Piezosurgery: Is the Integration of the Implants I’m Placing Compromised by the Piezo?

Dear Dr. B, I started use piezo last 2004 and preparing implants almost 2 years ago without problem. Piezo is really nice technology, but need some training. When we press the tip against the bone, we can generate heat, so "drilling" bone should be delicate and fast moving hand. I suggest you 2 links for videos at youtube. Hope can give you some tips... regards http://www.youtube.com/watch?v=Gtz0CTOzb7Q and http://www.youtube.com/watch?v=sffFLLok3_Q

I have to say taht I have had tremendous bone loss and the bone necrosed. I have had this more than once adn I was told that I was too heavy handed adn kept teh end in one place for too long. I now soley use it to open lateral walls for sinus lifts adn cut out monocortical bone blocks that is it.

You have to let the water cool down the tip of the blade. It also depends on the brand you are using, some heat more than others. I've never had a problem doing this procedure. Regards

I use Mectron piezosurgery from 3 years for oral surgery and implant site preparation. I never used then lindmann burs or implant twist drills. After several courses of Vercellotti, the inventor of piezosurgery, I'm very proud of this technique and I never had a failure in the osseo-integration period: every implant was stable and had a good sound 30-45 days after surgery. It is my opinion that you burned socket bone with a wrong use of the device, maybe you pressed much on the bone with a low irrigation. The ideal techmiete is a cut oriented on root cement with 30 degree angle, rapid and gentle movement, high irrigation Finally a piezoelectic curetting action with op3 insert to opening vascularity of lamina dura giuseppe sepe

Dr B, Both my partner and I have had problems with the piezo machine and extractions. I don't think it has anything to do with the type of machine you have. We have the Mectron. It has everything to do with technique. Unfortunately, the training was not sufficient on proper technique with extractions. I would make sure you get really good training on proper technique for implant placement because severe problems with bone necrosis will occur if you overheat the bone. We have seen this. Personally, I do not feel there is any advantage to using piezsosurgery for implant placement.

Thank you all for your helpful comments. The reason I posted this question is that I had a patient that complained of severe throbbing pain that started a few days after the extraction with Piezo and immediate placement. I suspect he developed a dry socket. At this point I'm taking a wait and see approach and hopeful that the implant will integrate properly. But I have my concerns obviously. Thanks again. Dr. Bokhari

There is significant heat buildup when using a piezo tip. If you inadvertantly rest the side of the tip against the lip while you are cutting, within a few seconds you will develop a first or even second degree burn on the soft tissue. The key to using this type of instrument is copious irrigation, good retraction, an appropriate tip for the procedure, and rapid movement of the tip to dissipate heat buildup. If you notice a change in the color of bone, indicating thermal damage, your technique needs to be modified. This will account for lack of bleeding and post-operative pain. Used correctly (aka taking a good piezo course), piezo surgery is a superior instrument for many procedures. RJM

Mectron offers VIP courses. They are very informative. I have used the mectron as well as 3 otter peizo units. Mectron is the most powerful as the tips tend not to loosen as you work. This is a plus and minus. Good for constant power bad for the heavy handed user. A light touch is essential otherwise you will burn bone, at that point you might as well use a bur. See the mectron website for course info.

If you get a chance, look to attend the AAOMS 94th Annual Meeting, Sept. 13 thru 15th in San Diego, US http://www.aaoms.org/annual_meeting.php . Some of the comments on this site seem to be an endorsement of the product by those who market and sell the device which leaves much to be desired. If the Piezosurgery 3 by Mectron and osseo-intergration results are superior, it would seem the instrument/ technique would catch on for further anatomical osseus procedures.