Piezosurgery is the method of choice
Why do you use a piezosurgical device?
Pelekanos: The decisive advantage of piezotechnology is that the soft tissue is preserved. Bone removal, in contrast, is particularly atraumatic. Patients experience less postoperative swelling and consequently better healing [1,2].
Can you illustrate that with figures?
Pelekanos: For example, the risk of damaging the Schneiderian membrane during an external sinus lift is reduced from 30% when using rotary instruments to just 7% when working with piezo . Generally speaking, the atraumatic approach causes the patients virtually no problems at all. Young colleagues in particular display great interest in piezosurgery at training events, and I really expect to see a paradigm shift in the near future.
Does this “gentle” surgery not come at the expense of lower efficacy?
Pelekanos: Patients want shorter operations. The first time I operated with piezo ten years ago, I admit that I was a little disappointed by the efficacy. Now, however, the new devices such as Piezomed are just as powerful as rotary instruments. In addition, the micro-oscillations allow much more precise working than is possible with the directly acting rotary drive. In addition, the cavitation effect causes less bleeding in the working field. That offers a better view and saves time too.
Your favourite indication is the external sinus lift. Could you please take us through the procedure?
Pelekanos: In my opinion, external augmentation of the sinus floor (or a sinus lift) is an ideal indication for piezosurgery. The most common complication with this surgery is damage to the Schneiderian membrane  – why should I put my patient at risk unnecessarily? Following preparation of the mucoperiosteal flap, I use a saw (B1 or B6/B7) to define the bone window. These instruments boast very fine toothing and for the same reason can be used more slowly than instruments with fewer teeth if necessary. Then I change to a diamond-coated sinus instrument (S1) until the bluish, glistening membrane comes into view. If you want to be extra careful, you can round off the edges of the bone cover with the spherical, diamond-coated piezo instrument S2.
Is it not easier to make finer incisions with rotary saws?
Why do you use the rounded, diamond-coated instrument for expansion?
Pelekanos: If I use micro saws, I can’t tell if I have damaged the membrane. Gently rounding off the bone cover with the S2 prevents it from being perforated by sharp edges. Experienced surgeons may feel comfortable skipping this step. The next stage is to raise the bone cover carefully and then to use the elephant foot (S3) to smooth out any remaining bone.
So you don’t remove the bone cover completely with the elephant foot?
Pelekanos: No, I like to recycle the ground bone as augmentation material. In addition, the erosive ablation takes too long. For the same reason, I prefer to detach the membrane with a Kramer curette (SKRA 36, Hu-Friedy). It is essential to proceed extremely cautiously now, as the membrane can rupture very easily in some patients. Alternatively, the piezo instruments are also ideal (first S3, then S4 or S5).
And what about the automatic instrument detection?
Pelekanos: Automatic instrument detection is a technology patented by W&H which is unique in the piezo industry. The device detects the instruments and selects the optimal power settings automatically. It is convenient, saves time and is not least beneficial to the patients and instruments alike.
Your practice is specialized in aesthetic restorations and implantology. What indications do you use your Piezomed for?
Pelekanos: Due to the thin buccal bone lamellae, extreme caution is required when removing the upper front teeth. We like to employ the instruments EX1 and EX2 for this. In my clinic we also harvest bone blocks from the oblique line of the mandible and create crown extensions for prosthetics. In this case, for example, the sharp chisel B4 or the diamond-coated sphere S2 are ideal for careful shortening of the alveolar limbus. However, there are also ideally angled, effective instruments for periodontal debridement.
So piezosurgical devices are not just for oral surgeons?
Pelekanos: Anyone who works as a general dentist and performs surgery is sure to benefit enormously from devices such as Piezomed. Whether it’s for prosthetics, periodontology, endodontics, minor or even major surgery: Piezosurgery is extremely versatile. However, the most important aspect is the atraumatic and yet effective approach: Patients appreciate the difference and come back to your practice.
- Wallace SS, et al. The journal of evidence-based dental practice 2012;12:161-171.
- Delilbasi C, Gurler G. Implant Dent 2013;22:662-665.
- Wallace SS, et al. Int J Periodontics Restorative Dent 2007;27:413-419.
- Schwartz-Arad D, et al. J Periodontol 2004;75:511-516.