Piezosurgery Versus Conventional Osteotomy in Orthognathic Surgery

Abstract

The aim of the study was to compare in a randomized controlled clinical trial the use of the piezoelectric osteotomy as an alternative to the conventional approach in terms of surgery time, intraoperative blood loss, cut quality, nerve injury, and costs.One hundred ten patients who had orthognathic surgery procedures with bimaxillary osteotomy were divided into 2 groups: group A was treated with a piezosurgery device, and group B, with a reciprocating saw and bur.The piezosurgical bone osteotomy permitted individualized cut designs. The surgical time in group A was reduced, with a mean for the mandibular osteotomy (1 side) between 3 minutes 31 seconds and 5 minutes 2 seconds, whereas in group B, the surgical time was between 7 minutes 23 seconds and 10 minutes 22 seconds. The surgical time in group A for the Le Fort I osteotomy was between 5 minutes 17 seconds and 7 minutes 55 seconds in group A and between 8 minutes 38 seconds and 15 minutes 11 seconds in group B. All patients in group A had a low blood loss (<300 mL) versus patients of group B who had a medium to high blood loss (medium loss: 400 mL, high loss: >500 mL). Inferior alveolar nerve sensation was retained in 98.2% of group A versus 92.7% in group B at 6 months postoperative testing.Piezoelectric osteotomy reduced surgical time, blood loss, and inferior alveolar nerve injury in bimaxillary osteotomy. Absence of macrovibrations makes the instrument more manageable and easy to use and allows greater intraoperative control with higher safety in cutting in difficult anatomical regions.

Piezoelectric surgery—primary bone grafting in craniofacial trauma revisited

“…4,5 Its use has been advocated in orthognathic and oral surgery, however the literature regarding its use in trauma surgery is sparse. 6,7 The limited vibration amplitude and specific design of the osteotome allow for precise and geometric cutting with minimal collateral bone damage. There is thought and evidence that bone healing is enhanced by the reduced size of the osteotomy and adjacent cellular damage.…”

Comparison between piezoelectric surgery and conventional saw in sagittal split osteotomies: a systematic review

“…The remaining eight studies presented an evaluation with follow-up varying from 1 to 55 months 10,12,[31][32][33][34][35]39 . Two studies reported the percentage of neurosensory disturbance by zone and it was not possible to determine the numbers of patients 9,38 .…”

“…In the studies in which the two types of surgical instruments were compared, the results obtained were compared between different patients 10,12 , or the comparison was made in the same patient where one side of the SSO had been performed with a saw and the contralateral side with a piezoelectric device 9,36,37 . Two articles reported 34 cases of rotation of the occlusal plane (Table 2) 10,39 .…”

“…With regard to SSO, some studies on the use of ultrasonic devices have reported minor postoperative complications such as oedema, bleeding, and IAN lesions [9][10][11] . The major limitations of ultrasonic devices are related to the prolonged time needed to perform the bone cuts and the necessity of completing the bone cuts with other instruments [12][13][14] .…”

Comparison between a piezoelectric device and rotary instruments in implant site preparation: an in vivo morphological, histological analysis using pigs

“…Piezoelectric surgery, which is a high-frequency surgical ultrasound system, has been advocated for carrying out precise, less invasive surgical procedures, the main advantages being the selective cutting of hard tissue and preservation of the soft tissue, less vibration and noise, absence of trauma in adjacent tissue, reduction in bleeding and an excellent view of the operative field 1 . Many studies have been published regarding osteotomies performed using piezoelectric instruments for the extraction of third molars [2][3][4][5][6] , in various categories of oral and maxillofacial surgery [7][8][9][10][11] and even in orthodontic microsurgery 12 . Specifically with regard to Implant Dentistry, piezoelectric instruments have been proposed for the removal of bone grafts [13][14][15] , the preparation of the bone window in sinus lift procedures [16][17][18] and the lateralization, immobilization and transposition of the inferior alveolar nerve [19][20] .…”