These vibrations are amplified and transferred to the insert (tip) of a handpiece which, when applied with slight pressure on the bone, results in a cavitation phenomenon – a mechanical cutting of mineralized tissue. When these crystals are subjected to an electrical charge in the surgical unit, they expand and contract alternately to produce ultrasonic waves. ![]() 8 Materials used are piezoelectrical crystals such as quartz, Rochelle salt and certain types of ceramic. This effect involves the principle of ‘Pressure Electrification’, meaning when an electric current is applied across certain materials, the material in question expands and contracts, thus producing ultrasonic vibrations. The instruments used in piezosurgery of bone create microvibrations that are caused by the piezoelectric effect, first described by the French physicists Jacques and Pierre Curie in 1880. The term “piezo” originates from the Greek word piezen, which means “to press tight, squeeze”. This innovative technique is termed piezosurgery. To overcome the limitations of manual and rotatory osteotomy techniques, a novel surgical technique for the precise and selective cutting of bone without traumatizing the adjacent soft tissues has been introduced. This potentially affects the accuracy of the bone cuts, decreases fine touch sensitivity for the surgeon 6 and increases discomfort for the nervous patient. 5 Depending on the design of the bur and the speed and torque of the rotary handpiece, a certain degree of pressure is required to limit skipping of the bur on the bone surface when performing the osteotomy. 4 Also, burs may accidentally cut into surrounding soft tissues during osteotomy resulting in severe damage to muscles, blood vessels and nerves, especially in sites with difficult or limited access. ![]() 3 Although copious irrigation directed on the bur is used to limit heat generation, this can be obscured in difficult access areas, by other instruments, adjacent soft tissues, and an increasing depth of the osteotomy. Excessive high temperatures may be produced during osteotomy that can lead to marginal osteonecrosis and impair regeneration and healing. However, there are some drawbacks to its use. All this changed with the introduction of the high-speed handpiece. The development of conventional rotatory instrumentation represented a major advancement in the removal of third molars, but it was still a slow process. Moreover, this technique is not easily performed on the awake patient. Although heat is not generated with the use of this technique, it does require the use of high forces that could lead to damage to the bone and surrounding structures. At one time, third molar removal with a mallet and osteotome was state of the art. As a result, there is a wide variation in the amount of pain, swelling, and trismus that occurs postoperatively and in the development of injuries to the inferior alveolar and lingual nerves.Ĭlinicians and researchers have continually strived to develop instrumentation to reduce these complications and improve efficiency and ease of use. ![]() Third molar removal can range from simple extractions to overly complex and difficult procedures. 2 It is also a procedure that instills fear and anxiety in many patients. 1 Therefore, the removal of impacted teeth is one of the most common procedures to be performed in oral surgery practices. Approximately 20 percent of the general population have impacted teeth, the majority of which are third molars.
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