Clinical booklet - The Ultrasonic dental bone surgery
Contents
1. Power ultrasonics for Safety Preservation of soft tissue Speed A fast precise and effortless selective cut thanks to ultra sharp robust and resistant tips Comfort Atraumatic treatments no bone loss or bleeding fast healing and greatly reduced post operative pain IEZOTOME PiezoeUltrasoniceSurgeryeUnit bone surgery by Satelec More power up to three times more powerful in Piezotome mode up to 60W on Piezotome 2 SoLo LED IMPLANT CENTER 2 New light function the Piezotome 2 and Newtron handpieces are equipped with very high power LEDs 100 000 Lux Finely adjusted power thanks to the progressiveness of ultrasonics on PIEZOTOME 2 AND IMPLANT CENTER 2 A wide touch sensitive screen easier navigation and programming on PIEZOTOME 2 AND IMPLANT CENTER 2 l z0 TOME Piezo Ultrasonic Surgery Unit Piezo Ultrasonic Surgery amp Implantology Unit M PLANTCENTER Acknowledgements This clinical booklet has been written with the guidance and backing of university lecturers and scientists specialists and scientific consultants Dr G GAGNOT private practice in periodontology Vitre and University Hospital Assistant Rennes University France Dr S GIRTHOFER private practice in implantology Munich Germany Pr F LOUISE specialist in periodontolgy implantology Vice Dean of the Faculty of Dentistry University of the Mediterranean Marseilles France Dr Y MACIA p2. Benefits of ultrasonics fficiency R e C Instruments for crestal sinus lift Developed for sinus lift by the crestal approach the IntraLirT kit makes it possible to perform non invasive surgery in full safety i Reveal Alveolar Crest Bone by a 8x8mm top crest flap or 6mm diameter crestal punch and use an implant pilot drill if the residual bone is more than 3mm Stop drilling before sinus floor Pilot drilling with TKW1 1 35mm in very dense cortical bone when residual bone is less than 3mm Stop drilling 1mm before reaching the sinus floor bone Use the cylindrical TKW2 tip 2 1mm to drill widen the access canal and open the sinus floor to have a direct view on the membrane Check with unilateral Valsalva test Perform a receptacle preparation with TKW4 2 8mm of 2mm depth control with the laser marks which are placed every 2mm If alveolar crest is only 1 2mm receptacle depth should be 0 5mm Place a collagen sponge in contact with the sinus membrane for additional perforation protection Insert the TKW5 tip into the receptacle preparation previously performed check if TKW5 is press fit sealed into the receptacle and activate the ultrasonics for 5 seconds this will create an augmentation volume of 2 5ml under the sinus membrane Check floating of sinus membrane by direct view or by unilateral Valsalva test Use the TKW3 2 35mm to widen the access canal to the sinus membrane
3. LED 1 to 3 Scalpel SYNDESMOTOMY Oriented at 45 to the right the LC2R facilitates access to the posterior areas The tip s slimness respects the morphology of cortical plate and offers working comfort in the sectors with reduced visibility Length of active part 10mm PIEZOTOME Recommended modes Irrigation eeoo cc PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation 0000 m mn 1 to 3 Not applicable to Piezorome SoLo LED SYNDESMOTOMY Saw 14 This saw tooth tip with double cutting surfaces is endowed with a laser marker every 3mm to evaluate depth or cutting thickness It is particularly effecient for hemisections and root amputations It is also indicated to split impacted molars during extraction Length of active part 9mm Dr E Normand Pr F Louise PIEZOTOME Recommended modes Irrigation ua PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation Goo mw Li Not applicable to Piezorome SoLo LED 1to3 Instrument sequence Instrument sequence Using the LC1 around the root to facilitate the root avulsion 76 2 Crown Extension CE a Crown lengthening technique The aim of crown lengthening techniques surgical or orthodontic is to increase the clinical crown height
4. Surgical tips designed for the first generation of Piezorome and ImPLanT CENTER Cannot be used with Piezotome SoLo LED Piezotome 2 ImpLant CENTER 2 high power generators and vice versa Wear of tips must be regularly checked by the user A tip with dulled active part must be changed Diamond tips must be replaced when the active diamond part becomes smooth and shiny In anticipation of tip wear it is recommended to sterilize a second tip kit in advance Furthermore to prolong their efficiency and precision it is important to avoid dropping them For further details please refer to the relevant kit user s manual Piezorome handpiece Before each operation it is recommended to check the integrity of the handpiece cord Unscrewing the handpiece extremity allows access to the sealed joint as well as to the screw thread zone of tip screwing and thus allows checking for their wear status The sealed joint ordered through your local retailer can be easily changed For further details please refer to the relevant user s manual 2 Generator After each operation it is necessary to check the integrity of power cords the footswitch and handpieces The whole generator can be cleaned with disinfectant wipes It is however important to quickly mop up liquids which might penetrate into the device during the decontamination procedure For further details please refer to the user s manual of your device Lettres eee L
5. syndesmotomies and sinus lift Until the early 90s certain general practitioners were dissuaded from attempting implantology procedures by the risk of bone loss Thanks to the latest technological developments it is possible to offer patients a credible alternative SATELEC ultrasonic power generators offer comfort safety and precision to the practitioner during delicate operations This clinical booklet presents piezoelectric surgery under a technical as well as a surgical angle It aims to guide the practitioner in the application of this recent technique by means of new protocols 11 12 Foreword The recommended protocols and instrument sequences described in this booklet are the fruit of our consultants experiments developed during clinical trials in a phase development and B phase pre launching It is up to each user to adapt or modify them according to the situation IMPORTANT Surgical tips designed for the first generation of PiezoTome and ImPLANT CENTER Cannot be used with Piezorome 2 Piezorome SoLo LED IMPLANT CENTER 2 high power generators and vice versa TECHNOLOGY SATELEC inventor of the piezoelectric ultrasonic generator for dentistry is entering a new era by adapting powerful ultrasonics to oral surgery Ultrasonics Ultrasound waves have a sound frequency greater than 20 000 Hertz vibrations per second Humans can hear waves between 20 and 20 000 Hertz Ultrasoun
6. E NE CA ee Cleaning disinfection automatic cycle Discard perforator D S Clean decontaminate brush Clean with wipes enzyme solution or alkaline Assemble instruments Mechanical Ultrasonic bath cleaning device enzyme solution or alkaline 94 Summary ZO A E s WO s MO sR Gee ss 0800 s WO s OO s2 13 D s4 Ol 15 a ceSurgeryeUnit Irrigation ml min 40 50 40 50 40 50 35 40 35 40 35 40 40 50 40 50 35 40 35 40 35 40 Summary Tips recommended modes TKW1 TKW2 TKW3 TKW4 TKW5 LC1 LC1 90 LC2 LC2L Maximum cR B0 NINJA GO cer CE2 ce Piezo Ultrasonic Surgery Unit 30 40 60 80 ON e GS oo ie cy e fo e o o oO ao i co Co co co an an OO an oy oo a 60 80 95 096 Tips BS15 BS1L BS2L BS2R BS4 BS5 BS6 SL1 SL2 SL3 SL4 SL5 TKW1 TKW2 TKW3 TKW4 recommended modes PiezoeUltrasoniiceS Maximum urgery Unit D4 U U La Ls iezo Ultrasonic Surgery Fine setting Irrigation ml min Gay WwW amo 100 Not applicable to Piezorome SoLo LED Summary l sion iezorome mevantoeyrer Tips Maximum Fine Irrigation recommended modes setting ml min TKW5 CS1 Mandible Maxillary CS2 Mandible Maxillary CS3 Mandible Maxillary CS4 Mandible Maxillary CS5 M
7. LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation 0000 i 35 1 to 3 Not applicable to Piezotome SoLo LED OSTEOTOMY 36 BS6 Curved scalpel particularly recommended for osteoplasty Treatments remodeling curettage and harvesting of bone chips An osteoplasty tip the BS6 cleans the recipient site smooths surface defects and eliminates adhering periostium fibrocellular layer in order to best adapt the recipient site to the graft It can serve for remodeling the graft to eliminate any secant or aggressive zone and to separate the cortical bone graft from subjacent medullary tissue during grasp of the graft Finally it levels the surrounding ridge during ridge expansions PIEZOTOME Scalpel Recommended modes Irrigation PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Not applicable to Piezorome SoLo LED Recommended modes Fine settings Irrigation 01 JD een Gas ami 1to3 Instrument sequence Ramus bone harvest Ramus bone harvest and graft remodeling for filling of bone deficit on tooth 11 ae A Sinus Lift SL 38 a Lateral sinus lift The sinus cavity naturally tends to increase its volume with time see illustration below Furthermore the extraction of a tooth situated in the maxillary sinus area entails a loss of bone height called pneumatisation of the sinus and a
8. Piezorome SoLo LED IMPLANT CENTER 2 Tip dedicated to the second osteotomy up to 8mm of depth Thickness 0 85mm PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation aw 80 100 Not applicable to Piezorome SoLo LED Mandible Maxillary 1to3 Scalpel Scalpel used for the discharges incisions in mesial and distal sides always up to 8mm of depth Thickness 0 5mm PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Mandible Maxillary Fine settings Irrigation min o E 1to A 3 80 100 CREST SPLITTING Available for Piezorome 2 Piezorome SoLo LED ImPLANT CENTER 2 Not applicable to Piezotome SoLo LED TKWeResearch Group 61 CREST SPLITTING Available for Piezorome 2 Piezorome SoLo LED ImpLant CENTER 2 62 Conical tip for bone expansion Tip thickness 1 80mm at 8mm Not applicable to Piezotome SoLo LED Expander Pr F Louise PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Mandible Maxillary 66 Fine settings Irrigation min Expander CREST SPLITTING Available for Piezorome 2 Piezorome SoLo LED Implant CENTER 2 Conical tip for bone expansion Tip thickness 2 75mm at 8mm Pr F Louise PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings I
9. between the cortical bone and the membrane or the bone block according to the method and separates them approximately 2 5mm apart from the edge The SL4 and SL5 tips are then used in apical mesial and then distal position to elevate the edges deeper It is important during this operation to keep good contact with the edges of the vestibular bone window The filling of sinus is then performed Autogenous bone shavings harvested during the operation can be mixed with biomaterials The bone filling material is then introduced into the bone window and over the whole site Before suturing the site collagen or GORE TEX or even VICRYL membranes can be placed to protect and maintain the filling material Finally depending on the case implants are inserted approximately three months after the operation The following tip index charts specify the different clinical applications of each one 39 _ 40 Maxi lary sinus lift Diamond SINUS LIFT SL Diamond coated tip for vestibular bone window cut and for attenuation of sharp angles This tip is used to perform bone incisions less aggressive than saws It is recommended to be used during a vestibular bone window cut and attenuation of the sharp angles to protect the nearby anatomical structures During its use the practitioner has to perform a constant longitudinal sweeping of the surface to be incised The SL1 remodels all the secant bone zones susceptible to damage the sin
10. implant is then placed approximately two months after the extraction and the prosthetic phase will be performed three to six months after the implant placement Reliable technique advised in areas where esthetics are a priority Immediate post extraction implant placement considerably reduces the time and the cost of treatment Treatment time and cost reduction Fewer interventions Limited bone resorption After the immediate placement of 1925 implants between 1988 and 2004 Wagenberg 20 obtains an overall success rate of 96 This technique of extraction and immediate implant placement can thus be recognized as reliable c Benefits of ultrasonics The use of ultrasonic instruments is much less traumatizing for the patients and preserves the bone tissue essential for osseointegration Inserted between the cementum and the periodontal ligament of the tooth the tips will widen the ligamental space Thus separated from its attachment system the tooth can be removed rapidly and with a less traumatic luxation The alveolar bone edge can be kept intact since the tip essentially acts on the tooth and not on the bone An alveolectomy is therefore avoided Less aggressive than cutting burs mounted on rotary instruments the risk of involuntarily damaging the bone septum which could harm the gingival papilla is avoided Without inertia these extraction tips limit the risk of lesions to adjacent teeth and roots 1 Classificati
11. in the case of a cyst the SL5 tip separates it from the osseous wall PIEZOTOME Recommended modes Irrigation min md PiezoromE 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation min M cn 45 1to3 Not applicable to Piezorome SoLo LED Instrument Sequence Discarded vestibular bone window The surgical principle of a sinus lift is as follows cutting the vestibular bone window elevating the sinus membrane filling and suturing the site A6 Photos were taken during two operations Instrument Sequence Preserved vestibular bone window Swinging vestibular bone window towards sinus membrane during a sinus lift 4 _ _ Intralift 48 a Sinus lift by the crestal approach The sinus elevation can be achieved by the lateral or crestal approach The IntRaLiFT kit is intended for the latter technique consisting in using the same path as the implant socket raising the sinus membrane and placing if the primary stability permits it the implant s during the same surgery 21 Introduced by Summers in 1994 this technique used manual osteotomes Minimally invasive it is now feasible with the InrraurT kit associated with SATELEC ultrasonic power devices Drilling is done with four diamond coated tips of increasing diameter The TKW5 non diamond coated tip with internal irrigation is designed for sinus membrane elevation b
12. of a tooth planned for a conservative or prosthetic restoration The indications for crown lengthening are many e Esthetics Gingival hyperplasia Poor gingival contour e Bacterial destruction Sub gingival caries e Accident Crown or root fractures or cracks e Pathology occlusion Bruxism Poor occlusion e latrogenic factors Prosthesis which does not respect the biologic width of the cervical margin perforation etc b Biologic width The biologic width as defined by Gargiulo and al 1961 is measured from the bottom of the gingival sulcus to the alveolar crest This length is approximately 2 04mm The mean depth of the gingival sulcus is 0 69mm The sum of these two figures rounded off to 3mm constitutes the space occupied between the summit of the gingival margin and the alveolar crest the pre prosthetic surgical space to be preserved Respect of the biologic width is essential during treatment and restorative or prosthetic procedures Not respecting it can engender periodontal lesions such as gingivitis gingival recession and bone resorption In order to increase the clinical crown height and restore a healthy physiology the alveolar crest must be apically positioned at 3mm with regard to the apical finish line of the preparation The biologic width can therefore physiologically be organized while the access to the cervical finish line of the preparation is improved The alveolar crest level will determine the final pos
13. 67 c Benents of AA cdi eine cac cie 67 d Syndesmotomy instruments 68 INSTUMEAT SUECO SE arterial 15 G Crown EXONS O asco ne dd cea dun ab cui 17 a Crown lengthening technique eee F are alo a O ad et ad dites 77 c Benefits of ultrasonics 78 INSTTIM NESEQUENC sr rincon ea den Errored adanan iiei 83 IV Organization of technical environment 0 1 Packaging of the generators and their accessories 86 2 Operating zone organization a ee OO 3 Cleaning decontamination and sterilization A erase 88 V Maintenance 90 VESUIM Verena arroces orar re ef 94 References 98 Synthesis gt MORE SAFETY Selective cutting A selective cut distinction between hard and soft tissues only the bone is cut no risk of injuring soft tissues nerves membranes arteries Controlled irrigation for great bone healing The two peristaltic pumps with integrated cassette offer accurate control and extremely precise irrigation to avoid any heating resulting in better bone healing and absence of postoperative effects such as edema and pain 10 According to Dr Harder s clinical study 5 The Piezorome produced the smallest increase in intraosseous temperature MORE PRECISIO
14. International Vol 8 Issue 3 2007 99 Ps wa rh CSL bad iad ELA PT aL www piezotome com Non contractual document Ref 157373 W6 V2 Copyright 2012 SATELEC All rights reserved No information or part of this document may be reproduced or transmitted in any form without the prior permission of SATELEC A Company of ACTEON Group 17 av Gustave Eiffel e BP 30216 33708 MERIGNAC cedex FRANCE Tel 33 0 556 340 607 Fax 33 0 556 349 292 E mail piezotome acteongroup com www piezotome com oe PUBLICIS ACTIV RCS Paris B 337 934 483 023702 SATELEC
15. N Very fine clean narrow and regular cut to retain maximum bone volume Particularly robust SATELEC tips are also adapted to each anatomical context Visibility of the operative field The hemostatic effect of cavitation spray improves the visibility of the operative field Tactile sense The Newrron technology that drives the handpiece by Cruise Control guarantees gentle regular and controlled vibrations of the SATELEC tips allowing continuous action even on deep cuts gt MORE COMFORT Reliability PiezotomE Piezotome SoLo LED Piezorome 2 ImpLanT CENTER 2 are reliable powerful and silent devices Temperature control No overheating of the handpiece or tips Efficiency of ultrasonics Cuts are made without any effort or pressure Only a back and forth movement is needed gt PRINCIPLES An efficient use of SATELEC ultrasonic tips 1 The active part in contact with the surface is generally located on the last 2 3 millimeters of the tips 2 Paintbrush movement ultrasonics piloted by the Newrron technology require no pressure to be effective A so called paintbrush movement where smoothness and dexterity are preferred to obtain the desired atraumatic result 3 Selective cut the undeniable advantage of ultrasonic cutting is soft tissue preservation gt MAIN CHARACTERISTICS OF ULTRASONIC POWER GENERATORS PIEZOTOME PIEZOTOME 2 IMPLANT CENTER 2 e Two ultrasonic functioning mode
16. Piezotome SoLo LED OSTEOTOMY Scalpel Circular scalpel angled at 130 for osteoplasty and harvesting of bone particles or chips Treatments Ridge osteoplasty periodontal surgery cysts exeresis etc During bone graft this tip shapes the recipient site osteoplasty in order to ensure the graft stability facilitating its integration Used during sinus lift it collects bone shavings of the vestibular bone window The aspirated autogenous bone will be harvested in a bone filter to be integrated later into the bone filling material In the case of a cyst the BS4 planes the site until the cystic follicle is perfectly exposed PIEZOTOME Recommended modes Irrigation min ogogo PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation 34 UUW m Es Not applicable to Piezotome SoLo LED 1 to 3 Scalpel OSTEOTOMY BSS Flat scalpel for fine osteotomies Treatments ridge expansion thin osteotomy distraction preparation of buccal bone flap on thick cortical terrain prior to sinus lift surgery Sharpness and precision characteristics of the BS5 are undeniable advantages for performing other numerous surgical acts For instance it can be used at the very beginning of the surgery to perform a marking line during bone distraction or sinus lift Ridge expansion PIEZOTOME Recommended modes Irrigation PiezoTome 2 and SoLo
17. ales du secteur anterieur maxillaire Clinic 2004 Vol 25 N 10 Edition CaP 15 Simion M Baldoni M Elargissement du materiel osseux de l arcade par implantation imm diate associ e a un clivage de la cr te et a la r g n ration tissulaire guidee International Journal of Periodontics amp Restorative Dentistry 1992 Vol 12 n 6 463 473 16 Torella F Pitarch J Cabanes J Anitua E Ultrasonic ostectomy for the surgical approach of the maxillary sinus A technical note International journal of oral amp maxillofacial implants 1998 13 697 700 17 Van der Weijden F De stille kracht van Ultrasoon The power of ultrasonics 2005 18 Vercellotti T Crocave A Palermo A Molfetta A The piezoelectric osteotomy in orthopedics clinical and histological evaluations pilot study in animals Mediterranean Journal of Surgery and Medicine 2001 9 89 95 19 Vercellotti T Nevins ML Kim DM Nevins M Wada K Schenk RK Fiorellini JP Osseous response following resective therapy with piezosurgery International Journal of Periodontics amp Restorative Dentistry 2005 Dec 25 6 543 9 20 Wagenberg B Froum SJ a retrospective study of 1925 consecutively placed immediate implants from 1988 to 2004 Int J Oral Maxillofac Implants 2006 21 71 80 21 Wainwright M Troedhan A Kurrek A The IntraLift A new minimal invasive ultrasonic technique for sinus grafting procedures Implants magazine Dental Tribune
18. andible Maxillary C56 Mandible Maxillary 30 40 Co e O OS co _ O e gt CO ES O am fo e O a co CO ED E ed O O amo a LC1 60 80 cw C2 60 80 Le CD ica CD 60 80 LC2R Dt 60 80 NINJA GJ CE1 Es 60 80 CE2 c3 Not applicable to Piezorome SoLo LED 98 References 1 Bonnet L Alternatives aux greffes osseuses autogenes et comblements sinusiens en chirurgie implantaire these Universite d Auvergne Clermont Ferrand Unit de Formation et de Recherche d Odontologie 2001 2 Dibart S Sebaoun J D Surmenian J Piezocision A Minimally Invasive Periodontally Accelerated Orthodontic Tooth Movement Procedure Compendium Volume 30 N 6 July August 2009 3 Gaphian F Nichols K La Pi zochirurgie ses apports en chirurgie buccale these Universite de Rennes Unite de Formation et de Recherche d Odontologie 2005 4 Giraud J Y Etude et mise en oeuvre d un osteotome assist par ultrasons these Universite Paul Sabatier de Toulouse Sciences 1991 5 Harder S Mehl C Performance of Ultrasonic Devices for Bone Surgery and Associated Intraosseous Temperature Development The International Journal of Oral amp Maxillofacial Implants Volume 24 Number 3 2009 6 Harris D Advanced surgical procedures bone augmentation Dental Update 1997 24 332 37 7 Horton JE Tarpley TM Wood LD The healing of su
19. ane elevation by crestal approach The membrane elevation is achieved gradually by a successive increase of irrigation flow rate The TKW5 can also be used for compacting bone filling materials Never place the vibrating TKW5 tip in direct contact with the membrane ae Detachment Compaction PIEZOTOME Recommended modes Irrigation qu PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Compaction lt 3 seconds Piezotome mode 2 10ml min Recommended modes Fine settings Irrigation min Prezorome 2 and SoLo LED lupLanr Center 2 D3 1 to 3 10ml min 0090 a 5 1 Not applicable to Piezorome SoLo LED 56 Instrument sequence Photos were taken during two operations Crest Splitting CS a Crest splitting technique The ridge expansion technique introduced for the first time by Bruschi and Scipioni in 1990 13 allows an implant placement in the ridges originally having deficient thickness With use of CS tips the vestibular and lingual or palatal cortical bones are separated then the implant can be introduced between both cortical bones The CS tips can smoothly enlarge the crest one by one avoiding the risks of bone breaking b Benefits of ultrasonics Precision Tips thinness provide less bone loss 9 c Protocol No Ww SN D WO A Perform with a traditional scalpel a single top alveolar crest incision and then use the CS1 ultrasonic
20. d is thus inaudible to humans but perceivable by certain animals such as dogs or dolphins The use of ultrasound was developed in the 50s and is widely employed today notably in industry and medical imaging With the Piezotome handpiece the ultrasonic wave is transmitted to the tip by a transducer in the handpiece The piezoelectric ultrasonic vibrations are constituted by waves which e Move longitudinally e Move in an environment e Are reflected and absorbed at the interface of various encountered surfaces 17 An ultrasonic device comprises a piezoelectric generator driven by a footswitch a handpiece and cord and a choice of specific instruments according to the clinical protocol Piezoelectricity 14 At present the use of piezoelectric instruments in dentistry has become common and their efficacy is demonstrated by different clinical studies The piezoelectric effect was discovered in 1880 by the physicists Pierre and Jacques Curie in collaboration with Gabriel Lippmann According to these two French researchers the application of compressive forces on certain solid bodies would generate an electric charge The term Piezo is derived from the Greek verb piezein which means to compress or squeeze or to press The solid bodies that possess such a property have crystalline structures such as Quartz Tourmaline Seignette Salt or Baryum Titanate Today Quartz crystals have been abandoned and piezoelectric handpiece
21. deficit and control depth of cut This extremely long saw is particularly effective during ramus graft simply by applying the tip all along the graft PiezoTomE 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation 200 m y o 1to3 Not applicable to Piezotome SoLo LED OSTEOTOMY Saw Left angled bone saw with four teeth used for cutting the ramus cortical bone This tip specially adapted to the anatomical situation facilitates the cut of ramus cortical bone Left oriented it is used to create vertical and horizontal osteotomy lines on the patient s right mandible PIEZOTOME Recommended modes Irrigation min 0001 PiezoTOME 2 and SoLo LED IMPLANT CENTER 2 Fine settings Irrigation un Gb 1 to3 Recommended modes 34 0000 Not applicable to Piezotome SoLo LED Saw OSTEOTOMY BS2R Right oriented bone saw with four teeth used for cutting the ramus cortical bone This tip specially adapted to the anatomical situation facilitates the cut of ramus cortical bone Right oriented it is used to create vertical and horizontal osteotomy lines on the patient s left mandible PIEZOTOME Recommended modes Irrigation min 8800 PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation min WU un 33 1to3 Not applicable to
22. e tissue not assuring the tooth support It will be particularly suitable for osseous reshaping over large areas as well as reducing exostosis or osseous irregularities Not applicable to Piezorome SoLo LED PIEZOTOME Recommended modes Irrigation Um O PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation mi D TT 11 Ki 103 Diamond CROWN EXTENSION Diamond coated spherical tip designed for osteoplasty of bone margins Ball diameter 1 20mm with diamond coating This diamond coated tip is particularly designed for osteoplasty in interproximal zones Its extremely small diameter facilitates very precise osseous reshaping The CE2 is used notably to recreate a good interproximal morphology thin out bone margins etc PIEZOTOME Recommended modes Irrigation mn 60 80 Plezorome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation m 60 80 81 Not applicable to Piezorome SoLo LED CROWN EXTENSION Diamond 82 Diamond coated cylindrical tip designed for delicate osteotomies Extent of the diamond coated active part 5mm Diameter of the active zone 1 20mm For a fast restoration of the biologic width laser mark placed at 3mm Used perpendicularly or parallel to the bone this tip is designed for ostectomies of the tooth supporting bone in
23. educed sensitivity and precision of the practitioner due to the vibrations types of bone Less control of cutting depth Dangerous when used close to soft tissues inferior alveolar nerve and sinus membrane Saws cannot be employed in zones with difficult access Piezoelectricity Piezoelectricity in pre implant and periodontal surgery provides much more comfort and safety to the practitioner Indeed it provides precise fine effortless cutting without soft tissue injury Post operative pain is minor and healing is fast Furthermore much less effort is required to obtain a cutting line Horton J E et al 7 8 have demonstrated the advantages of ultrasonic tools such as the precision provided to the practitioner the coagulating effect and the absence of post operative trauma A comparative study performed at Harvard University by Vercellotti T 19 compares the extent of bone healing after use of a piezoelectric instrument a carbide bur and a diamond bur during an osteotomy and osteoplasty on a dog on the 14 28 and 56 day after the procedure At the 56 day the sites operated with burs carbide and diamond showed bone loss 0 37 and 0 83mm respectively whereas the sites operated with piezoelectricity presented bone gain of 0 45mm This study thus proves that the piezoelectric instrument generates bone repair more favorably than burs during osteotomies and osteoplasties The surgical gesture required for using piezoelectric generat
24. filling is spread and the site is sutured Healing varies between 3 to 6 months The BS5 tip is especially designed for delicate osteotomies ridge expansion premarking during a sinus lift The following tip index charts specify the different clinical applications of each one Chin bore grafting 29 OSTEOTOMY Saw BS1 available for Piezorome BS1S available for Piezorome 2 Piezorome SoLo LED ImpLant CENTER 2 Ultra sharp and robust saw equipped with four specifically sharpened teeth intended for in depth cutting of cortical bone in pre implant surgery surgical orthodontics Piezocision 2 bone distraction Depth of cut 9mm The laser marker placed every 3mm makes it easier to gauge bone deficit and control depth of cut This extremely sharp bone saw is particularly effective during chin and ramus bone harvesting PIEZOTOME Recommended modes Irrigation 8800 Piezotome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation GouG ew Not applicable to Piezotome SoLo LED 1 to 3 30 Saw OSTEOTOMY Available for Piezorome 2 Piezorome SoLo LED IMPLANT CENTER 2 _ f Bs11 d ong Ultra sharp saw slim profile equipped with four specifically sharpened teeth intended for facilitating ramus grafts Depth of cut 15mm The laser marker placed at 3 6 9 12 and 15mm makes it easier to gauge bone
25. ft Diagnosis of bone loss ey Above all a general evaluation of the patient status is essential in order to identify his her previous medical history physical and psychological needs Clinical investigation must be performed to evaluate the extent of bone loss by X ray notably panoramic type tomographies and scanners or three dimensional MRI Magnetic Resonance Imaging The practitioner must evaluate bone height and its density by radiography before treatment According to the study of Harris D in 1997 6 bone resorption can have four principal origins e Pathological periodontal diseases cysts etc e Surgical extraction of embedded canine apical resection etc e Congenital micrognathy oligodontia clefts etc e Physiological tooth loss age pneumatisation of the maxillary sinus Bone resorption is a constraint for implant insertion However disparities exist because the anterior ridge resorption is four times faster in the mandible compared to the maxilla 3 Bone resorption brings the crestal edge closer to the inferior alveolar nerve in the mandible and to the sinus cavities in the maxilla For an implant of 3 75mm in diameter the quantity of required minimal bone is 4mm transversely and 7mm vertically 15 If the bone height is lower than 6 7mm a surgical operation of type bone graft or sinus lift will be necessary for insertion of an implant However the practitioner will have to encounter different
26. g to the production of nascent oxygen The cavitation is characterized by the appearance of micro bubbles when liquid comes into contact with the tip further to ultrasonic vibrations When imploding the cavitation bubbles have a caustic effect This phenomenon allows achievement of optimal visibility of the operative field limits the blood extravasation cleans the working zones of bone debris and avoids temperature rise susceptible to tissue degradation 16 Histology 20 A histological study was performed in 2001 by T Vercellotti A Crovace A Palermo L Molfetta 18 in order to observe tissue healing mechanisms after having performed cutting lines with a piezoelectric device Three orthopedic surgeries were carried out on dogs involving ulnar osteotomy head and neck osteotomy and laminectomy This study demonstrated an absence of necrosis signs on the cutting surfaces Furthermore the presence of living osteocytes exhibited the weak trauma engendered by this new technique The macroscopic examinations showed the neatness of cutting Indeed devoid of pigmentation or visible signs of necrosis the cutting surface is perfectly smooth CLINICAL APPLICATIONS Developed by the Research and Development Department of SATELEC the ultrasonic power generators PIEZOTOME PIEZOTOME SoLo LED Piezotome 2 Implant CENTER 2 are designed for delicate operations such as osteotomies osteoplasties ridge expansions or sinus li
27. ing and chemical detergent cleaning Furthermore cassettes and trays can be placed in a mechanical cleaning device PiezoTome 2 handpiece The handpiece s extremity can be completely unscrewed facilitating access to and cleaning of the amplifier The light guide and the LED ring of the Piezotome 2 handpiece are accessible for optimum cleaning It is imperative to remove each item handpiece nosecone light guide and LED light ring before cleaning decontamination and sterilization Protocol Rinse brush each element in a current cold water remove dirt Immerse the items in a cleaning solution or alkaline enzyme Rinse under cold running water Clean decontaminate manually each element in a cleaning solution or alkaline enzyme Rinse thoroughly with distilled water Hand washing in a solution at pH neutral Rinse with deionized or purified water Dry Packaged and sterilized in an autoclave according to current standards Automatic method Rinse brush each element in a stream of cold water remove dirt Hand wash each piece in a cleaning solution or alkaline enzyme Rinse under cold running water Pass only the nose of the handpiece in an ultrasonic tank Rinse nose under cold running water Put each item in a washer disinfector Packaged and sterilized in an autoclave according to current standards 89 90 Maintenance 1 Instruments and accessories Tips
28. interproximal and oral vestibular and palatal periradicular zones PIEZOTOME Recommended modes Irrigation as 60 80 PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation mi CCE Not applicable to Piezotome SoLo LED 1 to3 Instrument sequence Crown lengthening with full thickness flap following the fracture of a lateral incisor n 12 83 84 Instrument sequence Crown lengthening pre prothesis with esthetic goal ORGANIZATION OF TECHNICAL AU ue An Ce pay pi be Packaging of the generators and their accessories Delivered non sterile various packages BS SL InrraLirT CS Extraction CE consist of a sterilization box a handpiece connected to its cord a dynamometric wrench and a tips support Before performing an operation it is necessary to perform a cycle of sterilization Operating zone organization Generators can be placed on a mobile Newrron or IMPLANT CENTER Cart The shelves allow a combination of a piezoelectric generator Piezorome PIEZOTOME SoLo LED Piezotome 2 ImpLant CENTER 2 and a high frequency electrosurge SERVOTOME The irrigation line is connected to the handpiece clipped with the cord the cassette placed in the pump and finally the perforator is inserted into a bottle or a pouch of sterile solution Tips supports Prior to the operation
29. it is advised to place a bridge table above the patient The stainless steel support and its tips maintained by silicone rings facilitating their grip can be easily decontaminated sterilized and placed on this bridge table Bone SURGERY osteotomy Sinus LIFT CREST SPLITTING CROWN EXTENSION 86 Handpiece support It is also recommended to install the handpiece support on the bridge table The handpiece mounted with its tip can be presented with the head at the top of the support 1 At the end of the operation the Piezorome handpiece can be introduced upside down on its support over a kidney dish 2 Dynamometric wrench The dynamometric wrench allows tip changes as necessary Having screwed the tip on the handpiece transducer the practitioner can interlock the wrench and tighten at 90 past abutment The longer tips that do not fit in the dynamometric wrench can be changed by using the universal flat wrench see illustration below 8 Cleaning Decontamination and Sterilization After surgery it is important to follow the procedure of decontamination and re packaging of the device as well as their accessories The irrigation line must be purged in distilled water after each operation to eliminate remaining physiological serum Accessories such as tips support tips and wrench must be disinfected decontaminated and sterilized The sterilization box can follow a process of physical brush
30. ition of the marginal gingiva 7 _ 78 c Benefits of ultrasonics Cutting selectivity Comfort Specially developed for this type of procedure the BS6 tip and three diamond coated Crown Extension tips are designed for ostectomy bone removal and osteoplasty bone reshaping The length of the diamond coated active part of the CE3 dedicated to ostectomy is calibrated at 5mm thus allowing a rapid re establishment of the necessary biologic width laser mark at 3mm A few millimeters of the root will be exposed by removal of bone to lengthen the clinical crown Scalpel CROWN EXTENSION Curved scalpel particularly effective for substancial osseous reshaping This tip is used to perform osteoplasties and reshaping of the bone not assuring the tooth support It can also be used to mark a prosthetic reference point on enamel if needed where osteoplasty will begin PIEZOTOME Recommended modes Irrigation 0068 i PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation mir Gj ma Li 79 1 to3 Not applicable to Piezotome SoLo LED CROWN EXTENSION 80 Diamond Diamond coated spherical tip designed for osteoplasty of bone margins Ball diameter 1 75mm with diamond coating Diamond coated spherical tip designed particularly for osteoplasty in oral and palatal zones the CE1 is used on bon
31. loss of alveolar bone The placement of an implant in a bone deficit zone can then lead to a membrane perforation The sinus membrane acts as an immune barrier responsible for the maintenance of the healthy sinus It is thus necessary to perform a sinus lift by an elevation of the membrane then by an integration of biomaterials For this type of operation the patient is put under local anesthesia A flap is then performed and then opened on the antero lateral wall of the upper maxilla Different techniques of window cutting can be employed However considering the risks of membrane perforation when moving bone window inward into the sinus Tatum s technique it is recommended to remove and separate the whole perimeter of bone window fragment b Instruments for lateral sinus lift approach The Sinus LirT SL kit consisting of five ultrasonic tips is specifically designed for sinus lift The sinus cavity naturally tends to increase in volume with time Having identified the bone deficit a flap must be performed with scalpel under local anesthesia The vestibular bone window is operated with the SL1 diamond tip by a horizontal incision followed by two vertical lines then a second horizontal incision The angles of this window are then smoothed with the SL1 and or the SL2 in order not to damage the sinus membrane Once the bone block has been prepared the elevation of the membrane is assured with the SL3 tip It is introduced
32. obstacles such as the inferior alveolar nerve the maxillary sinus or the nasal fossas according to the location of the future implant Bone classification In implantology the identification of bone volume is mostly based on the classification of Lekholm and Zarb 1985 who have listed four types of bone density D High bone density Very high bone E density and thick and thick cortical cortical bone bone Intermediate bone o Weak bone density fine density thin cortical or even absent cortical bone and dense bone and spongy bone spongy bone Healing Bone fracture leads inevitably to a trauma which activates a healing response Within the first four hours following the operation the inflammatory reaction induces vasodilation plasma and leukocytes seepage and an appearance of inflammatory cells contributing to phagocytosis of cellular and tissue debris such as macrophages Simultaneously at the healing site angiogenesis or formation of a blood clot containing blood platelets and new blood vessels can be observed This revascularization provides nutrition to cells necessary for their development and proliferation It is thus particularly important during patient diagnosis to make sure of the good quality of vascularization Finally the weaker the mechanical trauma the faster the local circulation will be restored 12 The use of piezoelectric instruments limits the development of trauma 23 Contraindication
33. on of Lekholm and Zarb 67 The ultrasonic tips active on hard tissue and non active on soft tissues offer the practitioner greater safety in the presence of such anatomical elements as the inferior mandibular nerve lingual nerve antral artery sinus membranes etc Indeed the frequency modulation renders the tips harmless to surrounding soft tissues mucosa d Syndesmotomy instruments Usage guidelines according to Dr Gagnot s recommendations 11 e The tip must be activated before its insertion in the periodontal space The tip must be placed parallel to the root Perform a to and fro movement towards the apex e It is important not to exert a lever effect with the tips 60 80 Irrigation t min A IS ps J amp y P 4 3 di J y E y Y y g F f y P 4 Schematic representation courtesy of Dr Gagnot G 68 Scalpel SYNDESMOTOMY Ultrasonic periotome intended for syndesmotomy and periradicular osteotomy Length of active part 9mm This tip can be inserted deeply and with great care along the periodontal ligament between the root and the alveolar bone PIEZOTOME Recommended modes Irrigation Um Plezorome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation mi uy 69 1to3 Not applicable to Piezotome SoLo LED SYNDESMOTOMY Scalpel LC1 90 Oriented at 90 the active part of
34. ors is different from other bone surgery techniques for example rotary instruments Therefore since it is much more precise and less traumatizing to tissue this technique demands training and practice to find the perfect balance between the practitioner s gesture and the movement speed of the tip Selectivity of ultrasonic cutting effect Due to the selected frequencies ranging between 28 and 36 kHz in Piezotome mode the tips are active on hard tissue limiting the risk of soft tissue injury The generator produces intermittent ultrasonic vibrations which alternate with weaker amplitude known as the modulated piezo signal This modulated signal is said to allow tissue relaxation and optimal cell repair for a clean cut and better healing Finally it guarantees an incision free of friction and vibration Amplitude Piezotome modulation mode ananas INT I MW N N 0 Time W lt 1 second In particular the study of Horton Tarpley and Jacoway in 1981 8 demonstrates the cutting precision The robust tips associated with limited vibration amplitude enable very highly precise cutting Finally the great maneuverability of the handpiece combined with the range of tips adapted to each clinical application allow precise control during all types of treatment 19 EJ Hemostasis Due to its irrigation subject to cavitation the generators have a hemostatic effect on the cutting surfaces partially owin
35. prior to plugging bone graft Because of the selective cut of the ultrasonics and as the membrane has already been fully detached the risk of membrane perforation is almost zero if applied carefully Widen even more the canal with the TKW4 2 8mm Insert the bone grafting material Perform the Plug amp Spray technique with TKW5 for 2 3 seconds if bone graft gets Stuck in the canal and or to disperse the bone graft evenly on the sinus floor 11 Complete the biomaterial insertion 12 Place the implant if you have enough primary stability Take into consideration that the implant will consume 50 of the augmentation volume so insert only 50 of bone graft in order to prevent a membrane rupture during implant insertion 49 50 Drill SINUS LIFT crestal approach Conical tip intended for bone drilling Diameter 1 35mm Conical 9 1 35mm and diamond coated tip for pilot drilling Drill the upper maxilla from the crest to the sinus floor PIEZOTOME Recommended modes Irrigation Um PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation mi dada uu UY 51 3 Not applicable to Piezorome SoLo LED nn o0 ams ai ot d cy SINUS LIFT Drill crestal approach Cylindrical tip intended for bone drilling Diameter 2 1mm Cylindrical 2 1mm and diamond coated tip for drilling and fracturing the sinu
36. r ire 22 LONE CLICA Orio adi ari ets smic mecs 23 CALMO erstes pad Re asta ias 23 A AA 24 Ill Clinical procedures 25 1 Bone Surgery BS AA 26 AL AUTOSenous DONE STAPS nn dre cda van 26 b Osteotomy instruments LD iM SECUMGRIE SCCUCNCE inc esaorchsordadinestigveminiaasedvdiaerwares lt iaanees 37 PSS A de mr lins dis di dti 38 D PASSE ae sd nl ich lie de une 38 b Instruments for lateral sinus lift approach 39 Instrument sequence discarded vestibular bone window 46 Instrument sequence preserved vestibular bone window 47 Ma cnica ddd EE ET E EEEE dond ers eedoutabaseded TT 48 a Sinus lift by the crestal approach 48 b Benefits of ultrasonics s 442 darian ita 48 c Instruments for crestal sinus Lift 49 Instrument sequence 1 56 4 Crest Splitting eee AV Read a iaa o 97 a Crest Splitting technique 97 b Benefits of ultrasonics Sa 57 CROO eraa EE an A 58 Instrument sequence 1 65 RDA CO nn 66 a Causes and consequences 66 b Immediate or delayed implant placement
37. rgical defects in alveolar bone produced with ultrasonic instrumentation chisel and rotary bur Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology 1975 39 536 546 Elsevier 8 Horton JE Tarpley TM Jr Jacoway JR Clinical applications of ultrasonic instrumentation in the surgical removal of bone Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology 1981 51 3 236 242 Elsevier 9 Kerawala C J Martin 1 C Allan W Williams E D The effects of operator technique and bur design on temperature during osseous preparation for ostheosynthesis self tapping screws Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology 1999 88 145 150 Elsevier 10 Louise F Macia Y La chirurgie piezo lectraiue peut elle changer l exercice quotidien de l odontologiste Dentoscope N 32 2008 11 Poblete Michel M G Michel J F Les applications chirurgicales des ultrasons Reussir Quintessence International 2008 12 Sautier J M Loty C Loty S Biologie de la r paration osseuse Information Dentaire 1995 n 38 2955 2960 13 Scipioni A Bruschi G B Technique d largissement de la cr te dent e Etude sur 5 ans International Journal of Periodontics amp Restorative Dentistry 1994 Vol 14 n 5 451 459 14 Seban A Bonnaud P Deboise A Greffe autogene pr implantaire dans le traitement des insuffisances osseuses transvers
38. rivate practitioner University Hospital Assistant in the Department of Oral Surgery Marseilles France Dr P MARIN private practice in implantology Bordeaux France Dr J F MICHEL private practice in Periodontology and Implantology Rennes France Dr E NORMAND private practice in Periodontology and Implantology Bordeaux University Hospital Assistant in Victor Segalen Bordeaux II France Our protocols and the findings that support them originate from university theses and international publications which you will find referenced in the bibliography We have of course gained tremendous experience over the last thirty years from the dentists worldwide who through their recommendations and advice have contributed to the improvement of our products But our special thanks go to each SATELEC user who shows faith in us each time they choose one of our products Gilles Pierson President Summary Synthesis gee ad te eee AEE pe eee ee eae paddy ace se tease 8 Introduction A 11 A A teenie de ee oe 12 l Technology ss ride caserne tie t reemin emenerssone 13 A A stern 14 2 Piezoelectricity abe swe ne 14 3 The contribution of piezoelectric generators to oral surgery 17 4 Selectivity of ultrasonic cutting effect 19 DEMOS ASS E E E E ses 20 A E PEERED EESE AE EAEE EE AEE EELEE 20 ll Clinical applications occ 21 1 Diagnosis of DOMO roe
39. rrigation LODO 63 Mandible Maxillary 1 to 3 Not applicable to Piezorome SoLo LED 64 TOE CREST SPLITTING Expander Available for Piezorome 2 Piezorome SoLo LED IMPLANT CENTER 2 Conical tip for bone expansion Tip thickness 3 75mm at 8mm Plezorome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation 80 100 Not applicable to Piezorome SoLo LED Mandible Maxillary _1to3 Instrument sequence Photos taken by TKW Research Group 65 Extraction a Causes and consequences Wisdom teeth impacted or not and or ankylosed teeth Insufficient bone and or gingival support Advanced caries on exposed roots or furcations Crown or root fracture crack Abscess eg situated at the root apex The extraction of a tooth leads to an inevitable loss of hard tissue in height and thickness and soft tissues Any delay in treatment presents a risk of engendering such bone loss that an implant placement can only be performed after pre implant surgery to restore the necessary bone volume Two approaches are currently used conventional or delayed post extraction implant placement and immediate post extraction implant 66 placement b Immediate or delayed implant placement An extraction causes anatomical disorganization Conventional delayed post extraction implant placement favors osseointegration The
40. s 24 For a favorable progress of the operation it is important to verify the general status of the patient The contraindications are the same as for any surgical operation However the use of devices with ultrasound is contraindicated for the bearers of active implants for both practitioner and patient such as pacemakers Furthermore certain diseases such as cardiopathy heart disorders diabetes bone diseases and patients receiving radiotherapies can be a constraint for an implant placement Bone structure validation and circulatory evaluation of the patient are essential elements to ensure efficient graft integration and healing CLINICAL PROCEDURES Bone Surgery BS a Autogenous bone graft Autogenous bone remains the best choice for bone graft operations Autogenous graft is defined when the graft is derived from the same patient as donor and recipient Both surgical acts harvest and graft placement have to be done during the same surgical session The graft can be procured from various parts of the body where dense cortical bone can be found such as skull parietal bone hip iliac bone or certain intraoral sites The Piezorome handpiece and its tips are specifically intended for small to average harvests from intraoral sites Prior to all acts of harvesting or cutting of a bone window an incision and flap elevation must be performed to have access to the site It is then essential to preserve a good vi
41. s Piezotome is intended for pre implant bone surgery and Newrtron for conventional tooth treatments e Automatic recognition of the connected handpiece Newtron or PIEZOTOME e IMPLANT CENTER 2 has an integrated Surce LED micro motor e Two silent peristaltic pumps e A footswitch to control the device from a distance PIEZOTOME SoLo LED e The best of SATELEC technology in a compact generator e Dedicated to ultrasonic pre implant bone surgery Introduction Oral surgery has long been performed with traditional equipment because oral tissue presents good healing potential apart from certain systemic risk factors and an absence of vital risk However it does have its drawbacks such as difficulty to access the operating site heavy fatigue for the practitioner and post op trauma for the patient At the present time dental surgeons have two types of instrument available to them to perform oral surgery e Manual instruments e Motorized instruments with rotary movement with sonic or ultrasonic vibrations SATELEC piezoelectric generators Piezorome Piezotome SoLo LED Piezotome 2 IMPLANT Center 2 belong to the second category of motorized instruments with ultrasonic vibrations employing a piezoelectric transducer They were designed with the objective to respond to the drawbacks encountered with traditional instruments and give access to such delicate operations as osteotomies osteoplasties ridge expansions
42. s floor PIEZOTOME Recommended modes Irrigation min PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation m 5 Not applicable to Piezorome SoLo LED Drill SINUS LIFT crestal approach Cylindrical tip intended for bone drilling Diameter 2 35mm Cylindrical 9 2 35mm and diamond coated tip dedicated to drill and widen the access canal to the sinus membrane PIEZOTOME Recommended modes Irrigation Um PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes 93 Not applicable to Piezorome SoLo LED crestal approach G Flat end tip intended for bone drilling Diameter 2 80mm Cylindrical 2 80mm and diamond coated tip intented for the receptacle preparation and widening the access canal to the sinus membrane PIEZOTOME Recommended modes Irrigation 000 PiezoTOME 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation 3 Not applicable to Piezorome SoLo LED Spatula SINUS LIFT crestal approach Non cutting tip for sinus membrane elevation by the crestal approach Non cutting tip that delivers sterile irrigation spray through the end of the tip used for sinus membrane elevation by means of microcavitation Tip to be placed in the receptacle preparation for sinus membr
43. s mainly contain ceramics of crystalline structure Piezo effect can be explained as e Direct the properties of certain solid bodies called piezoelectric for example Quartz or Ceramic to electrically polarize movement of positive and negative charges under the effect of a mechanical force e Indirect all the deformations expansion or contraction of certain bodies called piezoelectric under the influence of polarization from application of an electric field SATELEC piezoelectric handpieces are thus subjected to an indirect effect Electric current generates a deformation of piezo ceramic rings The movement of these rings leads to vibrations in the transducer s axis The amplifier associated to a tip increases the vibrational movements emitted by the piezo ceramic rings The tip thus vibrates along a longitudinal axis as presented in the illustration below The counterweight deadens the vibrations to the rear and optimizes the electromechanical output 15 Piloted by SP Newrron technology the most advanced patented electronics in the market surgical SATELEC devices benefit from several instrument control systems Auto tuning Push Pull Feed Back System Speed Automatic frequency adjustement 28 36 kHz The tip is always tuned into the right vibration frequency gt Guaranteed efficiency whatever the environment and or treatment performed Cruise Control Sy
44. saw Various styles of cutting have been introduced such as circular and rectilinear movements Burs activated by a micromotor force the practitioner to go against the torque from the instrument rotation Saws produce macro vibrations which also have to be controlled by the practitioner The cutting feature of a saw does not allow the dental surgeon to control its depth It is thus preferable to finish this type of intervention by manual instruments in order to avoid too deep an incision which might damage soft tissues nerves or membranes The use of these instruments thus remains controversial see tables below Bur cutting vantage Disadvantages Bur can be employed on almost Cutting dependent on the force exercised by the practitioner all types of bone resulting in an increase of manual pressure Temperature rise is more related to the pressure exercised by the Speed of action practitioner than to the rotation speed temperature harmful to the bone 47 C for one minute 9 Reduced sensitivity and precision of the practitioner due to the vibrations Dangerous when used close to soft tissues inferior alveolar nerve and sinus membrane Strong torque of the instrument makes it dangerous to stop due to its inertia 17 Saw cutting Cutting speed and linearity of the Cutting dependent on the force exercised by the practitioner saw cutting line resulting in an increase of manual pressure Saw can be employed on almost all R
45. sibility of the operative field and a good blood supply by respecting anatomical structures and avoiding unsightly scars It is highly recommended to clean the bone out of any trace of soft tissue before the use of tips Because as previously explained the tips cut only hard tissues and will not produce the expected effect in presence of soft tissues The suture is made by a wound closure without tension Chin bone harvest The chin bone allows a bone harvest of about 2cm wide and 3cm long The central part is preserved in order not to modify the shape of the chin This operation performed under local anesthesia has only moderate operative consequences However a risk of mobility disturbance of the chin muscles and nerve lesions notably labial and incisive can occur following the operation Local anesthesia Limited bone quantity Rapid healing Frequent loss of sensitivity of anterior teeth Limited swelling reaction See reference 14 26 Ramus bone harvest Ramus bone is useful when small and average extent of bone is needed Operative consequences are simple and comparable to those of a wisdom tooth extraction However it is important to be careful not to hurt nerves particularly the inferior alveolar nerve No esthetic impairment See reference 14 To favor a graft integration on the recipient site the practitioner must first check the presence of spongy bone the stability and good integration of the graf
46. stem Piloted by Cruise Control System Automatic system of frequency and power regulation gt Stay in complete control and confidence 16 System Gentleness Controlled amplitude of the tip vibrations Treatments performed with smooth and painless vibrations gt For preservation of fragile tissues and patient comfort Principle Power Real time power adjustment Power torque is adjusted intelligently according to the resistance met by the tip With minimum pressure more precision and less hand fatigue ARA o The contribution of piezoelectric generators to oral surgery Instruments dedicated to pre implant surgeries are becoming more and more sophisticated Here is a succinct analysis of various instruments sorted according to their arrival on the market 3 4 Manual instruments remain effective but difficult to maneuver They hinder the visibility of the practitioner Moreover they require a considerable physical effort on the part of the practitioner and their use remains very traumatizing for the patient Among these instruments the most commonly employed are scalpels mallets and surgical osteotomes They are still widely used in areas with easy access but are often used in conjunction with motorized instruments Motorized cutting tools transform their electrical or pneumatic energy into mechanical energy producing micro vibrations of the bur or the bone
47. t For that purpose he she is brought to perform osteoplasties Required qualities of the recipient site and the graft Site preparation See reference 14 27 28 b Osteotomy instruments Bone Surcery BS tips principally intended for performing bone graft allow cutting excising and remodeling bone structures without any risk of soft tissue lesions Protocol Having identified the bone deficit the intraoral harvest site from chin or ramus bone must be chosen and the flap performed The recipient site must be exposed before harvesting the graft in order to measure the bone deficit and anticipate the graft integration The BS1 saw marked every 3mm creates the lines of osteotomy The angled forms of the BS2L and BS2R saws facilitate horizontal and vertical cuts during ramus bone harvest The precise and selective cut of saws limits any risk of soft tissue lesions Ultrasound favors the cleavage of the bone block and thus the graft harvesting The use of striking instruments and its consequences for the patient is greatly reduced The recipient site is then prepared commonly called osteoplasty The BS4 and BS6 tips allow elimination of granulation tissue leveling of the site osteoplasty and collection of bone shavings to be later integrated into the bone filling material The bone block is then screwed in and the graft edges rounded off with the BS6 tip or the diamond tips of the SL kit SL1 or SL2 The bone
48. the SL3 tip separates it from the osseous wall PIEZOTOME Recommended modes Irrigation 0088 gt PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation ws as B 1103 Not applicable to Piezotome SoLo LED SINUS LIFT 44 Spatula SL4 Non cutting spatula oriented at 90 for sinus membrane elevation inside the sinus Spatula diameter 4mm This tip is intended for sinus membrane elevation and disengagement of anatomical structures During use the practitioner should keep it permanently touching the bone edges The elevation is undertaken at the apical mesial then distal parts Finally in the case of a cyst the SL4 tip separates it from the osseous wall Not applicable to Piezorome SoLo LED PIEZOTOME Recommended modes Irrigation PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation dad Spatula SINUS LIFT Cy r SL5 Non cutting spatula oriented at 135 used for sinus membrane elevation inside the sinus and for disengagement of anatomical structures Spatula diameter 4mm This tip is used for sinus membrane elevation and disengagement of anatomical structures During use the practitioner should keep it in contact with the bone edges The elevation is undertaken at the apical mesial then distal parts Finally
49. the tip can easily reach the difficult to access areas Length of active part 9mm This ultrasonic periotome facilitates widening of the periodontal space in the interproximal lingual and distal areas of molars Pr F Louise PIEZOTOME Recommended modes 8800 PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Irrigation nin Recommended modes Fine settings Irrigation A 0000 mw Li Not applicable to Piezotome SoLo LED 1to3 Scalpel SYNDESMOTOMY The particularly slim LC2 allows access to the tight spaces between the root and the alveolar bone without risk of damaging cortical bone Length of active part 10mm Pr F Louise PIEZOTOME Recommended modes Irrigation Um u sw PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation mi 0000 a a 1 to Not applicable to Piezotome SoLo LED SYNDESMOTOMY Scalpel Oriented at 45 to the left the LC2L facilitates access to the posterior areas The tip s slimness respects the morphology of cortical bone and offers working comfort in the sectors with reduced visibility Length of active part 10mm PIEZOTOME Recommended modes Irrigation min 8800 PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation _ 0000 mn Li Not applicable to Piezorome SoLo
50. tip for a vertical longitudinal pilot osteotomy with 8mm depth A laser mark every 2mm gives control over the osteotomy until the minimum depth of 7 8mm is reached Continue your initial lateral expansion with the CS2 again to a minimum depth of 8mm With the CS3 perform the buccal relief osteotomies discharge osteotomies at mesial and distal end of the longitudinal osteotomy to a minimum depth of 8mm equal to the depth of the longitudinal osteotomy Start your bone expansion with the CS4 tip Tip thickness 1 80mm at 8mm Continue the enlargement with the CS5 tip Tip thickness 2 75mm at 8mm Finalize the expansion with the CS6 tip Tip thickness 3 75mm at 8mm For a one step surgery insert the implant s and fill gaps with bone graft material and close mucosa with adaptive sutures For a two step surgery fill the expanded osteotomy with bone graft material and perform adaptive sutures Insert the implant s after a healing period of 3 to 5 months Scalpel CREST SPLITTING Available for Piezorome 2 Piezorome SoLo LED Implant CENTER 2 Fine tip dedicated to pilot osteotomy up to 8mm of depth Thickness 0 55mm Pr F Louise PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation BO m a 59 Mandible Maxillary 1to03 Not applicable to Piezotome SoLo LED 60 oa CREST SPLITTING Scalpel Available for Piezorome 2
51. us membrane or the tissues surrounding the graft The marking phase of the bone window can possibly be performed with the BS5 PIEZOTOME Recommended modes Irrigation PiezoTOME 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation w mr Sp 41 _1to3 Not applicable to Piezotome SoLo LED 42 mm SA SINUS LIFT Diamond Diamond coated ball tip for smoothing the vestibular bone window and precise osteoplasty Ball diameter 1 5mm Laser mark every 2mm This diamond tip performs very fine bone incisions It is intended for the vestibular bone window cut of very thin bone and precision osteoplasty The SL2 remodels all the secant bone zones likely to damage the sinus membrane or the tissue surrounding the graft It cleans and refines alveolar bone after tooth extraction PIEZOTOME Recommended modes Irrigation PiezoTome 2 and SoLo LED IMPLANT CENTER 2 Recommended modes Fine settings Irrigation mir Not applicable to Piezorome SoLo LED 1 to 3 Spatula SINUS LIFT Plateau tip non cutting for sinus membrane elevation on the window s edges Plateau diameter 5mm This non cutting tip is intented for elevating the sinus membrane by approximately 2 5mm on the window edges During use it is essential to keep permanent contact between the membrane and the lining bone Finally in the case of a cyst
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