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ePaper created 2016-09-30, 16:42:46 | version 1.38.0
news 25th EAO Annual Scientific Meeting 4 Caringfor implants Different types of implants require different cleaning devices. TePe offers a wide selection of products, specially developed and tailored for implant patients. For your sample kit, please visit us in booth S 20. www.tepe.com Visit us in booth S20 AD160010INT AD n On the first day of the EAO congress, an expert panel discussed current re- search and benefits of piezoelectric sur- gery in implantology. In the fully packed symposium sponsored by ACTEON, Dr Angelo Trödhan began by presenting his clinical experience of ex- panding alveolar ridges with widths of only 1 mm using the Piezotome device. Dr Philippe Bousquet spoke about the new orthodontic bone stretching tech- nique that permits conservation of in- fra-occluded ankylosed teeth or se- verely malpositioned implants. In an in- terview, today internatinal spoke to both speakers about these new techniques in the field of piezoelectric surgery. todayinternational:DrTrödhan,inyour presentation, you introduced the flapless Piezotome-enhanced crest splitting and widening technique (FPeCSWT) for implant placement in the lateral atrophic alveolar crest. What were your major aims when de- veloping the technique? Dr Angelo Trödhan: Before piezo- electric surgical devices had been de- veloped, there was no means of cutting bone without resulting bone loss and with ultimate precision. Instruments like oscillating saws and diamond- coated discs were extremely difficult to handle and a substantial amount of bone was lost in the cutting procedure owing to these instruments coarse means of working. Furthermore, the perfect geometry necessary for the task of vertical alveolar crest splitting was unachievable with these instru- ments and only very experienced max- illofacial and oral surgeons were able to perform this surgery with predictable results. With these older instruments, crest splitting was limited to alveolar crest widths of greater than 3 mm. Since my research group explores new applications of piezoelectric surgery, we aimed to create piezoelectric de- vices that allow precise and easy use even for crests of only 1 mm in width in the hands of less experienced oral surgeons with the least trauma to the patient and the lowest risk of failure. In your presentation, you stated that 70 per cent of your patients lacked ad- equate alveolar crest width. How does FPeCSWT help in this respect? Dr Trödhan: For a sustainable dental implant in the molar region, an alveolar crest at least 6 mm wide is nec- essary to receive a 4 mm diameter im- plant. As an oral surgeon, one can choose to widen the alveolar crest by transplanting autologous bone blocks to the narrow crest, which is a very traumatic and challenging procedure and has the risk of failure in many cases. In contrast, with FPeCSWT one attains a very precise and simple bone fracture that will heal like any other simple fracture of any bone in the body provided proper immobilisation can be achieved. Since FPeCSWT reproduces a simple fracture exactly and is au- to-stabilised, the risk of failure is signif- icantlylowerthanthatofanyotherpro- cedure. Furthermore, since it is mini- mally invasive, the patient does not havetoendureanysubstantialpost-sur- gical morbidity; it is just like a simple extraction of a tooth. Our research has shown that, even in the most difficult cases with crest widths of only 1 mm, the vertical bone loss after three years was a maximum of 1.5 mm and the overall implant loss rate was less than 3 per cent. You mentioned that the Piezotome is the most suitable device for such pre-implantation surgical procedures. How does the use of the Piezotome for flaplessverticalalveolarcrestsplitting compare with other devices? Dr Trödhan: Simply by its unri- valled precision and ability to perform bone cuts without bone loss. Further- more, it can be perfectly adapted for use according to the specific patient’s situation and need. It is easy for the sur- geon to learn to use, the protocol is pre- cise and the surgeon does not have to tame stubborn rotating instruments, but can concentrate on the task at hand. When we started our research and development back in 2005, very little was known about the benefits of ultrasonic surgical tools in oral surgery and other areas of dentistry. Today, we have scientific proof of the Piezotome’s significantly reduced post-surgical mor- bidity, superior soft-tissue preservation and enhanced bone healing. Dr Bousquet, in your lecture, you discussed at length the orthodontic bone stretching (OBS) technique. This technique combines partial cortico- tomy and orthodontic treatment and results in expanded bone within eight to 12 weeks. Could you please explain the procedure? Dr Philippe Bousquet: Extrac- tion of ankylosed teeth does not resolve the under-development of the alveolar ridge resulting from lack of growth and can lead to a complex bony ridge defect that is a contra-indication to implant treatment. The lack of a high level of evidence for treatment options for an- kylosed teeth encouraged us to develop this new technique, which has the ad- vantage of moving the teeth into nor- mal occlusion through orthodontic forces and deep corticotomies only. With the OBS technique, the osteotomy (deep corticotomy) is limited to either the buccal side or the palatal side (but not both) of the alveolar bone, unlike a repositioned dento-osseous block or an osteodistraction. Vascularisation is en- sured by the palatal bone and the at- tached soft tissue. Surgical cuts are in the same axis in which the tooth moves, and the orthodontic device di- rects the movement in three dimen- sions. Finally, the ankylosed tooth will fall in level owing to resorption, but we cannot predict when this will occur. In OBS, the ankylosed tooth is kept on the arch for an aesthetic result and the bone is stretched to improve future im- plant placement with vertical bone augmentation. This concept is different from osteodistraction. Indeed, in OBS, it is important not to wait for the forma- tion of a callus in the area of the partial deep corticotomies. The applied forces are immediate and continuous, pre- venting healing in the area of the bone cuts and stretching the residual palatal bone. The use of a system to stabilise the block is not necessary, and the at- tached orthodontic device only induces and directs the movement along the de- sired axis. A clinical study is underway to codify OBS treatment and evaluate the duration of treatment and tooth movement. The preliminary results have shown movement of 1–2 mm per month and that the relocations are sta- ble after a period of two years. What are the advantages of using piezoelectric surgery in general and the OBS technique in particular to per- form corticotomies? Dr Bousquet: This less traumatic technique facilitates the movement of ankylosed teeth towards the occlusal plane owing to several phenomena. The cortical section decreases the re- sistance of the bone surrounding the ankylosed teeth. Surgical wounding of the bone by the piezoelectric surgical device induces increased bone turno- ver and decreased bone density. This phenomenon promotes bone stretching and has been demonstrated with the use of the Piezotome 2. The tips used are the BS1S and PZ1 to cut the cortical bone and the PZ3 to cut into the cancel- lous bone, but preserving the opposite cortical bone. Is the relocation of ankylosed teeth the only application of the OBS technique? Dr Bousquet: We have now devel- oped the technique for implant reloca- tion and I think it is the first time that orthodontic treatment has been used for implant movements. We have used this technique to relocate implants in the incorrect position and to treat the effect of residual growth on implant po- sition. The results are very promising and this technique has great potential for vertical bone augmentation. Thank you both very much for the interview. 7 Two breakthroughs in piezoelectric surgery 5 Dr Philippe Bousquet 5 Dr Angelo Trödhan