The use of ultrasonic vibrations for the cutting of bone was first introduced two decades ago. Piezoelectric surgery is a minimally invasive technique that lessens the risk of damage to surrounding soft tissues and important structures such as nerves, vessels, and mucosa. It also reduces damage to osteocytes and permits good survival of bony cells during harvesting of bone. Piezoelectric surgery was first used by oral and maxillofacial surgeons for osteotomies, but recently some specific applications in neurosurgery and orthopaedics have been proposed. We review the different applications of piezoelectric surgery.

Piezoelectric surgery: twenty years of use.

Potential of endogenous regenerative technology for in situ regenerative medicine

Perspectives and challenges in regenerative medicine using plasma rich in growth factors

Ultra-sonic bone surgery (USBS) has been recently introduced as a novel osteotomic technique. This clinical study reports on the application of this new technique to perform ridge-split procedures. Over a period of 3.5 years, 57 patients underwent a split-crest procedure with the aim to place 230 implants, 78 in the mandible and 152 in the maxilla, in order to rehabilitate nine full arches, three hemi-arcades, 43 partial bridges and 24 single crowns. The initial ridge width varied between 1.5 and 5 mm, average was 3.2 mm. The final width of the ridge ranged from 4 to 9 mm, average was 6 mm. The split length varied between 4.5 and 40 mm, average was 15 mm. Inserted implants were 3.25-5 mm in diameter however most of them (82.4%) were standard implants of 3.75 mm; implant length was classically 10-13 mm. Two hundred and twenty-eight (99.1%) out of the 230 planned implants were placed, the two non-suitable sites were in the maxilla. In the mandible, the ridge augmentation procedure was drastically eased by performing a basal longitudinal discharge notch. At second stage surgery, eight implants failed to osseointegrate; the success rate for the placed implants was 96.5%. All implants have been loaded for at least 2 months and no implant was lost after loading. One hundred and eighty-one and 77 implants have been loaded for at least 6 and 12 months, respectively. The 3-year life-table analysis of loaded implants showed a cumulative survival rate of 100%. The split-crest procedure performed with USBS showed to be safe and comfortable.

Split-crest and immediate implant placement with ultra-sonic bone surgery: a 3-year life-table analysis with 230 treated sites.

OBJECTIVES The aim of the present study was to investigate in a randomized-controlled clinical trial the performance of rotary instruments compared with a piezoelectric device during maxillary sinus floor elevation. MATERIALS AND METHODS Thirteen patients who required a bilateral maxillary sinus augmentation for implant-prosthetic rehabilitation were included in this study. A within-patient control study was carried out. The osteotomy for sinus access was performed on one side of the maxilla using the piezosurgery (test sites) and on the other side using conventional rotary diamond burs (control sites). The parameters recorded were as follows: bony window length (L), bony window height (H), bone thickness (T) and osteotomy area (A)--calculated by multiplying L and H. In addition, the time necessary for the osteotomy and sinus membrane elevation as well as the number of surgical complications were calculated. RESULTS The mean length and height of the bone window were similar in both groups. The osteotomy area (A) obtained by multiplying L and H was wider in the control group (151.2 +/- 20.4 mm(2)) compared with the test group (137 +/- 24.2 mm(2)). The time necessary for the osteotomy and the sinus membrane elevation with conventional instruments was 10.2 +/- 2.4 min, while with the piezoelectric device it was 11.5 +/- 3.8 min. Moreover, membrane perforation occurred in 30% of the maxillary sinuses in the test group and in 23% of the control group. None of the differences observed between the two groups reached a level of significance. CONCLUSIONS Within the limits of the present study, it may be concluded that piezosurgery and conventional instruments did not show any differences in the clinical parameters investigated for the maxillary sinus floor elevation.

Osteotomy and membrane elevation during the maxillary sinus augmentation procedure. A comparative study: piezoelectric device vs. conventional rotative instruments.

Because of its physical and mechanical properties, the odontologic applications of ultrasound are increasing. A new application of odontologic ultrasonic generators involves the lateral approach of the maxillary sinus in sinus augmentation. The procedure may provide important advantages over conventional ostectomy using diamond drills, as it reduces the risk of perforating the Schneiderian membrane, improves vision and hygiene of the operating area, and provides a more conservative and controlled osseous incision. (INT J ORAL MAXILLOFAC IMPLANTS 1998;13:697‐700)

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Julio Pitarch

Papers

Ultrasonic Ostectomy for the Surgical Approach of the Maxillary Sinus: A Technical Note