Piezo-osteotomy in orthognathic surgery: A comparative clinical study

Abstract

Background: After the clinical introduction of ultrasound scalpel in recent years, piezosurgery has become competitive with conventional instruments in orthognathic procedures to reduce the operative and postoperative complications reported to occur in association with these surgeries. Aims: The aim of this prospective clinical study was to compare intraoperative and postoperative outcomes of both piezoelectric device and the traditional bur technique in orthognathic surgery. Intraoperative bleeding time, operative time, postoperative swelling, and neurological impairment were evaluated. Materials and Methods: In this study, a split-mouth technique was applied on ten patients requiring orthognathic surgery. To make the osteotomy cuts, on the one side, piezo-osteotome was used, and on the other side, conventional osteotomy bur was used. Results: Duration of osteotomy was found to be greater with piezo osteotomy compared to bur osteotomy. Mild bleeding was observed with piezosurgery. Postoperative swelling was greater on the side of piezosurgery compared to the bur side. Altered neurosensory activity was found to be equal on the 1 st day postoperatively, but the piezo side recovered faster compared to the bur side in the 1 st month after surgery. Conclusion: Piezoelectric device offers better advantages over the conventional bur in orthognathic surgery and hence can be considered an alternative to the bur in some orthognathic procedures.

Evaluation of Computer Assisted Design Computer Assisted Manufactureing (Cad/Cam) Osteotomy Guide in Bilateral Mandibular Sagittal Split Osteotomy (A Randomized Controlled Clinical Trial)

“…In our study, piezotome was used for osteotomies due to its meticulous advantages which include, reduced nerve affection, enhanced visibility of surgical field and accurate bone cutting. This runs in parallel with Harshitha Raj (2022) (28). It provides smooth cutting due to its cavitation effect.…”

Minimally Invasive Approaches in Orthognathic Surgery: A Narrative Review of Contemporary Techniques and their Clinical Outcomes

“…[ 26 ] Concerning the duration of surgery and postoperative hospital stay, MITs often demonstrate shorter operative times and reduced hospital stays owing to their precise execution and decreased surgical trauma. [ 27 28 29 ] Finally, when examining long-term outcomes and stability, both approaches exhibit comparable results, with MIT showcasing potential benefits in maintaining postoperative stability due to their tailored, patient-specific planning. [ 30 ]…”

Use of piezoelectric instrumentation in craniofacial surgery

“…Several studies have also examined the utility of piezoelectric surgery in orthognathic surgery, where it is used to create precise osteotomies with minimal harm to adjacent structures [37][38][39]. Piezosurgery is most often used in bilateral sagittal split osteotomies, during which the inferior alveolar nerve bundle is at risk for injury.…”

“…Similar to other procedures, the main concerns with implementing piezosurgical techniques center on longer osteotomy and overall operative times, particularly in the context of having to cut through more dense cortical bone during orthognathic procedures. Studies have demonstrated mixed results with these outcomes, finding either longer [37,48,49], shorter [39], or equivalent [52] osteotomy or operative times.…”

“…However, these results were not statistically significant in their analysis. A 2022 study by Raj et al [37] compared the techniques by performing maxillary and mandibular osteotomies with conventional burrs on one side and piezo-osteotomy on the contralateral side. They observed reduced intraoperative bleeding, faster resolution of postoperative swelling, and improved sensory outcomes with most patients attaining complete recovery within a shorter postoperative window.…”