Periodontitis is a chronic inflammatory disease of the tooth-supporting structures. The treatment of this condition is based on the removal of local factors and restoration of the bony architecture. Traditionally osseous surgery has been performed by either manual or motor-driven instruments. However, both these methods have their own advantages and disadvantages. Recently, a novel surgical approach using piezoelectric device has been introduced. It is a promising, meticulous and soft tissue sparing system based on low frequency ultrasonic microvibrations. The absence of macrovibration makes the instrument more manageable and allows greater intraoperative control with an increase in the cutting safety in the more difficult anatomical cutting zone. This presentation emphasizes the mechanism of action, instrumentation, advantages and limitations as well as its applications in periodontology and implantology.

1. PIEZOSURGERY
DR.SHRADDHA KODE

3. WHY IS PIEZOSURGERY
NEEDED???????
HEAT
PRESSURE
LIMITATIONS
Rashad A, Kaiser A, Prochnow N, Schmitz I, Hoffmann E, Haurer P. Heat Production during different Ultrasonic
and conventional osteotomy preparation for dental Implants. Clin Oral Implant Res. 2011; 22: 1361-1365.

4. A novel surgical technique was introduced
based on ultrasonic micro-vibration for precise
and selective cut on the bone, without injuring
the surrounding tissues
PIEZOSURGERYChopra P, Chopra P. Piezosurgery and its applications in Periodontology and Implantology. Int J Contemp Dent.
2011; 2: 16-24.

5. 1988 - PROFESSOR
THOMAS VERCELLOTI
INVENTED PIEZOELECTRIC
BONE SURGERY

6. HOW DOES IT WORK?????
ULTRASONICS - Branch of
acoustics dealing with
sound vibrations in a
frequency that ranges
above the audible level
i.e. >20 kHz
Mechanical
Method – up
to 100 kHz
Magnetostatic
Method – 18
to 25 kHz
Piezoelectric
effect – 25 to
50 kHz
Kshirsagar JT, Prem KK, Yashodha SR, Nirmmal MT. Piezosurgery: Ultrasonic bone surgery in periodontics and
oral implantology- Review. Int J Appl Dent Sci 2015;1:19-22

7. PRINCIPLE OF ‘PRESSURE ELECTRIFICATION’
MOST
WIDELY
USED
Bains VK, Mohan R, Gundappa M, Bains R. Properties, effects and clinical applications of ultrasound in
periodontics: an overview. Periodontology 2000; 5:291–302.

8. THESE WAVES ARE TRANSMITTED TO THE HAND PIECE TIP, ALSO CALLED AN
INSERT, WHERE LONGITUDINAL MOVEMENT OCCURS
RESULTS IN THE CUTTING OF OSSEOUS TISSUE BY MICROSCOPIC
SHATTERING OF BONE
Leclercq P, Zenati C, Amr S, Dohan DM. Ultrasonic bone cut part 1: State-of-art technologies and common
applications. J Oral Maxillofac Surg. 2008; 66: 177-182.

9. THESE ULTRASONIC WAVES ALLOW SEGMENTATION OF INTERFACES FROM SOLID-
LIQUID BY MEANS OF A MICRO-BOILING PHENOMENON CALLED CAVITATION
ADVANTAGES
1. GOOD VISIBILITY IN THE FIELD OF OPERATION BY DISPERSING COOLANT AS AN
AEROSOL AND PROVIDING HEMOSTASIS
2. ANTIBACTERIAL PROPERTY BY FRAGMENTING BACTERIAL CELL WALL
Agarwal E, Masamatti SS, Kumar A. Escalating Role of Piezosurgery in Dental Therapeutics. J Clin Diagn Res
2014;8:ZE08-11.
Mani AM, Marawar PP, Shubhangi Amit, Dalvi A. Piezosurgery – A Review. Pravara Med Rev 2014;6:8-11

10. PROPERTIES:
MICROMETRIC CUTTING:
DUE TO LIMITED VIBRATION AMPLITUDE, DESIGN OF
OSTEOTOME TIPS AND HIGH TACTILE SENSITIVITY
Sohn D, Ahn M, Lee W, Yeo D, Lim S. Piezoelectric osteotomy for intraoral harvesting of bone blocks. Int J
Periodontics Restorative Dent 2007;27:127–131.

11. SELECTIVE CUTTING:
BONE CUTTING WITHOUT THE RISK OF DAMAGING
ADJACENT SOFT TISSUES
Schlee M, Steigmann M, Bratu E, Garg AK. Piezosurgery: basics and possibilities. Implant Dent 2006; 15:334–
340.

12. BLEEDING FREE SITE:
FOR MAXIMUM INTRAOPERATIVE VISIBILITY
AND HIGH PREDICTABILITY. CAVITATION EFFECT
PRODUCES MICROCOAGULATION
Stubinger S, Landes C, Seitz O, Zeilhofer HF, Sader R. Ultrasonic bone cutting in oral surgery: a review of 60
cases. Ultraschell Med 2008; 29:66–71.

13. PIEZOELECTRIC DEVICE

14. FREQUENCY OF 25–29 KHZ
& LINEAR VIBRATION
RANGING FROM 60–200µm
& POWER OF THE DEVICE IS
5 W
PIEZOSURGICAL UNIT
Schlee M. Piezosurgery: A precise and safe new oral surgery technique. Aust Dent Pract. 2009; 2009: 144-148.

15. CONTROL PANEL
TWO BASIC PROGRAMS: BONE AND ROOT
IN THE BONE PROGRAM IT IS POSSIBLE TO
ADAPT TO ANY FOUR LEVELS DEPENDING
ON THE QUALITY OF BONE.
IN THE ROOT PROGRAM THE POWER CAN
BE SET TO EITHER ENDO OR PERIO.

16. DYNAMOMETRIC WRENCH
INSERT TIPS ARE TIGHTENED TO THE
HAND PIECE USING A
DYNAMOMETRIC WRENCH WHICH
APPLIES A PREDEFINED FORCE TO
OBTAIN ENERGY TRANSMISSION.

17. PERISTALTIC PUMP:
CONTAINS IRRIGATING
SOLUTION FOR COOLING AND
REMOVAL OF DETRITUS FROM
CUTTING AREA

18. THE HANDPIECE
EACH PIEZOSURGERY UNIT COMES
WITH TWO HAND PIECES AND IS
PERMANENTLY CONNECTED TO A
HAND PIECE CORD WHICH CAN BE
STERILISED TOGETHER.

19. INSERT TIPS

20. INSERT TIPS
STEEL: USED FOR SOFT TISSUE OR
DELICATE STRUCTURES SUCH AS ROOTS OF
TEETH
GOLD: USED TO TREAT BONE. GOLD COLOUR IS OBTAINED
BY APPLYING A COAT OF TITANIUM NITRIDE TO IMPROVE
THE SURFACE HARDNESS FOR A LONGER WORKING LIFE
Piezosurgery: The new dimension in bone surgery. Mectron medical technologies.
Lands CA, Stubinger S, Laudemann K, Rieger J, Sader R. Bone harvesting at the anterior iliac crest using piezo-
osteotomy versus conventional open harvesting: A pilot study. Oral Surg Oral Med Oral Pathol Oral Radio
Endod. 2008; 105: 19-28.

21. CLINICAL CLASSIFICATION
OT: THE IDENTIFICATION CODE FOR INSERTS USED TO PERFORM OSTEOTOMY
OP: THE IDENTIFICATION CODE FOR INSERTS USED TO PERFORM OSTEOPLASTY
IM: THE IDENTIFICATION CODE FOR INSERTS USED TO PERFORM IMPLANT SITE
PREPARATIONS
EX: THE IDENTIFICATION CODE FOR INSERTS USED TO PERFORM EXTRACTION

22. • Has optimal vibration frequency for the mineralized tissue
required during cutting and maintaining the bone constantly
clean, avoiding excessive temperature
• Highly precise and safe cutting of hard tissue, whereas
adjacent soft tissue and nerve remain unharmed
• Strength required to make cuts is far less compared to that
with drill making surgical control with maximum
• Minimal intraoperative bleeding seen as it does not
traumatize bone thermally, with rapid postoperative wound
healing
Crosetti E, Battiston B, Succo G. Piezosurgery In head and neck oncological and reconstructive surgery:
Personal experience on 127 cases. Acta Otorhinolaryngol Ital. 2009; 29: 1-9.
Schlee M, Steigmann M, Bratu E, Garg AK. Piezosurgery: Basics and possibilities. Implant Dent. 2006; 15: 334-
340.
Walsh LJ. Piezosurgery: An increasing role in dental hard tissue surgery. Aust Dent Pract. 2007; 18: 52-56.

23. • Adequate dexterity and gentle touch is required for this type
of procedure with a different learning curve
• Increase in working pressure above a certain limit impedes
the vibrations of insert, transforming the energy into heat.
Thus, the most effective way is to use piezosurgery hand
piece with higher speed and a lower pressure
• Increase in operative time
• Inserts get worn away very rapidly
• Not cost effective.
Leclercq P, Zenati C, Amr S, Dohan DM. Ultrasonic bone cut part 1: State-of-art technologies and common
applications. J Oral Maxillofac Surg. 2008; 66: 177-182.

24. PERIODONTAL APPLICATIONS
SUPRAGINGIVAL AND SUBGINGIVAL SCALING
REMOVAL OF SUPRA AND SUBGINGIVAL CALCULUS, STAINS, AND DEBRIS BY
PLACING THE INSERTS VERTICALLY PARALLEL TO THE LONG AXIS OF THE
TOOTH AND MOVING CONTINUOUSLY
Walmsley AD, Laird WR, Williams AR. Dental plaque removal by cavitational activity during ultrasonic scaling.
J Clin Periodontol. 1988; 15:539-43.

25. CURETTAGE
BY DEBRIDING EPITHELIAL LINING OF THE POCKET WALL WHICH RESULTS IN
MICROCAUTERIZATION
CROWN LENGTHENING
WHERE BONE IS REDUCED EFFECTIVELY PRESERVING ROOT SURFACE
INTEGRITY
Hema S, Kranti K, Sameer Z. Piezosurgery in periodontology and oral implantology. J Indian Soc Periodontol
2009;13:155-6.
Sherman JA, Davies HT. Ultracision: The harmonic scalpel and its possible uses in maxillofacial surgery. Br J
Oral Maxillofac Surg 2000;38:530-2.

26. POCKET ELIMINATION AND OSSEOUS SURGERY
WHERE SOFT TISSUE DEBRIDEMENT IS DONE
AND BONE IS REDUCED EFFECTIVELY PRESERVING
ROOT SURFACE INTEGRITY
Carr M. Ultrasonics. Access, 1999, 2-8.

27. OSSEOUS RECONTOURING – FOR OSTEOTOMY AND OSTEOPLASTY PROCEDURES
Bains VK, Mohan R, Gundappa M, Bains R. Properties, effects and clinical applications of ultrasound in
periodontics: an overview. Periodontology 2000; 5:291–302.

28. HARVESTING BONE GRAFT
PIEZOSURGERY PROVIDES EASY DIFFERENTIATION BETWEEN CORTICAL AND
CANCELLOUS BONE. PIEZOSURGERY DECREASES THE RISK OF BONE FRACTURE,
MAKING BONES MORE ELASTIC AFTER OSTEOTOMY WITH ULTRASONIC
INTERMEDIATE VIBRATION
Sohn DS, Ahn MR, Lee WH. Piezoelectric osteotomy of intraoral harvesting of bone blocks. Int J Periodontics
Restorative Dent 2007;27:3-7.

29. DIRECT SINUS LIFT PROCEDURE
FACILITATES WINDOW
PREPARATION WITHOUT
DAMAGING SCHNEDERIAN
MEMBRANE
Vercellotti T, Paoli SD, Nevins M. The piezoelectric bony window osteotomy and sinus membrane elevation:
introduction of a new technique for simplification of sinus augmentation procedure. Int J Periodontics
Restorative Dent 2001; 21:561–567

30. INDIRECT OR CRESTAL SINUS
LIFT PROCEDURE
REDUCED SURGICAL TRAUMA
AND REDUCED MEMBRANE
PERFORATION AS COMPARED
TO TRADITIONAL BURS
Vercellotti T, Paoli SD, Nevins M. The piezoelectric bony window osteotomy and sinus membrane elevation:
introduction of a new technique for simplification of sinus augmentation procedure. Int J Periodontics
Restorative Dent 2001; 21:561–567

31. V
IMPLANT SURGERIES
THEY CAN BE PERFORMED WITH A SPECIFICALLY DESIGNED SET OF PIEZOSURGICAL
INSERTS. IT ALLOWS FOR SELECTIVE ENLARGEMENT OF ONLY ONE SOCKET WALL
REFERRED TO AS ‘DIFFERENTIAL ULTRASONIC SOCKET PREPARATION’
Vercellotti T, Klokkevold P. Technologic advances in implant surgery: piezoelectric bone surgery. Clinical
periodontology. 11th ed.. New Delhi, India: Saunders Elsevier; 2006. pp. 1131–1145.

32. WHEN THE
IMPLANT FAILS,
PIEZOSURGERY CAN
BE USED FOR ITS
ATRAUMATIC
REMOVAL
IMPLANT RETRIEVAL
Vercellotti T, Klokkevold P. Technologic advances in implant surgery: piezoelectric bone surgery. Clinical
periodontology. 11th ed.. New Delhi, India: Saunders Elsevier; 2006. pp. 1131–1145.

33. CONTRAINDICATIONS:
CARDIOPATHY
UNCONTROLLED DIABETES MELLITUS

34. RADIATION TREATMENT
METAL AND CERAMIC CROWNS
PACEMAKER
Thomas M, Akula U, Ealla KKR, Gajjada N. Piezosurgery: A Boon for Modern Periodontics. Journal of
International Society of Preventive & Community Dentistry. 2017;7(1):1-7. doi:10.4103/2231-0762.200709.

35. Piezosurgery is relatively new surgical technique, which
can be used to complement traditional oral surgical
procedures or replace them
Additional effects regarding bone healing, minimal intra-
operative bleeding, soft tissue sparing action, good
visibility, high predictability, etc.
In addition to its limitations, when used with their variable
frequency and power, it serves as a platform for range of
applications