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Bone Augmentation using Piezo surgery Clinical perspectives by Prof. José Carlos Rosas Díaz
- Expert in oral rehabilitation, implantology and periodontology
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.
Key Takeaways:
- Piezo surgery enables precise and minimally invasive osteotomies while preserving nerves, blood vessels and surrounding soft tissues.
- Autogenous block grafts are a well-established solution for the reconstruction of severe horizontal and vertical bone defects in preparation for implant placement.
- Primary graft stability, precise adaptation to the recipient site and tension-free wound closure are key factors for successful bone augmentation.
- Specialised piezoelectric instruments facilitate graft harvesting, cortical perforation and precise graft contouring, thereby supporting predictable integration.
What clinical criteria determine whether a defect should be reconstructed using autologous block grafts, and what role does piezoelectric surgery play in harvesting these blocks?
Dr Rosas Díaz: The use of autologous block grafts is considered the gold standard when particulate grafts or barrier membranes are insufficient for defect reconstruction. Key clinical criteria include:
- Defect severity: Indicated in horizontal defects with less than 3–4 mm of residual ridge width, as well as in significant vertical defects requiring mechanical support that particulate grafts cannot provide.
- Bone vitality: Autologous grafts offer osteogenic potential (viable cells), osteoinductive properties (growth factors), and osteoconductive characteristics (scaffold function).
- Multi‑wall defects: If both buccal and lingual/palatal cortical plates are missing, the block graft acts as a rigid cortical replacement, re-establishing anatomical contours.
Role of piezoelectric surgery in block harvesting: Piezoelectric technology is advantageous in this context, as it enables tissue-selective cutting: Operating at an ultrasonic frequency specific for mineralised tissue, it allows precise osteotomy preparation while preserving adjacent soft tissues such as blood vessels and nerves (including the inferior alveolar nerve).
Which factors are critical for the successful reconstruction of a pronounced horizontal alveolar defect (narrow alveolar ridge) using block grafts, and how does piezoelectric technology support the procedure?
Dr Rosas Díaz: For predictable reconstruction of a narrow ridge, several key parameters must be meticulously controlled:
- Soft-tissue management: This is the most critical factor. Tension-free flap closure is essential to prevent wound dehiscence and graft exposure, both of which almost invariably lead to failure.
- Primary stability of the block: The graft must be rigidly fixed with osteosynthesis screws. Any micromovement compromises revascularisation and graft incorporation.
- Close adaptation: The graft should be shaped to achieve close, passive adaptation to the recipient site.
- Decortication of the recipient site: Perforating the cortical surface enhances bleeding and facilitates the ingrowth of osteogenic cells from the cancellous compartment.
Influence of Piezoelectric technology: Piezoelectric systems enable cleaner osteotomies and atraumatic bone cutting with reduced thermal stress compared to rotary burs. This supports early healing dynamics. Dedicated shaping instruments allow precise contouring of the graft and controlled adaptation to the recipient site, thereby improving mechanical stability and biological integration.
Which piezo surgical instruments are most suitable for delicate reconstruction of the alveolar ridge?
Dr Rosas Díaz: For delicate alveolar ridge reconstruction, where maximum precision is essential to avoid fracturing thin cortical plates, the following instruments are recommended:
a) Recipient site preparation and precision osteotomies
These instruments are particularly suited for peripheral osteotomies in the donor site or for preparing the recipient bed:
- B1 (fine saw): The standard instrument for high‑precision osteotomies. Its micrometric cutting width preserves bone volume.
- B6/B7 (special saws): Designed for deep, controlled cuts during block harvesting. Their design improves visibility and thermal control through optimised irrigation.
b) Decortication of the recipient site
Successful integration requires activation of the recipient bone via cortical perforation:
- B3 (rounded abrasive tip): Used for decortication to stimulate angiogenesis and promote vascular ingrowth from cancellous bone. Instruments B1, B6, and B7 may also be used to create line-shaped cortical perforations when indicated.
c) Shaping and contouring of the block
Once harvested, the block must be meticulously adapted to the ridge anatomy:
- B2R/B2L (angled saws): Effective for rounding graft margins and preparing the recipient site, ensuring close adaptation of both surfaces.
- B4 (flat shaping instrument): Ideal for fine trimming and contouring of block edges prior to screw fixation.
- S1 (diamond-coated flat instrument): Suitable for delicate finishing and edge refinement before final placement.
Thank you for the interview.
W&H Piezo instrument selection overview
| Application | Recommended instrument | Key function |
| Block osteotomy | B1 or B6 | Micrometric, low‑trauma bone cutting |
| Access in confined sites | B7 | Improved access for osteotomies in deep or confined areas |
| Decortication | B3 | Promotes angiogenesis and enhances graft vascularisation |
| Final graft contouring | S1/B4/B2R/L | Surface refinement for primary stability |
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