Piezosurgery is a surgical technique that uses ultrasonic vibrations to selectively cut bone with minimal damage to soft tissues. It was developed in the late 1980s and uses a piezoelectric effect where crystals produce electrical current under pressure. Key advantages are precise cuts with good visibility and less soft tissue trauma compared to rotating burs. Applications include dental extractions, bone grafting, sinus lifts and implantology. While it reduces complications, limitations are longer operating times and higher costs compared to traditional techniques.

2. Deepu Mathews
Associate Professor
Malabar Dental College & Research Centre
Manoor - Chekanoor Road, Manoor, Edappal, Kerala
679582
https://macity.edu.in/

3. INTRODUCTION

4. TIMELINE OF SURGICAL
INSTRUMENTS

5. Prehistory
• bones, ivory, bamboo and stones
• early as 10,000 B.C.
Classical Age
• Classical surgeons used forceps, scalpels
• made from iron, bronze or gold
• had healing properties.

6. Scientific Revolution
• 17th century to the 19th century
• Bone drills and saws, lancets for bleeding and forceps.
• Steel and nickel plated instruments became common.
• Bone saws became notorious during civil war
• Surgeons were called as “ Sawbones”  amputations

8. 20th Century
• Stainless steel
• Rubber tubes and catheters 1960s.
• Recent developments  use of titanium and
disposable blades.
21st Century
• High-tech tools such as lasers and computer-guided
instruments.

9. • The piezoelectric effect first described by the French
physicists Pierre Curie and Jacques Curie, in 1880.
• Passage of an electric current across certain
ceramics and crystals modifies them and causes
oscillations.

10. Piezo effect

11. • Piezoelectric effect occurs only in non conductive
• materials.
• Piezoelectric materials : crystals and ceramics.
tourmaline, topaz, quartz, Rochelle salt
• The most well known piezoelectric material is quartz
(SiO2).
• everyday life application example is car's airbag sensor.
• The material detects the intensity of the shock and
sends an electrical signal which triggers the airbag

13. • Piezosurgery device  low-frequency piezoelectric
ultrasonic vibrations precisely cutting the bone
without cutting the soft tissue.
• Instrument's tip vibrates at different ultrasonic
frequencies
• Hard and soft tissues are cut at different frequencies
• "Selective cut"

14. • Oscillating tip drives the cooling irrigation fluid 
obtain effective cooling
• Higher visibility (via cavitation effect)
• Compared to conventional surgical instruments
(rotating burs and oscillating saws), can be used
even in deep spaces.

15. DEVELOPMENT

16. • Pierre Curie and Jacques Curie (1880): piezo-effect
 certain crystals produce electrical current while
under mechanical pressure.
• Piezosurgey device  electrical field is located in the
handle of the saw .
• Electrical current  deformation  cutting –
hammering movement.

18. • Dr. Tomaso Vercellotti (1988): Invented
the Piezosurgery device using a modulated
functional working frequency of 25- 30 kHz.

19. • Hoigne et al (2006); performed the first
ultrasound osteotomy in hand surgery.
• The cut was highly precise and there were no
vibrations of the bone.
(Piezoelectric osteotomy in hand surgery:
first experiences with a new technique BMC
Musculoskeletal Disorders 2006)

20. PIEZOSURGERY VS TRADITIONAL
Osseous surgery  2 types
1. Manual
2. Motor-driven.
• Manual instruments  good control used to remove
small amounts of bone in areas with less dense
mineralization.
• Difficult to control in cortical bone, particularly
where precise osteotomies are essential

21. • Motor-driven instruments : electric or
pneumatic energy  mechanical cutting action
• Heat produced in the cutting zone that must be
minimized by water irrigation.
• Overheating of adjacent tissue may alter or delay
the healing response

22. • Motorized cutting tools  decrease tactile sensitivity.
• Slower rotational speed  increased manual pressure
• Cause soft tissue complications such as lacerations or
burns during osteotomy.

23. • Piezosurgery device does not work on soft tissue
causes little or no soft tissue trauma
• Surgical access is easier in the deep oral cavity in
comparison to surgical burs, which use a straight
handpiece.
• Piezosurgery device makes a precise and tactile
controlled osteotomy

24. • Piezosurgery device virtually cannot cut the
schneiderian membrane (sinus lift), nerves, or
periosteum, cases where avoiding contact with such
structures is considered vital.

25. PIEZOSUGERY DEVICE

26. • Piezoelectric hand piece and a foot switch that
are connected to a main unit which supplies power and a
pump for irrigation.
• The unit is controlled by a interactive key board.
There are 2 programs 1.Bone
2. Root.
• Bone program the power can be set four levels
depending on the quality of the bone.
• Root program the power can be set to either Perio or
Endo

32. Insert tips: Sharp insert tips

36. THE COLOURS OF THE
INSERT TIPS

37. • Gold  for all insert tips used to treat bone.
• titanium nitride coating improve the surface
• working life may be longer (bone power).
Steel  for all insert tips used to treat soft tissues or
delicate surfaces such as the roots of teeth (root power).

38. INDICATIONS
Oral surgery
Dental extraction,
Third molar extraction
Osteogenic distraction,
Cyst removal
Endodontic surgery,
Bone harvesting (chips and
blocks),

39. Implantology
Maxillary sinus lift
Ridge expansion (crestal splitting),
Alveolar nerve decompression,
Harvesting techniques

40. Periodontology
Crown lengthening technique.
Resective and Regenerative Surgery
Orthodontic Surgery
Osteotomy and Corticotomy

41. METHOD OF USE

42. • Handpiece can be fitted with different tips for
osteoplasty, osteotomy, separating soft tissue from
bone, and cutting bone.
• Micro movements are in the frequency range of 25 to
29 kHz and, depending on the insert, with
amplitude of 60 to 210 μm

43. • Only mineralized tissue is selectively cut.
Neurovascular tissue and other soft tissue would
only be cut by a frequency of above 50 kHz
• Conventional micro-saws, the clinician must apply a
certain degree of pressure.
• Piezosurgery device needs only a very small amount of
pressure, which enables a highly precise cut. The
power of the device is 5 W (ultrasonic scaler 2 W)

44. • More power increases the cutting ability, requires
thicker tips, causes thicker and more imprecise cuts.
• The 5W power is the ideal compromise between
speed and precision.
• Piezosurgical tips have been developed for various
surgical applications (eg, a narrow tip to create a
straight-line incision vs a hoe-like tip to collect
autogenous bone).

45. • Piezosurgery can also be used safely  children
• Robiony M, Polini F used piezosurgery to perform
osteotomies in young children affected by hemifacial
microsomia. (J Craniofac Surg 2010 Nov; 21(6):1813-5.)

46. BIOLOGICAL EFFECTS ON
BONE SURGERY

47. • The effects of mechanical instruments on the structure
of bone and the viability of cells is important
in regenerative surgery.
• Relatively high temperatures, applied even for a
short time, are dangerous to cells and cause necrosis
of tissue.

48. • Chiriac G, Herten M, Schwarz F, Rothamel D,
Becker
• Autologous bone that had been harvested by
different methods
1. Round bur on low and high-speed hand piece,
2. Rhodes back action chisel,
3. Rongeur Pliers,
4. Gouge shaped bone chisel,
5. Piezoelectric surgery

49. • Microphotography and histomorphometric
analysis.
.Autogenous bone chips: influence of a new piezoelectric device
(Piezosurgery) on chip morphology, cell viability and differentiation. J
Clin Periodontol 2005;

50. The results showed that the best methods for
harvesting vital bone are:
1. Gouge-shaped bone chisel
2. Piezoelectric surgery
3. Rongeur pliers
4. Rhodes back action chisel
5. Round bur on low and high-speed hand piece

51. • Bone that has been harvested with a round
bur on low and high speed hand-pieces
• not suitable for grafting 
• absence of osteocytes and the predominance of
non-vital bone

52. APPLICATIONS IN
PERIODONTOLOGY AND
IMPLANTOLOGY

53. • Soft-tissue debridement
• Root surface scaling (changing to a thin, tapered tip
and altering the power setting)
• Osteoplasty and ostectomy  create positive
architecture for pocket elimination surgery.
• Bone harvesting
• Implant site preparation

54. • Implant removal
• Sinus lifts
• Precise removal of bone
• Minimal risk of injury to underlying root surfaces.
• Final smoothening of root surfaces and bony
margins

55. ADVANTAGES
• Micrometric cutting action
• Selective cutting action: minimum soft tissue damage
• Maximum intra-operative visibility (cavitation effect)
• Minimum surgical stress - Excellent tissue
healing .
• Sterile water environment for better asepsis (free
from contamination).

56. Preti G, Martinasso G, Peirone B, et al found out
that Piezoelectric bone surgery 
i. induces an earlier increase in bone morphogenetic
proteins,
ii. controls the inflammatory process better
iii. stimulates remodelling of bone as early as 56 days
after treatment.
Cytokines and growth factors involved in the osseointegration of oral
titanium implants positioned using piezoelectric bone surgery versus a
drill technique: a pilot study. J Periodontol 2007

57. LIMITATIONS
• Operating time for osteotomies is slightly
longer than with traditional saws.
• Increasing the working pressure impedes the
vibration of devices that transform the vibrational
energy into heat, so tissues can be damaged
• Learning curve
• COST

59. CONCLUSION
Piezosurgery is a relatively new surgical
technique for periodontology and implantology
that can be used to complement traditional oral
surgical procedures, and in some cases, replace
traditional procedures..

60. The main advantage is the selective
cutting of hard tissue without
minimum damage to soft tissue.
However the main limiting
factor is increased operation
time and cost,
unless the cost reduces
peizosurgery will remain a
treatment modality for the
elite club only .