Sinus Lift Using Piezosurgery- A Must Watch Video!

Here is a video of sinus lift procedure using the Piezosurgery. The advantage of using this system is that there is considerably lesser chances of the schneiderian membrane perforation.




Thanks to DentalXP and Dr Salama for this video

Basics of Piezosurgery

One important factor in implant success is position of implant for an ideal final prosthesis and not necessarily placing implant in the area of maximum bone. To achieve such a ideal implant position the local site need to be modified with either osteoplasty, alveolar ridge splitting, bone augmentation or sinus floor elevation. Piezo-electrical surgery can be used to perform these tasks in much simpler manner as compared to conventional surgical techniques.

What is Piezosurgery??

Piezosurgery® ( Mectron, Italy) is a recently developed system for cutting bone with ultrasonic microvibrations. Dr. Tomaso Vercellotti invented it. Ideally to cut soft tissue a frequency of 50kHz is needed where as Piezosurgery® device uses a frequency of 25-30kHz at which only bone is cut. The device when used as recommended would not cut nerves, periosteum or the schneiderian membrane. However damage to soft tissue can occur in form of heat or mechanical damage. Cooling of the device is ensured by irrigation using a cooling solution at 4 degree centigrade.

Piezosugery Device:

It has a Piezoelectric hand piece and a foot switch that are connected to a main unit which supplies power and a peristaltic pump for irrigation. The unit is controlled by a interactive key board. There are 2 programs, Bone and Root. In Bone program the power can be set to any of the four levels depending on the quality of the bone. In Root program the power can be set to either Perio or Endo.

The handpiece has several inserts some of which are shown below.

Basic Kit

Used for: -Osteotomy - Osteoplasty - Exstraction - Ridge expansion

Sinus Kit

Used For:
-Preparation of the bone windows
- Separation of the sinus membrane
- Elevation of the sinus membrane

To determine the amount of force used the sound of the cutting can be used as a acoustic feedback. Piezosurgery needs only small amount of pressure and delivers a highly precise cut. If excessive pressure is applied the tip dose not move and results in generation of heat.

Advantages of piezosurgery:
-blood free operation site
-clear visibility , the above 2 reasons being because of the cavitation effect by the cooling fluid and the kind of vibration generated by the instrument.
- less damage to bone at structural and cellular level compared to other techniques.

Indications in oral surgery:
1.dental extraction
2.osteogenic distraction
3.ridge expansion (crestal splitting)
4.endodontic surgery
5.bone harvesting
6.maxillayr sinus lift
7. third molar extraction
8.alveolar nerve decompression
9.cyst removal

Refrences:
1. Schlee M. et al. Piezosurgery: Basic and Possibilities. Implant Dentistry 2006;15(4): 334-338
2.Eggers G. et al. Piezosurgery: an ultrasound device for cutting bone and its use and limitations in maxillofacial surgery. British journal of oral and Maxillofacial Surgery 2004;42: 451-453
3.Mectron Piezosurgery Brochuer

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Sinu Lift Procedure - Nice Videos

For all those who have watched the animated video of the sinus lift procedure, here is 2 more videos which demonstrates the technique

Sinus Lift Procedure-III

The second video is a complete video of the sinus lift procedure. Here you should note the way the window is made, the sinus membrane pushed up and the area filled with bone graft material. Then a implant is also placed in the adjacent site before the area is closed and the flap sutured.

Hydrofloss Oral Irrigator -A Product Review

I had read all about oral irrigators as a dental student and so when I was asked to do a product review for Hydrofloss® oral irrigator I was excited. The product arrived in a nice blue box which contained this device with 4 different tips and a instructional DVD. The DVD and the information booklet provided by the company where really helpful to gain insight about the device and getting started with it.

I have had frequent problems with food lodging between my molars and premolars with gums getting inflamed every once in awhile causing irritation and that dull pain with a known fear of impending pocket developing in that area . This was one of those days where I was having this problem come visit me, so was keen to know if this new device would help me in anyway. And so began my test of the new oral irrigator at hand. The researcher in me got curious and I began reading the literature about oral irrigation to understand it better. When I speak of oral irrigation here it only is about supragingival irrigation and dose not entail subgingival or those that is done at dental office.

The rationale for the use of oral irrigation is in common with brushing and flossing; in that it is used nonspecifically to reduce the microbial deposits. It should be clearly understood that oral irrigation should not be used as a monotheraphy, and it is more effective when used as an adjunct to brushing and flossing. The Hydrofloss® produces a pulsating stream of water with compression and decompression. The decompression phase helps the displacement of the debris and the bacteria⁽¹⁾. If brushing and flossing reduced the microbial plaque then why would I need this additional oral irrigator?? The mechanism in which this Hydrofloss® works had some answers to this. The Hydrofloss® produces magnetized water. The water passing through the device passes through a magnetic field before being delivered out of the tip at high pressure. This magnetic field causes the water to be ionized. The high pressure ionized water prevents the attachment of plaque and bacteria to the tooth⁽²⁾. A study conducted to see the difference between the oral irrigators using the magnetized water and non-magnetized water on plaque and calculus formation saw significant difference. Magnetic water was shown to reduce the supragingival plaque and calculus at 3 month duration⁽³⁾.

The use of oral irrigator is quite simple if the instructional booklet and the DVD are followed, it however dose take some little practice to use it. The whole mouth irrigation with about 40-50 floz of water should take about 2.5 minutes, just about the same time as brushing. Oh yea! It did leave a nice tingling and fresh feeling when I used it. I used the oral irrigator with luke warm water and some times with Listerine® mouthwash as recommended and within couple of days I did see some positive changes with the gums especially in the molar region where it was inflamed because of the food impaction. It can be used with both plain water or along with couple spoon full of your favorite mouth wash. According to studies in literature supragingival irrigation with antimicrobial agents improved clinical and microbiological parameters than irrigation with water especially in periodontal supportive therapy by inhibiting the development of gingivitis.⁽¹⁾. A report published in JADA quoted a dentist recommending use of hydrogen peroxide and 2 squirts of antimicrobial liquid soap along with water to be used in oral irrigation. Such reports with no scientific backing or valid data should be considered with utmost care and are best avoided⁽⁴⁾.

The Hydrofloss® should not be considered as a replacement for brushing or flossing but rather as adjuncts to these. It certainly could be added to our armamentarium in fight against plaque and gingivitis. Regular dental visits and professional consultations are also important for good oral health. For sure it will be with me forever now and I would surely recommend it to all my patients.

References:

1) The Role of Supra- and Subgingival Irrigation in the Treatment of Periodontal Diseases: J. Periodontol 2005; 76:2015-2027.

2) Efficient Antimicrobial Treatment In Periodontal Maintenance Care, Slots et.al.; JADA 2000;31: 1293-1304.

3) The effect of oral irrigation with a magnetic water treatment device on plaque and calculus. Watt DL et.al; J. Clin periodontal; 1993 May;20(5):314-7.

4) A New Approach to At Home oral irrigation. Venneri J A; JADA 1997;128:755.

Disclaimer: The review for the product was not a paid review and comments made above are solely the experience of the author and are unbiased. However readers should buy the product at their own discretion and author is in no way to be held responsible.

Computer Guided Implants- A Unique Academy & Video

Computer aided implantology academy(CIA Academy) is a nonprofit association formed to provide continuous stimulus and education in computer aided implantology to the prosthodontists and implantologist. The traditional surgical approach has been revolutionized by the use of computer and software systems and platforms such as SimPlant®, SurgiGuides®, Procera®, Implant3D®, to name a few. Visit site here: CIA Academy

Below is one such video of computer guided flapless surgery.

Thanks to Dr. F. Valente & Dr. A. Sbrenna –Italy for this video.

One Piece Unibody Implant- Video

Here is a very nice video of Zimmer Unibody Implant placement and the prosthetic work with it. Dr Maurice Salama dose a wonderful work with least amount of hemorrhage, trauma or discomfort to the patient during the implant placement.A nice and clean video.



Thanks to DentalXP and Dr Salama for this video

Mesothelioma and Dentistry

Mesothelioma is the cancer of the mesothelium caused by asbestos. Mesothelium is the sac like covering around most of the internal organs. What is the relationship between mesothelioma and dentistry?? Well when I was reading about mesothelioma I found some abstracts in the literature which made me think, what if these where the patients I was treating. One case was of a mesothelioma patient developing pleuro-pericarditis following a dental surgery. The data suggested it was from a bug in the oral cavity. Another case reported was of metastatic malignant mesothelioma in the mandible. The occurrence of such a lesion in oral cavity is very rare, but should be considered when the patient has a highly metastatic neoplasm in any region.

The above cases puts across the point that no doubt the occurrence of a particular lesion may be however rare, it should not be ruled out and as a clinicians we should be aware and ready to handle it. There are many sites that you can read about mesothelioma. It is rare to find one website which covers all about it in detail. One such site which covers this topic in great depth is http://www.mesotheliomamedicine.com. This site is a good reading for you and as well as for your patients who want to get all the mesothelioma information. All topics starting from the cause, prevention, diagnosis, treatments and clinical trail information are dealt with in an elaborately yet simple to read fashion. Most of the patients of mesothelioma need to see lawyers and for this purpose lawyers by each state is listed on this website. One interesting thing that I noted on this website was that information on mesothelioma law is listed by state. For example it lists that death because of mesothelioma in Ohio has been high, and under New York it mentions that asbestos was used in every household during 1950’s. This specific information on each state would be very useful to us as clinicians and also to our patients. So if you have a old patient on your dental chair who you think might have had increased exposure to asbestos, then you need to put in that little bit of extra effort to see that patient is not showing and signs of possible malignancy. You and your patient both might need to read about mesothelioma law or mesothelioma information, the site I would recommend for reading all about it would be http://www.mesotheliomamedicine.com. We as doctor need to play our part in looking after the welfare of the patients. This we can done by being aware and observant towards those rare possibility like mesothelioma in a patient on our dental chair.

Refrences:

Abstract 1

Abstract2