iDentistry The Journal identistry_may_aug2019 | Page 10

The Journal
Surgical control with the piezosurgery is
maximum as strength required by the surgeon
to effect a cut is far less compared to that with a
oscillating saws or drill. Rather micromotor burs
controlled by a greater strength against the
rotating couple of the instrument obtained by
applying increased pressure of the hand. So
surgical sensitivity is reduced, especially when
there are structures presenting different
mineralization or even more complex soft
tissues, where one runs the risk of losing control
of the latter on the drill’s stem. 5 Oscillating saws
with macrovibrations, require a contrast action
which is necessary to perform a cut; even
though guaranteeing excellent linearity. They
do not allow the control of depth of cutting in the
centre or at the sides. Therefore, it is often
necessary to complete the incision with a
scalpel and hammer.
Clinically piezosurgery system offers three
different power levels
1. low mode indicated for apical endocanalar
cleaning in orthodontic surgery
2. high mode, useful for cleaning and smoothing
the radicular surface
3. boosted-mode, indicated in bone surgery
which is necessary in performing osteotomy
and osteoplasty.
This modality of work is further divided into a, b,
c which is according to modulation of the correct
frequency for the quality of the bone to be
treated. The correct use of piezosurgery
requires to overcoming psychological
obstacles, as well as familiarity with handling of
the surgical procedures. 6
Experience and repeating of the movements
forms the basis of surgical movements. The
surgical handling in piezoelectric surgery
required is completely different from that used
with the oscillating saws and drills and the
microvibrations in piezoelectric.
10
In order to increase the capacity of cutting,
pressure of the hand should not be increased
7
(as with bone drills or saws) an increase in
pressure prevents the microvibration of the
insert. The energy which is not used for cutting
is thus transformed into heat which if prolonged
can cause damage to the tissue. To avoid a
surgical obstacle, it is necessary to calculate
the pressure according to the speed of the
insert. 5-8
Discussion
Piezoelectric surgery was proposed for the
need to overcome the limits of the traditional
instruments available in bone surgery.
Osteotomy techniques consist in performing
cutting actions (osteotomy) 10 or remodelling
(osteoplastic procedures) of the bone surface.
All bone surgery in the different specialities,
originate from a combination of these two
techniques.
Two types of instruments exists:
1. manual instruments (scalpels, hammers,
saws) which is characterized by considerable
cutting efficacy, related to the mechanical force
exerted in an instantaneous fashion so they are
not easily controllable
2. motor-driven instruments, which is
characterized by a cutting capacity produced by
electric or pneumatic energy. The micromotors
used in bone surgery transform
the electric energy into mechanical energy; so
the cutting is the result of rotation produced by
the movement of the drill or by the oscillating
movement of the bone saw.
The drill produces a cutting action combines
the speed and the torque of the drill, with the
pressure exerted on the handle and the cutting
action of the bur. So this very pressure that
makes the surgical manoeuvre more difficult to
control and, therefore, less safe.
Vol. 15
No. 2
May-Aug 2019