A REVOLUTIONARY APPROACH in PERIODONTAL SURGERIES Swyeta Jain Gupta1,Vivek Gautam2,Amit Gupta3 1.Senior Lecturer,Department of Periodontics and Implantology,I.T.S
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International Journal of Dental and Health Sciences Review Article Volume 02,Issue 05 PIEZOSURGERY – A REVOLUTIONARY APPROACH IN PERIODONTAL SURGERIES Swyeta Jain Gupta1,Vivek Gautam2,Amit Gupta3 1.Senior Lecturer,Department of Periodontics and Implantology,I.T.S. Centre for Dental Studies and Research,Ghaziabad 2.MDS,Prosthodontics (Private Practitioner), Gautam Multispeciality Dental Clinic,P.N Plaza Complex,Below Bank Of India,Sigra,Varanasi,Uttar Pradesh ,India. 3.Senior Lecturer, Department of Oral and Maxillofacial Pathology and Microbiology,I.T.S. Dental College, Hospital and Research Centre,Greater Noida ABSTRACT: Piezoelectric surgery, also known as piezosurgery, is an osseous surgical technique first described by Vercellotti (2004) utilizing an innovative ultrasonic surgical apparatus, known as the Mectron piezosurgery device. Piezoelectric device is an innovative tool developed as an alternative to the mechanical and electrical instruments that are used in conventional oral surgical procedures. Because of its highly selective and accurate nature, with its cutting effect exclusively targeting hard tissue, its use may be extended to more complex oral surgical procedures, as well as to other interdisciplinary problems. It can be used for selective cutting of bone depending on bone mineralization, without damaging the adjacent soft tissue (e.g. vessels, nerves or mucosa), providing a clear visibility in the operating field, and cutting with sensitivity without the generation of heat. Hence, user must be knowledgable and trained enough to adapt their operating technique in order to utilize the advantages of piezosurgery. This review summarizes on the clinical importance of piezosurgery pertaining to its use in periodontal sugeries. Piezosurgery ensures the 3 ‘P’s that is predictability, less post operative pain and increased patient’s compliance in various disciples of dentistry. Keywords: Ultrasonic, microvibrations, piezoelectric, osteotomies, macrovibration. INTRODUCTION: In periodontics ultrasound has been periradicular osteotomy to extract an implicated since many years to remove ankylosed root of a maxillary canine. The tartar, debride root surfaces, and to implant positioned at the moment of the degranulate periodontal defects. In the extraction worked perfectly and this gave past few years ultrasonic powered devices rise to a series of experimental techniques have been developed that is using ultrasound for bone cutting.[1,2] revolutionizing periodontal surgeries and maxillofacial bone surgery. In 1997, The most convincing characteristics of Tomaso Vercellotti first introduced the piezoelectric bone surgery are low surgical idea to use an ultrasonic device for trauma, exceptional control during ablation fitted with a sharpened insert, surgery, and a quick healing response of such as a scalpel blade, to perform tissues. Clinical studies have demonstrated that the specificity of *Corresponding Author Address: Dr Swyeta Jain Gupta Email: [email protected] Gupta S et al., Int J Dent Health Sci 2015; 2(5):1205-1221 operation and the techniques employed possible to optimize surgical results even with piezoelectric bone surgery makes it in the most complex anatomical cases possible to advantageously exploit differences in hard and soft tissue The peizosurgery system consists of a anatomy. This not only increases main unit, peristaltic pump (for cooling treatment efficacy but it also improves and removal of blood and wastes), foot postoperative recovery and healing. switch, handpiece and tool inserts (flat, Ideally, surgical trauma should be blunt, scalpel and sharp saw tipped). The minimized to obtain the optimal healing, device can recognise changes in material which depends on gentle management of density and deactivate itself when a soft and hard tissues.[3] Surgery, by change is encountered, unlike definition, alters normal physiology by conventional tools. Piezosurgery uses a interrupting the vascular supply of tissues. modulated ultrasonic frequency to permit The extent of surgical invasiveness is highly precise and safe cutting of hard [7] extremely important for the quality of tissue. the most peculiar feature of the tissue healing and may affect whether piezoelectric device is selective cutting. wounds heal by repair or regeneration. The cutting of hard tissue with ultrasonic Indeed, when surgical trauma is kept to a vibrations that are formed by the bare minimum it generates enough piezoelectric effect was first described by [8] stimulation to favor healing mechanisms Catuna in 1953 and then by Volkov and [9] that lead to regeneration.[4,5] Shepeleva in 1974. In 1981, its application was described by Aro et al.[10] The Piezosurgery device was developed in orthopaedic surgery, and Horton et with the aim of enhancing the surgeon’s al.[11] in oral surgery. Although ability to perform meticulous bone piezosurgery cuts mineralized tissues such surgery, while reducing the risk of as bones, it does not cut soft tissues such intraoperative and postoperative as vessels, nerves and mucosa.[12] morbidity.[6] The philosophy behind the development of Piezoelectric bone Principle Surgery is based on two fundamental French physicists Jean and Marie Curie in concepts in bone microsurgery. The first is 1880 described the mechanism ‘Piezo minimally invasive surgery, which effect’ on which this device works. The improves tissue healing and reduces device operates at a frequency of 25-29 discomfort for the patient.. The second kHz, with the possibility of digital concept is surgical predictability, which modulation up to 30 kHz as a “boost” and increases treatment effectiveness. Indeed, an advanced oscillation control module the ease in controlling the instrument that introduces pauses in the high- during the operation combined with frequency vibrations. These pauses help reduced bleeding, the precision of the cut, to avoid heating of the bone and maintain and the excellent tissue healing make it optimum sectioning capacity. 1206 Gupta S et al., Int J Dent Health Sci 2015; 2(5):1205-1221 Piezosurgery devices are fitted with a defined by the term ‘piezo’ derived from cooling irrigation system with 0 to 60 ‘piezein’, meaning pressure in Greek mL/min of variable sterile solution flow. language. The amplitude of the micro vibrations has to be kept in the range of 60-210 μm, at Mechanisms of action of piezoelectric [15] an ultrasonic power of up to 16 Watts.[13] devices Piezosurgery units are some 3 times more The cavitation effect of piezoelectric powerful than conventional ultrasonic surgery is crucial in bone surgery. units (5 Watts), which allows them to cut Cavitation is the formation and the highly mineralized cortical bone. The immediate implosion of cavities within a reduced range and the linearity of the liquid (i.e. small liquid-free zones, ‘bub- vibrations allow for precise control of bles’). These bubbles are formed as a cutting corresponding to a handpiece consequence of the forces that are acting power rating of 5W.[14] upon a liquid. It typically occurs when a The Piezosurgery device offers three liquid is subjected to a rapid change in specific therapeutic features attributable pressure, leading to the formation of to the microvibrations and to specific cavities within the liquid where the modulation of the ultrasound frequency. pressure is relatively low. In piezoelectric Firstly, it allows micrometric sectioning, surgery, the cavitation phenomenon offering superior precision in cutting and describes the process of vapourization, with no bone loss. Secondly, the bubble generation and subsequent implo- instrument selectively sections sion (growth and collapse of bubbles) into mineralized structures, without damaging many minute fractions of its original size the adjacent soft tissues, which remain (microscopic gas bubbles) that will occur intact even in the case of accidental in a flowing liquid as a result of the contact with the device. Lastly, the decrease and increase in pressure that is physical cavitation phenomenon produced caused by the ultrasonic vibrations. In ul- by the device ensures less bleeding. trasonic osteotomy, the cavitation phenomenon helps to maintain good Creation of piezoelectric effect and visibility in the operative field by dis- ultrasonic vibration persing a coolant fluid as an aerosol that causes the blood to essentially be washed The piezoelectric effect is the creation of away. Furthermore, the cavitation effect electrical tension on some crystal and will bring about haemostasis, which ceramic materials such as quarts to which results in a bloodless surgery. Walmsley et a mechanical pressure is subsequently al.[16] has suggested that the cavitation applied. The material in question will effect fragments the cell walls of bacteria, expand and then contract leading to an and therefore has an anti-bacterial ultrasonic vibration. Also known as efficiency. ‘pressure electrification’, it has been 1207 Gupta S et al., Int J Dent Health Sci 2015; 2(5):1205-1221 Cutting characteristics of piezoelectric obtain the final bone shape. These inserts devices are specifically useful to prepare difficult and delicate structures such as sinus The cutting characteristics of piezosurgery window or access to nerve. Eg: Design no: are dependent upon the- OT5, OT-1, OT-4 and OP-4 Degree of bone mineralization (density)- Blunt Inserts: They have blunt, dull and The degree of bone mineralization rounded non cutting tip. These tips play determines the frequency of vibration (Hz) wonders in atraumatic elevation