implants - international magazine of oral implantology International Edition

piezoelectric inserts—limited to the initial prepara- tionoftheimplantsiteandcombinedwiththeuseof handpiece rotating burs specifically dedicated to the implant system during the final phases of the proce- dure—improves clinical outcomes, allowing the achievement of the following key objectives: − Correct positioning of fixtures. − Excellentinitialfittingandexcellentprimaryreten- tion. − Excellent secondary bone retention and excellent maintenance of bone peaks. − Optimal recovery in the medium and long-term. − Extremely reduced local tissue trauma. Theaboveismorepredictableandrepeatablethan thetechniquesofpreparationexclusivelycarriedout with rotating burs or with piezosurgery inserts. Technical advantages together with the biologi- cal benefits are valid only if the piezoelectric instru- ment is used in a proper and correct manner, and of course if the piezosurgery system chosen meets the characteristics described in the introduction of this paper. Actually, there are studies that show how, under certain circumstances, an improper use of the piezo- surgery may be potentially risky, even iatrogenic, when compared with traditional osteotomies made with dental drills. In particular, some studies show that an excessive and prolonged pressure exerted by the operator on the handpiece (and then on the vi- brating insert) during cutting, as can erroneously oc- cur in the case of extended osteotomies and in the presenceofparticularlyhighbonedensities,cangen- erate temperatures greater than those generated by traditional burs on hard tissues.13-16 As known, the thermal stress induces a conse- quent significant tissue damage and interferes with the neoangiogenesis. Such an intraoperative case is particularly important, especially when the bone di- mensionsareminimum,asisusualinimplantologyor, more generally, in oral surgery.17 In addition, it should be noted that not everything thatvibratesfallswithinthefieldofpiezosurgery.Itis possibletofindsystemsonthemarketthat,although describedasusefulforthisprocedure,donothavethe appropriate characteristics, are not accompanied by the necessary validating histological studies or do not allow the appropriate mode and frequency of use. It follows that the unwary purchase of a wrong system may lead the operator to rely purely and simply on the benefitofpiezosurgeryconceptsbut,becauseofthein- correct choice, obtain a clinical and biological result worse than that achievable with conventional rotary instruments.Inviewoftheseconsiderationsaboutthe prosandconsontheuseofpiezosurgeryinoralsurgery andobjectivedataprovidedbyarichliteratureofEBM andinthatsenseexhaustive,theauthorsdeemtheim- plementation of a surgical protocol advisable, repro- ducibleandstandardized,whichprovidesfortheuseof piezoelectric device only during the initial phase of preparation of the implant site, then completing the sitepreparationwiththebursprovidedbytheimplant protocolchosenbytheoperator. Finally,thesehighlysatisfactoryresults,therefore, encourage clinical research in this direction and the procedure described is, in the opinion of the authors, a viable alternative—albeit not a substitute—to con- ventionaltechniquesalreadythoroughlydiscussedin the literature._ Editorial note: A complete list of references is available fromthepublisher. research I Fig. 20_Histologic of bone tissue in mixed technique for the initial preparation of the implant site through piezoelectric inserts with a visible reduction of the cortical and basal level. Fig. 21_Drawing of bone tissue in mixed technique for the initial preparation of the implant site through piezoelectric inserts with only an initial reduction of cortical level. Fig. 22_Histologic of healthy bone tissue in technique for the preparation of the implant site only with piezoelectric inserts. Fig. 23_Histologic of bone tissue in technique for the preparation of the implant site only with dental drills. We can see an objective tissue’s damage, with a lot of necrotic areas. Fig. 24_The example of torque measurement. Fig. 25_The example of ISQ measurement. I 21implants4_2013 Prof.Dr Mauro Labanca Consultant Professor in Oral Surgery Corso Magenta,32 20123 Milano,Italy maurolab@tin.it _contact implants Fig. 25Fig. 24 Fig. 20 Fig. 21 Fig. 22 Fig. 23