6 . BRIEF RESUME OF THE INTENDED WORK 6.1 NEED FOR THE STUDY Here

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					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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