Proforma for Registration of Subje Cts for Dissertation

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

BANGALORE

PROFORMA FOR REGISTRATION OF SUBJE`CTS FOR DISSERTATION

1 Name of the candidate DR.ARAVIND NAIR P and address POST GRADUATE STUDENT (In Block Letters) DEPARTMENT OF ORAL & MAXILLOFACIAL SURGERY COORG INSTITUTE OF DENTAL SCIENCES KK CAMPUS, MAGGULA VIRAJPET- 571218

2 Name of the Institution COORG INSTITUTE OF DENTAL SCIENCES

3 Course of study & subject MASTER OF DENTAL SURGERY, ORAL & MAXILLOFACIAL SURGERY

4 Date of admission of course 18.04.2011

5 Title of the topic THE PIEZOELECTRIC AND ROTATORY OSTEOTOMY TECHNIQUE IN IMPACTED THIRD MOLAR SURGERY:COMPARISON OF POSTOPERATIVE RECOVERY

Brief Resume of the intended work

6.1 Need for the study:

Piezoelectric surgery has been used for a while as an alternative to rotary drilling instruments in oral surgery involving osteotomies. Piezosurgery offers distinct advantage, in that it is very efficient in osteotomy because it works selectively, being inert against soft tissues, a significant advantage compared with bur. It provides hemostatic field of vision that significantly reduces the thrust to soft tissue with nerve and blood vessel adjacent to the treatment arena and less traumatic experience for the patient and therefore has the potential to reduce post surgical swelling and discomfort. Piezo surgery helps to perform difficult extraction and to preserve surrounding tissue, buccal plate in the esthetic zone. These procedures are useful when removing damaged roots without elevators and to section ankylosed or impacted teeth in a precise fashion1,2.

Removal of impacted third molar teeth extraction including germectomy for orthodontic purpose is one of the most common procedure in oral surgery 7,8,9 numerous investigators have reported on the risk of various post operative complications like trismus, alveolitis, secondary infections, nerve lesions, post operative bleeding etc.the risk of such complications would appear to be lower when piezoelectric bone surgery is used10,11, because this technique is less traumatic to hard and soft tissues12,13..

This study hypothesise that piezosurgery would be more suitable than rotary drilling for removal of, bony impactions in terms of the postoperative sequelae.

6.2 Review of literature:

Piezoelectric devices are an innovative ultrasonic technique for safe and effective osteotomy or osteoplasty compared with traditional hard and soft tissue methods that use rotating instruments because of the absence of macrovibrations, ease of use and control, and safer cutting, particularly in complex anatomical areas.3

A study on comparision of postoperative outcome in mandibular impacted third molar treated by piezoelectric surgery shows that significant reduction in post operative facial swelling and trismus but a longer surgery time was required when compared with rotator osteotomy technique.1

A study on comparison of ultrasound bone surgery devices and the use of rotary instruments in lower third molar extractions using randomized control trail.Patient on contol group recived treatement with conventional rotary instrument and patient in test group recived treatement with the ultrasound bone surgery tools.The study shown by ultrasound bone surgery significantly reduce the postsurgical trismus, swelling and the number of analgesic taken after surgery.4

In a clinical study it was noted that osteotomies performed with the piezosurgery instrument did not result in any visible injury to the adjacent soft tissues from the generated micromovements. This finding is caused by the piezo instrument’s modulated ultrasonic frequency, which removes only mineralized hard substance.7

In an other study surgery was done to compare piezoelectric surgery and conventional rotatory osteotomy for mandibular third molar germ extraction in which mandibular third molar germectomy is performed bilaterally,randomly choosing one side for rotatory osteotomy and other for peizoelectric surgery.The predictor variable was the duration of surgical procedure, the out come variable were the suitability of the method used, bleeding, and postoperative parameters at 7 and 30 days postoperetavily.Piezoelectric osteotomy proved comparable to rotatory method in terms of surgeon’s perception of suitability of two methods and related postoperative sequelae.6 7. 6.3 Objectives of the study:

1) To compare piezoelectric versus rotator osteotomy technique in impacted third molar surgery for duration of surgery and patient satisfaction

2) To evaluate the post surgical swelling, pain and trismus between the 2 groups

3) To evaluate the role of piezoelectric device for bone cutting

Materials and Methods:

Study would entail the use of piezoelectric device(from mectron company) for one group and rotary bur for the removal of other group of patients

Piezo device uses a modulated ultrasonic frequency that permits bone cutting by microstreaming and cavitation phenomenon. The device consists of a hand piece and foot switch that are connected to a power source. The device also has irrigation fluid that creates an adjustable jet of 0-60ml/min through a peristaltic pump

A surgical straight hand piece connected to a micrometer would be utilized for bone cutting with the aid of external saline irrigation.Rotary speed will range from 25,000 to 35,000 RPM .S.S. white 702 and 703 fissure burs will be used for bone cutting.

7.1 Source of data

Fifty healthy adult patients reporting to the department of Oral and Maxillofacial Surgery, Coorg Institute of Dental Sciences and in need of prophylactic removal of lower third molar impacted tooth with ideal condition will be taken up for the study .

7.2 Method of collection of data.

Patients are subdivided into two groups randomly of 25 patients each so that the difficulty of surgery will be same in both the group.

Group A – Rotary osteotomy technique

Group B – Piezoelectric osteotomy technique

Methodology

After taking, case history, Intra oral periapical radiograph /orthopantomograph and informed consent from the patient , adequate local anesthesia will be administered under strict aseptic conditions. Under Group A, the impacted tooth will be surgically extracted using rotatory osteotomy technique and under Group B the impacted tooth will be surgically extracted using piezoelectric surgery.

The parameters examined in each patient will include; pain, post-operative facial swelling trismus,time taken for the procedure and patient satisfaction for the procedure .

Pain will be evaluated using visual analogue scale till the 7th postoperative day

Swelling and trismus will be evaluated on day 3 and day5 of the postoperative period

Patient satisfaction will be assessed subjectively

Any other complications/observation relevant to the study will be recorded if present

Inclusion criteria:

1. Only healthy patient between 20-40 years of age included in the study

2. Patient consenting to the study protocol

3. Patient having vertical ,mesioangular,horizontal class2,class3,level-B,level-C lower third molar impactions will be included in the study based on radiographic interpretation.

Exclusion criteria

1. Patients with systemic disease that could influence healing viz metabolic bone disease,endocrinal disease would be excluded

2. Patients who are taking antibiotics for current infection,or those who have taken antibiotics in the past 6 weeks or who require antibiotic prophylaxis before extraction eg; valvular heart disease or with prosthetic joint replacement.

3. Patient who had acute pericoronitis,severe periodontal disease or local infection involving the impacted teeth at the time of operation.

Patients who are contraindicated for radiograph.

4. Pregnant and lactating mothers

5. Cancer patients and those undergoing radiotherapy.

6. Patients who are under medications that alter bone metabolism or under anticoagulants or medications that influence wound healing.

7.3 Does the study require any investigations or intervention to be conducted on the patients or other humans or animals? (If so please describe briefly)

YES. Complete hemogram and serology for HIV and Hepatitis.

Intra oral periapical radiograph /orthopantomograph

Surgical interventions like incision, flap reflection and suturing under local anesthesia with written consent.

Extra oral and intraoral radiographic examination will be done after taking a written consent from the patient.

7.4 Has ethical clearance has been obtained from your institution in case of 7.3?

YES. A COPY HAS BEEN ATTACHED

References

1. Sortino F,Pedulla E,Masoli V.The piezoelectric and rotatory osteotomy technique in impacted third molar surgery:Comparision of post operative recovery.J Oral Maxillofac Surg. 2008;66:2444-2448.

2.Vercellotti T,Essential in piezosurgery,clinical advantages in dentistry 2009; 1st edition: page1-45

3. Labanca M,Azzola F,Vinci R,Rodella L.F.Piezoelectric surgery:Twenty years of use. British Journal of Oral and Maxillofacial Surgery.2008;46:265-269.

4. Barone A et al.A Randomised clinical evaluation of ultrasound bone syrgery versus traditional rotary instruments in lowar third molar extraction.J Oral Maxillofac Surg 2010;68:330-336

5.Yuasa H,Kawai T,Sugiura M.Classification of surgical difficulty in extracting impacted third molars. British Journal of Oral and Maxillofacial Surgery 2002;40:26-31

6.sivolella stefano et al.Osteotomy for lower third molar germectomy:randomized prospective crossover clinical study comparing piezosurgery and conventional rotatory osteotomy.j oral maxillofac surg 69:e15-e23,2011

7.Stubinger S et al. “Intraoral Piezosurgery: Preliminary Results of a New Technique”. J Oral Maxillofac Surg.2005;63:1283-1287.

8. Chiapasco M, Crescentini M, Romanoni G: The extraction of the lower third molars:germectomy or late avulsion minervva stomatol. 1994;43:191

9.Abu-El Naaj I, Braun R, Leiser Y,et al:Surgical approach to impacted mandibular third molars-operative classification.j oral maxilllofac surg 2010:68:6628

10. Ricketts RM, Turley P, Chaconas S, et al: Third molar enucleation: Diagnosis and technique. J Calif Dent Assoc.1976; 4:52,

11. Sortino F, Pedullà E, Masoli V: The piezoelectric and rotator osteotomy technique in impacted third molar surgery: Comparison of postoperative recovery. J Oral Maxillofac Surg. 2008;66:2444

12. Barone A, Marconcini S, Giacomelli L, et al: A randomized clinical evaluation of ultrasound bone surgery versus traditional rotary instruments in lower third molar extraction. J Oral Maxillofac Surg. 2010;68:330

12. Vercellotti T, Pollack AS: A new bone surgery device: Sinus grafting and periodontal surgery. Compend Contin Educ Dent. 2006;27:319 13. Vercellotti T, Nevins ML, Kim DM, et al: Osseous response following resective therapy with piezosurgery. Int J Periodontics Restorative Dent 2005;25:543

9. Signature of the candidate APPROVED AND RECOMMENDED

10. Remarks of the guide

11. Name & Designation of (in block letters) DR. THOMAS JOSEPH

11.1 Guide (PROF & HOD)

11.2 Signature

11.3 Co- guide (if any)

11.4 Signature

11.5 Head of the Department DR. THOMAS JOSEPH

(PROF & HOD)

11.6 Signature

12. 12.1 Remarks of the Chairman & Principal

12.2 Signature

DR. SEQUEIRA PETER SIMON