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Osteotomy speed, heat development, and bone structure influence by various piezoelectric systems—an in vitro study

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Abstract

Objectives

The aim of this in vitro study was to evaluate osteotomy speed, heat development, and bone structure influence from osteotomies performed by various piezoelectric devices and insert tips. These devices and tips were compared among each other with regard to conventional rotatory and oscillating systems with special focus on the insert tip design and thickness.

Material and methods

The osteotomies were conducted on porcine ribs utilizing 12 different insert tips (straight and angulated) and three conventional systems. After time and temperature measurements, histological analysis was carried out. Light microscopy was used to evaluate the roughness of the osteotomic surface and to search for indications of thermal bone necrosis. A special software analyzing tool was employed to determine cutting width (mm) and debris (%).

Results

All piezoelectric tips created smooth cuts. Cutting widths in general were wider than the actual insert tip size with a tendency for narrow straight insert tips producing relatively wide osteotomies, whereas narrow angulated inserts produced relatively small osteotomies. None of the samples demonstrated distinct indication of necrosis. Overall, there was only a small amount of debris in all osteotomy gaps. Conventional rotatory saws were faster and created less heat compared to all tested piezoelectric systems. Straight tips proved faster osteotomy speed than angulated tips. Thin insert tips indicated to have a positive correlation to osteotomy time and performed faster than conventional microsaw. The average temperature rise was lower when using conventional systems, but critical exceeding temperatures were only observed in short-time exceptional cases. In general, temperature rise was less when using angulated inserts.

Conclusion

All tested tips are appropriate for bone surgery. Only small differences were found among the piezoelectric insert tips. Although conventional rotatory systems in general performed faster osteotomies, special designed and thin piezoelectric insert tips seem to have a positive influence on osteotomy speed. Ultimately, none of the tested devices or inserts combined all best features of speed, heat development, bone structure influence, and safety.

Clinical relevance

Narrow and straight piezoelectric insert tips demonstrated reduced osteotomy times. Nevertheless, a combination of conventional and piezoelectric systems in clinical practice might be the best way to work time-efficient, patient-oriented, and safe. The choice of instrument should be based on clinical experience of the user and should be evaluated individually depending on the case.

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Funding

The work was supported by the Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany.

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Authors and Affiliations

  1. Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Nicolas Noetzel, Matthias Kreppel, Matthias Zirk & Ali- Farid Safi

  2. Department for Oral and Maxillofacial Plastic Surgery, University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany

    Tim Fienitz & Daniel Rothamel

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  1. Nicolas Noetzel
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Correspondence to Nicolas Noetzel.

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Conflict of interest

Surgical devices were provided by W&H Germany. D. Rothamel has received speaker honorariums from W&H. The other authors declare that they have no conflict of interest.

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Noetzel, N., Fienitz, T., Kreppel, M. et al. Osteotomy speed, heat development, and bone structure influence by various piezoelectric systems—an in vitro study. Clin Oral Invest 23, 4029–4041 (2019). https://doi.org/10.1007/s00784-019-02838-8

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