Piezoelectric Surgical Device Research Articles

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

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. 10 horse specimens for cadaveric study and 11 client-owned equines for clinical evaluation. 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. 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. 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.

The Curved Presplitting Technique in a Totally Edentulous Atrophic Mandible: A Surgical Case Report.

The management of horizontally fully edentulous atrophic ridges is a common problem in dental implantology. This case report describes an alternative modified two-stage presplitting technique. The patient was referred for an implant-supported rehabilitation of their edentulous mandible. CBCT scans showed a mean available bone width of about 3 mm. At the first stage, four linear corticotomies were performed using a piezoelectric surgical device. At the second surgical stage 4 weeks later, bone expansion was performed, and four implants were placed in the interforaminal area. The healing process was uneventful. No fractures of the buccal wall and no neurologic lesions were observed. Postoperative CBCT scans showed a mean bone width gain of about 3.7 mm. Implants were uncovered 6 months after the second surgery, and 1 month later, a fixed provisional screw-retained prosthesis was delivered. This approach could be used as a reconstructive technique that avoids using grafts and reduces treatment times, possible complications, postsurgical morbidity, and costs by exploiting the patient's native bone as much as possible. Considering the limitations of a case report, randomized controlled clinical trials are needed to confirm the results and validate this technique.

Effect of the Piezoelectric Device on Intraoperative Hemorrhage Control and Quality of Life after Endodontic Microsurgery: A Randomized Clinical Study

IntroductionThe purpose of this study was to evaluate the effect of the piezoelectric device on intraoperative hemorrhage control during surgery and the quality of life of patients after endodontic microsurgery. MethodsA total of 40 patients were randomly divided into the piezo group (n = 20) and the control group (n = 20). In the piezo group, after flap reflection, bone cutting, granulation tissue removal, and root-end resection were performed using the piezoelectric surgical device and surgical carbide burs, and curettes were used in the control group. The quality of life of patients was evaluated daily for 1 week postsurgery for limitations of oral and general functions, pain, and other symptoms. Limitation of functions and other symptoms were recorded by a modified version of the patient’s perception questionnaire using a 5-point Likert scale for mouth opening, chewing, speaking, sleeping, daily routine, missed work, swelling, nausea, and bad taste/breath, and the visual analog scale was adopted for pain. Hemorrhage control during surgery was independently assessed by the surgeon and 2 blinded observers and recorded as 0 (no hemorrhage control), 1 (intermittent control), and 2 (complete control). The chi-square test was used to assess hemorrhage control. For variables related to function and symptoms other than pain and analgesics taken, the Fisher exact test was used. For the assessment of pain between the 2 groups, the Mann-Whitney U test was used. ResultsFor parameters of quality of life, the piezo group showed significantly less swelling on the first, second, and third days and pain on the first and second days compared with the control group (P < .05). Analgesics taken were also significantly less in the piezo group (P < .05). In the piezo group, complete hemorrhage control was achieved in 10 patients, and in the control group, it was achieved only in 1 patient (P < .05). ConclusionsPiezoelectric surgery resulted in improved quality of life of patients in the first week postsurgery with lower levels of pain and swelling as well as the number of analgesics taken and better hemorrhage control during surgery.

Is Ultrasonic Bone Scalpel Useful in Le Fort I Osteotomy?

Safety and precision are 2 main goals in research to improve bone cutting in maxillofacial surgery. The aim of this prospective clinical study was to analyze the outcomes using an ultrasonic bone scalpel versus a piezoelectric surgical device and the conventional technique in a Le Fort I osteotomy. We designed a prospective, randomized, single-blind cohort study. The predictor variables were the devices used to perform the Le Fort I osteotomy, divided into 3 groups: 1) ultrasonic bone scalpel (BoneScalpel; Misonix, Farmingdale, NY), 2) piezoelectric surgical device, and 3) conventional technique (Lindeman burr and reciprocal saw). The primary outcome of the study was cutting time, whereas secondary outcomes were length of the procedure, total blood loss, intraoperative complications, and postoperative edema. Other variables of interest were age and gender. Data were analyzed using 1-way analysis of variance and the Kruskal-Wallis test. The study sample was composed of 34 patients with a mean age of 21.5years, and 63.3% of patients were women. The mean cutting time (P<.001) and length of the procedure (P=.012) were significantly shorter with the bone scalpel than with the other types of surgery. The ultrasonic bone scalpel showed a significant reduction in intraoperative blood loss of up to 45% compared with the piezoelectric surgical device and the conventional technique (P=.038). The results of this study suggest that the ultrasonic bone scalpel is an effective ultrasonic bone-cutting instrument in a Le Fort I osteotomy as evidenced by the significant decrease in the cutting time, intraoperative blood loss, and postoperative edema compared with the other techniques.

Comparison of Tunnel and Crestal Incision Techniques in Reconstruction of Localized Alveolar Defects.

The aim of this study was to compare the complication rates of recipient sites prepared using two incision techniques: crestal and tunnel. In this prospective study, patients underwent augmentation procedures (68 patients; 75 sites) by the same surgeon that were performed consecutively using the crestal incision technique (27 horizontal, 10 vertical; crestal group) or the tunnel incision technique (27 horizontal, 11 vertical; tunnel group). Autogenous bone block grafts were harvested with a piezoelectric surgical device, and the grafts were fixed at the recipient sites by two titanium screws in both groups. The authors evaluated minor exposure, transient paresthesia, major exposure, permanent paresthesia, gingival recession at adjacent teeth, surgery time, and visual analog scale pain scores. Soft tissue dehiscence and graft failure were significantly lower in patients undergoing the tunnel technique. The tunnel incision technique significantly decreased soft tissue exposure, the most common complication of augmentation procedures with autogenous onlay bone grafts. This technique should be considered an alternative to the crestal incision technique for preparation of the recipient site.

Efficacy and Safety of Piezosurgery Device in the Surgical Treatment of Oral Cancer

Introduction: A new piezoelectric surgical device, a new system for cutting bone system, has recently been developed. It uses lowfrequency ultrasonic vibrations to shape and cut bone. Case Presentation: In this paper, we report the case of a 70-year-old woman affected by (G2, T1, M0) oral cancer treated with osteotomy performed using this piezoelectric device. The case presents the complete surgical excision of a fornix squamous cell carcinoma in which the marginal mandibulectomy was effected by a piezoelectric system. Conclusions: People who have conditions involving bone that need to be surgically removed specifically nearby soft tissues or important structures (vessels, nerves, or brain), may benefit from this device. In the oral cavity, where the presence of essential structures may hinder safe osteotomy, the piezoelectric device allows the surgeon to cut bone without damaging nerves, glands, and vessels, even when in contact with them. The presence of angled inserts is also fundamental and facilitates osteotomies in areas that are unreachable by conventional cutters and burs.

Paradigm shift regarding sinus augmentation.

The atrophic posterior maxilla is a challenging site for oral rehabilitation with dental implants due to insufficient bone volume. Crestal or lateral window approaches for sinus augmentation are the most common surgical techniques to overcome the vertical deficiency of the atrophic posterior maxilla. Various bone graft materials have been used in recent decades as space makers in the compartment created under the elevated sinus mucosa. However, clinicians have occasionally experienced postoperative sinus complications after performing sinus bone graft. Sinusitis is the most serious complication associated with bone-added sinus augmentation. Sinusitis can be resolved using incision and drainage in some cases, but complete curettage of bone grafts and removal of implants is required when incision and drainage are not effective. When sinusitis occurs, the relationship between the patient and doctor can be harmed due to increased surgical costs and delayed healing; thus, prevention of sinusitis is key. To treat sinusitis is meaningless to our patients. How can we prevent sinusitis? Postoperative sinusitis is closely related to sinus mucosal perforation and bone graft. To reduce the rate of sinus perforation, first, clinicians should review in detail the step-by-step procedure for sinus augmentation. Second, a piezoelectric device should be used when preparing the bony window. A rotary bur has generally been used to prepare the bony window; however, surgeons who have limited experience with sinus augmentation may cause more frequent sinus membrane perforation during this part of the procedure. Mucosal perforation can delay surgery and lead to postoperative sinusitis. A piezoelectric surgical technique enables bone cutting with precision and has a low associated risk of sinus perforation. Furthermore, the ultrasonic piezoelectric surgical device minimizes damage to soft tissue and other structures, such as nerves and blood vessels, while cutting bone, even in cases of accidental contact. When a sizeable membrane perforation occurs, delay of sinus bone graft is recommended because mucosal perforation repair with a collagen membrane cannot completely prevent sinusitis. When the bone graft procedure is continued after sinus perforation and repair, numerous clinical studies have revealed high rates of sinusitis and implant failure1,2. Third, the use of bone grafts should be limited in the sinus. The key to inducing new bone formation in the sinus is not bone substitution, but, rather, space maintenance in the new compartment. Bone grafts, as a foreign material, are susceptible to infection. In addition, compared to bone-added sinus augmentation, more new bone formation is reported when bone grafts are not used.

Comparison of piezosurgery and traditional saw in bimaxillary orthognathic surgery

PurposeInvestigators have hypothesised that piezoelectric surgical device could permanently replace traditional saws in conventional orthognathic surgery. MethodsTwelve consecutive patients who underwent bimaxillary procedures were involved in the study. In six patients the right maxillary and mandible osteotomies were performed using traditional saw, whilst the left osteotomies by piezoosteotomy; in the remaining six patients, the surgical procedures were reversed. Intraoperative blood loss, procedure duration time, incision precision, postoperative swelling and haematoma, and nerve impairment were evaluated to compare the outcomes and costs of these two procedures. ResultsCompare to traditional mechanical surgery, piezoosteotomy showed a significant intraoperative blood loss reduction of 25% (p = 0.0367), but the mean surgical procedure duration was longer by 35% (p = 0.0018). Moreover, the use of piezoosteotomy for mandible procedure required more time than for the maxillary surgery (p = 0.0003). There was a lower incidence of postoperative haematoma and swelling following piezoosteotomy, and a statistically significant reduction in postoperative nerve impairment (p = 0.003). ConclusionsWe believe that piezoelectric device allows surgeons to achieve better results compared to a traditional surgical saw, especially in terms of intraoperative blood loss, postoperative swelling and nerve impairment. This device represents a less aggressive and safer method to perform invasive surgical procedures such as a Le Fort I osteotomy. However, we recommend the use of traditional saw in mandible surgery because it provides more foreseeable outcomes and well-controlled osteotomy. Further studies are needed to analyse whether piezoosteotomy could prevent relapse and promote bony union in larger advancements.

Piezoelektrische Osteotomie in der Handchirurgie: autologe osteokartilaginäre Transplantation zur Gelenksrekonstruktion

This article demonstrates the use of this piezoelectricsurgical device during an autologous osteocartilage transplantation in which the head of the phalanx of a finger is reconstructed from part of the phalanx condyle of a toe.

Comparative Histomorphometric Analysis of Maxillary Sinus Augmentation With and Without Bone Grafting in Rabbit

The aim of this animal study was to evaluate, by histomorphometric analysis, new bone formation in rabbit maxillary sinuses with, and without, bone grafting. Bilateral sinus augmentation procedures were performed in 20 adult male rabbits. Bony windows were made by a saw insert connected with a piezoelectric surgical device in both groups. In the experimental group, the replaceable bony window was repositioned after careful elevation of the sinus mucosa without bone grafting. In the control group, anorganic bovine graft (Bio-Oss; Geistlich AG, Wolhusen, Switzerland) was grafted in the new compartment of the maxillary sinus after elevation of the sinus membrane, and resorbable collagen membrane was used to cover over the bone graft. A mini screw was placed on the bony window to support the elevated sinus membrane. Animals were sacrificed at 1, 2, 4, 6, or 8 weeks after surgical procedure. The augmented sinuses were evaluated by histomorphometric analysis using hematoxylin-eosin and tartrate-resistant acid phosphatase stain. Histologically, new bone was revealed along the elevated sinus membrane, but new bone was not revealed under the collagen membrane or Bio-Oss in the control group after 1 week. In the control group, new bone formation was revealed on the surface of Bio-Oss particles from 2 weeks and continued to 8 weeks. However, new bone formation began from the floor of the replaced bony window and the elevated sinus membrane in the experimental group after 1 week. New bone formation increased under the floor of the repositioned bony window and the elevated sinus membrane, and blood clots appeared in the new compartment of the maxillary sinus throughout the experimental period in the experimental group. Significant higher new bone formation was revealed in the experimental group than in the control group. New bone formation in the experimental group was faster and denser than that in the control group. Replaceable bony window, as an autologous barrier, accelerates new bone formation early in the healing phase compared with the collagen membrane over a bone graft in the maxillary sinus. The replaceable bony window and elevated sinus membrane revealed osteoinductive potential.

Piezoelectric Surgical Device in Endoscopic Sinus Surgery: An Initial Clinical Experience

Piezoelectric Surgical Device in Endoscopic Sinus Surgery: An Initial Clinical Experience

Piezoelectric Surgical Device in Endoscopic Sinus Surgery: An Initial Clinical Experience

Revision endoscopic sinus surgery presents special challenges, such as the need to remove thick osteoneogenic bone close to the orbit or skull base. Currently available drills and microdebriders have shortcomings for this task, including risk to the underlying periorbita or dura. Recently, piezoelectric ultrasound technology has been used to remove bone while preserving adjacent soft tissue structures. This technology has been effective in several areas of the body, and it logically follows that it may have beneficial rhinologic applications. The purpose of this medical communication is to report an initial clinical experience with piezoelectric technology in revision sinus surgery. The piezoelectric surgical device was used during revision endoscopic sinus surgery in 14 patients in the author's practice from June 2006 to January 2009. All patients had an underlying bone component to their sinus condition, such as osteoneogenesis adjacent to the orbit or skull base. The piezoelectric surgical device performed successfully in removing osteoneogenic bone, and no complications were noted from its use. Piezoelectric surgical technology generates low-frequency ultrasound that dissects bone and appears to offer an option to mechanical drill instrumentation when used during endoscopic sinus surgery to address thick osteoneogenic bone. The clinical experience reported herein shows initial feasibility of the technology in selected cases of sinus surgery. On the basis of the favorable observations from this clinical experience, further exploration and discussion would appear to be valuable.

Autogenous particulate bone collected with a piezo-electric surgical device and bone trap: a microbiological and histomorphometric study

The aims of this study were to determine the microbiological and particle size characteristics of particulate bone collected with a piezosurgery device and bone trap, and to reduce bacterial contamination after treatment of debris with rifamycin SV. Samples were taken from 10 patients who underwent surgical extraction of their third lower molars. The ostectomy was performed with a piezosurgery device, and the debris was collected with a surgical aspiration set equipped with a bone trap. Two aliquots were taken from each sample, one of which was treated with rifamycin SV. The second aliquot, used as a control, was treated with a physiological solution. In the samples immersed in antibiotic solution, there was a statistically significant (P<0.005) reduction in bacterial contamination. The stringent protocol followed in this study has proved valid for collection of material, and treatment with rifamycin SV was found to reduce bacterial contamination in collected material.