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Effective surgical saws

Interview with Professor Emanuel Adrian Bratu on the new W&H piezosurgical instruments:

Professor Dr. Dr. Emanuel Bratu

The effectiveness of the saws is really impressive

Professor Dr. Dr. Emanuel Bratu, maxillofacial surgeon, oral surgeon and prostheticist, is head of the implantology departments at two Romanian universities. He runs a renowned private hospital in Timisoara and is an internationally known researcher. In the interview Bratu explains why he considers that the W&H Piezomed piezosurgical device, and particularly two patented saws, have become essential for bone surgery.

Professor Bratu, what is your experience with the new B6/B7 saws for the W&H Piezomed?

Bratu: These saws feel completely different from previously available piezosurgical instruments. They are really astoundingly effective. We noticed immediately that the Piezomed B6/B7 work much faster than other saws. They are also easier to guide in bone, particularly in thick bone layers.

According to W&H this is due to the high power output of the surgical unit combined with the very fine teeth and the small diameter of the saw blades of only 0.25 mm.

Even so, are not rotary instruments or microsaws much more effective?

Bratu: Most dentists and oral surgeons have much more experience with rotary instruments. But piezosurgical instruments, with their special micro-oscillation, cut more precisely and are more controllable than rotary instruments. They are now at least as effective as rotary instruments. This is certainly the case for the Piezomed, at least. The bone loss is also less compared with rotary saws or milling cutters. Another very important factor is the improved overview: The coolant is set in motion by the ultrashort oscillations of the instruments. This causes a microcoagulation effect at the surgical site and thus reduces bleeding. The Piezomed also offers very bright illumination with the quadruple LED ring.

For what indications do you use the saws?

Bratu: We routinely use the instruments for harvesting bone blocks and splitting alveolar ridges. We also use the Piezomed B6/B7 for osteotomy of impacted teeth and removing failed implants. All indications that require deep, clean cuts.

residual dentition
A 40-year-old patient with very poor residual dentition wanted an implant-based restoration. Because he is a smoker, a sinus lift in the maxilla with a fixed denture was contraindicated. A bar denture on four anterior implants was planned.
Piezomed B6
The alveolar ridge was split on both sides by piezo surgery (instrument: Piezomed B6). The implants were placed in the same procedure and the peri-implant bone was additionally built up using the GBR technique.
Implants
The four implants are in situ, as planned. The distal maxillary molars can still be used to fix the lined denture, which was introduced one month after implantation.

Is overheating of bone a factor to be considered with deep preparations?

Bratu: Yes, this problem cannot be disregarded. In other systems the coolant comes out of the handpiece or the instrument, but is relatively distant from the surgical site. In the hands of inexperienced clinicians overheating can result, particularly during deep cuts. In contrast, in the Piezomed the coolant outlet is close to the instrument tip. In my experience, this improves safety and gives better results.

Could you describe briefly, for example, your procedure for mobilizing bone blocks for transplantation?

Bratu: We prefer to harvest bone from the external oblique ridge of the posterior mandible, not from the interforaminal region. After the soft-tissue incision, we use the new saws to define the amount of bone to harvest. With this approach, we also use them for the entire preparation in almost 80% of cases. We may also use other piezo instruments and then at the end a chisel to mobilize the block. We find that this is a very effective surgical technique.

Could you give us a few surgical tips and tricks from your hospital?

Bratu: We like to use the sandwich technique for augmentation in the lateral mandible. A bone cover is prepared with the piezo saw and the crestal fragment is fixed with microscrews. We place a mixture of autologous bone and xenogenic bone replacement material in between. This works very reliably. You should always ensure sufficiently dimensioned vertical cuts when splitting the alveolar ridge in the mandible. Otherwise the bone may fracture easily.

What do you consider the advantages of piezo surgery in relation to oral tissue?

Bratu: I consider piezo surgery a great leap forward in oral surgery. The technique makes bone preparation safer and easier. Little bone is lost, for example in extractions. This is very important in the aesthetic zone, particularly if immediate implantation is planned. Piezo surgery is also safer for soft tissue: injuries to membranes in the sinus are basically history, as are nerve injuries when bone blocks are being harvested. Data indicating reduced postoperative swelling and pain are also available. Piezo surgery is also ideal for preparation of sinus septa. And last but not least, our patients benefit from the atraumatic nature of this technology.

Your hospital in Timisoara offers oral surgery and prosthetic reconstruction with a concentration on implantology. Do you also use your Piezomed device for other indications?

Bratu: We also use piezo for surgical crown extensions and in periodontal surgery.

In conclusion, a few words about another special feature of the Piezomed: what are the benefits of the automatic instrument detection?

Bratu: This is certainly a useful feature. It saves time and ensures that we always work with the correct power settings and cooling. This is a feature that distinguishes it from other systems, particularly for difficult and complex operations.

References

  1. Bratu, D. C., et al.; Rom J Morphol Embryol 2014. 55 (3): 909-913.
  2. Bratu, E. A., et al.; Clin Oral Implants Res 2009. 20 (8): 827-832.
  3. Bratu, E., et al.; Int J Oral Maxillofac Implants 2014. 29 (6): 1425-1428.
  4. Bratu, E., et al.; Int J Oral Maxillofac Implants 2015. 30 (2): 435-440.
  5. Felice P, et al.; Int J Periodontics Restorative Dent 2010;30:583-591.
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  9. Reside, J., et al.; Clin Implant Dent Relat Res 2015. 17 (2): 384-394.
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  11. Sohn, D. S., et al.; Int J Periodontics Restorative Dent 2007. 27 (2): 127-131.
  12. Stubinger, S., et al.; J Oral Maxillofac Surg 2005. 63 (9): 1283-1287.
  13. Vercellotti, T.; Essentials in Piezosurgery: Clinical Advantages in Dentistry. Quintessence Publishing. 2009.
  14. Wallace, S. S., et al.; Int J Periodontics Restorative Dent 2007. 27 (5): 413-419.
  15. Wallace, S. S., et al.; J Evid Based Dent Pract 2012. 12 (3 Suppl): 161-171.