piezosurgery in oral and maxillofacial surgery

Dr ARJUN SHENOY

DEPT OF OMFS

*PIEZOSURGERY

INDEX*HISTORY

*HOW PIEZOELECTRICITY WORKS

*PIEZOSURGERY EQUIPMENT

*DESIGN OF INSTRUMENTS

*APLLICATION IN MAXILLOFACIAL SURGERY

*ADVANTAGES AND FEATURES

*DISADVANTAGES

*LEARNING CURVE FOR A SURGEON

*REFERENCES

HISTORY*Greek word- ‘squeeze’ or ‘press’

*Dscovered 1880 – Jacques and Pierre Curie

*The converse effect- mathematically deduced by Gabriel Lippmann 1881

WHAT IS PIEZOELECTRICITYCharge that accumulates in certain solid

materials (notably crystals, certain ceramics) in response to applied mechanical stress.

It is reversible

CRYSTALLINE SOLIDS WITH ELECTRIC DIPOLE

SENSITIVE TO ELASTIC STRAIN OR ELECTRIC FIELD

*TWO TYPES OF PIEZOELECTRIC EFFECT

*DIRECT EFFECT

MECHANICAL STRESS

PIEZOELECTRIC MATERIAL

GENERATION OF ELECTRICITY

* INVERSE PIEZO EFFECT

APPLICATION OF ELECTRICITY

PIEZOELECTRIC MATERIAL

PHYSICAL DEFORMATION

(RESTRAINED)

MECHANICAL FORCE GENERATED

(USEFFUL IN INSTRUMENTS)

*PIEZOSURGERY

*Application in surgery by Tomaso Varcellotti

*Patented ‘piezosurgery’

*Recent advancement- 13 years old

*40 publications

*ADANTAGES*Selective cutting of only hard tissues

- sparing the soft tissues

it does not cut soft tissues such as vessels, nerves and mucosa

*Clean and precise micrometric osteotomy cuts -limiting damage to osteocytes

Due to the absence of macro-vibrations, patients feel very comfortable during surgeries under local anaesthesia

Cut surfaces - no imperfections or pigmentation nor sign of cellular suffering.

*Maintainance of a clean surgical site with higher visibility

-cavitation effect

*CAVITATION*Cavitation disperses coolant fluid as an aerosol

that causes the blood to essentially be washed away.

*Brings about haemostasis, which results in a bloodless surgery.

*fragments the cell walls of bacteria

- anti-bacterial efficiency (Walmsley et al)

*Oscillating tip drives cooling fluid

-Effective cooling

local bone necrosis would occur in cases where the temperature exceeds 47°C for 1 min due to the contact of rotating tools

*INSTRUMENT DESIGN

TIPSCUTTING

SMOOTHING

NON CUTTING

longitudinal vibration 40 to 200 µm, vertical vibration 20 and 60 µm

*PRESSURE

*In contrast to conventional micro saws or drills, they require minimal pressure.

*Contact load of 150 gms gives the greatest depth cut

*APPLICATIONS IN OMFS

IMPLANTOLOGY

cylindrical diamond-coated insert with 2.4-mm diameter used for differential preparation

cutting insert with 3-mm diameter -final preparation

There is still a need of using the final drill of the selected implant system in order to tightly accommodate the implant into its socket.

*SINUS LIFT

Access window preparation -diamond-coated square or ball-shaped inserts

sinus membrane can be elevated with rounded soft tissue inserts

Atraumatic dissection of a sinus membrane with a lateral approach

*HARVESTING BONE GRAFT

*Dual-angled saw-shaped piezosurgery insert.

*Clean-cut edges of the harvested bone graft

* Bloodless and clear surgery during osteotomies and fixation of the bone graft

*ENUCLEATION OF JAW CYST

*Only a small number of applications have been reported in the literature

*careful removal of the thin bone laminate that covers the cyst

*meticulous handling of the cyst without tearing the epithelial wall, reduced recurrence

*FURTHER USES*Dentoalveolar procedures

*Hemisection

*Apical resections

*Alveolar ridge splitting

*Mental nerve repositioning

*TMJ ankylosis resections

*Head and Neck

*Craniofacial

* RESECTION OF ODONTOGENIC TUMORS

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

*ORTHOGNATHIC* Lateral maxillary wall cuts can be

performed using a standard saw-shaped insert

*medial wall cuts require a specifically designed insert

*Fifty patients had orthognathic surgery procedures in typical distribution using piezosurgical osteotomy

* Controls were 86 patients with conventional saw and chisel osteotomies

*Conclusions: reduced blood loss and inferior alveolar nerve injury at no extra time investment. single cases require auxiliary chiseling or sawing.

*J Oral Maxillofac Surg. 2008 Apr;66(4):657-74.

*DISADVANTAGES*Substantial amount of initial investment.

*The duration of the surgical procedure is longer with the application of piezosurgery.

*CONTROVERSIES*The use of piezoelectric units on patients with

pacemakers is generally discouraged, although there is no empirical evidence of the effects of current piezoelectric units on pacemaker activity in vitro.

*LEARNING PERIOD FOR A SURGEON

An important feature of the device is its good manageability

This makes it easy for a well trained surgeon to create a straight osteotomy cuts

No need for any learning period

*CONCLUSION

* Piezosurgery, with its precision and intra-operatory safety, today, seems to be the only evidence based alternative to traditional bone surgical tools.

*Further research needs to be conducted to clarify any misconception.

*REFERENCES*Pavlikova G, Foltan R, Horka M, Hanzelka T, Borunska H, Sedy J.

Piezosurgery in oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2011 May;40(5):451-7.

*Landes CA, Stubinger S, Rieger J, Williger B, Ha TK, Sader R. Critical evaluation of piezoelectric osteotomy in orthognathic surgery: operative technique, blood loss, time requirement, nerve and vessel integrity. J Oral Maxillofac Surg 2008 Apr;66(4):657-74.

*Kocyigit ID, Atil F, Alp YE, Tekin U, Tuz HH. Piezosurgery versus conventional surgery in radicular cyst enucleation. J Craniofac Surg 2012 Nov;23(6):1805-8.

*Landes CA, Stübinger S, Laudemann K, Rieger J, Sader R. Bone harvesting at the anterior iliac crest using piezo osteotomy versus conventional open harvesting: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008 Mar;105(3):e19-28.

*Horton JE, Tarpley TMJr, Jacoway JR. Clinical applications of ultrasonic instrumentation in the surgical removal of bone. Oral Surg Oral Med Oral Pathol 1981 Mar;51(3):236-42.

*Pekovits K, Wildburger A, Payer M, Hutter H, Jakse N, Dohr G. Evaluation of graft cell viability-efficacy of piezoelectric versus manual bone scraper technique. J Oral Maxillofac Surg 2012 Jan;70(1):154-62.

* Ueki K, Nakagawa K, Marukawa K, Yamamoto E. Le Fort I osteotomy using an ultrasonic bone curette to fracture the pterygoid plates. J Craniomaxillofac Surg 2004 Dec;32(6):381-6.

*Ultrasonic osteotomy as a new technique in craniomaxillofacial surgery. Int J Oral Maxillofac Surg. 2007 Jun;36(6):493-500.