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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Flapless Implant Procedure

Here is a video of a flapless implant placement. This technique is most commonly used in placement of mini implants like IMTECH or MILO type of implants. Flapless implant placement needs more experience and properly prepared stents to guide the implants in the planned direction. since there is limited visibility of the implant direction in this case care should be taken to see that the implant is not lingually or bucally directed and avoid perforation of the cortical plates.
This video dose not have clear commentary and the sounds of instrumentation at times is quite loud. It is a nice video if you want to watch the procedure.
Read the exclusive comments by Dr Luchetti (comments section) to understand the video better.

Thanks to Dr Cesar Luchetti for this video

Emodogain- A regenerative material- Video

Enamel matrix protein (EMDOGAIN) has been quite popular regenerative material. Though it is often so expensive and not affordable for patients. It still is a wonderful material with some amazing results seen (not with all cases).
Lets just take a view about the procedure of placing this material in this video.