What Is Surgical Instrumentation in Periodontal Therapy?
Periodontitis is definitely one of the chronic and severe inflammatory diseases associated with the tooth-supporting structures or apparatus that cushions and anchors your tooth, that is the periodontium. As we know the periodontium is the main anchorage that can aid the tooth to be stabilized within the underlying alveolar bone, its importance is pivotal to tooth preservation.
The treatment of this chronic condition is hence largely only dependent according to current dental research based upon the elimination of local factors that may be causing the pathogenic disease process of anaerobic infections in the periodontium or by addressing the functional restorations within the bony architecture that has been breached because of poor oral hygiene or immunity in the afflicted patients.
In the case of periodontal therapies, where full-fledged surgical curettage needs to be performed by your dentist/periodontist or other procedures like major osseous (bone) surgeries need to be performed- in these cases, your dentist would either be utilizing manual or motor-driven surgical instruments. However, it is important to note from the modern-day dentistry viewpoints that despite the benefits of these traditional or conventional surgical methods, surgical instruments that are manual or motor driven that are utilized by your dental surgeon/periodontist/dental implant specialists, have their drawbacks or disadvantages.
What Is Instrumentation in Implant Dentistry?
In the current era of modern-day dentistry, it is important to note that for treating periodontal diseases or infections as well as in the fields of implant dentistry, to successfully initiate an implant therapy in the patient, both these situations would thereby require the underlying alveolar bone to be uncompromised or sound. This means that the underlying bone should offer the tooth or the implant a firm osseous support to ensure that a dental implant retains its primary stability, thereby eliminating risks of either biological or prosthetic failures.
For implant dentistry, the first step of dental implantation is always the osteotomy (bone cutting and reshaping) hole preparation, where your implant dentist will gradually and sequentially use a systematic set of specialized burs to attain the correct diameter and height for the dental implant to be placed, at the site of jaw implantation/the surgical site.
What Are the Types of Surgical Instrumentation Used in Periodontal Therapy?
1. As manual instruments are difficult to control in alveolar bone, dentists, oral surgeons, or periodontists usually apply manual surgical pressure only for gross cutting related to eliminating large bone segments.
2. Motor-driven instruments on the other hand are often the most utilized instruments surgically by your dental operator for bone cutting or osseous surgeries or osteotomy preparation, when the patient's jaw bone is very dense in nature. Motor-driven instruments have the potency to transform electric or pneumatic energy by inducing the mechanical cutting action that can be implemented through the edges of burs or saw extremely sharp blades. These motor-driven instruments hence, may be generating much more heat during the oral surgical procedures, in the cutting zone by the dental operator. Because of this major drawback during dental implantation or periodontal or other osseous surgeries, the heat generated by motor instruments should be minimized by abundant or copious amounts of water usage/water irrigation. Overheating of adjacent tissues surrounding the surgical areas may further result in post-operative complications in the patient or considerably delay the healing response in patients indicated for periodontal and implant surgeries.
3. The piezoelectric device is a revolutionary instrument that gives the dental surgeon precise control in terms of cutting or shaping the cortical bone, especially when the osteotomies or osseous surgeries need to be not only precise but also conservative. Therefore, piezoelectric surgery can be a conservative method even in terms of blood coagulation or achieving good hemostatic control by the dental operator over manual or motor-driven surgical methods.
How Is the Piezoelectric Device More Beneficial in Periodontal Therapy?
In the piezoelectric device, the operator can modulate the ultrasonic frequency from 10, 30, and 60 cycles/s (Hertz) to 29 kHz (kilohertz) in the surgical setting. The low frequency of the device is primarily to enable only when the cutting of mineralized structures like bone is needed. The operator can fine-tune or adjust these settings or soft tissue elimination.
The piezoelectric device can also be useful in periodontal pocket lavage with the help of its ultrasonic tip movements. Even for procedures of crown lengthening, osteotomy, and osteoplasty (reshaping and repairing bone) procedures, which require the dental operator to cautiously and conservatively remove only small quantities of bone. The piezosurgery device definitely would be hence useful over manual and motor-driven instruments in the fields of periodontology and implant dentistry. Moreover, this device can be used for both soft-tissue debridement to eliminate the secondary flap after surgical incision by the dental operator. The piezoelectric device offers much more efficiency and conservative scope to the patient as the dentist can change over to a thin, tapered tip during surgery, and also ability to alter the power settings is inherently included in the device.
The piezosurgery device can also be used to debride both residual soft tissues, for effective root surface scaling and also prevent heat-generated osteonecrosis (death of bone tissue due to lack of blood supply) of the bone for osteotomy preparation in dental implants (as seen commonly as a drawback in the case of motor-driven instruments in dentistry). Power can be adjusted by the dental operator ranging in between 2.8 to 16 W (watt), in the piezoelectric device that already would have preset power settings. These power settings need to be changed or enabled basically for various types of bone density, depending on the patient's bone density.
The piezosurgery tip vibrates further mainly within a range of 60 to 200 mm (millimeter). At this range, its function is to induce clean-cut precise incisions or can even effectively help eliminate both supra and subgingival deposits or calculus/stains from teeth, thereby being effective in periodontal therapies.
Conclusion
To conclude thus, in comparison with both manual and motor-driven instruments that are surgically used in implant dentistry and in periodontal surgeries or therapies, the piezoelectric device definitely has a higher scope and conservative potential to exert a positive post-operative response in the patient's physiologic architecture, in retaining bone support and in promoting osseointegration.
