Interview: What sets Piezosurgery devices apart from others?

What is Piezosurgery and where does it originate from?

Piezosurgery is a patented ultrasonic technology specifically engineered for bone surgery. Piezosurgery was developed in the late 1990s by Tomaso Vercellotti, MD, DDS, and Mectron Medical Technology to overcome the limits in precision and safety of traditional bone-cutting instruments.

This technology employs the vibration of piezoelectric ceramics to cut bone but not soft tissues. Despite the fact that they are based on similar physical phenomena, Piezosurgery is so technologically advanced that it has no elements in common with normal ultrasonic ablation devices. The operation of this ultrasonic surgical device is driven by sophisticated software, which controls and optimizes the ultrasonic vibration necessary for bone cutting. The vibration is generated in the handpiece and exerts its cutting action through insert tips specifically designed for drilling, cutting and remodeling mineralized tissues. The cutting action produced by the unique modulated ultrasonic vibration of Piezosurgery is micrometric (extreme precision) and selective (no trauma to soft tissue); additionally, combined with irrigation, the vibration produces a “cavitation effect” that helps to keep the surgical site sterile and bloodless.

Over the years, as the result of Mectron’s continuous technological innovation, more than 50 insert tips have been designed and engineered to provide surgeons with the best cutting tools for each anatomical situation. Indeed, Piezosurgery allows one to perform bone surgeries with high precision, greater respect for soft tissues, greater visibility and enhanced healing.

What are the advantages of Piezosurgery in implant and bone surgery?

The surgical advantages of Piezosurgery are many and truly remarkable.¹ First, Piezosurgery delivers high precision. The ultrasonic wave employed by the device is a “microvibration,” which compared to the macrovibrations of traditional bone-cutting instruments makes this technology incredibly more precise and safe. Indeed, the cutting action does not require as much pressure and can be interrupted at any time to check the progress of the surgery. The cutting action is then resumed and refined as needed, with precision and safety for both the surgeon and the patient. Second, Piezosurgery’s cutting action is harmless to soft tissues. Thanks to the specific resonance range, the device is extremely effective on mineralized tissues but totally harmless to soft tissue, allowing for a safety level never experienced before.

This feature is obviously of crucial importance when operating in proximity of delicate soft-tissue structures, such as blood vessels, nerves, mucosa, etc. Third, thanks to its dual-wave technology, Piezosurgery delivers maximum intraoperatory visibility.

When the ‘hammering effect’ produced by the wave modulation on the insert tip hits the irrigation solution, the latter is converted in a fine spray. The sprayed molecules of the irrigation fluid hit the cutting site, cool it down and produce a temporary hemostatic effect, allowing for maximum visibility during surgery. Once terminated, the surgery bleeding resumes, hence starting all biological processes leading to proper healing. Lastly, one of the greatest advantages of Piezosurgery is the fact it is gentler to the tissues and, in fact, induces faster healing. Histological and biomolecular studies have shown that compared to traditional techniques, the use of Piezosurgery is not only characterized by minimal postoperative bone loss but actually promotes faster healing.^2,3 In my opinion, this incredible feature makes Piezosurgery the preferable instrumentation for most bone surgical applications.

How did your father, Dr Tomaso Vercellotti, get involved with Piezosurgery?

Prompted by the limitation in precision and safety of traditional bone-cutting instruments, my father pioneered the use of piezoelectric ultrasonic frequencies for bone surgery. Upon realizing that the effectiveness of conventional ultrasonic instruments in cutting bone was extremely limited, he set off, in conjunction with Mectron Medical Technology, to develop a new technology that would allow overcoming such limitations. Their joined efforts resulted in the creation of Piezosurgery, a technology that has truly revolutionized the way we approach bone surgery.

My father’s clinical and scientific efforts were truly indispensable to make Piezosurgery into a surgical revolution. First, he wanted to ensure that this new technology would truly benefit surgeons and patients alike, improving surgical predictability and reducing morbidity and complications.

To this goal, my father engaged in several research collaborations with clinicians and institutions across the world. In addition to studies on cutting efficacy of the technology and bone healing response in animal models, fervid clinical research activity has arisen immediately since the initial distribution of the Piezosurgery technology.

To date, Piezosurgery is the only piezoelectric surgical technology that has been demonstrated to be effective and successful by the clinical community through peer-reviewed publications. The number of publications on Piezosurgery increases every day, testimony of the clinicians’ understanding of the truly revolutionary nature of this technology.

The results of this research, published in more than 70 scientific articles, prove the advantages of Piezosurgery and make a compelling, evidence-based argument for its adoption in a variety of bone surgical applications.

Why did he get so passionate about this procedure?

My father realized immediately the technology he had developed had remarkable characteristics and understood he had an opportunity to simplify and improve a variety of surgical procedures. Along with several international colleagues, for several years he has been developing new surgical protocols and procedures. As a result, an entirely new surgical discipline based on the advantage of Piezosurgery’s unique features was developed. This new discipline, known as Piezoelectric Bone Surgery (PBS), has notably simplified a variety of clinical applications and has allowed surgeons across the world to perform procedures that would have been almost impossible with any other instruments.

Thanks to the intense clinical research, many surgical techniques have been radically simplified and predictability has increased, with dramatic reduction of patient morbidity.^4,5 As an example, the use of Piezosurgery is changing evidence-based medicine in the surgical studies of the maxillary sinus, where membrane perforation rates have been decreased from 30 per cent to 7 per cent.⁶

What is the best and least indicated use of the Piezosurgery?

Piezosurgery is extremely versatile and can be used in a great variety of surgical applications. Indeed, through the sapient use of osteotomy, osteoplasty and drilling techniques, the device allows one to perform bone surgery even in the most difficult anatomical situations. Examples of procedures that can be performed with Piezosurgery include extractions, sinus lifts, ridge expansion, bone block harvesting, bone chips harvesting, accelerated surgical orthodontics, nerve lateralization, retrograde endodontics, crown lengthening and implant site preparation in delicate anatomical situations. In general, Piezosurgery is ideal for all surgeries that require fast, precise and safe bone cutting. Our device is not indicated for procedures that involve cutting soft tissues, poorly mineralized bone structures and dental enamel.

Are there other units in the dental industry, and what is the difference between the technologies?

Following the invention of Piezo-surgery by Tomaso Vercellotti and Mectron Medical Technology, several companies, recognizing the great potential of our technology, seized the opportunity to enter the market with imitations of our device. Despite other companies’ claim that all devices are equal, that is simply not the case. In my opinion, while this may be a commercially sound strategy, it is a true disservice to the clinical community. Unfortunately, equating all devices creates confusion and leads clinicians exposed to inferior devices to conclude that the technology per se is not valid.

However, it is important for clinicians to be aware that Piezosurgery is not a generic term and does not refer to any technology or application. Piezosurgery refers to the only patented, evidence-based piezoelectric technology for bone surgery. When clinicians try and use our technology, they realize that imitations do not compare to it at all. As a testimony to this fact, all major opinion leaders in the United States employ and endorse only the real Piezosurgery technology.

There are experiences and insights in the technology that only the original developer can have, and that cannot be simply retro-engineered. The imitation units utilize different ultrasonic frequencies, different power levels and inferior insert tip designs. In this latter regard, for instance, no other device has saws that are as thin and fast as ours. Indeed, Mectron Medical Technology developed a proprietary manufacturing process that takes months to complete, and the resulting insert tips are unrivalled in terms of precision and performance. Because no other company could replicate this process, the performance of imitation devices in cutting bone thicker than a few millimeters is unsatisfactory for most clinicians who perform heavy-duty bone surgery.

A major difference between our technology and its imitations is that only Piezosurgery is clearly and unequivocally proven and supported by scientific research. To my knowledge, there are only a handful of publications relative to other technologies, and none proves substantial equivalence to Piezosurgery in regard to biomolecular, histological and clinical results. In a world where medicine is constantly striving to improve, only evidence-based technology should be trusted and incorporated in daily practice. Unfortunately, sometimes commercial interests and strategies confound the public, hence hindering the progress of the discipline. As a scientist, I understand that a discipline’s progress is achieved through trial and error, independent verification and hypothesis testing. Therefore, I always encourage clinicians to research Piezosurgery thoroughly and independently, seeking the advice of reputable experts and always keeping in mind what is best for their patients.

Lastly, at Piezosurgery Incorporated, we are experts dedicated full-time to the Piezosurgery technology only, and truly believe that our products can improve the quality of life of both surgeons and patients. To fulfill this goal, we value clinical education and customer service. For instance, when a clinician incorporates Piezosurgery in his or her practice, our product specialists provide in-office training for the staff and the surgeon and assist to surgeries. Additionally, on a monthly basis Piezosurgery Incorporated offers complimentary clinical, hands-on courses across the United States to all of its customers. In our experience, best results using Piezosurgery are obtained through education.

In short, despite the fact that several companies attempted to produce competitive products, the Piezosurgery technology remains unrivaled, and is the only one supported by research and education.

What are some of the recent innovations?

Over the years, Dr Vercellotti and Mectron Medical Technology have continued to perfect the Piezosurgery technology to make it applicable to a wider array of surgeries. This constant evolution of the product is clearly seen in the development of new insert tips for implant site preparation and microsaws. Implant site preparation tips — available in a series up to 4 mm in diameter — are used in the preparation of the implant site in anatomical situations when placing implants with conventional tools is risky if not almost impossible. The microsaws are designed for use in thin ridge splitting and accelerated surgical orthodontics. These saws are 11 mm long and have a section of 0.35 mm, hence allowing extreme precision in the osteotomy at the same time sparing bone when it is precious to save!

Another recent innovation was the development of the Piezosurgery 3 device, now available in the North American market. This new device has a specific function optimized for implant placement, new and simpler settings, and is up to 30 per cent faster than the previous model. Additionally, thanks to the development of more sophisticated software, the Piezosurgery 3 device has improved self-diagnostic and safety features, which allow the surgeon to operate with confidence.

Any other directions you and your company are involved in?

As a company focused on bone surgery, Piezosurgery Incorporated is constantly seeking ways to improve the surgical experience for clinicians and patients alike. We are currently preparing to launch the Piezosurgery Medical device in North America. The Piezosurgery Medical device is the most sophisticated and advanced device for Piezoelectric Bone Surgery and brings the advantages of our unique technology in a wider array of surgical procedures. Specifically designed for hospital-based surgical procedures, the Piezosurgery Medical device is intended for use in a variety of medical specialties, such as neurosurgery, otolaryngological surgery, minute orthopedic surgery and oral and maxillofacial surgery.

References

A complete list of references is available from the publisher.