Invited Review Paper
Surgery
Piezosurgery in oral and maxillofacial surgery

https://doi.org/10.1016/j.ijom.2010.11.013Get rights and content

Abstract

This review summarizes current knowledge and experience with piezosurgery, a promising, meticulous and soft tissue-sparing system for bone cutting, based on ultrasonic microvibrations. The main advantages of piezosurgery include soft tissue protection, optimal visibility in the surgical field, decreased blood loss, less vibration and noise, increased comfort for the patient and protection of tooth structure. To date it has been indicationed for use in oral and maxillofacial surgery, otorhinolaryngology, neurosurgery, ophthalmology, traumatology and orthopaedics. The main indications in oral surgery are sinus lift, bone graft harvesting, osteogenic distraction, ridge expansion, endodontic surgery, periodontal surgery, inferior alveolar nerve decompression, cyst removal, dental extraction and impacted tooth removal. In conclusion, piezosurgery is a promising technical modality for different aspects of bone surgery with a rapidly increasing number of indications throughout the whole field of surgery.

Section snippets

Literature search

This review is based on an analysis of 343 original papers, case reports and short communications published in the English language from January 1988 to September 2010 in peer-reviewed journals. Keywords used included piezosurgery; piezoelectric surgery; piezoelectric bone surgery; bone surgery; piezosurgical; osteotomy; ultrasound surgery; oral surgery. A publication was included if the experimental or clinical study used piezosurgery in any manner during the treatment of patients. Special

Piezosurgery overview

Piezosurgery is based on the piezoelectric effect, first described by Jean and Marie Curie in 1880, which states that certain ceramics and crystals deform when an electric current is passed across them, resulting in oscillations of ultrasonic frequency. The vibrations obtained are amplified and transferred to a vibration tip which, when applied with slight pressure on bone tissue, results in a cavitation phenomenon – a mechanical cutting effect that occurs exclusively on mineralised tissue7. A

Advantages of piezosurgery

Piezosurgery was invented for safely performing sinus lift operations, but new indications are still appearing. The device is generally useful in cases in which bone needs to be cut close to important soft tissues such as nerves, vessels, Schneiderian membrane and dura mater, where mechanical or thermal injury must be avoided. Schaeren et al. have shown that direct exposure of a nerve to piezosurgery, even in worst-case scenarios, does not dissect the nerve but only induces some structural or

Bone graft harvesting and biopsy

Bone graft harvesting includes several procedures for obtaining chips or blocks of bone tissue. Bone chips are used as space makers and guides for bone regeneration through osteoconduction, and for support of growth factors at the recipient site to speed up bone healing. Bone blocks should be used when large defects need to be filled or when the immobilisation of particulate grafting material is not possible. Piezosurgery is important in bone graft harvesting, which also includes bone

Sinus lift

Sinus augmentation surgery is the widely accepted preprosthetic gold standard for creating sufficient bone volume for the placement of endosseous implants in an atrophic posterior maxilla (Fig. 1). The most frequent intraoperative complication of sinus elevation surgery is perforation of the sinus mucosa (Schneiderian membrane) reported to occur in 14–56% of cases36. Repairing perforations can be simple, difficult or impossible. For this purpose several techniques have been proposed, including

Other oral surgery indications

Specific oral surgery indications include osteogenic distraction (distraction osteogenesis), ridge expansion (crestal splitting) (Fig. 2), endodontic surgery, periodontal surgery, inferior alveolar nerve decompression, cyst removal and dental extraction—mainly impacted teeth33. A bone cut by piezosurgery appears to heal more efficiently initially during osseointegration of oral titanium implants, as shown in studies using minipigs20 or humans4.

Craniomaxillofacial surgery

Since its inauguration in oral surgery, the use of piezosurgery has rapidly spread into craniomaxillofacial procedures, mainly orthognathic and reconstructive surgery. Beziat et al. in one of the largest studies to date, used piezosurgery in 144 cases of Le Fort I osteotomy, 140 cases of palatal expansion after the Le Fort, 134 cases of bilateral sagittal split osteotomy (BSSO), 2 cases of Le Fort III osteotomy for treatment of Crouzon syndrome, 5 cases of segmental osteotomy, 3 cases of

Orthognathic surgery

The use of piezosurgery in several orthognathic procedures is gaining the interest of maxillofacial surgeons (Fig. 3). It has been used for minor orthodontic microsurgical procedures, and for orthognathic surgeries such as BSSO, surgically assisted rapid maxillary expansion (SARME) and Le Fort I osteotomy16, 21, 35.

The scalpel used for Le Fort I osteotomy is slightly curved at the base, and it becomes rectilinear, wider and thinner at the extremity. With light pressure, it is moved along the Le

Removal of osteosynthetic materials

The formation of callus that covers miniplates and screws, making the removal of such devices difficult, is a common problem in maxillofacial surgery. Using piezosurgery, the removal of such callus is quick and safe, without damaging the screw heads for subsequent screwdriver use9.

Reconstructive operations

The role of piezosurgery in reconstructive surgery is slowly increasing. Crosetti et al. claimed that the main advantages of this technique are: precision in performing osteotomies close to important soft tissues such as the inferior alveolar nerve or the dura mater; minimal bleeding from soft tissues surrounding the osteotomy line; and minimal trauma to the bony part of the flap, necessary for reconstruction7. Kotrikova et al. reported 2 cases of cranial osteoplasty in patients having cranial

Other indications

Many examples have been reported on the numerous other indications for piezosurgery in both the craniomaxillofacial region and in most other regions of the body. Crosetti et al. used piezosurgery successfully for the removal and cleaning of bone residues in bisphosphonate osteonecrosis, which developed during therapy of bone metastases from breast carcinoma. Their most important finding was that piezosurgery prevented additional bone necrosis after removal of the necrotic parts7.

Sakkas et al.

Analysis of published papers

Only 10 of 343 papers met the inclusion and exclusion criteria4, 5, 7, 10, 11, 16, 17, 30, 31, 33, which was considered insufficient for meta-analysis (Table 1). In conclusion, there are currently not enough relevant clinical studies on piezosurgery to perform a meta-analysis. Most studies on the use of piezosurgery hardly adhered to the recommendations of the International Committee of Medical Journal Editors and the Declaration of Helsinki; nor did they mention human subject protections and

Funding

None.

Competing interests

None.

Ethical approval

Not required.

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