Piezosurgery in endoscopic-assisted trigonocephaly correction: a technical note.

PURPOSE: This study aims to evaluate the effectiveness of the Piezosurgery® device in endoscopic-assisted correction of trigonocephaly. Trigonocephaly is a type of craniosynostosis characterized by a triangular-shaped forehead due to the premature fusion of the metopic suture. Traditional open cranial vault reconstruction, although common, is invasive and poses risks. The study explores a less invasive alternative using ultrasonic microvibrations for bone cutting, potentially reducing soft tissue damage and improving surgical outcomes. METHODS: The Piezosurgery® device was employed in endoscopic trigonocephaly correction surgeries performed on patients under 4 months old at the French Referral Center for Craniosynostosis in Lyon. The technique involves making a small skin incision and performing osteotomies from the anterior fontanel to the glabella. A rigid 0° endoscope provides visibility, and the Piezosurgery® device enables precise bone cutting while preserving the dura mater. Post-surgery, patients were discharged within 3 days and required to wear a remodeling helmet for 6-8 months. RESULTS: The use of Piezosurgery® device allowed precise osteotomies with minimal soft tissue damage. No dura mater injuries occurred in the patient series. The procedure was efficient, with an average duration of 80 min, and blood loss was minimal, reducing the need for blood transfusions. The endoscopic approach facilitated shorter surgical times and reduced postoperative infection risks. Enhanced visibility during surgery, due to cavitation effects, improved the accuracy of bone cuts. The technique demonstrated promising safety and esthetic outcomes, although it incurred higher costs compared to traditional methods. CONCLUSION: Piezosurgery® device provides a safe and effective method for minimally invasive endoscopic correction of trigonocephaly. The device's ability to selectively cut bone while preserving soft tissues offers significant advantages, despite longer surgical times and higher costs. This technique represents a viable alternative to traditional open surgery, promoting better clinical outcomes and reduced recovery times.

Is Piezosurgery Associated with Improved Patient Outcomes Compared to Conventional Osteotomy in Rhinoplasty? A Systematic Review and Meta-Analysis of RCTs.

Background: Rhinoplasty is a common plastic surgery procedure with evolving surgical techniques. This systematic review and meta-analysis compares the outcomes of piezosurgery versus conventional osteotomy in rhinoplasty. Methods: A comprehensive search of six databases yielded 12 randomized controlled trials (RCTs) comparing piezosurgery (292 cases) to conventional osteotomy (338 cases) in rhinoplasty patients. The examined outcomes included postoperative edema, ecchymosis, complications, pain (using the Visual Analogue Scale-VAS), and operative time. Subgroup analyses were conducted based on the assessment timepoint, surgical approach, and outcome grade. The risk of bias was evaluated using the revised Cochrane tool. Results: Piezosurgery showed a significant reduction in the degree of postoperative edema (second and seventh postoperative days) and ecchymosis (second, fourth, and seventh postoperative days). The external approach in piezosurgery demonstrated greater benefits for both outcomes. Piezosurgery was associated with a significant reduction in overall complications, especially mucosal injuries, compared to conventional osteotomy, with no significant difference regarding postoperative hemorrhage. A significant reduction in pain scores and the need for analgesia was observed with piezosurgery. No significant difference was found in operative time. Conclusions: Piezosurgery offers significant benefits in patient outcomes, with similar operative time between both techniques. However, long-term investigations are still needed.

Comparison of Four Different Dental Implant Removal Techniques in Terms of the Weight and Volume of Bone Loss.

PURPOSE: Several approaches have been suggested for implant removal. However, further research is necessary to review data regarding the amount of bone removed and the duration of removal time for different procedures. This study evaluates and compares various implant removal techniques.  Materials and methods: A polyurethane block was scanned to create an implant surgical guide. Afterward, implant-guided surgery was performed on 60 simulated bone blocks. The implants were then separated into four groups and removed utilizing the counter-torque ratchet, trephine drills, burs, and piezosurgery. RESULTS: For the weight of bone loss, there were significant differences in the median between the counter-torque ratchet technique (CTRT) and trephine (p < 0.01), CTRT and bur (p < 0.01), trephine and piezo (p < 0.01), and bur and piezo (p = 0.04). All groups, except CTRT and the piezo group, demonstrated a statistically significant difference (p < 0.01) in the procedure durations. Regarding the volume of bone loss, a statistically significant difference (p < 0.01) was found between each group.  Conclusions: CTRT showed the least amount of bone loss. On the other hand, the trephine technique was demonstrated to be the fastest. It is essential to consider the limitations and risks when choosing the approach for implant removal.

Evaluation of minimally invasive esthetic crown lengthening using an open flap versus flapless surgical approach: A randomized controlled clinical trial.

OBJECTIVES: Esthetic crown lengthening (ECL) is commonly advocated to treat patients with altered passive eruption (APE). Since the introduction of the minimally invasive surgical concept, a limited number of studies have investigated this technique in a standardized manner, with further studies required to verify the validity and predictability of the minimally invasive FL-technique. The current randomized trial compares a minimally invasive (ECL), using piezosurgery with flapless-approach (FL), versus an open-flap (OF) approach in the management of patients with APE Type 1B. MATERIALS AND METHODS: Twenty-four patients diagnosed with APE Type 1B were randomly assigned into test (FL) with tunneling approach or control (OF) group with minimally invasive flap reflection (n = 12/group). Postoperative pain was assessed during the first 48 h. Gingival margin (GM) level relative to a custom-made stent (rGM) and patient satisfaction were assessed preoperative, immediately after surgery, at 3 and 6 months postsurgically. Postoperative swelling was reported for the first week postsurgically. Plaque index (PI), bleeding on probing (BoP), clinical attachment level (CAL), pocket depth (PD) and pink esthetic score (PES), were evaluated at baseline and 6 months. Linear regression analysis was conducted for pain. RESULTS: OF-group reported significantly higher pain and swelling scores than FL-group during the first 48 h (p < 0.05). FL-group showed no significant differences regarding rGM between 3 and 6 months, in contrast to OF-group, where a significant decrease in rGM was notable (p < 0.05). No significant differences in PI, BoP, CAL, PD, PES, and patient satisfaction scores were evident between groups (p > 0.05). Regression analysis demonstrated that treatment and gender were significant predictors for pain (p < 0.05). CONCLUSIONS: Within the current study's limitations, piezo-surgical ECL with FL-approach presented significantly lower postoperative pain, swelling, and early GM stability compared to OF-approach. CLINICAL SIGNIFICANCE: Piezosurgical ECL with a FL-approach can be considered a predictable technique with advantages over the OF-approach in the management of patients with APE Type1B.

Digitally guided root removal and simultaneous implant placement: A case study.

BACKGROUND: Encountering a retained root tip post-extraction and prior to implant placement is a possible clinical complication. There are numerous approaches for removing retained roots that may be traumatic or atraumatic. Regardless of the approach, careful treatment planning is important to minimize complications, reduce morbidity, and preserve bony structures. The aim of the current case study is to introduce a technique and digitally generated device used for identifying and atraumatically removing a retained root tip and simultaneously placing a stable dental implant. METHODS: A 63-year-old female with a history of myocardial infarction, hypertension, and acute pancreatitis presented for implant placement at site #5. Clinical examination revealed adequate interocclusal, mesiodistal, and buccolingual dimensions for implant placement. Radiographic examination using cone beam computed tomography revealed that retained root #5 interfered with implant placement. Digital planning was used to extract the root tip with minimal trauma to maintain adequate bone for simultaneous implant placement with good primary stability. RESULTS: The follow-ups at 1, 3, and 6 weeks and 4, 8, and 10 months revealed good bone preservation with an osseointegrated implant. CONCLUSIONS: Employment of digital planning to create a palatal window allowed excellent accuracy in removing the retained root while maintaining the bony foundation for a well osseointegrated dental implant. KEY POINTS: Pre-planning using cone beam computed tomography scan merged with an intraoral digital scan is necessary for precise location of a retained root and correct implant placement with excellent primary stability. A digitally planned 3D surgical guide is a useful method for extracting retained roots during implant placement to minimize bone damage. Digital planning provides a precise and minimally invasive implant surgery.

Temperature variations during bone removal procedures similar to third molar extraction using different instruments.

Bone removal is commonly used in the extraction of third molars and the heat generated during the process can interfere with the repair of bone. The aim of this study was to evaluate the temperature variation presented in bone removal performed with a high-speed turbine (400000 rpm), implant motor with straight piece (100000 rpm), low-speed micromotor (20000 rpm) and piezoelectric saw (30 kHz) in pig mandibles. For this, bone removal was carried out around 20 posterior teeth, under constant saline solution irrigation with a syringe and needle. In addition, the time required to perform bone removal was recorded. The results indicated a mean (SD) temperature variation of 0.96 °C (0.6 °C) for the high-speed turbine, 1.38 °C (0.5 °C) with the implant motor, 2.22 °C (0.7 °C) for the low-speed micromotor and 2.90 °C (1.3 °C) for the piezoelectric saw. The conventional variance was calculated discounting the variation of time used for bone removal around the teeth. There was a statistically significant difference in temperature variation between the high-speed turbine vs the micromotor (p = 0.009) and the high speed micromotor vs the piezoelectric saw (p = 0.04). We conclude that there is a statistically significant difference in temperature variation between the instruments used in oral and maxillofacial surgery, with higher rotation speeds resulting in the lowest temperature variations and a reduced surgical time.

Application of Piezosurgery in Revision Surgery through Posterior Approach for Infection after Percutaneous Vertebral Augmentation: Technique Note with Case Series.

OBJECTIVES: Pyogenic spondylitis after vertebral augmentation (PSVA) is a severe complication and even threatens the life of patients. How to deal with infectious bone cement is a big problem for surgeons. The application of piezosurgery has advantages in removal the infectious bone cement in limb bone and spinal laminectomy, but it is rarely used in PSVA. So, the present study aimed to introduce the application of piezosurgery in revision surgery for PSVA and report the preliminary radiological and clinical results. METHODS: The data of nine patients with PSVA who had undergone revision surgery were retrospectively reviewed between May 2017 and January 2023 in our hospital. The technique of removal of infectious bone cement and lesion by piezosurgery and the reconstruction of the spinal stability were described, and the operation time and intraoperative blood loss were recorded. Postoperatively, radiographs and computed tomography scans were reviewed to evaluate the condition of bone cement removal, control of infection, and bone fusion. Oswestry disability index (ODI) and visual analog scale (VAS) were assessed pre- and postoperatively, and clinical outcomes were assessed using Odom's criteria. RESULTS: All patients achieved satisfactory tainted bone cement cleaning and restoration of spinal alignment. The surgical time was 258.8 ± 63.2 (160-360) min, and the intraoperative blood loss was 613.3 ± 223.8 (300-900) mL. The VAS score decreased from 7.0 (6-8) points preoperatively to 2.4 (1-4) points postoperatively. The ODI index decreased from 71% (65%-80%) preoperatively to 20% (10%-30%) postoperatively. The patient's VAS and NDI scores after operation were significantly improved compared with those before surgery (p ≤ 0.05). Odom's outcomes were good for all patients in the last follow-up, and all patients reported satisfactory results. CONCLUSIONS: Piezosurgery can effectively remove large blocks of infectious bone cement through a posterior approach while avoiding nerve and spinal cord damage. We cautiously suggest that a one-stage posterior approach using piezosurgery is an alternative option for surgical treatment of PSVA.

Microendoscopic Tailored Spine Decompression as a Less-Invasive, Stability-Preserving Surgical Option to Instrumented Correction in Complex Spine Deformities: A Preliminary Multicenter Experience.

OBJECTIVES: The aim of this study was to explore the effectiveness of a less-invasive posterior spine decompression in complex deformities. We studied the potential advantages of the microendoscopic approach, supplemented by the piezoelectric technique, to decompress both sides of the vertebral canal from a one-sided approach to preserve spine stability, ensuring adequate neural decompression. METHODS: A series of 32 patients who underwent a tailored stability-preserving microendoscopic decompression for lumbar spine degenerative disease was retrospectively analyzed. The patients underwent selective bilateral decompression via a monolateral approach, without the skeletonization of the opposite side. For omo- and the contralateral decompression, we used a microscopic endoscopy-assisted approach, with the assistance of piezosurgery, to work safely near the exposed dura mater. Piezoelectric osteotomy is extremely effective in bone removal while sparing soft tissues. RESULTS: In all patients, adequate decompression was achieved with a high rate of spine stability preservation. The approach was essential in minimizing the opening, therefore reducing the risk of spine instability. Piezoelectric osteotomy was useful to safely perform the undercutting of the base of the spinous process for better contralateral vision and decompression without damaging the exposed dura. In all patients, a various degree of neurologic improvement was observed, with no immediate spine decompensation. CONCLUSIONS: In selected cases, the tailored microendoscopic monolateral approach for bilateral spine decompression with the assistance of piezosurgery is adequate and safe and shows excellent results in terms of spine decompression and stability preservation.

Piezosurgery versus conventional rotary surgeryfor impacted third molars: A randomised, split-mouth, clinical pilot trial / Piezocirugía versus cirugía rotatoria convencionalpara terceros molares retenidos: un ensayo piloto clínico aleatorizado, de boca dividida

Background: Few studies have compared the effects of piezosurgery and conventional rotary surgery for impacted wisdom teeth on the quality of life. Among these studies, the inclusion parameters and evaluation methods have varied. Material and Methods: This study aimed to compare the effects of piezosurgery and conventional rotary instruments on the quality of life using a standardised method. Patients with bilateral and symmetric mandibularimpacted wisdom teeth were included based on the Winter and Pell-Gregory scale and Yuasa difficulty index criteria. The primary objective was to assess the effects of the methods on the quality of life using the Oral Health Impact Profile-14 questionnaire. Secondary objectives included comparisons of swelling, trismus, pain, and total operative times. The study was conducted between October 2021 and March 2022. The clinical trial protocol was recorded in the United States National Library of Medicine clinical trial registry (NCT05545553). Results: We enrolled 20 patients (40 wisdom teeth) and found that the removal of impacted teeth using the piezosurgery method positively affected the quality of life and considerably improved swelling, trismus, and pain scores. However, piezosurgery may affect postoperative morbidities such as increased total operative times. Conclusions: Piezosurgery appears to have advantages over conventional rotary surgery for impacted wisdom tooth extraction in terms of quality of life and postoperative symptoms. However, further research should investigate potential drawbacks and confirm these findings.(AU)

A randomized controlled trial comparing conventional and piezosurgery methods in mandibular bone block harvesting from the retromolar region.

BACKGROUND: Although piezosurgery is now commonly used for various applications in maxillofacial surgery, its advantages over conventional rotary instruments in terms of postoperative edema, ecchymosis, postoperative morbidity, and prolonged osteotomy time have been questioned. MATERIALS AND METHODS: This study aimed to compare the efficiency, postoperative morbidity, and complication rates of piezosurgery and conventional methods in harvesting autogenous ramus grafts. In this randomized controlled trial, 21 patients (32 sides) underwent autogenous graft harvesting from the ramus area, with 16 sites treated using piezosurgery and 16 using the conventional method. The primary outcomes measured were osteotomy time, total operation time, and postoperative morbidity. Complication rates were also evaluated. RESULTS: The final analysis encompassed 19 patients, accounting for a total of 30 donor sites, following the exclusion of two patients who were unable to attend the scheduled follow-up visits. A total of 19 patients (30 donor sites) were included in the final analysis. No statistically significant difference was found in the mean osteotomy time between the piezosurgery group (mean: 10.35, SD: 2.74 min) and the conventional group (mean: 8.74, SD: 2.74 min) (95% CI: -3.67 to 0.442, p = 0.119). The total operation time, postoperative pain, and swelling were not significantly different between the two groups (p > 0.05). The complication rates, including wound dehiscence and inferior alveolar nerve exposure, were similar in both groups. CONCLUSIONS: Piezosurgery can be safely used for harvesting autogenous ramus grafts and does not increase osteotomy or total operation time compared to the conventional method. The postoperative morbidity and complication rates were also similar, indicating that both techniques can be effectively employed in clinical practice. CLINICAL TRIAL REGISTRATION: The protocol was registered on clinicaltrials.gov (ID: NCT05548049, First registration date: 21/09/2022).

Piezosurgery versus conventional osteotomy: a randomized clinical trial on pain and anxiety in children with unerupted mandibular third molars.

OBJECTIVE: Dental anxiety for unerupted mandibular third molars extraction in children under local anesthesia is a tricky problem. The purpose of this study was to compare psychological and physiologic findings of extractions of unerupted mandibular third molars in children by piezosurgery and conventional osteotomy. MATERIALS AND METHODS: This prospective, single-center, double-blind study included children who required extraction of mandibular third molars under local anesthesia. All subjects were randomly divided into two groups: piezosurgery and conventional osteotomy (control). The primary outcome variables were dental anxiety assessed by the Modified Child Fear Survey Schedule Dental Subscale (CFSS-DS) and postoperative pain qualified by the visual analog scale (VAS). Secondary outcome variables included blood pressure, heart rate, saturation, and operation duration. The data were analyzed by t-test and chi-square test (P ≤ 0.05). RESULTS: All 40 study patients (37.5% males and 62.5% females with an average age of 14.43 ± 1.32 years) completed the entire trial. There were no statistically significant differences observed between the two groups in terms of gender allocation, age, side of extraction, and Winter's Classification (P > 0.05). The operation duration of the piezosurgery group was significantly longer than the conventional osteotomy group (P < 0.01). The VAS scores showed that pain levels of children in the piezosurgery group were significantly less than the conventional osteotomy group on the first and third days postoperatively (P < 0.05 and P < 0.01, respectively). The CFSS-DS score in the piezosurgery group significantly decreased compared to the conventional osteotomy group (P < 0.05). Compared with the conventional osteotomy group, a significant decrease in heart rate, and lower systolic and diastolic blood pressures were observed after extraction in the piezosurgery group (P < 0.05 and P < 0.01, respectively). CONCLUSION: Compared with conventional osteotomy, piezosurgery can effectively reduce postoperative pain and have some effect in relieving dental anxiety for the extraction of unerupted mandibular third molars in children. CLINICAL RELEVANCE: Piezosurgery may be a viable technique for the extraction of unerupted mandibular third molars in children under local anesthesia.

The effectiveness of minimally-invasive corticotomy-assisted orthodontic treatment of palatally impacted canines compared to the traditional traction method in terms of treatment duration, velocity of traction movement and the associated dentoalveolar changes: A randomized controlled trial.

Objective: To evaluate the effectiveness of a minimally-invasive corticotomy-assisted treatment of palatally impacted canines (PICs) compared with the traditional method by evaluating treatment time, the velocity of movement, and the associated dentoalveolar changes. Materials and methods: Forty-six patients with palatally or mid-alveolar upper impacted canines were recruited and distributed into two groups: the corticotomy-assisted traction group (CAT group, mean age: 20.39±2.27 years) and the traditional treatment group (TT group, mean age: 20.26±2.17 years). The closed surgical approach was used in both study groups. The velocity of traction movement, traction duration and overall treatment duration were evaluated clinically. In addition, the bone support ratios and the amount of root resorption were assessed on cone-beam computed tomography (CBCT) images. Results: At the end of treatment, significant differences were found between the two groups regarding the velocity of traction movement, traction time, and overall treatment time (P<0.05). The mean velocity of traction movement in the CAT group was greater than the TT group ( x velocity=1.15±0.35 mm/month; 0.70±0.33 mm/month, P=0.027, respectively). The duration of the active traction and the overall orthodontic treatment in the CAT group were significantly shorter than the TT group by 36% and 29%, respectively. The mean bone support ratios of the aligned canines did not differ significantly between the two groups (88% vs. 89% in the CAT and TT groups, respectively). No significant differences were found between the two groups regarding the mean amount of root resorption on the adjacent laterals ( x resorption = 1.30±1.18 mm; 1.22±1.02 mm, P=0.612, in CAT and TT groups, respectively). Conclusions: The traction movement velocity of the palatally impacted canines can be increased using minimally-invasive corticotomy-assisted orthodontic treatment. The side effects of the acceleration procedure were minimal and almost similar to those of the traditional technique.

Piezoelectric Device and Dynamic Navigation System Integration for Bone Window-Guided Surgery.

INTRODUCTION: This study investigates the feasibility of integrating a piezoelectric device (PIEZO) into a dynamic navigation system (DNS) for bone-window guided surgery. It compares the accuracy and efficiency of PIEZO + DNS to PIEZO + Freehand (FH) procedure for bone-window cutting and root-end resection (RER). METHODS: Forty-eight mandibular molars of 3D-printed surgical jaw models were divided into two groups: PIEZO + DNS (n = 24) and PIEZO + FH (n = 24). Cone-beam computed tomography scans were taken before and after the procedure. The procedure was virtually planned on X-guide software. The bone-window cutting and RER were conducted with a PIEZO under dynamic navigation in the PIEZO + DNS group and using the dental operating microscope in the PIEZO + FH group. The 2D- and 3D-accuracy deviations and angular deflection were measured for the bone window cut. The root length resected and resection angle were calculated. The bone window cut, RER, total operating time, and number of mishaps were recorded. RESULTS: PIEZO + DNS was more accurate than PIEZO + FH for bone-window cutting, showing fewer 2D and 3D deviations and less angular deflection (P < .05). The resection angle was lower in the PIEZO + DNS (P < .05). The bone-window cut and total operating time were significantly reduced using a DNS (P < .05). There was no difference in the number of mishaps (P > .05). CONCLUSIONS: Within the limitations of this in vitro study, the integration of a PIEZO into a DNS is feasible for bone-window guided surgery. The DNS improved the accuracy and efficiency of bone-window cutting.

The Use of Piezoelectric Osteotomy Instruments During a Rhinoplasty Operation in a Patient With a Cochlear Implant.

A cochlear implant is a life-changing operation that significantly improves the lives of patients. Those with cochlear implants require ongoing measures to ensure the longevity of both their devices and their well-being. One concerning issue is the potential device failure due to the use of surgical instruments during procedures. In this report, we present a successful case of utilizing an ultrasonic osteotome for a primary septorhinoplasty in a 22-year-old patient who had undergone cochlear implant surgery 17 years prior. To our knowledge, this is the first recorded instance of applying a piezoelectric tool on a patient with a cochlear implant. Our findings support the safety of using a piezo osteotome in cochlear implant recipients.

Conventional drilling versus ultrasound and laser osteotomy in mandibular third molar surgery: A comparative study.

BACKGROUND: There are few research works with in-depth studies and direct simultaneous comparisons of the effects on tissue reactions and patients' recovery following in vivo conventional drilling, ultrasound- and laser-assisted osteotomy in humans. OBJECTIVE: The current study aims to compare bone cutting duration, pain, swelling, and trismus in patients following surgical mandible third molar extraction by bone removal using three different osteotomes-a conventional rotary device, an ultrasonic unit, and an Er:YAG laser. METHODS: A prospective, randomized three-group comparative clinical trial was performed. As an experimental setting for the study, аn open mandible third molar surgery was chosen because osteotomy is included in its protocol. Patients were divided into three groups according to the used device for bone removal. Bone cutting time intraoperatively, facial swelling, trismus, and pain on the first, second, and third postoperative days were assessed. The statistical analyses were performed using the SPSS v. 17.0-Kolmogorov-Smirnov test, one-way ANOVA, Student's t-test, Mann-Whitney test, and χ2  test. Statistical results were considered significant at p < 0.05 (confidence interval of difference, 95% CI). RESULTS: Eighty patients (34 males and 46 females with an average age of 25.18 years) were included in the study. The average time for bone removal by the conventional low-speed device (4.95 min), by the ultrasonic unit (5.13 min), and by the Er:YAG laser (9.00 min) differed significantly (p = 0.001). The mean postoperative facial swelling showed a marked difference between the groups (p < 0.05), in favor of the laser and piezo groups. The osteotome proved to influence pain intensity not only immediately after surgery (p = 0.002), but also during the followed-up period (p = 0.001), again in favor of the two above-mentioned groups. No association was found between trismus and the osteotome used by the followed-up patients (p > 0.05). CONCLUSION: Bone-cutting mechanism and the biological influence of the laser beam and ultrasound on living tissues proved to be favorable factors for patients' pain levels and tissue swelling postoperatively independent of the longer osteotomy duration compared to conventional drilling.

Comparative Efficacy of Traditional Corticotomy and Flapless Piezotomy in Facilitating Orthodontic Tooth Movement: A Systematic Review and Meta-Analysis.

Background and Objectives: This study aimed to perform a meta-analysis comparing the effects of corticotomy and flapless piezocision on accelerated tooth movement. Materials and Methods: A comprehensive search using a combination of controlled vocabulary (MeSH) and free-text terms was undertaken by two reviewers to identify published systematic reviews. Three major electronic databases (Medline via PubMed, Cochrane Database, and Embase) were searched up to 2 June 2023. Results: The results of the meta-analysis showed that the pooled standardized mean difference values of accumulative movement distances for flapless piezocision were 1.43 (95% CI, 0.38 to 2.48; p < 0.01), 1.09 (95% CI, -0.08 to 2.26; p = 0.07), and 0.73 (95% CI, -0.58 to 4.02; p = 0.14). The results of the meta-analysis demonstrated that the pooled SMD values of accumulative movement distances for the corticotomy were 2.76 (95% CI, 0.18 to 5.34; p = 0.04), 1.43 (95% CI, -1.10 to 3.96; p = 0.27), and 4.78 (95% CI, -4.54 to 14.10; p = 0.32). Although the test for overall effectiveness was significant for piezocision and corticotomy, there were no significant differences between piezocision and corticotomy. Conclusions: The study determined that both conventional corticotomy and flapless piezosurgery are effective as adjuncts to orthodontic treatment. Moreover, no significant difference was observed in the short-term effectiveness of canine retraction acceleration between conventional corticotomy and flapless piezocision. While piezocision may be a favorable option for orthodontic treatment, corticotomy can be considered in cases requiring additional procedures such as bone grafting.

Ultrasonic Bone Scalpel versus Conventional Methods for Osteotomy in Posterior Surgery for Cervical Spondylotic Myelopathy: A Review and Meta-Analysis.

Posterior methods for cervical myelopathy include laminoplasty and laminectomy with/without fusion. A more recent innovation in these treatments is the use of an ultrasonic bone shaver for osteotomy. In this study, we examined the perioperative results after laminectomy/laminoplasty between conventional methods (rongeur/high-speed drill) vs. piezosurgery-based instruments. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed and the search was performed on four databases (PubMed, Scopus, EMBASE, and Google Scholar). Seven comparative studies were chosen after thorough screening by the authors and a meta-analysis was performed between piezosurgery and conventional technique to ascertain intraoperative and postoperative results after laminectomy/laminoplasty. The analysis includes four retrospective cohort studies and three randomized controlled trials published between 2015 and 2022. The mean age ranged from 55.5 to 64.2 years. Blood loss was significantly reduced in the piezosurgery group, other findings were not significant. On subgroup analysis, laminoplasty dramatically reduced blood loss and the rate of iatrogenic dural rips in the piezosurgery group. The use of ultrasonic bone shaver for osteotomy in cervical spondylotic myelopathy is related to significantly decreased blood loss and no significant increase in postoperative drainage, operative time, complication rate, and functional outcomes as compared to traditional techniques. We noticed significantly reduced blood and rate of dural tears in the laminoplasty subgroup with the use of ultrasonic bone shaver, which was not mirrored in the laminectomy subgroup. Careful intraoperative handling of the instrument can help prevent iatrogenic dural tears and nerve damage.

Comparative and clinical evaluation between piezoelectric and conventional rotary techniques for mandibular impacted third molar extraction.

Purpose: The aim of this study was to evaluate and compare the operative and postoperative outcomes of the mandibular impacted third molar removal using piezoelectric technique and conventional rotary bur technique. Settings: The study was conducted in the department of oral and maxillofacial surgery between January 1, 2019, and January 1, 2020. Materials and Methods: Thirty patients, with an age of 18-40 years, with asymptomatic bilateral impacted mandibular third molars, were selected for the study and randomly surgical extraction was done either using piezoelectric or the conventional rotary bur technique on each site. The intraoperative time taken, postoperative pain, swelling, and trismus were assessed over a follow-up period of 7 days postoperatively. Results: Study and control groups were compared using paired t-test. There was statistical significance in reduction of pain and swelling in the study group where the duration of surgery was increased in the study group. Conclusion: Even if piezoelectric technique takes more time but can be used safely as another technique to conventional surgical method with surgical bur and handpiece for removal of impacted mandibular third molars.

A review on accelerated orthodontics.

When the duration of orthodontic treatment is shortened, the patient may have a number of benefits, including an increase in the number of dental cavities, root resorption, and gingival irritation, all of which are associated to a higher degree of decalcification. In addition to drugs, magnets, and other therapies, they include surgical methods (corticotomies, piezosurgery), mechanical/physical stimulation techniques (vibration, lasers), and other forms of therapy. These methods, each of which has been validated by extensive research, have been shown to reduce treatment times.

Sixty-Month Follow Up of Clinical MRONJ Cases Treated with CGF and Piezosurgery.

AIMS: Medication-related osteonecrosis of the jaw (MRONJ) is a drug-related adverse reaction characterized by bone destruction and necrosis in the jaw. This case series aims to evaluate the treatment approaches and outcomes in MRONJ patients. MATERIALS AND METHODS: The retrospective study was conducted at the Dental Unit of the University of Bari, Italy. Patients with MRONJ were treated and followed up for 60 months. The treatment approach involved piezosurgery and concentrated growth factor (CGF). Six clinical cases from this group are described in detail. RESULTS: None of the patients showed recurrence of necrotic MRONJ lesions during the follow-up period. The surgical interventions, including bone resections and the application of CGF, resulted in successful mucosal healing and the prevention of disease progression. CONCLUSIONS: This study highlights the complexity of managing MRONJ and the importance of a multidisciplinary approach. Conservative treatment options and minimally invasive surgery have shown efficacy in controlling symptoms and improving patients' quality of life. However, the optimal treatment approach remains a challenge, and further studies are needed to evaluate alternative therapies and resective surgery. A comprehensive preoperative evaluation and collaboration among dental, endocrinology, and oncology specialists are crucial for personalized and multidisciplinary management. Ongoing research efforts are necessary to explore new therapeutic modalities and improve our understanding of MRONJ management, providing better support to patients dealing with this complex condition.