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Clinical cases of regenerative bone procedures using piezo surgery

14.10.2026

*First published in Dental Tribune Latin America

The following clinical cases clearly demonstrate the advantages of piezo surgery in various regenerative bone procedures. In the first case, ridge reconstruction using block grafts was performed prior to implant planning in a patient with complete maxillary edentulism and severe bone resorption. In the second case, this technology was used to reconstruct implant sites with bovine-derived block grafts, followed by the placement of implants.
Both cases are featured in Chapter 9 of the book “Cirugía piezoeléctrica: generalidades y aplicaciones clínicas”..

The upper images show a ridge reconstruction using block grafts prior to implant planning; the lower images illustrate the vertical deficiency of the alveolar ridge and the treatment performed using piezo surgery.

Clinical Case: Complete Maxillary Edentulism

A 53-year-old female patient presented requesting an implant-supported prosthesis. Clinical examination revealed complete maxillary edentulism with severe generalised bone resorption, except for tooth 2.3, which had a residual root fragment. Tomographic assessment confirmed the clinical findings, therefore ridge reconstruction using block grafts was indicated prior to implant planning.

Figure 1: Clinical view showing severe horizontal deficiency of the alveolar ridge.
Figure 2: CBCT of the recipient site. Tooth 1.3 (a). Tooth 2.1 (b).
Figure 3: CBCT of the donor site.
Figure 4: Frontal (a) and occlusal view (b) of the recipient site.
Figure 5: Flap release and soft tissue elasticity assessment (a) to ensure tension-free closure (b).
Figure 6: Decortication of the recipient site using a drill to open the medullary compartment (a, b).
Figure 7: Verification of medullary bleeding after decortication (a, b).
Figure 8: Donor site: two osteotomy angles created with a serrated piezo insert (B6 by W&H) delineating the boundaries of the bone block (a, b).
Figure 9: Cut made by the piezo saw B6 by W&H) (a), cutting width approximately 0.3 mm (b).
Figure 10: Angled serrated piezo insert (B2L by W&H) (a), used to perform the inferior osteotomy with improved access (b).
Figure 11: Final view of the osteotomy (a) and segmentation of the bone block (b).
Figure 12: Sequence removal of the block fragments by controlled fracture (a–e).
Figure 13: Preparation and shaping of the bone block, using a piezoelectric instrument (S1 from W&H), including selection of the osteosynthesis screw (a–g).
Figure 14: Verification of flap extension to ensure tension-free closure (a, b).
Figure 15: Sequence of biomaterial placement between bone blocks (a–e).
Figure 16. Placement of the barrier membranes and tension-free closure of the soft tissue (a–d).

Clinical case: Non-autologous block graft for ridge reconstruction

A 36-year-old female patient presented with an inadequate prosthetic restoration. Clinical examination revealed a provisional acrylic prosthesis involving teeth 1.1 and 2.2. Additionally, gingival recession was observed at tooth 2.2, along with a severe horizontal ridge deficiency in the edentulous area corresponding to tooth 2.1. Cone-beam computed tomography (CBCT) revealed complete absence of the buccal bone plate at tooth 2.2 and confirmed the horizontal deficiency in the edentulous region of tooth 2.1. Based on these findings, reconstruction of the alveolar ridge using a bovine-derived block graft was indicated, followed by implant placement.

Figure 17: Frontal view showing vertical alveolar ridge deficiency in the region of teeth 2.1 and 2.2.
Figure 18: Full-thickness flap elevation extending beyond the mucogingival junction (a, b).
Figure 19: Bone defect and severe horizontal bone resorption: clinical view (a) and CBCT cross-section (b).
Figure 20: Flap release to ensure tension-free closure.
Figure 21: Decortication performed using a 1.2 mm drill (a, b).
Figure 22: Use of the flat serrated piezo insert (B6 by W&H) for extended decortication (a). Vascularisation and nutrition grooves (b).
Figure 23: Sequence of fixation and shaping of the bone block using the flat serrated piezo insert (B6 by W&H), including removal of sharp edges (a–d).
Figure 24: Shaping of the bone block with a flat diamond-coated insert (S1 by W&H) (a) to round off sharp angles and thus avoid dehiscence or fenestration of the soft tissues (b).
Figure 25: Sequence of crushing and preparing the block-form bone substitute material (a–d).
Figure 26: Placement of the crushed biomaterial (a–d).
Figure 27: Steps for placing the barrier membrane (a–d).
Figure 28: Flap closure and suturing (a–e). Postoperative follow-up at 7 days (f).
Figure 29: Postoperative follow-up at 10 days.

Conclusion

These two clinical cases demonstrate the advantages of piezo surgery in regenerative bone procedures, such as ridge reconstruction with block grafts and the preparation of implant sites.

About Dr. José Carlos Rosas Díaz

Dr José Carlos Rosas Díaz, former Director of the School of Stomatology at the Universidad Privada San Juan Bautista (UPSJB) in Lima, Peru, holds a master’s degree in stomatology and serves as a researcher at the UPSJB. He is a specialist in Comprehensive Oral Rehabilitation, Comprehensive Oral Implantology, and Periodontology.

Dr. José Carlos Rosas Díaz

Special Series: Piezo surgery
Click here to see the article
dental-tribune.com

The series of articles on piezo surgery is based on the book “Cirugía piezoeléctrica. Generalidades y aplicaciones ” by Joclínicassé Carlos Rosas and collaborators on this technology.

The book, co-authored with Jerson Palomino Zorrilla, Karla Díaz Cavero, and María Eugenia Guerrero Acevedo from Universidad Privada San Juan Bautista in Lima, Peru, provides the most up-to-date scientific evidence supporting the clinical value of various piezoelectric procedures, demonstrating their practical utility in the dental office through the publication of numerous clinical cases.

Dental Tribune Latin America


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The book "Cirugía piezoeléctrica. Generalidades y aplicaciones clínicas" explains the fundamental principles of this technology and demonstrates its practical utility in the dental clinical setting through detailed clinical case reports.

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Reports & Studies
Tags
Dental, Dentistry, Instrument, Patient, Treatment

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