6 . BRIEF RESUME OF THE INTENDED WORK 6.1 NEED FOR THE STUDY Here , the need for the study is to compare surgical and post surgical outcome of two different instruments i e, piezoelectric and conventional bur in impacted third molar removal. 6.2 REVIEW OF LITERATURE STEFAN STUBINGER ET AL (2005) stated that piezosurgery instrument uses a modulated ultrasonic frequency that permits highly precise and safe cutting of hard tissue . Nerves, vessels, and soft tissues are not injured by the microvibrations , which are optimally adjusted to target only mineralized tissue. The selective and thermally harmless nature results in low bleeding tendency. The precise nature of the instrument allows exact, clean, and smooth cut geometries during surgery. Piezosurgery’s accuracy and selectivity render it superior to conventionally rotating instruments in operations where the area of interest is adjacent to nerves, such as when strongly displaced and impacted wisdom teeth are located in close proximity to the inferior alveolar nerve, in osteotomies performed close to the mental foramen, or in lateral nerve displacements. THOMAS A. MCFALL ET AL ( 1961) stated when rotary abrasive devices used in bone surgery produce considerable heat and trauma, cut inefficiently , clog , and contaminate the region with abrasive particles which might interfere with healing. An ultrasonic instrument could be adapted for use in bone surgery as it is more accurate and predictable pattern to be cut in bone than usually accomplished with rotary burs. UMBERTO ROMEO ET AL (2009) conducted a study to compare the peripheral bone damage induced by different cutting systems. Four devices were tested: ER:YAG laser , piezosurgery , high speed drill and low speed drill. Four different parameters were analyzed: cut precision , depth of incision , peripheral carbonization and presence of bone fragments. Piezosurgery specimens revealed superficial incisions without thermal damage but with irregular edges. Laser showed poor peripheral carbonization. The sections obtained by traditional drilling showed poor peripheral carbonization , especially if obtained at lower speed. J. P. SHEPHERD ET AL(1993) conducted a study to compare morbidity following removal of third molars using rotary burs and lingual split technique in 52 consecutive healthy patients with bilateral, similarly impacted mandibular molars . Standard drug regimen were used. Pain, swelling, sensory disturbances, wound healing , periodontal pocket formation distal to second molar were evaluated. There was no statistically significant differences between two techniques although 8% lingual sensory disturbances were seen in case of burs as compared to lingual split which is 2%. GEORG EGGERS ET AL (2004) described piezosurgery saying that delicate bony structures can be cut easily and with great precision , without destruction of soft tissue . They found this device useful when exact cutting of thin bones is essential. For the cutting of bone in maxillofacial operations , the most efficient setting is boosted mode with maximum irrigation. M. ROBIONY , MD ET AL described the use for multipiece maxillary osteotomies because of its micrometric and selective cut , the piezoelectric device produces safe and precise osteotomies without any osteonecrosis damage . This device works only on mineralized tissues , sparing soft tissues and their blood supply. In particular , rotating instruments are potentially injurious , due to production of excessively high temperatures during osseous drilling, which can produce marginal osteonecrosis and impair bony regeneration. Piezosurgery was introduced by TOMASO VERCELLOTTI to overcome the limits of traditional instruments in oral bone surgery. AIMS AND OBJECTIVES 6.3 AIM To compare the surgical and post surgical outcome of third molar removal using piezoelectric and rotary bur. 6.4 OBJECTIVES a) To evaluate surgically - TIME REQUIRED FOR THE PROCEDURE - PATIENT’S SATISFACTION b)To evaluate post surgically - PAIN - SWELLING - MOUTH OPENING 7. MATERIALS AND METHODS In this we use piezoelectric on one side and rotary bur on other side for removal of bilateral impacted mandibular teeth . Piezoelectric uses a modulated ultrasonic frequency that permits highly precise and safe cutting of hard tissues . Nerves , vessels and soft tissues are not injured by the microvibrations (60 to 200 micrometer/sec) , which are optimally adjusted to target only mineralized tissue . Piezoelectric devices usually consist of a hand-piece and foot switch that are connected to the main power unit . This has a holder for the hand piece , and contains irrigation fluids that create an adjustable jet of 0-60ml/min through a peristaltic pump. Rotary devices consist of hand piece and foot switch which are connected to main power unit.A hand piece is a device for holding rotating instruments , transmitting power to them, and for positioning them intraoral. Rotary speed ranges from 20,000 to 35,000 rpm.Rotary burs either 702 or 703 used. 7.1 SOURCE OF DATA Patients visiting the Department of oral and maxillofacial surgery, Krishnadevaraya college of Dental science, Bangalore. 7.2 METHOD OF COLLECTING THE DATA Sample size is determined to be minimum of 20 patients. All patients chosen will have bilaterally impacted mandibular third molars who required removal , either for prophylactic reasons or because of pain. Time taken for the procedure is evaluated intraoperatively. Patient satisfaction of the procedure to be evaluated. The postoperative pain will be recorded on visual analog scale for a period of 7 days and swelling and mouth opening will be measured on day 3 , day 5 and day 7 postoperatively . Any other complications will be recorded if present. INCLUSION CRITERIA Patients with bilateral impacted lower teeth Aged : 20 – 45 years old Impacted mandibular third molars under following category mesioangular , vertical ,class I ,class II , position A and position B were included in the study based on the radiographic interpretation. EXCLUSION CRITERIA Patient with uncontrolled diabetes or other uncontrolled systemic disease involving bleeding or immune system Mandibular third molar impaction under following category class III , position c , horizontal and distoangular. 7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS YES Routine pre-operative hematological investigations (Hb%, BT, CT, RBS) HIV & HBs Ag Intra oral Periapical radiograph orthopantogram 7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION INCASE 7.3 APPLICABLE Yes. A copy of that will be attached. 8. LIST OF REFERENCES JOURNAL REFERENCES Intra oral piezosurgery: preliminary results of anew technique . Stefan Stubinger, Johannes Kuttenberger , Andreas Filippi , Robert Sader, Hans-florian Zeilhofer. J ORAL MAXILLOFAC SURG 63:1283-1287,2005. Comparison of the cutting effect on bone of an ultrasonic cutting device and rotary burs. Thomas A. Mcfall , George M.Yamane, George W.Burnett J.ORAL SURG.., ANESTH. & HOSP. D. SERV., VOL. 19, MAY 1961. A comparison of morbidity following the removal of lower third molars by the lingual split and surgical bur methods. E. G. Absi, J. P. Shepherd IJOMS 22;149-153,1993. Bone damage induced by different cutting instruments – an in vitro study . Umberto Romeo, Alessandro Delvecchio, Gaspare Palata , Gianluca Tenore, Paola Visca , Claudia Maggiora BRAZ. DENT. J. VOL.20 NO.2 RIBEIRAO PRETO 2009. Piezosurgery: an ultrasound device for cutting bone and its use and limitations in maxillofacial surgery. Georg Eggers , Johannes Klein, Julia Blank , Stefan Hassfeld BJOMS 42, 451-453, 2004. Piezoelectric surgery: twenty years of use . Mauro Labanca, Flavio Azzola , Raffaele Vinci , Luigi F. Rodella BJOMS 46;265-269, 2008. Piezoelectric bone cutting in multipiece maxillary osteotomies. M. Robiony, F. Polini, F. Costa , T. Vercellotti , M. Politi J ORAL MAXILLOFAC SURG 62:759-761, 2004. Comparison of morbidity following the removal of mandibular third molar by lingual split, surgical bur and simplified split bone technique. Praveen G , Rajesh P , Neelakandan RS, Nandagopal CM INDIAN J DENT RES 2007;18:8-15. Third molar surgery: an audit of the indications for surgery, post-operative complaints and patient satisfaction V. Lopes, R. Mumenya, C. Feinmann, M. Harris BJOMS 33, 33-35,1995.
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