Piezosurgery-assisted, flapless split crest surgery for implant site preparation

Assessment of immediate clotting after flapless extraction using piezosurgery or turbine handpiece in patients receiving dual antiplatelet therapy

PURPOSE

This study aimed to investigate the efficacy of piezosurgery (PI) in promoting immediate clotting after flapless extraction in patients undergoing dual antiplatelet therapy (DAPT).

METHODS

In this randomized controlled trial, 80 DAPT patients were equally divided into the PI and turbine handpiece (TH) groups. Accordingly, flapless extraction of a single tooth using PI or TH was performed on each patient, and the immediate clotting status was evaluated. The results of the preoperative hematological examinations, surgery-related variables and postoperative complications were recorded for analysis.

RESULTS

Both groups presented with low platelet aggregation and similar coagulation functions. The PI group exhibited a higher proportion of patients with normal intra-alveolar clotting (≤30 min) (70% vs. 40%, P = 0.007) and fewer intraoperative complications (25% vs. 47.5%, P = 0.036) than that in the TH group. Logistic regression analysis indicated that the applied instrument was an independent risk factor for prolonged immediate bleeding (odds ratio = 3.10, 95% confidence interval: 1.20-8.00, P = 0.019). Intergroup differences were insignificant in terms of the other surgery-related variables and postoperative complications, except for the longer surgical duration in the PI group.

CONCLUSION

The application of PI may contribute to better immediate clotting in DAPT patients after flapless extraction compared with the use of TH.

Ridge Augmentation Is a Prerequisite for Successful Implant Placement: A Literature Review

Alveolar ridge defects are commonly seen in partially dentate patients, and they jeopardize speech, appearance, and oral hygiene maintenance. These defects affect both soft tissues and bone and are mainly caused by trauma. These defects are more prevalent in middle-aged male patients and it is imperative that the defective ridge is augmented before receiving an implant or a fixed partial denture. This review focuses on the different types of ridge defects and their treatment options.

Flapless Piezotome Crest Split Achieves Comparable Outcomes to Autologous Onlay Grafts With Significant Less Patient Morbidity and Complications-A Randomized Clinical Study

PURPOSE

In the management of the narrow alveolar ridge, the flapless piezotome crest split (FPCS) technique with horizontal distraction was introduced as an alternative to lateral alveolar ridge augmentation using autologous bone block grafting (ABBG). The study purpose was to measure and compare the alveolar crest width and complications between FPCS and ABBG.

MATERIALS AND METHODS

We implemented a nonblinded, randomized clinical trial. The sample included patients requiring lateral alveolar ridge augmentation before implant insertion. The predictor variable was lateral alveolar ridge augmentation performed using ABBG (control group) or FPCS using an ultrasonic surgical device (Piezotome II or Piezotome CUBE; Acteon, Norwich, UK) and specific crest split working tips (test group). The primary outcome variable was the overall coronal crest width achieved after completed healing measured at 6 months using 3-dimensional imaging studies. Other study variables included the postoperative morbidity, staged using the Universal Pain Assessment Scale, complications, and surgery duration. Descriptive and bivariate statistics were computed using SPSS, version 22.0 (IBM Corp, Armonk, NY), and P ≤ .05 was considered to indicate statistical significance.

RESULTS

The sample included 567 patients treated with ABBG (56.1% female; age, 64.1 ± 20.2 years) and 562 treated with FPCS (57.2% female; age, 62.3 ± 18.2 years). The baseline crest width in the control and test groups was 2.1 ± 0.5 mm and 1.9 ± 0.4 mm, respectively. The final crest width achieved with ABBG and FPCS was 5.8 ± 0.8 mm and 6.5 ± 0.7 mm, respectively (P > .05). Statistically significant differences (P < .05) were found between the ABBG and FPCS groups in the postoperative complication rate, morbidity, and operative time, all in favor of FPCS.

CONCLUSIONS

FPCS seems to be a significantly less traumatic alternative to buccal onlay grafting with autologous bone blocks, providing a comparable or better net gain in the alveolar crest width with a significantly shorter operative time and less postoperative morbidity.

Flapless boning to increase space by piezosurgery: A novel mini-invasive strategy for teeth extraction. A retrospective study

This study aimed to investigate the application of piezosurgery-associated flapless surgery for increasing bone space during teeth extraction and evaluate its success rate, postoperative outcomes, and incidence of major complications.From January 2014 to December 2016, patients who experienced teeth extraction via piezosurgery-associated flapless surgery were enrolled in this study. The positions, diagnosis, dental medical history, and radiographic examination of teeth were recorded before the treatment. During the surgery, the fracture or displacement of root, injuries of soft tissue, and fractures of the alveolar process were noted.A total of 140 patients fulfilled the eligibility criteria in the present study. All these teeth were classified into 4 groups based on diagnosis: residual roots that underwent root canal therapy (28 cases), teeth with root fracture (37 cases), teeth extraction because of orthodontics needed (31 cases), and the vertically impacted lower third molar (44 cases). The radiographic presentation revealed about 50% ankylosed teeth. No root fracture and root displacement emerged, and all roots were removed intact. Moreover, fracture of the alveolar process did not occur. Two cases with buccal mucosal injury were noted, which were because of heat injuries caused by the basement of the tip while cool water was used out.This study introduced a novel mini-invasive strategy for increasing space during teeth extraction. The advantage of this piezosurgery-associated flapless surgery included maximal preservation of the alveolar bone, minimal injury to soft tissues, and prevention of root fracture during the surgery. Furthermore, the cool water used during the surgery must be carefully checked before the procedure.

Conventional Drilling Versus Piezosurgery for Implant Site Preparation: A Meta-Analysis

The aim of this study was to evaluate if the stability of dental implants varies between dental implants placed by piezosurgery compared with those placed by conventional drilling. An electronic search in MEDLINE, SCOPUS, and the Cochrane Library was undertaken until August 2016 and was supplemented by manual searches and by unpublished studies at OpenGray. Only randomized controlled clinical trials that reported implant site preparation with piezosurgery and with conventional drilling were considered eligible for inclusion in this review. Meta-analyses were performed to evaluate the impact of piezosurgery on implant stability. Of 456 references electronically retrieved, 3 were included in the qualitative analysis and quantitative synthesis. The pooled estimates suggest that there is no significant difference between piezosurgery and conventional drilling at baseline (weighted mean differences [WMD]: 2.20; 95% confidence interval [CI]: -5.09, 9.49; P = .55). At 90 days, the pooled estimates revealed a statistically significant difference (WMD: 3.63; 95% CI: 0.58, 6.67, P = .02) favoring piezosurgery. Implant stability may be slightly improved when osteotomy is performed by a piezoelectric device. More randomized controlled clinical trials are needed to confirm these findings.

Piezosurgery in implant dentistry

Piezosurgery, or the use of piezoelectric devices, is being applied increasingly in oral and maxillofacial surgery. The main advantages of this technique are precise and selective cuttings, the avoidance of thermal damage, and the preservation of soft-tissue structures. Through the application of piezoelectric surgery, implant-site preparation, bone grafting, sinus-floor elevation, edentulous ridge splitting or the lateralization of the inferior alveolar nerve are very technically feasible. This clinical overview gives a short summary of the current literature and outlines the advantages and disadvantages of piezoelectric bone surgery in implant dentistry. Overall, piezoelectric surgery is superior to other methods that utilize mechanical instruments. Handling of delicate or compromised hard- and soft-tissue conditions can be performed with less risk for the patient. With respect to current and future innovative surgical concepts, piezoelectric surgery offers a wide range of new possibilities to perform customized and minimally invasive osteotomies.

The alveolar ridge splitting/expansion technique: a systematic review

PURPOSE

The aim of this systematic review was to evaluate clinical, radiological and histological outcomes of the alveolar ridge splitting/expansion technique (ARST) with or without GBR.

MATERIALS AND METHODS

A screening of two databases MEDLINE (PubMed) and EMBASE (OVID) and hand search of articles were performed. Human and animal studies reporting on dental implants placed with simultaneous ARST up to May 31st 2014 were considered. Quality assessment of selected full-text articles was performed according to the ARRIVE guidelines and the Cochrane collaboration's tool to assess risk of bias.

RESULTS

Overall, 18 human and six animal studies (risk of bias: high/unclear) were included in this review. No randomized controlled trials were found. Due to the heterogeneity of study designs, definitions of success criteria, outcome variables, observation times and surgical procedures, no meta-analysis was performed. Reported survival (18 studies) and success (nine studies) rates ranged from 91.7 to 100% and 88.2 to 100%, respectively, with a mean follow-up of 1-10 years. Crestal bone level changes (∆CBL) in some studies indicate slightly higher bone loss before and after loading. Histologic and histomorphometric data from six animal studies confirm the crestal bone loss, particularly at buccal sites.

CONCLUSIONS

Within the limitations of this review, ARST seems to be a well-functioning one-stage alternative to extended two-stage horizontal grafting procedures. Data indicate that during healing and first year of loading, increased ∆CBL particularly at buccal sites must be anticipated. Additional horizontal GBR can help to preserve buccal bone height and width.