Piezosurgery in periodontal therapy .pptx

Piezosurgery in Periodontics.
Presented by Dr Pratiksha Gaikwad
in Department of Periodontology and Implantology

1. Presented by – Dr. Pratiksha Gaikwad Piezo surgery in Periodontics

2. Content Introduction What is Piezoelectric effect? History Equipment Indications Contraindications Applications Scaling and root planning Curettage Periodontal surgery Harvesting Bone blocks and Bone grafting Ridge expansion Sinus lift procedure Implant site preparation Tooth extraction Advantages Disadvantages Conclusion Reference

3. Introduction

4. Piezoelectric effect The word “piezo” derived from the Greek word P iezein which means “to press tight or to squeeze.” The word piezoelectricity means electricity resulting from pressure.

5. What is Piezoelectric effect? The piezoelectric effect is the property of certain material (such as crystals, certain ceramics, and biological matter such as bone, and various proteins) to generate an electric charge when pressure / mechanical strain applied. 5 Tension & Compression (MECHANICAL ENERGY) Voltage in proportion to force applied (ELECTRICAL ENERGY) PIEZOELECTRIC EFFECT INVERSE PIEZO ELECTRIC EFFECT

6. Types of piezoelectric effect

7. History

8. Concept of piezoelectric surgery Piezoelectric surgery is the new technique which performs osteotomy/osteoplasty utilizing ultrasonic vibrations. Simplifies surgical procedure. Minimally invasive surgery piezoelectric surgery device does not work on soft tissue

9. Piezoelectric surgery device Ultrasonic vibrations – 25 to 29 kHz Oscillations – 60 to 210 micrometer Power – 50 W

10. Equipment 12

11. Main body Display screen Electronic touchpad Peristaltic pump Stand for handle

12. Handpiece

13. Dynamometric wrench Insert tips are tightened by using dynamometric wrench. Applies a predefined force to obtain energy.

14. Peristaltic pump Contain irrigating solutions for cooling

15. Insert tip Mechanical action of bone cutting takes place due to linear micro-vibrations of inserts

16. Classification of inserts

17. Sharp Insert Tips – Give a fine, well defined cut in bone enabling gentle & effective treatment Used for : - osteotomy & osteoplasty techniques, harvesting bone chips, implant site preparation Made of : nitrite titanium steel, gold in color

18. Smooth insert tips Enables s moothening action with precise control Made of : Diamond surface coating over nitride titanium Used for : To prepare delicate structures like Sinus window or nerve access To obtain final bone shape / complete the cut next to soft tissue

19. BLUNT INSERT TIPS – Steel color inserts with rounded ends Used for Refining the cut in contact with soft tissue Preparing soft tissues :elevating Schneiderians membrane, lateralizing nerves Root planing

20. Clinical Classification OT: The identification code for inserts used to perform osteotomy is OT followed by a number. ( OT1, OT2, OT3, OT4, OT5, OT6, OT7, OT7S4, OT7S3, OT8R/L) OP: The identification code for inserts used to perform osteoplasty is OP followed by a number. ( OP1, OP2, OP3, OP4, OP5, OP6, OP7) EX: The identification code for inserts used to perform extraction is EX followed by a number. ( EX1, EX2, EX3) IM: The identification code for inserts used to perform implant site preparation is IM followed by a number. IM1(OP5 -IM2A-IM2P OT4-IM3A-IM3P)

21. Colour Gold: For all instruments used to treat bone. Steel: For all instruments used to treat soft tissue or delicate surfaces, such as the roots of teeth.

22. Properties Better visibility Micro precision Selective cutting Excellent healing

23. Indication Implantology:  Implant site preparation Splintting and expansion of the alveolar ridge Alveolar crest recontouring Inferior alveolar nerve repositioning Harvesting block grafts Maxillary sinus bone grafting surgery:  Creating lateral bone window Sinus mucosa atraumatic dissection Elevation of internal sinus floor 3. Periodontal treatment procedures:  Crown lengthening Soft tissue debridement Resective and regenerative surgerical procedure 4. Others:  Apicectomy Extraction Tooth extraction with osteogenic distraction Ankylosed tooth. Removal of cyst

24. Contraindication Patients or the clinician with pacemakers. Certain systemic diseases such as cardiovascular diseases, diabetes and bone disease or in patients undergoing radiotherapy, all of which can hinder the dental implant surgery. S moking

25. Periodontal application 27

26. Scaling and root planning The piezoelectric surgery ultrasonic scaler set on function On/Mode Periodontics (ROOT), with the insert PS1 and PP1, applied at a medium power of two for 15 sec is used on all the surfaces for removal of deposits The piezoelectric device appears to produce better results in terms of roughness and less damage to the root surface than the conventional magnetostrictive ultrasonic scaler .

27. Curettage piezoelectric surgery device are used for the debridement of the epithelial lining of the pocket wall resulting in micro cauterization. piezoelectric surgery device can be used for efficient removal of diseased soft tissue and removal of root calculus compared to manual instruments by using thin tapered tips and altered power setting [Hema et al 2009 ].

28. Periodontal surgery Simplifies and improves handling of soft and hard tissues In resective periodontal surgery, using a scaler-shaped insert to detach the secondary flap and remove inflammatory granulation tissue. Little bleeding as the result of the cavitation of the saline solution (coolant). Facilitates effective scaling, debridement, and root planing

29. Clinical case demonstrating the use of piezoelectric bone surgery for periodontal surgery. (A) Ultrasonic scaling using Piezosurgery PS2 insert ( Mectron Medical Technology, Carasco , Italy). (B) Root surface debridement using Piezosurgery diamondcoated OP5 insert. (C) Ultrasonic root planing using Piezosurgery blunt insert PP1. (D) Interproximal infrabony defect with probe. (E) Autogenous bone chip–harvesting technique using Piezosurgeryosteoplasty insert OP3. (F) Autogenous bone-grafting technique. (G) Collagen membrane stabilizing microbone grafting. (H) Flap repositioned and sutured.

30. Crown lengthening procedure The crown lengthening technique performed with piezoelectric surgery using appropriate inserts makes it possible to effectively reduce bone while preserving root surface integrity The ostectomy is simple to perform using piezoelectric surgery in direct contact with the root surface because control of the instrument during surgery is precise, even in very difficult proximity cases (piezoelectric surgeryOP3 insert). The root planing phase can be performed very effectively using blunt ultrasonic inserts (piezoelectric surgeryPP1 insert). Sherman et al 2000

31. Bone harvesting Particulate Bone Chip Harvesting Technique . Particulate bone chips are harvested using special osteoplasty inserts to scrape the bone surface Bone chips as big as 500μm are the basis of osteoconductive bone regeneration. The piezo unit enables to gently scrub the bone surface to obtain graft material in sufficient amount.

32. Block Harvesting Technique Bone chips can be harvested from intraoral sources. Precise bone block as compared to conventional. Majewski, int j periodontics restorative dent 2012;32:e210–e217

33. Ridge expansion Horizontal alveolar ridge expansion is an extremely useful technique for increasing bone width and simultaneously placing implants in narrow ridges. The great advantage is that both augmentation and implant placement are accomplished in one surgical procedure. Piezoelectric surgery is an indispensable tool used to create a horizontal osteotomy through the alveolar bone crest caused by its precise (narrow) cutting action. In some cases ( e.G. , Areas of dense bone with little elasticity), it may also be necessary to make one or two vertical cuts in the alveolar bone to allow ridge expansion. The horizontal osteotomy is expanded in subsequent steps using piezoelectric inserts for implant site preparation together with screw-type or fan-type expanders for increasing the diameter or section, respectively

34. Implant site preparation Six insert tips available for implant site preparation. – Two pilot cylindrical tips. – Four conical ones, corresponding to the various implant diameters .

35. Sinus lift procedure In 2000, a new technique was developed that entails cutting an antrostomy (lateral window) using piezo surgery. This technique has greatly reduced the risk of membrane perforation (approximately 5% to 7%) Wallace et al, reported the perforation rate was reduced from the average of 30% with rotary instrumentation to only 7% with piezo surgery Window preparation- Thin bone- diamond ball smoothing insert Diamond scalpel 2. Thick bone- osteoplasty insert Diamond ball smoothing insert

36. Tooth extraction One of the main advantage of ultrasonic unit is the ability to prepare the bony window in the external cortex, which provides greater accessibility to the root or impacted tooth with limited loss of bone. Moreover, it enables one to replace the removed bony piece in its original position to improve the healing process and reduce the regeneration period [Francoli et al 2004].

37. Case demonstrating use of piezoelectric bone surgery for tooth extraction. (A) Radiograph of mandibular incisors with severe periodontal bone loss that are to be extracted because of a hopeless prognosis. (B) The Piezosurgery ( Mectron Medical Technology, Carasco , Italy) insert operates only on the root surface without cutting, damaging, or overheating the surrounding bony walls of the extraction socket. (C) The Piezosurgery insert is directed at cutting the root surface only ( rootplasty ) without cutting, damaging, or overheating the surrounding bony walls of the extraction socket in this simplified extraction technique. (D) Mobility is obtained with an elevator in a mesiodistal direction. (E) Teeth are extracted with forceps after displacement. (F) Notice the preservation of the alveolar bone. The narrow socket walls are completely intact after this rootplasty extraction technique. (G) Implant placement and particulate bone grafting of extraction socket defects. (H) Flap closure

38. Advantages Good hemostasis is achieved Micro precision bone cutting Excellent healing Patient feel very comfortable due to absence of macro vibrations Provides a blood free operation site Clear visibility , => Due to cavitation effect by the cooling fluid => Due to the kind of vibration generated by the instrument. Less damage to bone at structural and cellular level compared to other techniques Reduced risk of damage to surrounding soft tissue & critical structures ( like nerves , vessels & mucosa , periosteum or the schneiderian membrane )

39. The most compelling characteristics of piezoelectric bone surgery are Low surgical trauma, Exceptional control during surgery, A fast healing response of tissues

40. Disadvantages Increased operating time required for bone preparation Increased cost of the PS equipment as compared with the motor-driven or manual instruments Longer operating time and increasing the working pressure impedes the vibration of device that transforms the vibrational energy into heat, so tissues can be damaged, therefore, the use of irrigation is essential not only for the effect of cavitation but also to avoid overheating T he technique is difficult to learn

41. Conclusion PS appears to be an advanced and conservative tool when compared with existent traditional methods for the treatment of bone and soft tissues. It has the ability to increase treatment effectiveness while improving postoperative recovery and healing. Inspite of the fact that a great deal of scientific research focuses on new products for tissue engineering and bone regeneration, the importance of minimal surgical trauma for optional bone healing and regeneration should not be overlooked. The effectiveness of PS has the potential to redefine the concept of minimally invasive surgery in bone regeneration procedures and implantology.

42. References Carranza’s clinical periodontology-13th ed Kshirsagar et al . Piezosurgery : Ultrasonic bone surgery in periodontics and oral implantology- Review; International Journal of Applied Dental Sciences 2015; 1(5): 19-22 Mithlesh Bhagat et.al. piezoelectric surgeryin periodontics;Galore International Journal of Health Sciences and Research Vol.5; Issue: 1; January-March 2020  Sakthi Devi et al. piezoelectric surgeryIn Periodontics-review ;International Journal of Prosthodontics and Restorative Dentistry, April-June 2015;5(2):51-55 Seshan et al. piezoelectric surgeryin periodontology and oral implantology; Journal of Indian Society of Periodontology - Vol 13, Issue 3, Sep-Dec 2009.  Bhatnagara et al. Piezowave in periodontology and oral implantology - an overview; Tanta Dental Journal, Volume 14 No. 1, January-March 2017 Khan S, Khatri M, Bansal M, Rehan M, Tripathi P, Mishra A. piezoelectric surgeryin periodontology. Piezosurgery in periodontics ; IP international journal of periodontology and implantology, 2023.

43. Thank you