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.

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 surgeryfor impacted third molars: A randomised, split-mouth, clinical pilot trial / Piezocirugía versus cirugía rotatoria convencionalpara terceros molares retenidos: un ensayo piloto clínico aleatorizado, de boca dividida

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 mandibularimpacted 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.(AU)

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.

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.

Split crest con colocación simultánea de implantes en sector anterior: reporte de un caso / Split crest with simultaneous placement of implants in the anterior sector: a case report

La pérdida ósea en el sector anterior, ya sea por un defecto horizontal, vertical o combinado, actualmente es un desafío, no sólo por la integración del implante, sino por la estética involucrada. Entre las técnicas de regeneración ósea que permiten solucionar estos defectos, cabe destacar la técnica de expansión de crestas. Se presenta el caso de una paciente de 58 años con reborde atrófico, que se sometió a la expansión de crestas con colocación simultánea de implantes en sector anterior, con xenoinjerto previo a técnica de expansión de crestas con piezoeléctrico, colocación simultánea de implantes Narrow Connection SLActive Straumann. Se logró ganancia ósea y estabilidad primaria de los implantes, sin complicaciones. En escenarios seleccionados, la técnica de expansión de crestas de manera predecible permite ganancia de hueso horizontal adecuada, el éxito de los implantes con tasa de supervivencia y mínimas complicaciones intra y postoperatorias (AU)

Bone loss in the anterior sector, both a horizontal, vertical or combined defect is a challenge today; not only for the integration of the implant but also the aesthetic involved. There are techniques of bone regeneration that help us to solve this type of defects, among them we should highlight the crest expansion technique. We present the case of a 58-year-old patient with atrophic flange, who underwent the expansion of crests with simultaneous placement of implants in the anterior sector, with xenograft prior to the piezoelectric crest expansion technique, Simultaneous placement of Narrow Connection SLActive Straumann implants, bone gain and primary stability of the implants were obtained, without complications. In selected scenarios, the crest expansion technique could be considered a predictable approach that demonstrates a high implant survival rate, adequate horizontal bone gain, and minimal intra- and postoperative complications (AU)

Three-dimensional facial swelling evaluation of piezo-electric vs conventional drilling bur surgery of impacted lower third molar: a randomized clinical trial.

BACKGROUND: Among the post-surgical complications of lower wisdom teeth surgery, swelling is considered by patients one of the most impairing, with both social and biological influences and impacting patients' quality of life. Aim of the study was to evaluate the swelling following the osteotomy when performed with drilling burs versus piezo-electric instruments in the mandibular impacted third molar extraction, using a facial reconstruction software. MATERIALS AND METHODS: A randomized, split-mouth, single-blind study was conducted on patients, ranging between 18 and 40 years of age, requiring lower third molars extraction and referred at the Oral Surgery Unit of the School of Dentistry of the University of Messina. Twenty-two patients were recruited during an 8 months period according to the following criteria: good general health conditions; bilateral, symmetrical, impacted third molars; no use of medication that would influence or alter wound healing; no temporomandibular joint disorder history; no smoking. All patients underwent bilateral surgical removal. For each patient, a facial scan was obtained prior to the surgical procedures. The two extractions were conducted performing, in a randomized way, osteotomy with rotatory burs or use of piezo surgical instruments. Facial scans were repeated at 3 and 7 days after the surgical procedures. Volumetric differences were calculated via superimposition using a dedicated software. The data obtained were processed using paired t-test. RESULTS: The results obtained from our study showed no significant differences between two groups regarding post-operative swelling. To the best of our knowledge, this study represents the first experience of using an objective method that can be reproducible on the collection of patients' clinical parameters. CONCLUSIONS: The 3D digital analysis, in the evaluation of facial swelling, is a technique of simple application, objective, reproducible, reliable, decreasing the variables of error. Based on these data, it is possible to conclude that piezo surgery is a safe way for performing the osteotomies during third molar surgery. However, regarding the post-operative swelling, it does not show an advantage over classical rotary instruments. TRIAL REGISTRATION: Registered on ClinicalTrials.gov (ID: NCT05488028, on 04/08/2022). Approved by Ethical Committee of Messina: (ID 01-2020, on 27/04/2020).

A clinical study of the piezosurgery, high-speed contra-angle handpiece, and the combined application of both for extraction of embedded supernumerary teeth.

OBJECTIVES: To compare the effectiveness of three methods: high-speed contra-angle handpiece (HSCAH), piezosurgery, and combined in the extraction of different locations and types of embedded supernumerary teeth. METHODS: Sixty cases with different locations and different types of embedded supernumerary teeth were randomly divided into three groups for extraction by HSCAH, piezosurgery, and the combination of both, and the intraoperative and postoperative conditions of the three groups were compared and analyzed. RESULTS: In the extraction of embedded supernumerary teeth in the inverted, horizontal, and root tip positions, the piezosurgery group required significantly longer operative time and reduced intraoperative bleeding compared with the HSCAH and the piezosurgery combined with the HSCAH; it could effectively relieve postoperative pain and facial swelling. In the extraction of oblique, orthodontic, middle, and crown segments of embedded supernumerary teeth, the use of a piezosurgery combined with an HSCAH can effectively reduce the operative time, while the factors of bleeding, postoperative pain, and facial swelling not statistically significant when compared with a piezosurgery. Compared with the HSCAH and combined piezosurgery, piezosurgery can significantly reduce the fear of patients. CONCLUSION: Piezosurgery is effective in extracting embedded supernumerary teeth in inverted, horizontal, and apical positions, effectively reducing intraoperative and postoperative trauma and shortening the time required for healing. The piezosurgery combined with an HSCAH can effectively reduce intraoperative and postoperative trauma when extracting embedded supernumerary teeth in oblique, orthodontic, middle, and crown positions. piezosurgery is a technique suitable for the treatment of patients with fear.

Comparison of Piezosurgery and Conventional Osteotomy for Orbital Hypertelorism Surgical Correction.

The purpose of this study was to compare the safety and effect of piezosurgery with conventional osteotomy in a box-shifting procedure for orbital hypertelorism (ORH) correction surgery. This study retrospectively analyzed the clinical record of 10 ORH patients aged from 5 to 12 years, and they were second-degree ORH with an interorbital distance (IOD) of 35 to 37.8 mm. Three of them received the osteotomy with piezosurgery (the piezosurgery group), whereas the other 7 patients received osteotomy with the conventional osteotomy method (the control group). They were compared with age and preoperative IOD. All the patients' IOD was effectively improved to normal range after the surgery. The results showed that the application of piezosurgery did not prolong the surgery time (piezosurgery group: 8.3±0.5 hours; control group: 8.7±1.4 hours, P =0.68). Furthermore, the patients in the piezosurgery group had less drainage volume (piezosurgery group: 79.1±12 mL; the control group: 170±41.3 mL, P =0.0065) and shorter postoperative hospital stay (piezosurgery group: 8.3±2.0 d; control group: 12.43±2.29 d, P =0.029). There were 2 patients who had wound infections, 1 in the piezosurgery group and 1 in the control group, respectively. However, 1 patient in the control group suffered from cerebrospinal fluid leakage. On the basis of the results, the application of piezosurgery benefited the patients on a better and smoother recovery course with less drainage and shorter hospital stays. The advantages of piezosurgery are the fine and precise osteotomy and the protection for soft tissue, which make it a comparatively safe and effective tool for craniofacial surgery, especially for young patients.

Quantification and comparison of the regional acceleratory phenomenon in bone following piezosurgery or bur osteotomy: A pilot study in rats.

BACKGROUND/OBJECTIVE: The Regional Acceleratory Phenomenon (RAP) can be induced surgically via decortication (selective cortical penetrations) of bone to accelerate orthodontic tooth movement. Few studies have compared the impact and efficiency of different decortication methods to induce the RAP. The aim of this study was to determine if there is a significant difference in the intensity of the RAP induced by a surgical defect created either using a piezoelectric knife or a rotary bur. METHODS: Twenty-two Sprague-Dawley rats were divided into two treatment groups (each n = 8) and a control group (n = 6). The treatment groups were subjected to transcortical penetrations (TP) of the right tibia using either a piezoelectric knife (PTP) or a rotary bur (BTP). The right tibias of the control group animals had reflection of tissues (SHAM) and the left legs were kept for comparison (INTACT). The animals were killed at 7 and 14 days after the operation in an equally distributed manner. Microcomputed tomography images were obtained and analyzed utilizing artificial intelligence for bone cortical porosity (Ct.Po) locally and regionally. RESULTS/CONCLUSION: Regionally, TP using a PTP induced significantly (p < .05, Kruskal-Wallis test) more Ct.Po than BTP or INTACT for both the 7- and 14-day time points. PTP was not found to induce significantly more Ct.Po than SHAM at any time point. However, PTP induced significantly more Ct.Po than the INTACT group for each time point, while SHAM did not. The local analysis did not reveal any relevant significant differences between groups.

Assessment of immediate clotting after flapless extraction using piezosurgery or turbine handpiece in patients receiving dual antiplatelet therapy.

PURPOSE: This study aimed to investigate the efficacy of piezosurgery (PI) in promoting immediate clotting after flapless extraction in patients undergoing dual antiplatelet therapy (DAPT). METHODS: In this randomized controlled trial, 80 DAPT patients were equally divided into the PI and turbine handpiece (TH) groups. Accordingly, flapless extraction of a single tooth using PI or TH was performed on each patient, and the immediate clotting status was evaluated. The results of the preoperative hematological examinations, surgery-related variables and postoperative complications were recorded for analysis. RESULTS: Both groups presented with low platelet aggregation and similar coagulation functions. The PI group exhibited a higher proportion of patients with normal intra-alveolar clotting (≤30 min) (70% vs. 40%, P = 0.007) and fewer intraoperative complications (25% vs. 47.5%, P = 0.036) than that in the TH group. Logistic regression analysis indicated that the applied instrument was an independent risk factor for prolonged immediate bleeding (odds ratio = 3.10, 95% confidence interval: 1.20-8.00, P = 0.019). Intergroup differences were insignificant in terms of the other surgery-related variables and postoperative complications, except for the longer surgical duration in the PI group. CONCLUSION: The application of PI may contribute to better immediate clotting in DAPT patients after flapless extraction compared with the use of TH.

Piezosurgery Versus Conventional Osteotomy: A Comparison of Techniques in the Extraction of Unerupted Mandibular Third Molars in Children.

PURPOSE: Piezoelectric bone surgery is a precise and effective osteotomy technique used in maxillofacial surgery. The purpose of this study was to compare postoperative sequelae and efficacy of extractions of unerupted mandibular third molars in children by piezosurgery and conventional osteotomy. METHODS: Healthy subjects, aged 10 to 14 years, needing removal of their bilateral lower third molars were included in this study. The right or left unerupted mandibular third molars were randomly extracted by either piezosurgery or conventional osteotomy. Pain (qualified by the visual analog scale), facial swelling, trismus, and operation duration were evaluated. RESULTS: All 32 study patients (40.6% males and 59.4% females with an average age of 11.91 ± 1.40 years) completed the entire trial. Swelling and trismus experienced by the conventional osteotomy were more severe than the piezosurgery group on the third (10.34 ± 2.36 mm vs 4.9 ± 1.95 mm and 6.09 ± 2.08 mm vs 2.34 ± 1.79 mm, respectively) and seventh (2.03 ± 1.26 mm vs 0.25 ± 0.57 mm and 0.91 ± 1.00 mm vs 0.09 ± 0.30 mm, respectively) days postoperatively (P < .01). Visual analog scale showed that pain levels of children in the piezosurgery group were significantly less than the conventional osteotomy group on third day postoperatively (2.06 ± 1.41 vs 4.81 ± 1.94; P < .01). The operation duration of the piezosurgery group was significantly longer than the conventional osteotomy group (27.16 ± 5.75 minutes vs 16.69 ± 3.22 minutes; P < .01). CONCLUSION: Compared with conventional osteotomy, piezosurgery can effectively reduce the severity of postoperative sequelae for the extraction of unerupted lower third molars in children.

One-stage versus two-stage piezocision-assisted orthodontic tooth movement: A preclinical study based on Nano-CT and RT-PCR analyses.

OBJECTIVE: To evaluate the effect of a second-stage piezocision on the biological response. MATERIALS AND METHODS: 60 rats were randomly allocated to 6 experimental groups of 10 rats. Rats undergoing a one-stage piezocision were sacrified on day 7, 28 and 42 (groups 1-3) while rats undergoing a two-satge piezocision were sacrified on day 42, 63 and 90 (groups 4-6), respectively. The biological response was investigated in 3D at the tissue level using Nano-computed tomography (Nano-CT) and, at the molecular level using the qRT-PCR technique. Bone Volume Fraction (BVF) loss was the primary endpoint. RESULTS: Similar loss of BVF were observed both after the first and second piezocisions. The change in BVF loss between 7 and 28 days after each piezocision were 25.1 ± 13.0 (SE)% and 11.2 ± 11.6 (SE)% respectively and did not differ from each other (p = 0.43). Changes in BVF loss from 7 to 42 days were also comparable in one-stage and two-stage piezocision (4.9 ± 12.3 (SE) vs. -19.9 ± 13.4 (SE), p = 0.19). At the molecular level, all parameters except Translating Ribosome Affinity Purification (TRAP) protein had identical patterns. CONCLUSION: Within the limits of the present study, a second piezocision allowed to re-induce the Regional Acceleratory Phenomenon (RAP) effect. Nevertheless, the relevance of the findings to the clinical effect has not been tested.

Piezosurgery versus Conventional Cutting Techniques in Craniofacial Surgery: A Systematic Review and Meta-Analysis.

BACKGROUND: Despite its increasing use in craniofacial surgery, the evidence for piezosurgery over conventional bone-cutting techniques has not been critically appraised. The purpose of this systematic review and meta-analysis was to identify and assess the evidence that exists for the use of piezosurgery in craniofacial surgery. METHODS: A systematic review was undertaken using a computerized search. Publication descriptors, methodologic details, and outcomes were extracted. Articles were assessed using the methodologic index for nonrandomized studies and Cochrane instruments. Random effects meta-analysis was completed. RESULTS: Thirty-nine studies were included. Most studies were published within the past 5 years (51.3 percent) and were randomized controlled trials (56.4 percent). The mean age of patients was 27 years (range, 0.2 to 57 years), and the mean sample size was 44 (range, 12 to 180). Meta-analysis revealed that compared to conventional instruments, piezosurgery had a lower postoperative incidence of sensory disturbance, principally in mandibular procedures (OR, 0.29; 95 percent CI, 0.11 to 0.77; p = 0.01) and pain at postoperative day 3 (mean difference, -0.86; 95 percent CI, -1.20 to -0.53; p < 0.01). There was no statistically significant difference in operating room time (mean difference, 8.60; 95 percent CI, -1.27 to 18.47; p = 0.80) or osteotomy time (mean difference, 0.35; 95 percent CI, -2.99 to 3.68; p = 0.84). Most studies were clinically homogenous (92 percent) and of high quality based on the methodologic index for nonrandomized studies instrument (84 percent). Few studies had domains at high risk of bias based on the Cochrane instrument (28.6 percent). CONCLUSIONS: Piezosurgery has considerable benefits when compared to conventional instruments. Future studies should investigate its cost-effectiveness and benefits in terms of blood loss, edema/ecchymosis, and patient satisfaction.

Neuronavigation Applied to Piezosurgery: Toward Robotic Image-Aided Craniotomy? A Technical Note.

BACKGROUND: Although simple in its concept, craniotomy can still cause serious consequences to the patient. A recent alternative to standard techniques (i.e., perforator and craniotome) is represented by piezosurgery (PS), which exploits a microvibration-emitting blade that cuts the bone directly from the outer surface of the skull. Although PS has been demonstrated to decrease complications, dural lacerations and neurovascular injuries are still possible from inadvertent penetration of the inner tabula. Modern neuronavigation systems can provide the surgeon with the possibility to track the instrument while carving the skull, thus potentially lowering the complication rates. METHODS: Two cases of miniretromastoid craniotomy for trigeminal neuralgia were performed using neuronavigated PS. Before surgery, the patients underwent volumetric brain magnetic resonance imaging and computed tomography. The piezosurgical cutter was registered on the S8 StealthStation neuronavigation system (Medtronic, Dublin, Ireland) using the step-by-step cranial standard instrument calibration protocol. RESULTS: The craniotomy was performed with the surgeon using the neuronavigation monitor to visualize both the position and the trajectory of the instrument's blade while penetrating the bone. No dural lacerations or neurovascular injuries were reported. At the end of the procedure, the bone flaps were perfectly repositioned within their craniotomy margins without the use of cranial fixation devices. CONCLUSIONS: Neuronavigated PS has the potential to decrease craniotomy-related complication rates. By allowing for real-time visualization of the blade's level of penetration, it provides the surgeon with the ability to halt progression when needed, avoiding dural lacerations and neurovascular injuries. The principles behind this technique could anticipate the advent of robotic-image aided craniotomy.

Topographic superficial craniectomy for invasive scalp carcinoma.

The management of non-melanoma skin cancer of the scalp that invades the deep structures can be challenging. An operative technique of topographic superficial craniectomy using a piezoelectric instrument (Piezosurgery (Mectron S.p.A., Carasco, Italy)) for tumours with periosteal invasion without diploic space invasion is presented here. The tumour was resected including the periosteum of the craniectomy area. A grid was carved through the outer table using the Piezosurgery device. The grid squares measured approximately 1.5 cm on each side. A bony strip was removed from one side of the grid to complete a deep cut while avoiding crossing the inner table. The squares were collected individually with a chisel and sent for pathological analysis. This technique was used to identify and localize any possible bone invasion. As this method allowed an accurate pathological diagnosis to be obtained from the Piezosurgery squares, it was possible to determine the appropriate adjuvant treatment, thereby reducing the risk of malignant cells spreading.

Piezosurgery for safe and efficient petrous bone cutting in cerebellopontine angle and petroclival meningioma surgery.

Intradural petrous bone drilling has become a widespread practice, providing extended exposure in the removal of cerebellopontine angle (CPA) or petroclival tumors. Adjacent neurovascular structures are at risk, however, when drilling is performed in this deep and narrow area. Hence, this study evaluates the use of Piezosurgery (PS) as a non-rotating tool for selective bone cutting in CPA surgery. A Piezosurgery® device was used in 36 patients who underwent microsurgery for extra-axial CPA or petroclival tumors in our Neurosurgical Department between 2013 and 2019. The clinical and radiological data were retrospectively analyzed. The use of PS was evaluated with respect to the intraoperative applicability and limitations as well as efficacy and safety of the procedure. Piezosurgical petrous bone cutting was successfully performed in the removal of meningiomas or extra-axial metastases arising from the dura of the petroclival region (21 patients) or petrous bone (15 patients). PS proved to be very helpful in the deep and narrow CPA region, considerably reducing the surgeon's distress toward bone removal in close proximity to cranial nerves and vessels in comparison to common rotating drills. The use of PS was safe without injuries to neurovascular structures. Gross total resection was achieved in 67% of petroclival and 100% of petrous bone tumors. Piezosurgery proved to be an effective and safe method for selective petrous bone cutting in CPA surgery avoiding rotating power and associated risks. This technique can particularly be recommended for bone cutting in close vicinity to critical neurovascular structures.