Experimental analysis about the evaluation of tungsten carbide-bur, piezoelectric and laser osteotomies

Aim: Osteotomies are performed in oral surgery with five kinds of cutting instruments: 1) burs (Tungsten carbide cylindric burs), 2-3) ultrasound Piezosurgery (type I and II), 4-5) and lasers (Er:YAG; Er,Cr:YSGG). This study compares the quality of cutting of every single instruments, evaluating accuracy (length, thickness, depth and morphology), velocity (number of passages and time) and entity of damage. Methods: In vitro experiments with ten osteotomies were performed on one-hundred of cow ribs with each instrument. In vivo surgery was performed on New Zealand white rabbit: two osteotomies are made with all instruments on the mandible and on the shinbone, totalizing four osteotomies for each instrument. Samples are processed to be evaluated through histological exam at stereomicroscopy Discussion: Results show a statistically significant variability on "thickness" (p value=0.001), "time" (p value=0.001), "depth" and penetration speed (p-value=0.001; p-value=0.001) and the "number of passages" (p-value=0.001). No differences have been observed in "length" (p-value=0.078). Histological analysis reveals that osteotomy performed with laser and Piezosurgery II generates major damage to osteocytes near cutting surfaces. Conclusion: Currently, purchase and management elevated costs, minor versatility of use, and long training times for equipments such as Piezosurgery and laser limit their general use, but remain advantageous in case of risky interventions near noble structures. Choice of device depends on experience maturated by operator in time, characteristics of operation and patient's clinical conditions