Comparative Study of Piezoelectric and Rotary Osteotomy Technique for Third Molar Impaction

Comparative Effect of Celecoxib, Diclofenac, and Ibuprofen in Controlling Postoperative Pain, Edema, and Trismus After Third Molar Extraction: A Double-Blinded Randomized Controlled Trial

The objective of this study was to compare celecoxib, diclofenac, and ibuprofen for managing postoperative pain, swelling, and trismus after a third molar extraction. There were 90 patients included and randomly allocated, 30 in each of the three study groups. The primary outcome of this trial was postoperative pain, and the secondary outcomes were postoperative swelling and trismus. The celecoxib and diclofenac groups showed better postoperative pain control compared to ibuprofen. Moreover, diclofenac showed better pain control compared to both celecoxib and ibuprofen within the first 72 hours postoperatively: one hour (p=0.005), six hours (p=0.001), 12 hours (p=0.044 ), 24 hours (p=0.017), 48 hours (p=0.006), and 72 hours (p=0.012 ). Regarding the secondary outcomes, there was no statistical difference in the swelling and trismus measurements during the postoperative period between the three study groups. The results of this study showed that celecoxib pain management post-third molar extraction is comparable to that of diclofenac and superior to that of ibuprofen.

Comparative Study of the Surgical Excision of Impacted Mandibular Third Molars Using Surgical Burs and an Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) Laser

Background The use of lasers has increased in the field of dentistry in recent years. However, in the field of oral and maxillofacial surgery, the use of lasers has been largely restricted to soft tissue, and less focus is placed on the use of lasers for hard tissues. Aim The present study aimed to comparatively evaluate the efficacy of a erbium-doped yttrium aluminum garnet (Er:YAG) laser for cutting the bone while removing the impacted mandibular third molar with the use of a surgical bur. Methods The study assessed 80 subjects undergoing removal of impacted mandibular third molars. The subjects were recruited from the Department of Oral and Maxillofacial Surgery, Luxmi Bai Institute of Dental Sciences and Hospital, Patiala, Punjab, India. They were randomly divided into two groups, each consisting of 40 subjects. Group I used an Er:YAG laser to remove the bone, while Group II used a surgical bur. Assessments and comparisons were made for complications, wound healing, trismus, edema, bleeding, and pain. Results The study examined the efficacy of the Er:YAG laser for cutting the bone and extracting the impacted mandibular third molars using a surgical bur in two groups of 80 patients each. When the laser was used in place of a surgical bur, Group I patients experienced less edema, bleeding, and discomfort; nevertheless, the difference was not statistically significant. Time taken by laser for bone cutting was significantly higher compared to the surgical bur. In Group I (laser), trismus existed for a longer time. For mouth opening, the preoperative mouth opening was comparable in the two groups with p = 0.87. Conclusion Pain, hemorrhage, and edema were lesser, and the time required for bone cutting was substantially longer in the laser group. Apart from these, laser-assisted intra-oral bone cutting should be preferred because of its less invasive nature, simpler procedure, and simpler osteotomy when compared to traditional surgical burs and also in anxiety-prone patients.

Endoscopic visualization of the inferior alveolar nerve associated with somatosensory changes after impacted mandibular third molar extraction

The aim of this study is to assess the relationship between somatosensory functional changes and inferior alveolar nerve (IAN) exposure after impacted mandibular third molars (M3M) removal. We recruited 35 patients who underwent impacted M3M extraction near the IAN. The M3Ms were extracted by combined endoscopy, piezosurgery, and contra-angle high-speed turbine handpiece. All IAN canal perforations and exposed regions were recorded and measured by endoscopy after extraction and on cone-beam computed tomography (CBCT) images before extraction. The patients were followed up 1, 7, and 35 days after surgery. A standardized quantitative sensory testing (QST) battery was performed on the lower lip skin. All of 35 cases had exposed IAN on CBCT images, 5 of which had no exposed IAN under endoscopy. For the other 30 cases, the endoscopy-measured IAN length and width were shorter than the CBCT measurements (P < 0.001). The warm and mechanical detection thresholds (MDT) on the operation side were significantly higher than the contralateral side after surgery (P < 0.05). Thermal sensory limen, MDT, and cold pain threshold were strongly correlated with the exposed IAN length and MDT also with the exposed IAN width one day after surgery. In conclusion, it was found that not all exposed IAN in CBCT images were real exposure after surgery. The intraoperative exposed IAN endoscopic measurements were smaller than by CBCT and strongly correlated with some QST parameters.

[Effectiveness of piezoelectric versus straight hand piece at low speed within the surgical extraction of retained lower third molars]

Objective

Determine the effectiveness of the piezoelectric handpiece vs. the straight handpiece at low speed in surgeries of impacted lower third molars, in relation to post-surgical effects (edema, pain and trismus) and the operative time of the osteotomy, in patients attending the Maxillofacial Surgery Service of the "Hospital de Especialidades Fuerzas Armadas N°1".

Method

It is an observational, analytical, longitudinal prospective cohort clinical study. A sample of 40 patients of both sexes aged between 18 and 25 years was taken, divided into two groups of 20 patients each, in group A extractions were performed with piezoelectric and in group B with straight rotary handpiece at low velocity. The results were analyzed on the third, fifth and eighth day, the edema was measured with the method of Amin and Laskin, for the pain the Visual Analogous Scale (VAS) was used, and for the presence of trismus with the instrument foot of king.

Results

In group A, edema (11.72 mm), pain (4.67) and mouth opening (39.49 mm) were lower than in group B edema (12.29 mm), pain (4.8) and mouth opening (35.83 mm) and osteotomy time was significantly longer with piezoelectric (6.54 ± 3.05 min) compared to the straight handpiece (1.55 ± 0.57 mm). min) and there was a difference in edema, pain and trismus under normal conditions in contrast to what was obtained at 3, 5, 8 days between the two instruments.

Conclusion

the post-surgical effects of edema, pain and trismus of the extraction of retained lower third molars are less intense with the piezoelectric compared to the straight handpiece, the use of the piezoelectric being recommended.

Piezoelectric Surgery Is Effective in Reducing Pain, Swelling, and Trismus After Removal of Impacted Lower Third Molars: A Meta-Analysis

PURPOSE

Surgery of impacted lower third molars may be associated with postoperative complications. The aim of this study is to determine whether piezoelectric surgery is effective in reducing pain, swelling, and trismus compared to conventional rotary instruments during extraction of impacted lower third molars.

METHODS

For this systematic review, the searches were performed independently by 2 researchers. Randomized clinical trials that used the piezoelectric instrument for the removal of impacted lower third molars in humans were included. The predictor variable was the study group (piezo surgery vs rotary instruments). The main outcome was the analysis of postoperative pain, swelling, and trismus. Data analysis included risk of bias assessment (RoB 2 Cochrane) and meta-analysis with heterogeneity based on random effects I² and 95% confidence interval.

RESULTS

In the initial results, 956 articles were revised and after applying inclusion/exclusion criteria, the final sample was composed of 18 publications, all being randomized clinical trials. The results of this meta-analysis demonstrated a significant reduction in pain scores with a Cohen's d of -0.95 [CI 95% = -1.23 to -0.67] of high clinical impact (P < .001). In the piezo group there was a significant increase in mouth opening of 4.29 [CI 95% = 2.33 to 6.25] mm (P < .001). Regarding swelling, Tragus-Ang and Go-eye, both showed a significant reduction in the piezo group (P < .001). There was a significant increase of 7.32 [CI 95% = 4.40 to 10.24] minutes in the piezo group (P < .00001), and none of the studies showed a significant risk of bias.

CONCLUSIONS

Piezo proved to be effective in reducing pain, swelling, and trismus in third molar surgeries even with longer surgical time, but due to the lack of standardization in primary studies regarding swelling, new, controlled and standardized studies should be carried out with the objective of proving the effectiveness of this therapeutic modality in the reduction of postoperative swelling.

Effect on implant drills and postoperative reactions for pre-extraction interradicular implant bed preparation during the COVID-19 pandemic and beyond

The aim of the present study was to observe the abrasion of implant drills and postoperative reactions for the preparation of the interradicular immediate implant bed during the COVID-19 pandemic and beyond. Thirty-two implant drills were included in four groups: blank, improved surgery, traditional surgery, and control. In the improved surgery group, a dental handpiece with a surgical bur was used to decoronate the first molar and create a hole in the middle of the retained root complex, followed by the pilot drilling protocol through the hole. The remaining root complex was separated using a surgical bur and then extracted. Subsequently, the implant bed was prepared. Implant drills were used in the traditional surgery group to complete the decoronation, hole creation, and implant-drilling processes. The tooth remained intact until the implant bed was prepared. The surface roughness of the pilot drill was observed and measured. Surgery time, postoperative reactions (swelling, pain, and trismus), and fear of coronavirus disease 2019 scale (FCV-19S) were measured and recorded, respectively. Statistical analysis revealed significant difference with surface roughness among blank group (0.41 ± 0.05 μm), improved surgery group (0.37 ± 0.06 μm), traditional surgery group (0.16 ± 0.06 μm), and control group (0.26 ± 0.04 μm) (P < .001). Significant differences were revealed with surgery time between improved surgery group (5.63 ± 1.77 min) and traditional surgery group (33.63 ± 2.13 min) (P < .001). Swelling, pain, and trismus (improved group: r ≥ 0.864, P ≤ .006; traditional group: r ≥ 0.741, P ≤ .035) were positively correlated with the FCV-19S. This study proved that a new pilot drill could only be used once in traditional surgery but could be used regularly in improved surgery. Improved surgery was more effective, efficient, and economical than the traditional surgery. The higher FCV-19S, the more severe swelling, pain, and trismus.

Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial

Background

Surgical extraction of the impacted mandibular third molar is commonly associated with postoperative pain, swelling, and trismus. Usually, rotatory instruments like burs have been used for osteotomy, while Piezosurgery is an innovative technique introduced to overcome the weaknesses related to the conventional technique. In addition, Dexamethasone administration before the extraction of impacted third molars is an efficient way to reduce postoperative pain due to robust anti-inflammatory activity. The purpose of the study is to evaluate the effect of piezo-surgery and dexamethasone injection on postoperative sequelae after the surgical extraction of impacted mandibular third molars, and ultimately to compare their effect on reducing postoperative pain.

Methods

A randomized controlled clinical trial was conducted with a sample of 80 patients. Participants were divided into four groups: Group 1 (Conventional rotatory), Group 2 (Conventional rotatory with 8 mg dose of dexamethasone 30 min before surgery), Group 3 (Piezo-surgery), and Group 4 (Piezo-surgery with 8 mg dose of dexamethasone 30 min before surgery). The outcome variables were surgical working time calculated in minutes, maximal mouth opening measured in millimeters using Vernier Caliper at baseline and day 3 and postoperative pain assessed using a Visual Analog Scale (VAS) on days 1, 3, and 7.

Results

The surgical working time was longer in piezo-surgery groups compared with the conventional rotatory instruments groups (15.82 ± 3.47 vs 23.33 ± 2.54; p value < 0.0001). The lowest reduction in mouth opening between baseline and 3rd-day post-op was found in the Piezo-surgery with Dexamethasone group (mean difference = 5.0, SD = 3.9, p value < 0.0001) followed by the Piezosurgery without Dexamethasone group (mean difference = 5.8, SD = 4.5, p value < 0.0001) and the highest average was reported by the Conventional rotatory without Dexamethasone (mean difference = 9.7, SD = 4.5, p value < 0.0001. In the four groups, the mean pain score was highest on the 1st day and gradually decreased over the following days. Comparison of the 1st and 3rd postoperative pain between groups revealed a lowest mean pain score in the Piezo-surgery with Dexamethasone group, followed by Conventional rotatory with Dexamethasone group and a highest mean score in the Conventional rotatory without Dexamethasone group (p value < 0.0001).

Conclusion

The association of Piezosurgery osteotomy and Dexamethasone intramuscular injection could be an effective combination to reduce postoperative pain and trismus after impacted third molar surgery.

Trial registration: NCT04889781 (https://clinicaltrials.gov/), Date of Registration: 17/05/2021 (retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04889781?term=NCT04889781&draw=2&rank=1

Nursing Research of Optic Canal Decompression Operation under Nasal Endoscopic Medical Treatment Based on Intelligent Internet of Things for Traumatic Vision Disorders

Traumatic vision is an important factor that causes people to have a vision. In our country, the vast majority of vision is caused by trauma. To understand the role of optic nerve decompression in the treatment of traumatic visual disturbances based on the pathological states of traumatic visual disturbances and intelligent Internet of tumors medical nasal endoscopy optic nerve decompression. This article collects relevant information by investigating patients, investigating relevant literature, interviewing professionals, etc., constructing a case template and using a comprehensive quantitative and qualitative analysis method to create a damage assessment matrix. The results of the study found that most traumatic vision disorders occur in the young and middle-aged stage, which is more than three times that of other age groups. The permanent blindness rate of patients reaches 8%, which is extremely harmful. Optic canal decompression surgery can play a great role in the treatment of patients. It can greatly reduce the patient's neurological damage. The effect is about 30% higher than that of general treatment methods, and it can also play a certain role in the prognosis of rehabilitation. It can effectively prevent related postoperative complications. This shows that optic canal decompression in the treatment of traumatic vision disorders should attract people's attention and increase research and development efforts and promotion efforts so that optic canal decompression can be used in the diagnosis and treatment of patients with traumatic vision disorders based on smart Internet of things China can play a greater role.

Effects of Impacted Lower Third Molar Extraction on Periodontal Tissue of the Adjacent Second Molar

The extraction of impacted lower third molars (ILTM) is one of the most common procedures in oral-maxillofacial surgery. Being adjacent to lower second molars, most impacted lower third molars often lead to distal periodontal defects of adjacent second molars. Several symptoms may occur after extraction, such as periodontal pocket formation, loss of attachment, alveolar bone loss and even looseness of second molar resulting in extraction. The distal periodontal defects of second molars are affected by many factors, including periodontal conditions, age, impacted type of third molars, and intraoperative operations. At present, several studies have suggested that dentists can reduce the risk of periodontal defects of the second molar after ILTM extraction through preoperative evaluation, reasonable selection of flap design, extraction instruments and suture type, and necessary postoperative interventions. This review summarizes the research progress on the influence factors, interventions methods and some limitations of distal periodontal defects of adjacent second molar after extraction of impacted mandibular third molars, with the aim of opening up future directions for studying effects of ILTM extraction on periodontal tissue of the adjacent second molar.

Augmented Reality Research of Measuring X-Ray Dental Film Alveolar Bone Based on Computer Image Analysis System

The important application of computer imaging technology in the medical field is a necessary auxiliary method for clinical diagnosis and treatment. At present, many people are affected by various factors and have various problems caused by the dental cellular bone. Traditional treatment methods are complex and long, which can cause damage to body tissues. Based on this problem, this paper takes the augmented reality measurement of X-ray dental film as the research object. Based on the in-depth measurement algorithm of the computer image analysis system, two three-dimensional reconstruction methods based on the center of gravity and the matching of the front and side positions are proposed. These two methods only need two X-rays of the front and side of the dental film, the three-dimensional parameters are obtained through calculation and analysis of each spine in the X-ray film, and these parameters are used to fit the dental alveolar bone model. The experimental results prove that the computer-based image analysis system has a great effect on the measurement of X-ray dental film alveolar bone. The positive correlation coefficient reaches 0.87. Compared with the cerebral infarction caused by other methods, the proportion of people with dental film alveolar bone injury is about 15%; after treatment, the functional recovery rate reaches more than 80%. Studies have found that there is a great difference in the age of the population that needs to be treated for dental slices and alveolar bone. The grade of patients is generally under 20 and over 60. This shows that the measurement of X-ray dental film alveolar bone based on computer image analysis system can play an important role in protecting people's oral health.

Severe Pain after Endodontic Surgery: An Analysis of Incidence and Risk Factors

INTRODUCTION

The aim of this study was to determine the prevalence and characteristics of postoperative pain after endodontic microsurgery and to identify potential predictors for severe pain.

METHODS

One hundred seventy-three patients who underwent endodontic microsurgery at a private practice were included in the study. The patients were asked to fill out a questionnaire to assess their postoperative pain levels for 5 days after surgery. The questionnaires were analyzed to record the changes in pain levels over time. The presence and size of preoperative lesions and bone thickness were determined on preoperative cone-beam computed tomographic scans. Statistical analyses were performed to identify predictors for developing severe pain after surgery. A binary logistic regression model was established to predict the occurrence of severe pain.

RESULTS

Severe pain was most prevalent on day 1 (17.3%) and gradually decreased until a small increase on day 5. The average pain level also peaked on day 1 postoperatively and gradually decreased afterward. No significant difference was observed between patients who reported severe pain and those who did not report severe pain regarding tooth position (anterior vs posterior), lesion size, and presence of fenestration. However, sex, age, and bone thickness were all significant predictors of severe postoperative pain, with odds ratios of 2.8, 0.96, and 1.41, respectively.

CONCLUSIONS

Severe pain was reported only in a small number of patients after endodontic microsurgery. Younger patients, females, and patients with thicker bone covering the apex are significantly more likely to develop severe pain.

Comparison of piezosurgery and conventional rotatory technique in transalveolar extraction of mandibular third molars: A pilot study

Objectives

To compare the postoperative outcomes in impacted mandibular third molar extraction using piezosurgery and conventional rotary technique; and to assess the stress levels in both the techniques by measuring salivary cortisol levels.

Methods

Ten patients with symmetrical impacted lower third molars were included in this split mouth pilot study. Measurements for mouth opening and swelling were taken preoperatively on the day of surgery and 1 week after surgery. Pain was evaluated using Visual Analog Scale (VAS) from first postoperative day for six consecutive days. Saliva collection for analysis of cortisol levels was done at four time intervals - before starting the procedure, immediately after the procedure, 20 min and 1 week later. The mean in two groups was compared using paired t-test/Wilcoxon signed rank test as applicable. Friedman test was used to compare multiple readings of pain and salivary cortisol.

Results

Reduction in mouth opening was more in rotary group than piezosurgery group but was not statistically significant (p = 0.092). Increase in facial swelling was more in the rotary group than piezosurgery group with statistically significant values (p = 0.020). Rotary group had higher values for postoperative pain as compared to piezosurgery on all the days and the difference was statistically significant on each day except second postoperative day. Salivary cortisol levels were elevated in both the groups with the mean values higher in group I (rotary) than in group II (Piezosurgery).

Conclusion

Extraction of impacted lower third molar results in more favourable outcome when carried out by piezosurgery technique. Further studies are needed to compare the salivary cortisol response in rotary and piezosurgery techniques.

Surgical techniques for the removal of mandibular wisdom teeth

BACKGROUND

Pathology relating to mandibular wisdom teeth is a frequent presentation to oral and maxillofacial surgeons, and surgical removal of mandibular wisdom teeth is a common operation. The indications for surgical removal of these teeth are alleviation of local pain, swelling and trismus, and also the prevention of spread of infection that may occasionally threaten life. Surgery is commonly associated with short-term postoperative pain, swelling and trismus. Less frequently, infection, dry socket (alveolar osteitis) and trigeminal nerve injuries may occur. This review focuses on the optimal methods in order to improve patient experience and minimise postoperative morbidity.

OBJECTIVES

To compare the relative benefits and risks of different techniques for surgical removal of mandibular wisdom teeth.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 8 July 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library; 2019, Issue 6), MEDLINE Ovid (1946 to 8 July 2019), and Embase Ovid (1980 to 8 July 2019). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication.

SELECTION CRITERIA

Randomised controlled trials comparing different surgical techniques for the removal of mandibular wisdom teeth.

DATA COLLECTION AND ANALYSIS

Three review authors were involved in assessing the relevance of identified studies, evaluated the risk of bias in included studies and extracted data. We used risk ratios (RRs) for dichotomous data in parallel-group trials (or Peto odds ratios if the event rate was low), odds ratios (ORs) for dichotomous data in cross-over or split-mouth studies, and mean differences (MDs) for continuous data. We took into account the pairing of the split-mouth studies in our analyses, and combined parallel-group and split-mouth studies using the generic inverse-variance method. We used the fixed-effect model for three studies or fewer, and random-effects model for more than three studies.

MAIN RESULTS

We included 62 trials with 4643 participants. Several of the trials excluded individuals who were not in excellent health. We assessed 33 of the studies (53%) as being at high risk of bias and 29 as unclear. We report results for our primary outcomes below. Comparisons of different suturing techniques and of drain versus no drain did not report any of our primary outcomes. No studies provided useable data for any of our primary outcomes in relation to coronectomy. There is insufficient evidence to determine whether envelope or triangular flap designs led to more alveolar osteitis (OR 0.33, 95% confidence interval (CI) 0.09 to 1.23; 5 studies; low-certainty evidence), wound infection (OR 0.29, 95% CI 0.04 to 2.06; 2 studies; low-certainty evidence), or permanent altered tongue sensation (Peto OR 4.48, 95% CI 0.07 to 286.49; 1 study; very low-certainty evidence). In terms of other adverse effects, two studies reported wound dehiscence at up to 30 days after surgery, but found no difference in risk between interventions. There is insufficient evidence to determine whether the use of a lingual retractor affected the risk of permanent altered sensation compared to not using one (Peto OR 0.14, 95% CI 0.00 to 6.82; 1 study; very low-certainty evidence). None of our other primary outcomes were reported by studies included in this comparison. There is insufficient evidence to determine whether lingual split with chisel is better than a surgical hand-piece for bone removal in terms of wound infection (OR 1.00, 95% CI 0.31 to 3.21; 1 study; very low-certainty evidence). Alveolar osteitis, permanent altered sensation, and other adverse effects were not reported. There is insufficient evidence to determine whether there is any difference in alveolar osteitis according to irrigation method (mechanical versus manual: RR 0.33, 95% CI 0.01 to 8.09; 1 study) or irrigation volume (high versus low; RR 0.52, 95% CI 0.27 to 1.02; 1 study), or whether there is any difference in postoperative infection according to irrigation method (mechanical versus manual: RR 0.50, 95% CI 0.05 to 5.43; 1 study) or irrigation volume (low versus high; RR 0.17, 95% CI 0.02 to 1.37; 1 study) (all very low-certainty evidence). These studies did not report permanent altered sensation and adverse effects. There is insufficient evidence to determine whether primary or secondary wound closure led to more alveolar osteitis (RR 0.99, 95% CI 0.41 to 2.40; 3 studies; low-certainty evidence), wound infection (RR 4.77, 95% CI 0.24 to 96.34; 1 study; very low-certainty evidence), or adverse effects (bleeding) (RR 0.41, 95% CI 0.11 to 1.47; 1 study; very low-certainty evidence). These studies did not report permanent sensation changes. Placing platelet rich plasma (PRP) or platelet rich fibrin (PRF) in sockets may reduce the incidence of alveolar osteitis (OR 0.39, 95% CI 0.22 to 0.67; 2 studies), but the evidence is of low certainty. Our other primary outcomes were not reported.

AUTHORS' CONCLUSIONS

In this 2020 update, we added 27 new studies to the original 35 in the 2014 review. Unfortunately, even with the addition of these studies, we have been unable to draw many meaningful conclusions. The small number of trials evaluating each comparison and reporting our primary outcomes, along with methodological biases in the included trials, means that the body of evidence for each of the nine comparisons evaluated is of low or very low certainty. Participant populations in the trials may not be representative of the general population, or even the population undergoing third molar surgery. Many trials excluded individuals who were not in good health, and several excluded those with active infection or who had deep impactions of their third molars. Consequently, we are unable to make firm recommendations to surgeons to inform their techniques for removal of mandibular third molars. The evidence is uncertain, though we note that there is some limited evidence that placing PRP or PRF in sockets may reduce the incidence of dry socket. The evidence provided in this review may be used as a guide for surgeons when selecting and refining their surgical techniques. Ongoing studies may allow us to provide more definitive conclusions in the future.

Piezoelectric bone surgery for impacted lower third molar extraction compared with conventional rotary instruments: a systematic review, meta-analysis, and trial sequential analysis

The aim of this study was to evaluate whether piezoelectric bone surgery (PBS) for impacted lower third molar extraction reduces the surgical time and risk of intra- and postoperative complications in comparison with conventional rotary instruments. This meta-analysis followed the PRISMA guidelines and was registered in the PROSPERO database. The PubMed, Embase, Scopus, and OpenGrey databases were screened for articles published from January 1, 1990 to December 31, 2018. Selection criteria included randomized controlled trials (RCTs) comparing PBS with conventional rotary instruments for impacted lower third molar extraction and reporting any of the clinical outcomes (intra- and postoperative complications and duration of surgery) for both groups. A risk of bias assessment was performed using the Cochrane Collaboration tool. A meta-analysis was performed, and the power of the meta-analytic findings was assessed by trial sequential analysis (TSA). Strong evidence suggests that PBS prolongs the duration of surgery and low evidence suggests that PBS reduces postoperative morbidity (pain and trismus) in comparison with rotary instruments. Data were insufficient to determine whether PBS reduces neurological complications and postoperative swelling in comparison with burs.

Randomized clinical study comparing Piezoelectric Surgery with conventional rotatory osteotomy in mandibular third molars surgeries

Purpose

The aim of this study was to evaluate the performance and to assess the postoperative sequel and quality of life after removal of impacted mandibular third molars using piezoelectric surgery compared with conventional rotatory osteotomy.

Patients and methods

A single blinded, randomized, control clinical study was performed. Sixty-three patients (44 males, 19 females) who presented with bilaterally asymptomatic impacted mandibular third molars were included in this analysis. Each patient was treated, at two separate sessions approximately 4 weeks apart, with a conventional rotatory hand piece on one side of the mandible and a piezoelectric device on the contralateral side. Patients were followed up on postoperative days 1, 3, 5, 7, and 15 to rate the pain, swelling and trismus. Inferior alveolar nerve paresthesia was evaluated up to 12 months postoperatively.

Results

The severity of the pain, trismus and swelling using the piezosurgery were significantly different from the rotary group. In both groups, pain was most intense and peaked during the first post-operative day, while swelling and trismus reached peak levels on the third postoperative day. The piezoelectric procedure resulted in a significantly longer procedural duration compared to the rotatory surgery (P < 0.001).

Conclusion

Piezoelectric surgery is considered a viable alternative technique compared to the conventional rotary systems and can improve a patient’s quality of life. Thus, piezoelectric surgery might be a preferred modality for patients undergoing complicated surgical extraction of impacted lower third molars.

Use of piezoelectric surgery and Er:YAG laser:which one is more effective during impacted third molar surgery?

Background

Reduction in postoperative complications is of vital considerations in impacted third molar teeth surgery. The aim of this study was to compare postoperative complications of impacted third molar surgeries for bone removal using laser, piezoelectric equipment, and conventional rotary instruments.

Methods

To address the research purpose, the investigator designed the prospective double-blind clinical trial study. The sample size was determined 20 (40 teeth) by sampling formula in any kind of operation. The data of patients were obtained in the different periods in terms of pain, trismus, swelling, ecchymosis, and patient's satisfaction and then analyzed using SPSS 20 software via paired t test and Wilcoxon and McNemar's tests.

Results

The pain immediately after surgery and 2 days and 7 days after surgery was higher in the laser group. The swelling immediately after surgery was more in the laser group but not significant. The amount of mouth opening immediately after surgery and 2 days and 7 days after surgery was significantly lower in the laser group than in the piezosurgery group. The total duration of surgery and duration of osteotomy were significantly longer in the laser group. The patient's satisfaction from surgery with piezosurgery was more than that with laser, but this difference was not significant.

Conclusion

Due to the rising demand for impacted wisdom tooth surgery, the present study suggests that hard tissue laser surgery and piezosurgery can clear the future of impacted molar surgery, and these approaches are more efficient in reducing postoperative complications compared to the conventional surgeries.

The effects of piezosurgery and submucosal dexamethasone injection on post-operative complications after third molar surgery

BACKGROUND

A retrospective clinical study was performed to compare the post-operative effects of the conventional surgery, piezo surgery technique and submucosal dexamethasone injection in lower third molars extractions.

METHODS

Data from 62 patients, subjected to surgical extraction of lower third molars, were pooled and divided into three groups such as: Conventional Group (22 patients), Piezo Group (20 patients) and Dex Group (conventional surgery + 4 mg/1 mL dexamethasone) (20 patients). Pain, swelling, trismus, analgesic consumption and operation time were comparatively evaluated.

RESULTS

Pain values were found lower in Dex Group in comparison to Conventional Group at 7th day (P = 0.007). Edema found to be higher in Conventional Group than Dex Group at 2nd day (P = 0.025). Minimally trismus values were found in Dex Group and the difference between the Dex and Conventional Group found to be statistically significant both in 2nd (P = 0.048) and 7th days (P = 0.010). The analgesic consumption in the Conventional Group was found to be higher than Piezo Group at 2nd day (P = 0.002).

CONCLUSION

The better post-operative values were obtained in the Dex Group. Although longer operative time is considered to be a disadvantage for the piezo technique, piezotome may be preferred for surgical procedures due to its positive results in comparison to the conventional technique.

Giant Peripheral Ossifying Fibroma Treated With Piezosurgery and Platelet-Rich Fibrin: A Rare Case Report

INTRODUCTION

The peripheral ossifying fibroma (POF) is a benign reactive lesion that exclusively arises from gingiva. The lesion may gain considerably large sizes and present peculiar clinical and radiographic features that would then allow it to be called a giant POF; in that case, its otherwise simple surgical extraction could create a challenge. Thus, we elect here, for the very first time, a plausible alternative for treating giant POF: piezosurgery followed by placement of platelet-rich fibrin (PRF).

CASE PRESENTATION

A 31-year-old black male presented a large asymptomatic nodule on the lower gingiva; the lesion had caused vestibular displacement of teeth and had been present for 18 years. Following the diagnostic hypothesis of a giant POF, an excisional biopsy was performed under local anesthesia using piezosurgery (microvibration of 36,000 times/sec was used in a bone cortical working mode), which confirmed the diagnosis. The surgical procedure was facilitated with the use of piezosurgery followed by placement of PRF, being the trans- and postoperative periods occurred with no complications. One year after the treatment, the patient shows no signs of disease recurrence and remains under follow-up.

CONCLUSIONS

Giant POF is a rare gingival reactive lesion that can reach large dimensions, causing teeth displacement, functional, and esthetic impairments. The lesion can be successfully managed with piezosurgery and PRF, as illustrated herein, avoiding extensive bone loss and damage to the surrounding soft tissues.

Piezo High Accuracy Surgical Osteal Removal (PHASOR): A Technique for Improved Cranial Window Surgery in Mice

Multiphoton microscopy has been widely adapted for imaging neurons in vivo. Repeated imaging requires implantation of a cranial window or repeated thinning of the skull. Cranial window surgery is typically performed with a high speed rotary drill, and many investigators find it challenging to prevent the drill from damaging the delicate dura and blood vessels. Extensive training and practice is required to remove the bone without damage to underlying tissue and thus cranial window surgery can be difficult, time consuming, and produce tissue damage. Piezoelectric surgery, which is extensively used for maxillofacial and dental surgery, utilizes ultrasonic vibrations to remove bone without damaging soft tissues. We have developed a method applying piezoelectric surgery to improve cranial window surgery in mice in preparation for multiphoton imaging. Comparisons within our lab find that the method requires less surgery time and has a lower average rate of complications due to dural bleeding than cranial window surgery with a rotary drill.