Title Use of Piezoelectric Surgery for BSSO Does Not Reduce Incidence of Inferior Alveolar Nerve Damage Compared to Traditional Osteotomy
Clinical Question In patients requiring a bilateral sagittal split osteotomy, does the use of piezoelectric surgery compared to traditional osteotomy performed with reciprocating saws and/or burs reduce postoperative damage to the inferior alveolar nerve?
Clinical Bottom Line Piezoelectric surgery potentially caused more nerve damage when used for a bilateral sagittal split osteotomy versus a traditional osteotomy.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
24480761Monnazzi/2014Patient Group 20 patients who had an indication for SSRO. One side was treated with piezoelectric surgery, the other with a reciprocating saw.Study Type Split-mouth randomized controlled trial
Key resultsSeven days following the surgery all patients reported having altered sensation in areas tested, innervated by the inferior alveolar nerve. There were slight differences in sensitivity in relation to time postoperatively, but there was no significant difference in sensation between the two groups.
24388635Shirota / 2014Patient Group 59 patients diagnosed with mandibular prognathism treated by BSSO (n= 30 for patients treated with piezoelectric surgery, n=29 for patients treated with a Lindeman bur on a straight handpiece)Non-randomized controlled trial
Key resultsThree months postoperatively, the patients treated with piezoelectric surgery reported significantly higher values using the Semmes Weinstein test (p = 0.02). Therefore patients in which piezoelectric surgery had more neurosensory damage three months postoperatively.
Evidence Search ("piezosurgery"[MeSH Terms] OR "piezosurgery"[All Fields]) AND sagittal[All Fields] AND split[All Fields] AND ("osteotomy"[MeSH Terms] OR "osteotomy"[All Fields])
Comments on
The Evidence
Validity: Both studies were controlled trials that included similar patients that all required a BSSO. They also used the same specific surgeon or surgical team to complete each surgery. The study by Monnazzi et al used a split-mouth approach where a patient received piezoelectric surgery on one side of the mouth and traditional osteotomy on the other.  The study by Shirota et al did not use a split-mouth approach. Patients in the study by Shirota et al received only one method, piezoelectric or traditional, on both sides of their mouth. Both study reported having competing interests, and recall bias was unlikely in both. Perspective: Due to the nature of these studies it is impossible to double blind them. More randomized controlled trials would be beneficial, especially since the studies had different conclusions as to the specific outcome measured.
Applicability Many patients require a BSSO to either advance or set back the mandible to correct dentofacial abnormalities. Piezoelectric ultrasound technology has been used in dentistry for years but has only been approved by the FDA for use in bone surgery since 2005. It offers the possible benefits over traditional osteotomy of improving healing, minimizing trauma, and the ability to be make more selective cuts by offering greater tactile sensation, and more control and precision. Due to the limited number of studies conducted thus far, there is not enough information to give a definitive recommendation at this time.
Specialty (Oral Surgery)
Keywords Piezoelectric, piezosurgery, BSSO, inferior alveolar nerve, traditional osteotomy
ID# 3000
Date of submission 03/06/2016
E-mail vegajs@livemail.uthscsa.edu
Author Josue Vega
Co-author(s) e-mail
Faculty mentor Edward Ellis, III, DDS
Faculty mentor e-mail EllisE3@uthsca.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available