Piezoosteotomy in orthognathic surgery versus conventional saw and chisel osteotomy

Abstract

Piezoelectric osteotomy did not prolong the operation and reduced blood loss as alveolar nerve impairment. A few patients required additional sawing or chisel. Piezoelectric screw insertion as complex osteotomies may be initiated to simplify the procedure and increase segment interdigitation after repositioning as to minimize the osteofixation time and dimensions.

Comparison of piezosurgery and traditional saw in bimaxillary orthognathic surgery

“…performed 12 bimaxillary procedures while patients were under general anaesthesia with nasal intubation. The surgical technique was chosen on the basis of the personal experience of the surgeon, by comparing surgical techniques reported in literature (Kahnberg, 1997;Landes et al, 2008aLandes et al, , 2008bNada et al, 2010;Gilles et al, 2013). The surgeon prepared and dissected the subperiosteum as usual before performing the bilateral sagittal split osteotomy (BSSO), and the mandibular osteotomy was initiated at 45 on the lingual ramus side.…”

“…To compare each device's characteristics, we analysed several surgical and clinical parameters on the basis of literature reports (Eggers et al, 2004;Beziat et al, 2007;Landes et al, 2008aLandes et al, , 2008bGilles et al, 2013). We analysed the following intraoperative and postoperative parameters:…”

“…In the following decades, it has been applied to the following more challenging oral surgical procedures: alveolar ridge expansion (Blus and Szmukler-Moncler, 2006;Schlee et al, 2006) exposure of impacted canines (Grenga and Bovi, 2004), lateralisation of the inferior alveolar nerve (Bovi, 2005), sinus lifts for the placement of implants (Eggers et al, 2004;Stübinger et al, 2005;Barone et al, 2008), endodontic and periodontal surgery (Vercellotti and Pollack, 2006;Peñarrocha et al, 2007), and to harvest autologous bone grafts (Sohn et al, 2007). The end of the second millennium saw the growing clinical introduction of the ultrasonic scalpel (Shelley and Shelley, 1986;Lee and Park, 1999;Gonzalez-Garcia et al, 2009), and it has become competitive with conventional instruments in maxillo-facial surgery for orthognathic operations in certain frameworks (Stübinger et al, 2005;Kotrikova et al, 2006;Landes et al, 2008aLandes et al, , 2008bBeziat et al, 2009;Gilles et al, 2013;Hoffmann et al, 2013).…”

“…This instrument seems to offer several main advantages in oral and maxillo-facial surgery (Stübinger et al, 2005;Kotrikova et al, 2006;Beziat et al, 2007;Landes et al, 2008aLandes et al, , 2008bMaurer et al, 2008;Beziat et al, 2009;Gonzalez-Garcia et al, 2009;Gilles et al, 2013) such as: (1) minimal risk for soft tissue, which vibrates without fracture when in contact with the osteotome tip; (2) excellent visibility within the surgical field due to minimal bleeding and the cavitation effect removing osteotomic detritus; (3) precision and geometric cutting, due to the limited vibration amplitude and specific design of the osteotome; and (4) low acoustic and vibration impact. However, three main disadvantages have been reported: (1) dense bone cutting could take up to 4 times longer than a traditional rotary saw; (2) it is necessary to maintain a stock of tips; and (3) higher cost than mechanical osteotomes.…”

“…All of these characteristics have translated by authors into clinical and surgical results such as a reduction of intraoperative blood loss, more cutting precision, a longer operation duration mean time, a less incidence of postoperative swelling and haematoma, a lower incidence of nerve damage and a faster nerve recovery when impaired (Eggers et al, 2004;Beziat et al, 2007;Landes et al, 2008aLandes et al, , 2008bGonzalez-Garcia et al, 2009;PineiroAguillar et al, 2011;Gilles et al, 2013).…”