treatment of mandibular lesions.

BACKGROUND: Jaw lesions are frequent in the oral and maxillofacial areas. Different methods for enucleating jaw lesions in the oral and maxillofacial sites have been proposed, including the bone lid technique. PURPOSE: The aim of this study was to compare the clinical and radiographic results of the bone lid technique employing a piezoelectric surgery to the traditional technique in individuals with mandibular lesions. MATERIALS AND METHODS: A randomized controlled trial was conducted on 24 patients with mandibular lesions. They were randomly allocated into two groups (n = 12 for each group). Group I: the mandibular lesion was excised with bone lid technique using a piezoelectric device, followed by the fixation of the bony window after its repositioning. Group II: the lesion was excised with the traditional method using rotatory burs. Pain, soft tissue healing, bone exposure, bone lid integration, and the volume of the residual bone defect were all assessed clinically and radiographically after one week, one month, and six months. RESULTS: All patients in both groups showed adequate soft tissue healing except for one case in group I experienced wound dehiscence and bone lid exposure. The bone lid group reported significantly less pain than the usual approach at the 3rd and 7th days. After six months, the volume of bone defect filling was considerably higher in the bone lid group compared to the conventional group. CONCLUSION: The bone lid technique was an effective procedure in the management of mandibular lesions compared to the standard method. Besides, this technique provides better bone healing and reduces bone loss. TRIAL REGISTRATION: This clinical trial was registered at clinicaltrials.gov on 14/8/2023 and had registration number NCT05987930.

Piezosurgery in endoscopic-assisted trigonocephaly correction: a technical note.

PURPOSE: This study aims to evaluate the effectiveness of the Piezosurgery® device in endoscopic-assisted correction of trigonocephaly. Trigonocephaly is a type of craniosynostosis characterized by a triangular-shaped forehead due to the premature fusion of the metopic suture. Traditional open cranial vault reconstruction, although common, is invasive and poses risks. The study explores a less invasive alternative using ultrasonic microvibrations for bone cutting, potentially reducing soft tissue damage and improving surgical outcomes. METHODS: The Piezosurgery® device was employed in endoscopic trigonocephaly correction surgeries performed on patients under 4 months old at the French Referral Center for Craniosynostosis in Lyon. The technique involves making a small skin incision and performing osteotomies from the anterior fontanel to the glabella. A rigid 0° endoscope provides visibility, and the Piezosurgery® device enables precise bone cutting while preserving the dura mater. Post-surgery, patients were discharged within 3 days and required to wear a remodeling helmet for 6-8 months. RESULTS: The use of Piezosurgery® device allowed precise osteotomies with minimal soft tissue damage. No dura mater injuries occurred in the patient series. The procedure was efficient, with an average duration of 80 min, and blood loss was minimal, reducing the need for blood transfusions. The endoscopic approach facilitated shorter surgical times and reduced postoperative infection risks. Enhanced visibility during surgery, due to cavitation effects, improved the accuracy of bone cuts. The technique demonstrated promising safety and esthetic outcomes, although it incurred higher costs compared to traditional methods. CONCLUSION: Piezosurgery® device provides a safe and effective method for minimally invasive endoscopic correction of trigonocephaly. The device's ability to selectively cut bone while preserving soft tissues offers significant advantages, despite longer surgical times and higher costs. This technique represents a viable alternative to traditional open surgery, promoting better clinical outcomes and reduced recovery times.

Minimally traumatic extraction of fractured bilateral maxillary canine teeth using a piezoelectric surgical unit in an African lion (Panthera leo).

IMPORTANCE: Canine extraction of large carnivores can pose significant risk due to extensive tissue damage during aggressive bone reduction. This report highlights a rare instance in which the use of a piezoelectric surgical unit (PSU) for maxillary canine extraction in a large carnivore resulted in successful outcomes with minimal tissue damage. CASE PRESENTATION: A 10-year-old male African lion presented with decreased appetite because of bilateral maxillary canine fractures. Intraoral radiographs revealed enlarged root canals and periapical radiolucency of the fractured canines, leading to a diagnosis of periapical periodontitis and pulpitis. To extract the right maxillary canine, conventional method using hand instrument failed to achieve adequate luxation, necessitating the use of the flat blade of the PSU to sever the periodontal ligament. The left maxillary canine was extracted using PSU from the beginning, and the extraction time was markedly shortened by using PSU without additional alveolar bone damage or bleeding. CONCLUSION AND RELEVANCE: This case demonstrated that utilizing PSU for canine extraction in a lion resulted in periodontal ligament separation, reducing damage to the alveolar bone and shortening surgical time. It suggests the promising application of PSU in tooth extraction for large wild animals, indicating its potential significance in veterinary dentistry.

Use of piezoelectric instrumentation in craniofacial surgery.

PURPOSE OF REVIEW: The use of piezoelectric instrumentation is increasingly recognized as an alternative to traditional bone-cutting techniques across a wide array of surgeries. Here, we provide an overview of the technique, including device principles, benefits, and drawbacks. We also review its use in craniofacial surgery. RECENT FINDINGS: Piezoelectric surgery is a minimally invasive bone-cutting system with lower risk of damage to surrounding soft tissue structures. Indications for its use are rapidly expanding across multiple fields, including craniofacial surgery. To date, piezosurgical techniques have been most widely adopted and studied in the contexts of rhinoplasty, orthognathic surgery, and cranioplasty in craniosynostosis. Piezosurgery can facilitate more precise and consistent osteotomies while decreasing morbidities associated with traditional osteotomy techniques. Primary limitations include cost and concerns regarding increased operative times secondary to operator learning curves and decreased cutting efficiency. SUMMARY: Piezoelectric surgery represents an alternative to traditional bone-cutting modalities to improve precision, consistency, and safety of osteotomies. Further research is needed to better understand the efficacy of the technique as well as potential for additional applications.

Piezoelectric device use in sinus osteotomy for equines is feasible but may extend time to accomplish frontonasal bone flap.

OBJECTIVE: Sinus osteotomy is currently performed in equine surgery with conventional surgical methods, such as trephines and oscillating bone saw, leading to subsequent trauma to the bone during cutting. Piezoelectric devices are now used in maxillofacial surgery in humans as a standard tool as it is less traumatic than the oscillating bone saw and shortens the healing period. The aim of this study was to show that the piezoelectric device can be used for equine sinus surgery, compare its use with the oscillating bone saw, and describe the outcome of cases involving osteotomy performed with a piezoelectric surgical device. ANIMALS: 10 horse specimens for cadaveric study and 11 client-owned equines for clinical evaluation. METHODS: Each cadaveric head underwent a frontonasal bone flap on a randomly assigned side with the piezotome and the oscillating bone saw on the opposite side. Surgical time was recorded for every procedure, and gross examination was performed. A Welch t test was used to compare the surgical time between piezoelectric and oscillating saw use. For the clinical study, animals presented for sinonasal surgery at the hospital from March through October 2023 were included. RESULTS: Osteotomy was possible with the piezotome in all animals. Surgical time was significantly increased when using the piezotome in comparison with the oscillating saw (P < .05). All clinical patients were treated adequately for the sinonasal disorder they were presented for using the piezotome instead of the oscillating saw. No adverse effects nor long-term complications related to its use have been noted, and preservation of the surrounding soft tissues was evident. CLINICAL RELEVANCE: The use of a piezoelectric device in equine surgery is feasible. However, the cadaveric study showed an increased surgical time to perform a frontonasal bone flap.

Impact of Piezo and other Osteotomy Models on Soft Tissue, Blood Oxidative Stress, and Proinflammatory Markers.

BACKGROUND: Rhinoplasty is a common surgical procedure used in nose esthetics and pathologies. Shaping the nasal bones is a crucial step in achieving successful rhinoplasty surgery. However, complications such as excessive bleeding, edema, mucosal damage, and periosteal damage may occur during osteotomy for nose shaping. AIM: To investigate the damage to soft tissue and the effects on oxidative stress and proinflammatory cytokines in the blood caused by osteotomy performed on rabbits, using different osteotomy methods. Methods: Thirty-two albino New Zealand rabbits were divided into four groups. Group A was the sham group (n = 8), Group B the piezoelectric device group (n = 8), Group C the manual saw group (n = 8), and Group D the classical osteotomy group (n = 8). About 3 ml of blood was drawn to compare preoperative and postoperative interleukin-1ß (IL-1ß), thiobarbituric acid-reactive substances (TBARS), tumor necrosis factor-alpha (TNF-alpha), nitric oxide (NO), interleukin-10 (IL-10), and glutathione (GSH) levels. A 1 mm3 piece of soft tissue from the nasal bone of each animal in the study groups was sent for histopathological examination. The Chi-square test was used to analyze the incidence of postoperative necrosis, inflammation, and edema in the groups. RESULTS: Histopathologically, edema was significantly higher in Group C and Group D compared to Group B. Inflammation was increased in all groups. The necrosis was significantly higher in Group B compared to Group C and Group D. Except for two parameters, no significant changes were found in the biochemical markers for all groups. CONCLUSIONS: The piezoelectric device was found to be a better option for reducing edema and inflammation, while manual saws and classical osteotomy may lead to more tissue damage.

Lefort 1 Osteotomy Study of Maxillary Bone in Caprine Skull Model: Comparison of Different Osteotomy Techniques (Piezo Versus Lindemann Bur Versus Manual Chisel).

OBJECTIVE: In this study, we aimed to compare the efficiency of different osteotomy techniques for Lefort 1 osteotomy in an experimental caprine skull model. METHODS: Twelve caprine skulls were used for the study. Skulls were divided into 3 groups: (1) manual chisel group, (2) Lindemann bur group, and (3) piezo osteotomy group. Bilateral osteotomies were performed on each skull. Results were evaluated with three-dimensional computerized tomography scans and macroscopic observations of the mucosal tears and soft tissue. RESULTS: The mean length of the bone gap in the manual, Lindemann, and piezo groups was 4.8 (±0.7), 3.38 (±1.49), and 1.39 (±0.3) mm, respectively ( P < 0.05). The mean number of comminuted fractures in the manual, Lindemann, and piezo groups was 5.5 (±1.4), 1.6 (±0.3), and 0.6 (±0.5), respectively ( P < 0.05). Mucosal tearing and soft tissue damage based on subjective inspection observations were negligible in the piezo technique. Soft tissue and mucosal damage were observed significantly more in the manual chisel osteotomy method compared with the other 2 techniques. CONCLUSION: We anticipate that piezo, which has started to be used in new application areas besides rhinoplasty, will continue to be used more widely, especially in reconstructive orthognathic surgery, due to the minimal damage it causes to tissues. With the long-term results, much healthier interpretations can be made.

Microendoscopic Tailored Spine Decompression as a Less-Invasive, Stability-Preserving Surgical Option to Instrumented Correction in Complex Spine Deformities: A Preliminary Multicenter Experience.

OBJECTIVES: The aim of this study was to explore the effectiveness of a less-invasive posterior spine decompression in complex deformities. We studied the potential advantages of the microendoscopic approach, supplemented by the piezoelectric technique, to decompress both sides of the vertebral canal from a one-sided approach to preserve spine stability, ensuring adequate neural decompression. METHODS: A series of 32 patients who underwent a tailored stability-preserving microendoscopic decompression for lumbar spine degenerative disease was retrospectively analyzed. The patients underwent selective bilateral decompression via a monolateral approach, without the skeletonization of the opposite side. For omo- and the contralateral decompression, we used a microscopic endoscopy-assisted approach, with the assistance of piezosurgery, to work safely near the exposed dura mater. Piezoelectric osteotomy is extremely effective in bone removal while sparing soft tissues. RESULTS: In all patients, adequate decompression was achieved with a high rate of spine stability preservation. The approach was essential in minimizing the opening, therefore reducing the risk of spine instability. Piezoelectric osteotomy was useful to safely perform the undercutting of the base of the spinous process for better contralateral vision and decompression without damaging the exposed dura. In all patients, a various degree of neurologic improvement was observed, with no immediate spine decompensation. CONCLUSIONS: In selected cases, the tailored microendoscopic monolateral approach for bilateral spine decompression with the assistance of piezosurgery is adequate and safe and shows excellent results in terms of spine decompression and stability preservation.

Application of Piezosurgery in Revision Surgery through Posterior Approach for Infection after Percutaneous Vertebral Augmentation: Technique Note with Case Series.

OBJECTIVES: Pyogenic spondylitis after vertebral augmentation (PSVA) is a severe complication and even threatens the life of patients. How to deal with infectious bone cement is a big problem for surgeons. The application of piezosurgery has advantages in removal the infectious bone cement in limb bone and spinal laminectomy, but it is rarely used in PSVA. So, the present study aimed to introduce the application of piezosurgery in revision surgery for PSVA and report the preliminary radiological and clinical results. METHODS: The data of nine patients with PSVA who had undergone revision surgery were retrospectively reviewed between May 2017 and January 2023 in our hospital. The technique of removal of infectious bone cement and lesion by piezosurgery and the reconstruction of the spinal stability were described, and the operation time and intraoperative blood loss were recorded. Postoperatively, radiographs and computed tomography scans were reviewed to evaluate the condition of bone cement removal, control of infection, and bone fusion. Oswestry disability index (ODI) and visual analog scale (VAS) were assessed pre- and postoperatively, and clinical outcomes were assessed using Odom's criteria. RESULTS: All patients achieved satisfactory tainted bone cement cleaning and restoration of spinal alignment. The surgical time was 258.8 ± 63.2 (160-360) min, and the intraoperative blood loss was 613.3 ± 223.8 (300-900) mL. The VAS score decreased from 7.0 (6-8) points preoperatively to 2.4 (1-4) points postoperatively. The ODI index decreased from 71% (65%-80%) preoperatively to 20% (10%-30%) postoperatively. The patient's VAS and NDI scores after operation were significantly improved compared with those before surgery (p ≤ 0.05). Odom's outcomes were good for all patients in the last follow-up, and all patients reported satisfactory results. CONCLUSIONS: Piezosurgery can effectively remove large blocks of infectious bone cement through a posterior approach while avoiding nerve and spinal cord damage. We cautiously suggest that a one-stage posterior approach using piezosurgery is an alternative option for surgical treatment of PSVA.

The biological effects of Piezocision™ on bone for accelerated tooth movement: A systematic review of animal studies.

OBJECTIVES: This systematic review aimed to assess the biological response at tissue, cellular, and molecular levels following Piezocision™ surgery, and its efficacy in accelerating orthodontic tooth movement. MATERIAL AND METHODS: A systematic review of the literature was conducted across 4 databases following the PRISMA guidelines up to May 2022. Prospective controlled animal studies involving healthy animals under active orthodontic treatment assisted by corticotomy performed with a piezotome (Piezocision™) published in the English language without time restrictions were included. The article selection, data extraction and risk of bias assessment (SYRCLE tool) were performed by two independent blinded review authors. RESULTS: Out of 738 articles screened, 10 studies were included with various level of bias. Biological responses were categorized into tissue, cellular, and molecular levels. Tissue-level changes included a global decrease in bone mineral content post-Piezocision™. At the cellular level, increased bone turnover activity was noted. Molecularly, elevated RANKL and OPG expression, along with increased TRAP+ and cytokines, were observed after Piezocision™. Studies confirmed Piezocision's efficacy, reporting 1.35 to 3.26 times faster tooth movements, peaking between the 3rd and 50th day post-surgery. Biological responses were transient, reversible, and proportional to surgical insult, with reactivation possible through a second Piezocision™. CONCLUSIONS: After Piezocision™ surgery, a transient and reversible biological response was described at the tissue, cellular and molecular levels, which induced faster orthodontic tooth movements. This biological response could be re-activated by an additional Piezocision™ and is proportional to the surgical injury. SYSTEMATIC REVIEW REGISTRATION: Prospero CRD42022303237.

Comparison of different bone substitutes in the repair of rat calvaria critical size defects: questioning the need for alveolar ridge presentation.

OBJECTIVE: This study aimed to evaluate the effectiveness of biomaterials in bone healing of critical bone defects created by piezoelectric surgery in rat calvaria. METHOD AND MATERIALS: Histomorphologic analysis was performed to assess bone regeneration and tissue response. Fifty animals were randomized into five groups with one of the following treatments: Control group (n = 10), spontaneous blood clot formation with no bone fill; BO group (Bio-Oss, Geistlich Pharma; n = 10), defects were filled with bovine medullary bone substitute; BF group (Bonefill, Bionnovation; n = 10), defects were filled with bovine cortical bone substitute; hydroxyapatite group (n = 10), defects were filled with hydroxyapatite; calcium sulfate group (n = 10), defects were filled with calcium sulfate. Five animals from each group were euthanized at 30 and 45 days. The histomorphometry calculated the percentage of the new bone formation in the bone defect. RESULTS: All data obtained were evaluated statistically considering P < .05 as statistically significant. The results demonstrated the potential of all biomaterials for enhancing bone regeneration. The findings showed no statistical differences between all the biomaterials at 30 and 45 days including the control group without bone grafting. CONCLUSION: In conclusion, the tested biomaterials presented an estimated capacity of osteoconduction, statistically nonsignificant between them. In addition, the selection of biomaterial should consider the specific clinical aspect, resorption rates, size of the particle, and desired bone healing responses. It is important to emphasize that in some cases, using no bone filler might provide comparable results with reduced cost and possible complications questioning the very frequent use of ridge presentation procedures.

Piezosurgery versus conventional rotary surgery for impacted third molars: A randomised, split-mouth, clinical pilot trial.

BACKGROUND: Few studies have compared the effects of piezosurgery and conventional rotary surgery for impacted wisdom teeth on the quality of life. Among these studies, the inclusion parameters and evaluation methods have varied. MATERIAL AND METHODS: This study aimed to compare the effects of piezosurgery and conventional rotary instruments on the quality of life using a standardised method. Patients with bilateral and symmetric mandibular impacted wisdom teeth were included based on the Winter and Pell-Gregory scale and Yuasa difficulty index criteria. The primary objective was to assess the effects of the methods on the quality of life using the Oral Health Impact Profile-14 questionnaire. Secondary objectives included comparisons of swelling, trismus, pain, and total operative times. The study was conducted between October 2021 and March 2022. The clinical trial protocol was recorded in the United States National Library of Medicine clinical trial registry (NCT05545553). RESULTS: We enrolled 20 patients (40 wisdom teeth) and found that the removal of impacted teeth using the piezosurgery method positively affected the quality of life and considerably improved swelling, trismus, and pain scores. However, piezosurgery may affect postoperative morbidities such as increased total operative times. CONCLUSIONS: Piezosurgery appears to have advantages over conventional rotary surgery for impacted wisdom tooth extraction in terms of quality of life and postoperative symptoms. However, further research should investigate potential drawbacks and confirm these findings.

Tissue changes and tissue reactivity following osteotomy by a conventional rotary device, an ultrasonic unit, and an Er: YAG laser - A comparative study in humans.

INTRODUCTION: Innovative technologies from other fields of science are constantly being introduced in medicine. Research works on animals strongly confirm the belief in better results following ultrasound and laser surgery. The main conclusions are based on observations from different animal species, whose biological characteristics differ from those of humans. This requires scientific experiments to be performed and confirmed in humans. MATERIAL & METHODS: Human mandible specimens harvested in vivo by a conventional low-speed rotary device, an ultrasonic unit, or an Er: YAG laser were studied and analyzed to compare their effects on bone morphology and tissue response following surgery. RESULTS: The cutting surface of eighty biopsies was studied, as well the facial edema, pain levels, and jaw dysfunction were followed up in the same eighty patients from whom the slices were obtained. In the piezosurgery and drill groups, the borders exhibited irregular edges full of bone fragments and debris. Thermal alterations within the superficial surface in all bone samples were generally minimal. In all specimens, intact osteocytes were detectable away from the area of direct action of the bone-cutting device. It was established, that the reactive facial edema, pain levels, and jaw disfunction were with milder values following in vivo osteotomy by an ultrasonic unit and Er: YAG laser compared to the conventional drilling. Moreover, the recovery of the patients in these two groups was more pronounced. The observed tissue changes proved to affect the follow-up tissue reactions in the postoperative period (p ≤ 0.05). DISCUSSION: Based on the established effects on human bone by its in vivo cutting, it can be concluded that laser and ultrasonic bone surgery was a superior alternative osteotomy method in humans to conventional drilling.

A randomized controlled trial comparing conventional and piezosurgery methods in mandibular bone block harvesting from the retromolar region.

BACKGROUND: Although piezosurgery is now commonly used for various applications in maxillofacial surgery, its advantages over conventional rotary instruments in terms of postoperative edema, ecchymosis, postoperative morbidity, and prolonged osteotomy time have been questioned. MATERIALS AND METHODS: This study aimed to compare the efficiency, postoperative morbidity, and complication rates of piezosurgery and conventional methods in harvesting autogenous ramus grafts. In this randomized controlled trial, 21 patients (32 sides) underwent autogenous graft harvesting from the ramus area, with 16 sites treated using piezosurgery and 16 using the conventional method. The primary outcomes measured were osteotomy time, total operation time, and postoperative morbidity. Complication rates were also evaluated. RESULTS: The final analysis encompassed 19 patients, accounting for a total of 30 donor sites, following the exclusion of two patients who were unable to attend the scheduled follow-up visits. A total of 19 patients (30 donor sites) were included in the final analysis. No statistically significant difference was found in the mean osteotomy time between the piezosurgery group (mean: 10.35, SD: 2.74 min) and the conventional group (mean: 8.74, SD: 2.74 min) (95% CI: -3.67 to 0.442, p = 0.119). The total operation time, postoperative pain, and swelling were not significantly different between the two groups (p > 0.05). The complication rates, including wound dehiscence and inferior alveolar nerve exposure, were similar in both groups. CONCLUSIONS: Piezosurgery can be safely used for harvesting autogenous ramus grafts and does not increase osteotomy or total operation time compared to the conventional method. The postoperative morbidity and complication rates were also similar, indicating that both techniques can be effectively employed in clinical practice. CLINICAL TRIAL REGISTRATION: The protocol was registered on clinicaltrials.gov (ID: NCT05548049, First registration date: 21/09/2022).

Comparative Efficacy of Traditional Corticotomy and Flapless Piezotomy in Facilitating Orthodontic Tooth Movement: A Systematic Review and Meta-Analysis.

Background and Objectives: This study aimed to perform a meta-analysis comparing the effects of corticotomy and flapless piezocision on accelerated tooth movement. Materials and Methods: A comprehensive search using a combination of controlled vocabulary (MeSH) and free-text terms was undertaken by two reviewers to identify published systematic reviews. Three major electronic databases (Medline via PubMed, Cochrane Database, and Embase) were searched up to 2 June 2023. Results: The results of the meta-analysis showed that the pooled standardized mean difference values of accumulative movement distances for flapless piezocision were 1.43 (95% CI, 0.38 to 2.48; p < 0.01), 1.09 (95% CI, -0.08 to 2.26; p = 0.07), and 0.73 (95% CI, -0.58 to 4.02; p = 0.14). The results of the meta-analysis demonstrated that the pooled SMD values of accumulative movement distances for the corticotomy were 2.76 (95% CI, 0.18 to 5.34; p = 0.04), 1.43 (95% CI, -1.10 to 3.96; p = 0.27), and 4.78 (95% CI, -4.54 to 14.10; p = 0.32). Although the test for overall effectiveness was significant for piezocision and corticotomy, there were no significant differences between piezocision and corticotomy. Conclusions: The study determined that both conventional corticotomy and flapless piezosurgery are effective as adjuncts to orthodontic treatment. Moreover, no significant difference was observed in the short-term effectiveness of canine retraction acceleration between conventional corticotomy and flapless piezocision. While piezocision may be a favorable option for orthodontic treatment, corticotomy can be considered in cases requiring additional procedures such as bone grafting.

A Clinical Comparison of Er:YAG Laser, Piezosurgery, and Conventional Bur Methods in the Impacted Third Molar Surgery.

Objective: The aim of this study is to investigate whether Er:YAG laser and piezosurgery methods can be an alternative to the conventional bur method. Background: The purpose of this study is to compare the postoperative pain, swelling, trismus and patient satisfaction between Er:YAG laser, piezosurgery device, and conventional bur methods that are used to remove bone barrier during extraction of the impacted lower third molar. Methods: Thirty healthy patients who have bilateral, asymptomatic, vertically impacted mandibular third molar teeth according to Pell and Gregory classification Class II and Winter Class B were selected. Patients were randomly divided into two groups. In 30 patients one side of the bony cover around the tooth was removed by the conventional bur technique, on the other side 15 patients were treated with the Er:YAG laser (VersaWave dental laser; HOYA ConBio) 200 mJ, 30 Hz, 4.5-6 W, noncontact mode, SP and R-14 handpiece tip, under air and saline solution, and 15 patients with the piezosurgery technique (VarioSurg Piezo; NSK) with frequency 20-100 kHz, 10-80% power range in Surgery (S), continuous mode, with SG17 and SG5 handpiece tip blade. Preoperative, 48th hour and 7th day measurements were made and recorded about pain, swelling, and trismus. At the end of the treatment, patients were asked to fill out a satisfaction questionnaire. Results: The pain observed at the postoperative 24th hour was statistically significantly lower in the laser group than in the piezosurgery group (p < 0.05). Only in the laser group swelling was seen with statistically significant differences between preoperative and postoperative 48th h (p < 0.05). Postoperative 48th h trismus value was seen as the highest in the laser group than others. Patient satisfaction was found to be higher in the laser and piezo technique compared with the bur technique. Conclusions: Er:YAG laser and piezo methods can be a good alternative to the conventional bur method when postoperative complications are compared. We believe that laser and piezo methods will be preferred for patients due to increased patient satisfaction. Clinical Trial Registration number: B.30.2.ANK.0.21.63.00/08 date: 28.01.10 no:150/3.