What is piezoelectric surgery?

Ultrasonic bone surgery, or piezoelectric surgery, is a relatively modern technique used in dentistry for precise bone cutting and manipulation. Unlike traditional surgical tools that use mechanical cutting, ultrasonic devices convert electrical energy into mechanical vibrations. These high-frequency vibrations are transmitted through a specialised tip that selectively cuts bone without harming soft tissues. 

Professor Tomaso Vercellotti invented this revolutionary surgical technique in 1998. Although using ultrasonic energy in surgical procedures dates back to the 1950s – when it was first explored for various medical applications – it was not until the late 20th century that ultrasonic technology was widely adopted in dental surgery and used in oral and maxillofacial surgical procedures, such as third molar extractions, orthognathic surgery and bone grafting. 

Professor Vercellotti, who runs a private practice in Genova, Italy, specialising in periodontics and implant dentistry, had a singular goal: to overcome the limitations associated with traditional instruments used in oral bone surgery. 

Conventional rotary surgical techniques pose a risk of collateral damage to soft tissues. However, he found clinicians could achieve higher precision safety and efficacy levels by modifying traditional ultrasound technology. Piezoelectric surgery dental extraction, for example, allows for atraumatic tooth removal. The ultrasonic vibrations cut through bone without affecting the surrounding soft tissues, minimising trauma, reducing post-operative pain and speeding up recovery times.

The evidence

There is a wealth of evidence to support the application of dental piezoelectric surgery, including a systematic review and meta-analysis by Jiang et al. (2015) that compared piezoelectric surgery and conventional rotary osteotomy techniques in third molar extraction. They conclude that piezoelectric surgery dental patients developed less swelling, less pain and less postoperative trismus. In another paper focusing on Piezosurgery in implant dentistry, the authors suggest the application of piezoelectric surgery is ‘an excellent tool to handle delicate or compromised hard- and soft-tissue conditions with less risk for the patient’.  

They write: ‘Minimal accidental damage to adjacent soft-tissue structures allows for a safe and gentle surgical approach, particularly to thin and fragile bony structures.

‘The slightly longer amount of time required if the piezoelectric tool is used for cutting extensive bone volumes is acceptable, keeping in mind the overall advantages of precise cutting… piezoelectric surgery offers a wide range of new possibilities to perform customised osteotomies for bone reconstruction and placement of smart implants.’ 

Over the years, improvements in ultrasonic technology and device design have significantly enhanced performance, making it a preferred choice for many dental surgeons.

Piezoelectric surgery offers:

Precision and control: The micro-vibratory action of ultrasonic devices allows for exact bone cutting, which is crucial for delicate surgical procedures such as bone grafting, sinus lifts, and implant placements.

Reduced risk of soft tissue damage: One of the most significant benefits of piezoelectric surgery is its ability to selectively target bone tissue without harming adjacent soft tissues. This minimises the risk of postoperative complications and enhances patient safety.

Enhanced healing and recovery: The reduced trauma to soft tissues and the precise nature of the cuts made by ultrasonic devices contribute to faster healing times and improved patient postoperative recovery.

Minimised bleeding: Piezoelectric surgery helps coagulate blood vessels during cutting, reducing intraoperative bleeding and a more explicit surgical field.

Patient comfort: Using ultrasonic technology often results in less postoperative pain and swelling, providing a more comfortable patient experience.

Application versatility: Ultrasonic devices can be used in various dental procedures, including bone grafting, sinus lifts, ridge expansion and the removal of osteomas or cysts.

Clinical applications of piezoelectric dental surgery

Piezoelectric dental surgery devices have a variety of clinical applications due to their precision, safety and less invasive nature.

Implant dentistry

Bone grafting: Piezoelectric dental surgery devices offer precise, clean cuts with minimal trauma and better bone vitality preservation than traditional methods. 

Bone harvesting (chips): Piezoelectric dental surgery efficiently removes bone chips with ideal grain size and accessible collection, eliminating the need for bone traps. 

Distraction osteogenesis: Piezoelectric surgery reduces tissue damage and improves visibility and vascularisation for distraction osteotomies, though it may be slower. 

Ridge expansion: Piezoelectric surgery enables accurate cutting of bone ridges for implant placement, reducing treatment time and complications from donor sites. 

Sinus lifts: Piezoelectric surgery safely removes bone during sinus elevation with minimal risk to the Schneiderian membrane and reduced chances of sinus perforation. 

Osteotomy and bone contouring: Piezoelectric surgery enables precise bone cuts during implant preparation while minimising trauma to surrounding tissues. It is versatile and can be effectively utilised in various piezoelectric saw jaw surgery procedures.

Periodontics

Crown lengthening: Piezoelectric surgery is used to reshape the alveolar bone to expose more tooth structures during crown lengthening procedures. 

Furcation surgery: It can access and clean difficult areas with furcation defects with less risk of damaging surrounding soft tissues. 

Root debridement: Effective in removing calculus and biofilm during periodontal surgeries.

Oral and maxillofacial surgery

Apicoectomy: Piezoelectric surgery can be used for precise root-end resections during apical surgery. 

Impacted tooth removal: Beneficial for removing impacted third molars while preserving adjacent structures. 

Orthognathic surgery: Utilised for precise bone cutting during corrective jaw surgeries, reducing soft tissue trauma and risk of nerve damage. 

Bone reshaping: Useful for contouring and reshaping bone in areas like the chin or jaw.

Endodontics

Endodontic surgery: Piezoelectric surgery can aid root-end resection and retrograde filling with better visibility and precision. 

Root canal access: Helps create a more conservative and precise access to the root canal without damaging surrounding tissues.

Orthodontics

Corticotomy-assisted orthodontics: Piezoelectric surgery is used to perform corticotomies to accelerate tooth movement in orthodontic treatments. 

Accelerated tooth movement: Piezo-assisted techniques can reduce treatment times by enhancing bone remodelling.

Extraction of teeth

Atraumatic extractions: Allows for precise tooth removal and bone structure preservation, which is especially important for future implant placement.

Bone augmentation

Ridge splitting: Piezoelectric surgery is employed in ridge-splitting procedures to expand narrow alveolar ridges for future implant placement. 

Alveolar ridge augmentation: Useful in creating precise cuts to facilitate bone grafting and augmentation in preparation for implants.

Cyst removal and tumour excision

Piezoelectric surgery enables the precise removal of cysts and benign tumours in the jaw, reducing the risk of damaging vital structures.

Temporomandibular joint (TMJ) surgery

Used for arthroplasty or reshaping bone in TMJ surgeries, allowing for minimally invasive approaches to treat TMJ disorders.

Bone defect treatment

Piezoelectric surgery helps precisely prepare the recipient site for bone grafts in bone regeneration or grafting procedures.

Technology and mechanism 

The Piezotome Cube is built on advanced piezoelectric technology. Piezoelectric surgery utilises ultrasonic vibrations to cut bone with precision while minimising damage to surrounding soft tissues. The device converts electrical energy into ultrasonic vibrations ranging from 28 to 36 kHz. These high-frequency vibrations enable efficient and selective cutting of mineralised tissues such as bone while sparing non-mineralised tissues like nerves and blood vessels. 

The new generation of Acteon piezoelectric devices embodies the next step in superior and atraumatic osseous surgery procedures. Highly powerful, reliable and naturally intuitive, Piezotome Cube drastically improves the experience of bone surgery procedures.

Key components

Ultrasonic handpiece: Lightweight and ergonomic, the handpiece is designed for optimal manoeuvrability during surgery. It houses the piezoelectric transducer that generates ultrasonic vibrations. 

Tips/inserts: The Piezotome Cube offers a wide range of surgical tips tailored for different procedures, including osteotomies, osteoplasties, sinus lifts, and tooth extractions. 

Control unit: The Cube’s control unit features an intuitive interface with a touchscreen that allows users to select power settings, modes and irrigation options quickly.

Bone and density modes

D1 is the most powerful setting for dense cortical bone. 

D2 for dense to thick porous cortical bone. 

D3 for thinner porous cortical bone and fine trabecular bone. 

D4 is the least powerful setting ensuring safety around the soft tissues that are situated in areas with little or no crestal cortical bone.

Applications

The Piezotome Cube is versatile and applicable in various surgical scenarios:

Implant dentistry

Osteotomy and osteoplasty: The precision and control offered by the Piezotome Cube are ideal for shaping bone, preparing implant sites, and performing ridge augmentation. 

Sinus lift procedures: The device enables delicate and controlled sinus membrane elevation, reducing perforation risk and enhancing patient outcomes. 

Periodontics

Crown lengthening: The Piezotome Cube removes bone during crown lengthening procedures, ensuring minimal damage to adjacent tissues. 

Regenerative Procedures: The device suits regenerative surgeries requiring bone grafting and precise cutting. 

Endodontics 

Apicoectomy: The Piezotome Cube can be used for root-end resection, ensuring precise cuts and reducing the risk of accidental damage to adjacent structures. 

Orthodontic surgery 

Corticotomy: The device assists in corticotomy procedures, accelerating orthodontic tooth movement by selectively cutting the alveolar bone.

Benefits for patients

Precision and safety: One of the standout features of the Piezotome Cube is its precision. The selective cutting action of ultrasonic vibrations ensures that only mineralised tissues are targeted, significantly reducing the risk of injury to nerves, blood vessels, and soft tissues. This precision is especially crucial in complex surgical procedures near critical anatomical structures. 

Reduced trauma: Traditional surgical tools like burs and saws can cause significant trauma to the bone and surrounding tissues, leading to increased postoperative pain and longer healing times. The Piezotome Cube, by contrast, offers a minimally invasive approach with reduced trauma, leading to faster recovery and better patient comfort. 

Enhanced healing and bone preservation: The Piezotome Cube preserves bone integrity by reducing the heat generated during cutting, minimising bone necrosis risk. The reduced mechanical stress on the bone also helps maintain its viability, promoting better healing and osseointegration, which is particularly important in implant dentistry.

Versatility and customisation: With its range of interchangeable tips and adjustable power settings, the Piezotome Cube can be tailored to suit a variety of procedures and patient needs. This versatility makes it a valuable tool in routine and complex surgical cases. 

Improved visibility and irrigation: The Piezotome Cube includes an integrated irrigation system that cools the surgical site and clears debris, ensuring optimal visibility for the surgeon. This feature is essential for maintaining a clear view of the operative field, reducing the risk of errors.

User experience

Ease of use: The Piezotome Cube is designed with the user in mind, featuring a user-friendly interface that simplifies operation. The touchscreen display is intuitive, allowing quick adjustments to settings during surgery. Surgeons can easily switch between different modes and customise power levels to match the demands of each procedure. 

Ergonomics: The handpiece is lightweight and ergonomically designed to reduce hand fatigue during lengthy procedures. Its balance and grip are optimised for precision, enabling surgeons to perform delicate manoeuvres confidently. 

Clinical outcomes and research: 

Several studies and clinical trials have demonstrated the effectiveness of the Piezotome Cube in improving surgical outcomes. Research highlights its ability to reduce postoperative pain, swelling, and healing time compared to traditional rotary instruments. Additionally, patient satisfaction tends to be higher due to the less invasive nature of piezoelectric surgery. 

Maintenance and durability: The Piezotome Cube is built for longevity, with durable components that withstand the rigors of daily use in a clinical setting. The handpiece and tips are designed for easy sterilisation, ensuring compliance with hygiene standards.

Prospects and innovations

As piezoelectric technology evolves, the Piezotome Cube will likely see further power, efficiency and usability enhancements. Acteon remains at the forefront of innovation in the field, with future updates to the Piezotome Cube, including more innovative interfaces, advanced analytics and integration with digital surgical planning tools.

Key features

Glass touchscreen: The Piezosurgery Touch features a sleek black glass touchscreen with an intuitive, user-friendly interface. Surgeons can easily adjust settings like irrigation flow and power levels with a touch, and the screen can be protected using sterile, transparent foils. 

Ergonomic handpiece with LED lighting: The handpiece features a rotatable LED light for adjustable illumination. Based on their needs, surgeons can select from automatic, continuous, or no-light settings. Both the handpiece and cord are fully sterilisable. 

Flexible handpiece positioning: The holder offers four adjustable positions for ergonomic comfort and supports using sterile protection covers to maintain hygiene standards. 

Intelligent irrigation system: The Piezosurgery Touch features a flexible, cost-effective irrigation system. Its peristaltic pump tube is reusable, and the liquid line is integrated into the handpiece cord for improved efficiency and reduced costs. 

Feedback system for optimised performance: The advanced feedback system monitors the insert movement and adjusts power levels based on resistance.  

Micrometric and selective cuts. The system’s selective cutting ability ensures that soft tissues remain unharmed during bone cutting, minimising the risk of complications and enhancing patient safety. 

Cavitation effect for enhanced visibility: The ultrasonic vibrations create a cavitation effect that keeps the surgical site nearly blood-free.

Benefits for patients

The Piezosurgery Touch delivers precision and improved outcomes for patients. 

Protection of soft tissue: The selective cutting properties of Piezosurgery help reduce the risk of soft tissue injury. For example, in lateral sinus lift surgeries, the risk of membrane perforation is reduced by over 80%. 

Reduced post-operative swelling: Patients experience less swelling post-surgery, promoting faster recovery. 

Faster osseointegration: Implant site preparation with Piezosurgery improves osseointegration, with implants integrating with the bone more quickly and successfully. 

Less traumatic recovery: Piezosurgery is minimally invasive, resulting in less trauma for the patient and a smoother post-operative recovery.

Applications

The Piezosurgery Touch is suitable for a variety of treatments, including but not limited to: 

• Sinus lift techniques: Both crestal and lateral approaches. 

• Implant site preparation: Including mini dental implant preparation. 

• Extractions and explantation 

• Ridge expansion and corticotomy 

• Bone block grafting and bone chip grafting 

• Bone modelling 

• Endodontics 

• Osteotomy near nerves 

• Periodontal surgery 

• Implant cleaning.

Key features

Intuitive controls: The VarioSurg3 has highly responsive and intuitive controls that allow practitioners to quickly and easily adjust settings during procedures. The user-friendly interface reduces the learning curve and enables seamless operation even during the most delicate surgeries. 

Large backlit LCD screen: The VarioSurg3 has a large LCD screen that provides real-time information, including power settings and mode selections.  

Precision and safety: The VarioSurg3 includes safety features such as automatic overload protection and handpiece recognition to ensure consistent performance. 

Versatility: Compatible with a wide range of tips and accessories, the VarioSurg3 is highly versatile, allowing it to be used in various procedures such as bone cutting, bone grafting, sinus lifts, and osteotomies.  

Ergonomic design: The lightweight handpiece and well-balanced system reduce fatigue during lengthy procedures, allowing for precise movements and greater control. 

Enhanced feedback system: The VarioSurg3 offers real-time feedback during procedures, allowing practitioners to adjust power and frequency to match the tissue type they are working on. This feedback system ensures optimal cutting performance while maintaining the integrity of surrounding tissues. 

Sterilisation and maintenance: The VarioSurg3 is designed for easy maintenance and sterilisation. It features a durable, autoclavable handpiece that can withstand rigorous cleaning protocols, ensuring patient safety and prolonging the device’s life.

Benefits for patients

The VarioSurg 3 delivers precision and improved outcomes for patients. 

Precision cutting: Ultrasonic vibrations enable precise cuts with minimal damage to surrounding tissues and better bone preservation. 

Reduced heat: Minimal heat generation lowers the risk of tissue thermal injury. 

Reduced pain and swelling: Less mechanical stress than traditional drills, leading to less trauma, reduced inflammation and quicker recovery. 

Improved patient comfort: Lower noise and vibration, along with gentle handling of soft tissues, provide a more comfortable experience. 

Versatility: Suitable for procedures like bone surgery, sinus lifts, and implants with customisable settings to suit patient needs. 

Reduced risk of complications: Selective cutting minimises soft tissue damage, with built-in irrigation for a more explicit surgical field and infection prevention. 

Better outcomes: Enhanced accuracy and gentle technique improve success rates and reduce bone loss in critical procedures like implants.

Applications

The VarioSurg3 is suitable for a variety of treatments, including but not limited to: 

• Sinus lift 

• Bone graft harvesting 

• Ridge expansion 

• Mandibular nerve transposition 

• Peri-implant osteoplasty 

• Implant site preparation 

• Cystectomy 

• Tooth extraction 

• Endodontic surgery.

Key features

Automatic instrument detection: Piezomed is equipped with an automatic instrument detection feature. When an instrument is inserted, the system immediately identifies and assigns it to the appropriate power class.  

Three individual operating modes: The Piezomed offers three distinct operating modes: 

1. Power mode: The handpiece’s power increases as the pressure on the instrument increases. A boost function (temporary 20% power increase) can be activated if needed. 

2. Basic mode: The handpiece maintains a constant power level regardless of the pressure applied. Boost function can also be used in this mode. 

3. Smooth mode: The handpiece’s power decreases as the pressure on the instrument increases, ensuring more delicate handling. 

Temporary power boost (20%): The boost function enables a temporary 20% increase in power, ideal for moments when additional force is needed for more resistant bone sections. This boost can be activated in both Power and Basic modes, providing the flexibility to handle different surgical situations. 

Enhanced field illumination with LED ring: A shadow-free LED ring integrated into the handpiece ensures optimal surgical site illumination. 

Efficient cooling system: The Piezomed’s spray opening is positioned close to the instrument’s working area, ensuring the instrument and the hard tissue are efficiently cooled during the procedure. The coolant is delivered precisely to the operating point, which prevents overheating and maintains the integrity of the bone and surrounding tissues, minimising post-operative discomfort for the patient. 

Thermo washer disinfectable and sterilisable handpiece: The handpiece, including its LED socket and cable, is designed to be thermo washer disinfectable and sterilisable. This ensures optimal hygiene and infection control, adhering to strict clinical standards. 

Memory for personalised settings: Piezomed has a memory feature that automatically saves your last selected settings, allowing you to work consistently based on your preferences. This saves time and improves workflow efficiency during repeated or similar procedures.

Benefits for patients

Minimally invasive procedures: The Piezomed system allows for precise cutting of hard and soft tissues, meaning less trauma to surrounding tissues than traditional methods. 

Reduced pain and discomfort: Patients often experience less pain and discomfort during and after procedures due to its gentle cutting action. 

Quicker healing times: The minimised trauma can result in faster healing and recovery, allowing patients to return to normal activities sooner. 

Enhanced precision: The system offers high accuracy in surgical applications. 

Versatility: The Piezomed system is suitable for various applications, which can benefit patients needing multiple treatments. 

Less need for anaesthesia: In some cases, the system’s gentle approach may reduce the need for extensive anaesthesia. 

Improved safety: The technology allows for controlled cutting, minimising the risk of damaging adjacent nerves and soft tissues. 

Less bleeding: The precise cutting can also reduce bleeding during procedures, contributing to a more stable surgical field. 

Better visibility: Reduced bleeding and swelling during surgery can improve the surgeon’s visibility.

Applications

W&H offers a comprehensive range of 33 innovative instruments compatible with Piezomed. These instruments cover various surgical procedures, including: 

• Bone surgery and osteotomy 

• Periodontics

• Extractions 

• Retrograde endodontics 

• Lateral sinus lift procedures 

• Crown Lengthening 

• Apicoectomy  

• Cyst and tumour Removal 

• Alveolar Ridge Splitting
 

• Paediatric and geriatric applications. 

• Endodontic surgery.

Key features

Ultrasonic technology: Utilises ultrasonic vibrations to enhance precision in cutting and tissue removal, allowing for more controlled and minimally invasive procedures. 

Variety of tips: Comes with a range of interchangeable tips designed for different procedures, including bone surgery, tooth extraction, and endodontics. 

Adjustable power settings: This features adjustable power levels to accommodate various procedures and provide optimal performance based on specific requirements. 

User-friendly interface: Often includes a digital display that allows easy navigation of settings and real-time monitoring of the device’s performance. 

Ergonomic design: Designed for comfort during extended use, minimising hand fatigue for the practitioner. 

Water cooling system: Integrates a cooling system to irrigate the surgical site, helping to reduce heat generation and improve visibility during procedures. 

Lightweight and portable: It is compact and easy to transport, making it suitable for clinical settings.

Benefits for patients

The Woodpecker UltraSurgery system offers several significant benefits to patients: 

Precision and safety: The device’s selective cutting ability ensures maximum safety for soft tissues, minimising the risk of damage during surgical procedures.
 

Reduced trauma: The cold-cutting feature generates minimal heat, preserving cellular viability and promoting faster healing, which is crucial for patient recovery.
 

Enhanced visibility: The LED handpiece provides improved visibility during surgery, enabling surgeons to perform intricate tasks confidently.
 

High cutting efficiency: The Woodpecker UltraSurgery system demonstrates superior cutting efficiency, allowing quicker procedures with less patient discomfort. 

Robust working modes: The device’s versatile modes cater to various surgical needs, ensuring optimal effectiveness in bone and soft tissue procedures.
 

Autoclavable components: The entire handpiece assembly can be sterilised using high-temperature and pressure conditions, ensuring compliance with safety and hygiene standards in clinical settings.
 

Real-time monitoring: The built-in monitoring and alarm functions enhance the safety of the surgical process, allowing for immediate alerts in case of any operational issues.

Applications

The Woodpecker UltraSurgery system can be applied in the following clinical scenarios: 

• Dental extraction 
• Bone grafting 
• Osteogenic distraction 
• Endodontic surgery 
• Cyst removal 
• Osteoplasty: 
• Bone harvesting techniques 
• Periodontic surgery 

Additionally, the system features a root function that focuses on mechanical ultrasonic treatments, primarily used in periodontal and endodontic procedures.

Future technologies in piezoelectric surgery

Technological advancements are set to revolutionise the future of piezoelectric surgery in dentistry. Incorporating innovations such as AI, augmented reality, 3D printing and robotics will significantly enhance precision, safety, and effectiveness.

AI could transform piezoelectric surgery in dentistry by adjusting surgical parameters in real-time based on bone density and patient anatomy while also analysing pre-operative scans to optimise device settings.  

AI-driven robotics are already showcasing the potential for faster, more accurate automated procedures.  

Augmented reality and enhanced haptic feedback will offer surgeons precise control and real-time guidance, improving outcomes and reducing recovery times. 

3D printing will facilitate custom surgical guides and bone grafts tailored to individual needs, optimising procedures like sinus lifts and ridge augmentations.  

Future piezoelectric surgery tools may feature sensors to monitor temperature and pressure alongside wireless and remote-controlled devices that improve ergonomics and movement.  

Additionally, integrating lasers could allow for ultra-precise cuts, minimal tissue damage, and better sterilisation. Real-time imaging and advanced 3D navigation systems will provide continuous feedback, enabling precise intraoperative adjustments.  

As piezoelectric surgery develops, innovation will shape the future, streamlining procedures, enhancing surgical efficiency and ensuring improved patient safety.

Contact Acteon today to discover how their Piezotome Cube can transform your practice.