Piezosurgery: A Boon to Dentistry

Review Article

J Dent App. 2016; 3(4): 365-369.

Piezosurgery: A Boon to Dentistry

Firoz Babu P¹, Polepalle T², Loya M², Mani Deepthi CH³ and Nayyar AS4*

¹Department of Orthodontics and Dentofacial Orthopedics, Rama Dental College and Hospital, Kanpur, Uttar Pradesh, India

²Department of Periodontics and Implantology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India

³Department of Oral Pathology and Microbiology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India

4Department of Oral Medicine and Radiology, Saraswati- Dhanwantari Dental College and Hospital and Post- Graduate Research Institute, Parbhani, Maharashtra, India

*Corresponding author: Abhishek Singh Nayyar, 44, Behind Singla Nursing Home, New Friends’ Colony, Zodel Town, Panipat-132 103, Haryana, India

Received: December 06, 2016; Accepted: December 29, 2016; Published: December 30, 2016


Dentistry had undergone lots of advancement and has seen lots of changing concepts over the past few decades and one such novel innovation is Piezosurgery. Piezoelectric bone surgery, otherwise, known as Piezosurgery is a new technique that was introduced by Professor Vercellotti in the year 1988 to overcome the limitations of the conventional scalpel blade surgical procedures in oral bone surgery by modifying and improving the conventional ultrasound technology. It is a promising, meticulous and soft tissue sparing technique for bone cutting based on low frequency ultrasonic micro-vibrations. The absence of macro-vibrations makes the instrument more manageable and allows greater intra-operative control with a significant increase in the cutting safety in the more difficult anatomical cutting zones. The present review outweighs Piezosurgery over the conventional oral surgical procedures and emphasizes on its mechanism of action, instruments, biologic effects, advantages and limitations and its varied applications in the field of oral surgery and dentistry per se.

Keywords: Piezosurgery; Piezoelectric device; Cavitation


Over the past few decades, there has been rapid development in various dental surgical techniques evolving a world of painless dentistry. Traditionally, osseous surgery was performed using hand instruments and various rotary instruments with different burs which required external copious irrigation due to production of heat using these instruments. Besides heat, considerable pressure was, also, exerted in osseous surgeries and had limitations in case of fractured and/or, brittle bones [1]. To overcome the above limitations, a novel surgical technique was introduced based on ultrasonic microvibrations for precise and selective bone cutting with an added advantage of sparing the surrounding soft tissues [2]. This new alternative method, introduced in dentistry for bone related surgical procedures, was termed as Piezosurgery.

What is Piezosurgery? Piezosurgery is relatively a new technique introduced by Professor Vercellotti in the year 1988 which offers advantages and overcomes the limitations of traditional instrumentation in oral bone surgeries by modifying and improving the conventional ultrasound technology. The basic principle of piezoelectricity discovered by Jacques and Pierre Curie in late 19th century for bone cutting was based on ultrasonic micro-vibrations [3]. These micro-vibrations were created by the piezoelectric effect where certain ceramics and crystals deformed when an electric current was passed across them resulting in oscillations of ultrasonic frequency [4]. The current device consists of a novel piezoelectric ultrasonic transducer powered by an ultrasonic generator capable of driving a range of resonant cutting inserts, a hand piece and a footswitch connected to the main unit, which supplies power and has holders for the hand piece and irrigant fluids, besides a peristaltic pump for cooling with a jet of solution that discharges from the inserts and also, helps in removing the debris from the cutting area. The device has a control panel with a digital display to set the power and frequency modulation. The device, also, has several autoclavable tooltips known as inserts which are titanium and/or, diamond coated in various grades and which move by micro-vibrations created in the piezoelectric hand piece [5]. The device is widely used in dentistry serving various applications including root planning, removal of supra-and sub-gingival deposits and stains from teeth, crown lengthening procedures, a traumatic tooth extractions, ridge augmentation procedures, sinus floor elevation procedures, bone graft harvesting, lateralization of inferior alveolar nerve, implant surgeries, and ridge expansion procedures etc [6,7].


The term piezo originates from the Greek word pieze in which means to press tight and/or, squeeze. In the year 1880, piezoelectricity was first discovered by Jacques and Pierre Curie who found that applying pressure on various crystals, ceramics and bone, created electricity. This piezoelectric effect is based on the principle of physical interactions and the phenomena of basic electric and mechanical dimensions such as electric field strength, polarization and tension and extension in crystalline field which states that deformation in crystals on passing of electric current results in oscillations of ultrasonic frequency. The vibrations obtained are amplified and transferred to a vibration tip which, when applied with slight pressure on bone tissue, results in cavitation phenomena that is a cutting effect, exclusively on the mineralized tissues [4]. Gabriel Lippmann, in the year 1881, found the converse piezoelectric effect which was, further, investigated by different scientists. In the year 1953, Catuna MC developed ultrasonic drill for cavity preparation on human teeth and published an article on the effects of ultrasound on hard tissues [8]. In the year 1957, Richman MJ was the first to report the surgical use of an ultrasonic chisel without slurry to remove bone and resect roots in apicoectomies [9]. In the year 1960, Mazarow HB reported evidence of an ultrasonic scalpel-like blade to directly cut osseous tissues [10]. In the year 1961, Mcfall TA et al evaluated distinction of healing by comparison of rotating instruments and oscillating scalpel blades and found a slow healing with no severe complications reported by use of these scalpel blades [11]. In the year 1980, Horton JE et al stated that bone regeneration was better using ultrasonic devices [12]. A year later, he evaluated the clinical use of ultrasonic instrumentation in the surgical removal of bone and observed the removal of the mineralized tissue with an ease and efficiency with good acceptance by patient without any complications [13]. In the year 1998, Torrella F et al stated better use of ultrasonic generators compared to magnetostrictive devices due to their greater efficiency of cutting bone with less tissue destruction [14]. In the year 1999, Vercellotti T invented Piezoelectric bone surgery in collaboration with Mectron Spa and published about this topic in the year 2000 [15]. Subsequently, in the year 2001, Piezosurgery® was introduced. In 2005, the US Food and Drug Administration extended the use of ultrasonics in dentistry to include bone surgeries [16].

Mechanism of Action

Piezoelectric ultrasonic frequency is created by driving an electric current from a generator over piezoceramic rings leading to their deformation. In dental applications, the ultrasonic frequency usually ranges from 24-36 kHz with a capability of cutting mineralized tissues. Thus, the resulting movement from the deformation of piezoceramic rings sets-up a vibration in the transducer which creates the ultrasound output. These waves transmitted to the hand piece tips, also, known as inserts, leads to longitudinal movements resulting in cutting of the osseous tissues by microscopic shattering of bone [17]. The transducer is a very important part of instrument system as it incorporates a piezoelectric element which converts electrical signals into mechanical vibrations and mechanical vibrations into electrical signals.


It is the micro-boiling phenomenon occurring in liquids on any solid-liquid interface vibrating to an intermediate frequency corresponding to a rupture of the molecular cohesion in liquids and the appearance of zones of depressions, craters or, troughs, that fillup with vapor until they form bubbles about to implode. In case of detartrating tools, cavitation occurs when the water spray contacts the inserts vibrating to intermediate frequencies [18].

Piezoelectric Device

It consists of a hand piece and a foot-switch that are connected to the main unit which supplies power and has holder for hand piece and irrigant fluids. The main unit comprises of a platform with a control panel with a digital display and a keypad. A frequency of 25- 29 kHz is present with a series of inserts of different forms with a linear vibration range from 60-200μm. The power of the commonly used devices is 5W [6]. From a clinical point of view, this unit offers three different power levels:

Parts of instrument (Figure 1):