Piezoelectricity is the electricity resulting from pressure. It is effective in precise bone cutting. It spares soft tissue and hence less blood loss is seen.

1. PRESENTED BY:
DR. ANUSHRI GUPTA
1ST YEAR P.G. STUDENT
DEPT. OF PERIODONTOLOGY
PIEZOSURGERY
A Boon for Modern Periodontics

2. INTRODUCTION
• The term “piezo” originates from the Greek word, piezein, which
means, “to press tight, squeeze.”
• The word piezoelectricity means “electricity resulting from
pressure.”
• Piezoelectricity is the electric charge that accumulates in certain solid
materials (such as crystals, certain ceramics, and biological matter
such as bone, and various proteins) in response to applied mechanical
stress.
• It is highly precise and safe bone cutting system that is based on
ultrasonic microvibrations which are optimally adjusted to target
only mineralized tissues and spare soft tissues, nerves and vessels.

3. HISTORY
• Jacques and Pierre Curie first discovered piezoelectricity in the year
1880 who found that applying pressure on various crystals, ceramics
or bone, created electricity.
• In 1955, Zinner first introduced ultrasound in periodontal procedures
as ultrasonic scalers introducing a single, bulky universal tip.
• Mcfall et al., in 1961, evaluated the distinction of healing by
comparison of rotating instruments and oscillating scalpel blade, and
found slow healing with no severe complication by use of these
scalpel blade.

4. • In 1999, Dr. Thomas Vercellotti invented piezoelectric bone surgery
in collaboration with Mectron Spa and published in the year 2000.
• In 2003, Dr. Thomas discovered the ideal frequency (24- 36 kHz) in
which, various endodontic, orthopedic, neurologic, periodontal, and
oral and maxillofacial surgeries can be performed.

5. MECHANISM OF ACTION
• In piezosurgery, piezoelectric effect is used, where mechanical energy
in the form of tension and compression, is converted into electric
energy.
Piezoelectric ultrasonic frequency (24- 36 kHz) created by electric
current from generator over piezocramic rings leading to deformation
vibrations in transducer which creates the ultrasound output
waves transmitted to the hand piece tips, also known as inserts,
longitudinal movements resulting in cutting of the osseous tissues by
microscopic shattering of bone

6. PIEZOELECRIC DEVICE
• The device consists of a hand piece and a foot switch that are
connected to a main unit, which supplies power and has holder for
hand piece and irrigation fluids.
• Frequency of 25–29 kHz is present with a series of inserts of different
form along with a linear vibration ranging from 60–200 µm.
• The power of the device is approximately 5 W.
• The unit offers three different power levels from a clinical point of
view:
1-Low mode for orthodontic surgery and apico endocanal cleaning;
2- high mode for cleaning and smoothing the radicular surface;
3-boosted mode in osseous surgery for performing osteotomy and
osteoplasty

7. PARTS OF THE INSRUMENT
1. Control panel: The piezosurgery unit is solely controlled by an
interactive keyboard, which has two basic programs, the BONE
and ROOT. With this system, any
interference present in the unit,
hand piece, or electronics are recognized and
& highlighted on the display.
2. Dynamometric wrench:
Insert tips are tightened to the hand
piece using a dynamometric wrench
which applies a predefined force to
obtain energy transmission.

8. 3. Hand piece: Each piezosurgery unit comes with two hand
pieces and is permanently connected to a hand piece cord, which
can be sterilized together.
4. The peristaltic pump: Contains irrigating solution which
discharges from the insert with an adjustable flow of 0–60 ml/min
for cooling and removal of detritus from cutting area.
5. Insert tips: Insert available can be classified as:
• Titanium nitrate coating: They are effective for osteoplasty technique
• Diamond coating: Used in case of thin bone
osteotomy or for complete osteotomy close
• Sharp insert tips: For effective treatment in
bony structures such as in the osteoplasty
techniques or for harvesting bone chips
DIAMOND COATING INSERT TIPS

9. • Smooth insert tips: These are used in osteotomy when it is
necessary to prepare difficult and delicate structure such as those
preparing for sinus window or access to nerve
• Blunt insert tips: Used for preparing soft tissues. For e.g. elevating
Schneider’s membrane or lateralizing nerve. In periodontics, these
tips are used for root planning
SHARP INSERT TIPS SMOOTH INSERT TIPS BLUNT INSERT
TIPS

10. STEEL INSERT TIPS GOLD INSERT TIPS

11. BIOLOGICAL EFFECT ON BONE
• 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.
• Not only is this technique clinically effective, but also histogical
observation of postoperative wound healing and formation of bone
in experimental animal models has indicated that response of tissue
is more favorable after PS than after conventional techniques with
diamond or carbide rotary instruments.

12. • Blood free surgical site is another advantage because it provides a
better intraoperative view.
• Cavitation phenomenon and flow of cooling fluid by use of
piezoelectric tools may serve as possible explanations for absence
of blood at osteotomy site.
• The use of piezoelectric osteotomy in osteogenic distraction to
increase the alveolar ridge height prior to the installation of dental
implants is easier and less prone to intraoperative complications
compared to conventional osteotomy procedures

13. APPLICATIONS IN DENTISTRY
Periodontology applications:
• Supragingival and subgingival scaling,
• curettage
• Debridement of epithelial lining of pocket wall
• crown lengthening,
• regenerative surgeries for obtaining autogenous
grafts in the form of bone chips.
Oral and maxillofacial surgery:
• sinus lift,
• ridge expansion,
• inferior alveolar nerve decompression,
• cyst removal
• dental extraction,
• apicectomy
• impacted tooth removal

14. • Orthodontic applications:
• Osteotomy,
• corticotomy,
• orthodontic traction of third molars,
• orthodontic closure of edentulous spaces,
• surgically assisted rapid maxillary expansion .
• orthodontic microsurgery
• Implantology:
• Distraction osteogenesis followed by implant
placement,
• Implant site preparation
• drilling holes in bone for implant placement,
• for insertion of implant.
• Endodontics:
• root-end resection,
• root-end preparation for retrograde root canal ,preventing damage to soft
tissues.

15. CONTRAINDICATIONS
No absolute contraindications
• Cardiopathy (any disease related to heart)
• Patients with uncontrolled diabetes
• Patients receiving radiotherapy
• Patients with metal crowns
• Patients with pacemakers

16. ADVANTAGES
• Micrometric cutting action
• Selective cutting action: minimum soft tissue damage -
ultrasonic frequency used does not cut soft tissue.
• Maximum intra-operative visibility (cavitation effect).
• Minimum surgical stress - Excellent tissue healing. The
cutting action is less invasive, producing less collateral
tissue damage, which results in faster healing.
• Sterile water environment for better asepsis (free from
contamination)

17. LIMITATIONS
• Operating time for osteotomies is slightly longer than with
traditional instruments.
• Increasing the working pressure increases the vibration of devices
that transform the vibrational energy into heat, so tissues can be
damaged.
• Difficulties encountered in deeper osteotomies sites because lack
of insert of appropriate length and thickness.
• Inserts get worn away very rapidly.
• Not cost effective

18. CONCLUSION
• Peizosurgery is not only clinically effective, but also have
additional effects regarding first phase of bone healing and
minimises intraoperative bleeding.
• The precise nature of the instrument allows exact, clean, and
smooth cut geometries during surgery.
• In addition to its limitations, when used with their variable
frequency and power, it serves as a platform for range of
applications in periodontology, implantology, and various other
oral surgical procedures, making it a highly effective tool in
clinical practice.

19. THANK YOU