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.

Endoscopic atticotomy for attic cholesteatomas using piezosurgery.

BACKGROUND: Attic cholesteatomas can be exenterated by transcanal endoscopic ear surgery (TEES). In the limited operative field of exclusive transcanal endoscopic atticotomy, surgeons use either a piezosurgery scalpel or a drilling system to remove the posterior lateral bony wall of the epitympanum. We aimed to investigate the feasibility of using piezosurgery or microdrill for endoscopic atticotomy during exenteration of attic cholesteatomas. METHODS: This study is a retrospective chart review of patients diagnosed with attic cholesteatoma, who were treated by exclusive TEES. The superior and posterior external auditory canal bones were excised using a piezosurgery scalpel or microdrill. Preoperative and postoperative hearing thresholds were measured by pure-tone audiometry. RESULTS: The postoperative follow-up duration varied from 6 to 37 months. There were no significant differences in age, sex, laterality of the affected ear, and preoperative bone conduction thresholds between the piezosurgery scalpel and microdrill groups. The operative duration was longer in the piezosurgery group than in the microdrill group (135.6 ± 19.5 minutes vs 117.3 ± 29.1 minutes, p = 0.042). Seven of 30 (23.3%) patients in the microdrill group, but none in the piezosurgery group, had a friction injury from the drilling. Postoperative testing at higher frequencies of 2000, 3000, and 4000 Hz showed no deterioration in the bone conduction threshold in the piezosurgery group. CONCLUSION: Endoscopic atticotomy performed using a piezosurgery scalpel is potentially safer but slower than using a microdrill for exenteration of attic cholesteatomas.

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).

Piezosurgery versus conventional osteotomy: a randomized clinical trial on pain and anxiety in children with unerupted mandibular third molars.

OBJECTIVE: Dental anxiety for unerupted mandibular third molars extraction in children under local anesthesia is a tricky problem. The purpose of this study was to compare psychological and physiologic findings of extractions of unerupted mandibular third molars in children by piezosurgery and conventional osteotomy. MATERIALS AND METHODS: This prospective, single-center, double-blind study included children who required extraction of mandibular third molars under local anesthesia. All subjects were randomly divided into two groups: piezosurgery and conventional osteotomy (control). The primary outcome variables were dental anxiety assessed by the Modified Child Fear Survey Schedule Dental Subscale (CFSS-DS) and postoperative pain qualified by the visual analog scale (VAS). Secondary outcome variables included blood pressure, heart rate, saturation, and operation duration. The data were analyzed by t-test and chi-square test (P ≤ 0.05). RESULTS: All 40 study patients (37.5% males and 62.5% females with an average age of 14.43 ± 1.32 years) completed the entire trial. There were no statistically significant differences observed between the two groups in terms of gender allocation, age, side of extraction, and Winter's Classification (P > 0.05). The operation duration of the piezosurgery group was significantly longer than the conventional osteotomy group (P < 0.01). The VAS scores showed that pain levels of children in the piezosurgery group were significantly less than the conventional osteotomy group on the first and third days postoperatively (P < 0.05 and P < 0.01, respectively). The CFSS-DS score in the piezosurgery group significantly decreased compared to the conventional osteotomy group (P < 0.05). Compared with the conventional osteotomy group, a significant decrease in heart rate, and lower systolic and diastolic blood pressures were observed after extraction in the piezosurgery group (P < 0.05 and P < 0.01, respectively). CONCLUSION: Compared with conventional osteotomy, piezosurgery can effectively reduce postoperative pain and have some effect in relieving dental anxiety for the extraction of unerupted mandibular third molars in children. CLINICAL RELEVANCE: Piezosurgery may be a viable technique for the extraction of unerupted mandibular third molars in children under local anesthesia.

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.

A Comparison Between Piezosurgery and Conventional Osteotomies in Rhinoplasty on Post-Operative Oedema and Ecchymosis: A Systematic Review.

Piezosurgery use has become increasingly prevalent in osteotomies. Piezoelectric ultrasound waves can cut bone effectively, and some studies have shown reduced post-operative morbidities compared to conventional osteotomies. Oedema and ecchymosis are common complications of rhinoplasty and can impact patient satisfaction, wound healing, and recovery. We aim to provide an up-to-date comparison of post-operative oedema and ecchymosis in piezosurgery and conventional osteotomies. A literature search was conducted using the following online libraries; Pubmed, Cochrane, Science Direct, and ISRCTN (International Standard Randomised Controlled Trial Number). English publications between 2015 and 2020 were included. A systematic review was completed, and a comparison of oedema and ecchymosis in piezosurgery and conventional osteotomies was examined alongside other outcomes such as pain, mucosal injury, and surgery time. Eight randomised controlled trials (RCTs) met our criteria with a combined total of 440 patients: 191 male and 249 female. Piezosurgery had statistically significant (p < 0.05) reduction in short-term oedema compared to conventional osteotomies in 75% of the papers included, and in 50% this persisted across the whole follow-up period. Similarly, ecchymosis scoring was initially statistically lower (p < 0.05) in piezosurgery in 87.5% of the RCTs, and in 75% this persisted across the whole follow-up period. A reduction in pain (p < 0.05) and mucosal injury (p < 0.05) was also seen in piezoelectric osteotomies. The length of surgery time varied. Piezoelectric osteotomies reduce oedema and ecchymosis compared to conventional osteotomies, in addition to improving pain and mucosal injury. However, disadvantages such as length of surgery time and cost have been reported. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

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.

Evaluation of implant site preparation with piezosurgery versus conventional drills in terms of operation time, implant stability and bone density (randomized controlled clinical trial- split mouth design).

BACKGROUND: The preparation of the implant bed has a major influence on the success rate and long-term survival of dental implants. Piezoelectric devices and special implant drilling inserts are now emerging to replace conventional drills showing improved bone response and healing around implants. The purpose of this study is to compare the piezoelectric inserts versus the traditional drills for implant site preparation. METHODS: Twelve male patients who received a total of twenty-four dental implants have been selected to participate in this split-mouth clinical trial. Each patient received two implants; one installed after piezosurgery assisted osteotomy, while the contralateral side received the implant with the original drilling protocol. The timing of surgery, implant stability, and bone density around the installed dental implants have been evaluated during a follow-up period extended to 4 months. RESULTS: a significant difference in terms of time of surgery (p < 0.005) and in implant stability at 4 months (p = 0.024) on the study side, while a non-statistical significance in terms of bone density was detected (p = 0.468). CONCLUSION: The piezoelectric implant site drilling protocol seemed to be a reliable and repeatable technique. Despite the limited sample size and lengthier operative time, the piezoelectric inserts enhanced bone quality and implant stability. Clinical trial registration Current Controlled Trials (ClinicalTrials.gov) https://clinicaltrials.gov/ct2/show/NCT05512273 ; the date of registration: 23/08/2022. Retrospectively registered.

Comparison of second molar protraction using different timing for piezocision application: A randomized clinical trial.

OBJECTIVE: To compare second molar protraction between early, late and no piezocision groups. MATERIAL AND METHODS: Forty subjects with bilaterally extracted mandibular first molars were selected to participate in the study. Subjects were subdivided into two groups: piezocision and no piezocision. The piezocision group was further subdivided into two subgroups: early piezocision (piezocision performed immediately before second molar protraction) and late piezocision (piezocision performed three months after starting molar protraction). In the no piezocision group, molar protraction was done without surgery. The intervention (piezocision group and timing of piezocision/side within group) was randomly allocated using the permuted random block size of 2, with 1:1 allocation ratio. The amount of second molar protraction, duration of space closure and anterior anchorage loss were measured. A repeated measures analysis of variance was conducted to define the differences between the measured variables at the different time intervals. Differences between groups were assessed using ANOVA test. RESULTS: No difference was detected between early and late piezocision groups in the amount of molar protraction at the end of space closure. Duration of complete space closure was 9 and 10 months in the piezocision and no piezocision groups. Anchorage loss was similar between the three studied groups. CONCLUSIONS: Early and late piezocision have similar effect and both increased the amount of second molar protraction temporarily in the first 2-3 months after surgery. Duration of mandibular first molar space closure was reduced by one month when piezocision was applied. Anchorage loss was similar in the three 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.

Primary implant stability based on alternative site preparation techniques: A systematic review and meta-analysis.

AIM: To evaluate the effect of special implant site preparation methods in improving primary implant stability in low-density bone. MATERIAL AND METHODS: This meta-analysis included studies published in English and Mandarin Chinese up to March 31, 2022 from MEDLINE/PubMed, Embase, Scopus, and Wanfang databases. The primary stability of five site preparation methods were measured using implant stability quotient. The random-effects model was chosen for data analysis. Grading of recommendations assessment, development, and evaluation assessment was adopted as a collective grading of the overall body of evidence. RESULTS: 12 of the 17 studies included in the meta-analysis were randomized control trials. Three studies investigated osseodensification drilling (OD), eight studies examined osteotome technique (OT), five studies explored piezosurgery (PS), and four studies were conducted on under-drilling (UD). Meta-analysis showed a statistically significant increase in primary stability for the OD (mean difference [MD], 10.25; 95% CI: 4.97-15.52; p < 0.001), OT (MD, 6.34; 95% CI: 2.26-10.42; p = 0.002), and UD (MD, 11.43; 95% CI: 5.17-17.68; p < 0.001) groups when compared to the conventional drilling group, while the PS group did not (MD, 1.50; 95% CI: -2.54-5.54; p = 0.47). CONCLUSION: Significantly higher primary implant stability was shown in the OD, UD, and OT groups compared to the conventional drilling group. PS displayed the least favorable primary stability and when compared to conventional drilling, was not statistically significant.

Three-Dimensional evaluation of the effect of platelet-rich fibrin on edema in lower impacted third molar surgery performed with piezosurgery.

Background: Platelet-rich fibrin (PRF) are widely used in impacted lower third molar (IL3M) 7 surgery and its effect on postoperative edema was generally analysed with linear methods. Aim: To analyze the effectiveness of platelet-rich fibrin (PRF) applied to the socket after tooth extraction in impacted lower third molar (IL3M) surgery performed with piezosurgery in the reduction of edema observed in the postoperative period, together with conventional (linear) and three-dimensional (volumetric) measurement methods. Materials and Method: The study was designed as a prospective randomized split-mouth study and was conducted on 30 patients with bilateral IL3M teeth. Extraction of the patients' IL3M teeth was performed in the same session with the help of piezosurgery. After the extraction, PRF was randomly applied to one socket, but it was not applied to the other socket, which formed the control group. On the first, second, and seventh days after the procedure, volume was measured using 3dMD, and the distance between the topographic guide points was measured using a flexible ruler. The results were analyzed statistically. Alveolar osteitis (AO) presence was also recorded. Results: A significant improvement in edema was observed in both groups, but no significant difference was found between the groups (P > 0.05). A moderate correlation was found between the two methods of measuring edema. AO was not seen in any patient. Conclusions: Although PRF reduces edema after IL3M tooth extraction and 3dMD is effective in its evaluation, it has no statistical advantage over classical methods.

Bad splits in bilateral sagittal split osteotomy: A retrospective comparative analysis of the use of different tools.

This study aims to analyse the relationship between the incidence of bad splits and the surgical tools adopteded to perform bilateral sagittal split ramus osteotomy (BSSRO).BSSROs performed by the same experienced surgeon period were reviewed, retrospectively. The patients were divided into three groups according to the surgical instrument used to perform the osteotomy: a Lindemann burr, reciprocating saw or piezosurgery. Among the 1120 BSSROs performed, 5 bad fractures were detected during the observation period: 3 among patients operated with the Lindemann burr (0.8%) and 2 among those operated with a reciprocating saw (0.5%). There was no significant correlation between the bad split rate and age and gender of the patients, the type of malocclusion or the type of instrument used to perform the osteotomy. Within the limitations of the study it seems that the the choice of the osteotomy tool for BSSRO does not influence the rate of bad fractures and, therefore, the selection of the osteotmy tool should be left to the discretion of the surgeon.