Piezosurgery Applied to Orthognathic Surgery - Retrospective Study with New Mandibular Saggital Piezo - Osteotomy Technique Description

Piezoelectric surgery, known as Piezosurgery, is a relatively new technique which was initiated in oral surgery in the year 2000 with the classic publication of Dr. Tomaso Vercellotti’s article, and in orthognathic surgery only in 2004 and 2005. This technique is safe and useful for facial osteotomies and or osteoplasties with excellent results. Piezosurgery functioning principle is an ultrasonic transducer which modifies electric energy into vibrational one (mechanics). Connected to its handpiece is an ultrasonic tip (insert). The ultrasonic insert oscillates with microvibrations resulted from ceramics expansions and contractions. The ultrasonic tip vibration, along with a gentle manual pressure on its handpiece, and a manual back and forth movement upon the bony tissue will result in bone cavitation. Irrigation for tip refrigeration is an essential part of the procedure. This new method of bone cutting involves a total different learning curve from the one necessary for reciprocating saw usage. Although there is a small increase in the intra-operative time for bone procedures with Piezosurgery, its low morbidity (safety) due to mineralized tissue selectivity, associated to other advantages such as less bleeding, minor postoperative edema, rapidity in bone recovery (faster bone repair) reveals the potential of this new ultrasound bone cutting technique. This article reports the author’s five-year Piezosurgery experience in orthognathic surgical procedures. The results obtained until the present moment are promising, since the Piezosurgery manufacturer companies will continue to develop better ultrasonic inserts with specific geometrics on account of the characteristics of the various types of osteotomies, and illuminated handpiece by optic fiber or light emitting diode (LED). Above of all, with this new technology it is possible to perform very precise and micrometric osteotomy lines (precision) giving absolute confidence to surgeons, mainly to those who are new beginners in orthognathic surgery field where the saw cutting instrument generate imprecise cuts and increases the possibility for soft tissue (mucosae, periosteum and nerves) injuries. It is believed in the next years this will be the standard technique for bone procedures as far as the demanding art of orthognathic surgery is concerned.