REVIEW ARTICLE

https://doi.org/10.5005/jp-journals-10015-2315
World Journal of Dentistry
Volume 14 | Issue 10 | Year 2023

Effects of Piezoelectric Surgery on Implant Stability and Marginal Bone Level: Systematic Review and Meta-analysis

Supriya Kaule¹, Surekha R Rathod², Pranjali V Bawankar³, Abhay P Kolte⁴

^1–4Department of Periodontics and Implant Dentistry, VSPM Dental College and Research Center, Nagpur, Maharashtra, India

Corresponding Author: Surekha R Rathod, Department of Periodontics and Implant Dentistry, VSPM Dental College and Research Center, Nagpur, Maharashtra, India, Phone: +91 9011071477, e-mail: drsurekhar@gmail.com

Received on: 06 September 2023; Accepted on: 08 October 2023; Published on: 06 November 2023

ABSTRACT

Aim: The goal of this literature review and meta-analysis was to compare piezoelectric surgery to conventional surgery on parameters of both implant stability and marginal bone loss (MBL) for implant site preparation (ISP). In dental implant patients, what is the effectiveness of ISP by piezoelectric surgery in comparison to conventional drilling (CD) in terms of primary and secondary stability and MBL?

Background: An electronic search was conducted in PubMed, Cochrane Library, Scopus, and Google Scholar library databases following the search algorithm, “ISP or piezoelectric surgery or conventional surgery” and “piezoelectric surgery or conventional surgery.” A manual search for eligible studies was also performed in the Journal of Implant Dentistry, Quintessence International, Clinical Implant Dentistry and Related Research, and International Journal of Oral and Maxillofacial Journal.

Review results: A total of 93 articles were retrieved, among which 92 were from PubMed and one was obtained by manual search. After removing duplicates 12 articles were screened and seven were finally selected for qualitative and statistical analyses. Among the above studies, piezoelectric surgery (p = 0.0964) and conventional surgery (p = 0.8525) found nonsignificant p-values with comparable results.

Conclusion: Piezoelectric surgery provides a reliable alternative to traditional drilling for implant bed preparation, yielding implant stability quotient (ISQ) and MBL values that are comparable. More high-quality research is needed to evaluate the long-term stability and bone loss values of these two approaches.

Clinical significance: Both methods are useful in ISP. However, piezoelectric surgery reduces bone destructive inflammatory response during osseointegration.

How to cite this article: Kaule SS, Rathod SR, Bawankar PV, et al. Effects of Piezoelectric Surgery on Implant Stability and Marginal Bone Level: Systematic Review and Meta-analysis. World J Dent 2023;14(10):918–925.

Source of support: Nil

Conflict of interest: None

Keywords: Conventional drilling, Implant site preparation, Implant stability quotient, Marginal bone loss, Osseointegration, Piezoelectric surgery

INTRODUCTION

According to the American Academy of Implant Dentistry 1986, osseointegration is defined as contact established without interposition of nonbone tissue between normal remodeled bone and an implant entailing a sustained transfer and distribution of load from the implant to and within the bone tissue.¹

The quality of the bone, implant stability after surgery, the implant’s surface, and macrodesign features all play a role in the success of osseointegration of dental implants. Furthermore, obtaining good osseointegration necessitates careful preparation of the implant site with minimal trauma to adjacent structures. Surgical drills of appropriate sizes that fit implant geometry and a precise surgical drilling sequence have been used to prepare implant sites in the past.² Conventional drilling (CD) is the most common approach for implant site preparation (ISP). Their use may, however, cause bone tissue necrosis and eventually would result in osteonecrosis and osseointegration failure.³ Irrigation, rotating speed, drill design, drill wear, and drilling power all contribute to heat generation, which is the most important component in ISP treatment prediction.⁴^-⁸ Preventing temperature increase during ISP is therefore critical for osseointegration success.

To circumvent the limitations of CDs, new methods of ISP have been developed. Vercellotti and Vercellotti et al. used ultrasound in oral surgery, employing piezoelectric osteotomy (PO) a technique that permits hard tissue to be cut without affecting soft tissues like the oral mucosa, blood vessels, nerves, or Schneiderian membrane.⁹^,¹⁰

According to one study, the amount of heat generated during ISP with PO was unaffected by the pressure used. The volume of irrigation, on the contrary, has been related to an increase in bone cortical temperature.⁷ PO is less traumatic than CD with respect to peri-implant bone compaction and osteogenesis as per numerous randomized trials.¹¹^,¹² Others have discovered that during osseointegration, the creation of additional bone formed is the same.¹³

The goal of this literature review and meta-analysis would have been to compare piezoelectric surgery to conventional surgery on parameters of both implant stability and marginal bone loss (MBL) for ISP.

MATERIALS AND METHODS

Protocol and Search Strategy

This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and was registered in the PROSPERO (registration number CRD42022303377).

The focused PICO (patient/population, intervention, comparison, and outcomes) question was—in dental implant patients, what is the effectiveness of ISP by piezoelectric surgery in comparison to CD in terms of primary and secondary stability and MBL?

Inclusion Criteria

In vivo studies, randomized controlled trials (RCTs), human studies, healthy patients, with at least 6 months of healing after extraction, patients with totally or partially edentulous arches, patients who were unable to wear removable prosthesis, studies reported as original studies, studies comparing the clinical or radiological outcomes of implants implanted by CD against implants implanted by PO.

Exclusion Criteria

Meta-analysis and narrative reviews, studies with extra regeneration therapy during the surgical phase, no test and control groups, no follow-up, observational studies, case series, and reviews were excluded.

Search Strategy and Data Extraction

An electronic search was carried out on 3 December 2022 through PubMed, Web of Science, Cochrane Library, and Scopus databases following the search algorithm, “ISP or piezoelectric surgery or conventional surgery,” and “piezoelectric surgery or conventional surgery.” A manual search of the Journal of Implant Dentistry, Quintessence International, Clinical Implant Dentistry and Associated Research, and the International Journal of Oral and Maxillofacial Journal for relevant articles was also conducted.

Two separate researchers (SK and SR) examined the titles and abstracts after collecting the required data and according to inclusion and exclusion criteria, studies were selected. Around 92 studies were identified through PubMed, Web of Science, Cochrane Library, Scopus, and one through manual search from which 81 studies were excluded after screening of titles and abstracts. After five studies were excluded because they couldn’t answer our focus questions, the total number of records collected was seven.

The interexaminer agreement was assessed by Cohen’s κ index. Disparities were addressed with the help of a third researcher (PB). Country, research design, journal name, number of implants, total patients, age and sex of patients, area of implant placement in the oral cavity, follow-up duration, study results, number of implant failures, and piezoelectric device utilized have all been recorded (Table 1). Further data was collected on the type of implant, ISQ measurements, MBL measurements, and time of postrestoration (Table 2). ISQ measurements from baseline to 3 months (Table 3); MBL measurements from baseline to 6 months were recorded.

**Table 1:** Description of included studies
	Country	Type of study	Journal	Implants	Patients	Age/sex	Region	Follow-up	Variables	Implant failure	Piezosurgical device
Stacchi et al., 2013	Italy	Single-blinded randomized controlled clinical trial	Clin Implant Dent Relat Res	Test = 20 Control = 20	20	41–80 Male = 12 Female = 8	Maxillary premolar region	7–14–21–28–42–56–90 days and 1 year	ISQ	Test = 0 Control = 01	Piezo surgery (Mectron, Carasco Italy)
da Silva Neto et al., 2014	Brazil	Randomized controlled split-mouth study	Br J Oral Maxillo-fac Surg	Test = 34 Control = 34	30	20–60 Male = 06 Female = 24	Maxillary premolar region	90–150 days	ISQ	Test = 0 Control = 0	Not reported
Canullo et al., 2014	Spain	Randomized controlled trial	Clin Oral Implants Res	Test = 15 Control = 15	15	32–76 Male = 06 Female = 9	Mandibular molar region	1–3–8–12 weeks and 1 year	ISQ	Test = 0 Control = 01	EMS
Peker Tekdal et al., 2016	Turkey	Randomized controlled split-mouth trial	Clin Oral Implants Res	Test = 20 Control = 20	15	31–64 Male = 04 Female = 10	Maxillary posterior region	2–4–8–12–24 weeks	MBL	Test = 01 Control = 01	Piezon-master (EMS SA, Nyon)
Stacchi et al., 2018	Brazil	Randomized clinical trial		Test = 25 Control = 25	50	41–63 Male = 21 Female = 29	Mandibular posterior region	1–2–4–6 days and 3 months	MBL	Test = 0 Control = 01	Surgysonic
Gürkan et al., 2018	Turkey	Randomized split-mouth study	J Periodontal	Test = 19 Control = 19	14	31–64 Male = 04 Female = 10	Posterior maxilla	2–4–8–12–24 weeks	MBL	Test = 01 Control = 01	Not reported
Emera et al., 2018	Egypt	Split-mouth study	Alexandria Dental Journal	Test = 10 Control = 10	10	30–50 Male = 04 Female = 06	Anterior maxilla	3–6 months	ISQ MBL	Test = 0 Control = 0	Piezotome device (Acteon Satalec, France®)

**Table 2:** Methodology of selected studies
Author and year	Type of implant	Measurements of ISQ	Evaluation of MBL	Restoration of implant
Stacchi et al., 2013	Biomet 3I, nano tite parallel walled certain 4.0 × 10 mm	Single-blinded operator-recorded ISQ values in triplicate from mesiodistal, distomesial, buccolingual, linguobuccal directions	–	After 5 months of postimplantation
da Silva Neto et al., 2014	Neodent 3.5 × 13 mm	Twice in buccolingual and twice in mesiodistal directions	–	Between 90 and 150 days of postimplantation
Canullo et al., 2014	Premium SP, Sweden, Martina 3.5 × 10 mm	Duplicate measurements were taken from mesiodistal and buccolingual directions	–	Prosthetic loading after 12 weeks postimplantation
Peker Tekdal et al., 2016	Biodenta, Biodenta swiss AG, Berneck 4.1 × 8, 10, 12 mm	–	CBCT at baseline and 24 weeks. Standardized periapical radiographs at week 12	–
Stacchi et al., 2018	Premium AZT, Sweden and Martina, Italy), 3.8x11.5	–	Periapical radiographs with long cone paralleling technique at provisional crown insertion and at 6, 12, and 24 months after prosthetic loading	–
Gürkan et al., 2018	Biodenta®, Bone level implant; Biodenta Swiss AG	–	Radiographic images obtained by CBCT at implantation and 24 weeks. Standardized periapical radiographs at 12 weeks using photostimulable phosphor plate with position holders and long-cone paralleling technique	–
Emera et al., 2018	Kisses biogenesis dental implants	Immediately, 3 months, and 6 months postoperative using osstell IDx	CBCT assessment for the calculation of marginal bone loss (MBL) immediately, 3 months, and 6 months postoperative	–

**Table 3:** Summary of ISQ measurements
	Stacchi et al., 2013	da Silva Neto et al., 2014	Canullo et al., 2014	Emera et al., 2018
Baseline	PO—70.5 ± 5.8 (n = 20) CD—72.2 ± 5.8 (n = 20) p = 0.3215	PO—77.5 ± 4.6 (n = 34) CD—69.1 ± 6.1 (n = 34) p < 0.05	PO—67.3 ± 7.1 (n = 15) CD—67.9 ± 7.5 (n = 15) p = 0.969	PO—74.80 ± 5.25 (n = 10) CD—68.20 ± 4.42 (n = 10) p = 0.007
3 months	PO—71.0 ± 2.9 (n = 20) CD—69.2 ± 5.5 (n = 19)	PO—77 ± 4.2 (n = 34) CD—70.7 ± 5.7 (n = 34) p < 0.05	PO—75.7 ± 5.2 (n = 15) CD—73.3 ± 4.6 (n = 14) p = 0.092	PO—78.40 ± 3.95 (n = 10) CD—75.30 ± 2.71 (n = 10) p = 0.056

Quality Assessment and Risk of Bias

Two reviewers (SK and SR) assessed the quality of individual research. The Cochrane Collaboration Standards were appraised by following seven categories to assess the possibility of bias in all RCTs:

Creating a random sequence.
Disguised allocation.
Participants and employees are blindfolded.
Assessment of the outcome is conducted in a blinded manner.
Selective reporting.
Incomplete outcome data.
Bias in other areas.

Each “yes” or “no” throughout the evaluation showed a low- or high-risk of bias, respectively. Each of these biases was summarized into a qualitative, dichotomized response—“yes” or “no” for its “low-risk,” and “high-risk” impact status. When all components of a study were seen at low-risk, it was classified as “low-risk of bias,” and when one or more aspects were found at high or uncertain risk, it was classified as “high or unclear risk of bias (Fig. 1).”¹⁴

Fig. 1: Risk of bias assessment

Statistical Analysis

The included articles were subjected to a meta-analysis for two parameters—ISQ (n = 4) and MBL (n = 4). Q and I² (inconsistency) statistics were used to analyze the heterogeneity of the included studies. Given the importance of heterogenicity in the models, both random effect and fixed effect models were utilized in the meta-analysis. For each parameter, the standardized effect size [standardized mean difference (SMD)] was calculated along with the 95% confidence range. Egger’s and Begg’s tests were used to check publication bias. The test of significance of the data was determined using a p-value < 0.05. Because there were <10 studies that were included in the meta-analysis, the publication bias could not be assessed.¹⁶ Primary stability at baseline, secondary stability at 3 months, and MBL at baseline and 6 months were all compared across groups.

RESULT

An average of 93 articles were found using the search method with 92 coming from PubMed, Cochrane Library, Scopus, Web of Science, and one from a manual search. Following the removal of duplicates, 12 articles were chosen for further screening. Finally, seven articles were chosen for qualitative and statistical analysis (Flowchart 1).

Flowchart 1: Flowchart of search process

The studies that were chosen were all RCTs. This meta-analysis included a total of 153 patients with an age range of 20–81 years, from which 57 were males and 96 were females. A total of 286 implants were placed, that is, 143 of the implants were placed by PO and 143 by CD. The ISQ¹⁵^-¹⁷ and MBL¹⁸^-²⁰ values were evaluated in three studies separately and also in one study combined.²¹

There was bias in trials resulting from the timing of individual participant identification and recruitment in relation to the date of randomization.¹⁶^,²¹ In four of the trials, there was bias owing to variations from the planned interventions as well as biases due to lack of outcome data.¹⁶^,¹⁸^,²⁰^,²¹ All seven studies combined had a minimal risk of bias, according to the overall evaluation.

The results of responses of both the outcome variables (ISQ and MBL) are exhibited in Tables 3 and 4. Maxillary premolars were examined by Stacchi et al. and da Silva Neto et al. while Canullo et al.¹⁷ and Stacchi et al.¹⁹ studied the mandibular molar region. Emera et al. studied the maxillary anterior region. The maxillary posterior region was studied by Peker Tekdal et al. and Gürkan et al. Three of the trials featured a split-mouth design, while the other three had implants inserted next to teeth. In the CD group, five implants failed, while just one implant failed in the PO group (Table 1).

**Table 4:** Summary of MBL measurements (mm)
	Peker Tedkal et al., 2016	Stacchi et al., 2018	Gürkan et al., 2018	Emera et al., 2018
Baseline	PO—0.11 ± 0.23 (n = 19) CD—0.18 ± 0.33 (n = 19) p >0.05	–	PO—0.11 ± 0.2 (n = 19) CD—0.18 ± 0.33 (n = 19)	–
6 months	PO—0.11 ± 0.20 (n = 19) CD—0.12 ± 0.16 (n = 19) p >0.05	PO—1.39 ± 1.03 (n = 4 0) CD—1.42 ± 1.16 (n = 40)p >0.05	PO—0.11 ± 0.22 (n = 19) CD—0.12 ± 0.16 (n = 19)	PO—0.62 ± 0.12 (n = 10) CD—0.97 ± 0.22 (n = 10) p <00.1

The ISQ values were compared between the time of installation and the following time periods by Stacchi et al., da Silva Neto et al., Canullo et al., and Emera et al. ISQ values were obtained at baseline and 3 months after surgery in this review. Stacchi et al. reported no significant difference in average ISQ between the PO group (70.55.7) and the CD group (72.25.7) at baseline (p = 0.3215). The statistically significant difference between these two groups was observed from day 14 to 42 which was extremely significant (p < 0.001). da Silva Neto et al., on the contrary, discovered that the PO group (77.54.6) had substantially higher ISQ values than the CD group (69.16.1, p-value of 0.05), Canullo et al. found no statistical difference in stability between PO (67.37.1) and CD (67.97.5) groups at initial (p = 0.969) or at 12 weeks (75.75.2 vs 73, p = 0.092), although the PO group had a significantly greater ISQ score at 8 weeks (70.87.2 vs 67.75.2, p = 0.032). Emera et al. found ISQ values of 74.80 ± 5.25 and 68.20 ± 4.42 in the PO and CD groups, respectively which is statistically significant. There was no statistically significant difference between these two groups (p > 0.056).

In relation to MBL, four studies were compared. Peker Tekdal et al. discovered no significant between-group differences in MBL at 12 weeks when measured by periapical X-ray (0.110.23 vs 0.180.33, p > 0.05) or at 24 weeks when measured by cone beam computed tomography (CBCT) (0.110.20 vs 0.120.16, p > 0.05). Also, there is no statistically significant difference in MBL observed by Stacchi et al. between the PO group (1.39 ± 1.03) and the CD group (1.42 ± 1.16) at 6 months (p > 0.05). Gürkan et al. described MBL results that were very comparable, implying that their research populations may have overlapped. As per Emera et al., MBL levels in the PO arm (0.62 ± 0.12) were significantly lower (0.97 ± 0.22) than in the CD group (0.97 ± 0.22) over the 3- and 6-month follow-up periods (p ≤ 0.01).

This meta-analysis consisted of two parameters (ISQ, MBL) seven studies were studied and results were obtained. ISQ values were studied at baseline and after 3 months whereas MBL values were studied at baseline and at 6 months postoperatively.

For ISQ initially total of four studies were included.¹⁵^-¹⁷^,²¹ The results of the fixed effects (SMD = 0.00614, 95% CI = −0.308–0.320, and p-value = 0.969) and the random effect model (SMD = 0.037, 95% CI = −0.614–0.688, and p-value = 0.911) indicate that the standardized mean difference between the test and control groups in ISQ is not significant. The results of the fixed effects (SMD = 0.00614, 95% CI = −0.308–0.320, and p = 0.969) and the random effect model (SMD = 0.037, 95% CI = −0.614–0.688, and p-value = 0.911) indicate that the standardized mean difference between the test and control groups in ISQ is not significant. However, significant heterogenic inconsistency was observed as indicated by Q and I² statistics [Q = 11.8504; degree of freedom (df) = 3; p-value = 0.0079; I² = 74.68%; and 95% confidence interval (CI) for I = 29.59–90.90), but with no publication bias (Fig. 2A). When sensitivity analysis was performed excluding an outliner study by Stacchi et al., the heterogeneity was considerably reduced with nonsignificant p-value (Q = 4.6787; df = 2; p-value = 0.0964; I² = 57.25%; and 95% CI for I² = 0.00–87.82). The SMD from both fixed (SMD = 0.558, 95% CI = 0.199, and p-value = 0.199) and random effect models (SMD = 0.558, 95% CI = 0, and p-value = 0.483) also became more consistent with nonsignificant p-values. Publication bias was not found significant in the sensitivity analysis. As a result, it may be stated that there were no significant differences in ISQ between the test and control groups (Fig. 2).

Figs 2A and B: Forest plot (fixed and random-effects model). Implant secondary stability, ISQ at baseline/time 0 and at 3 months. (A) Considering four studies; (B) Sensitivity analysis excluding study by Stacchi et al.

For MBL also total of four studies were included.¹⁸^,²⁰^,²¹ The results of the fixed effect model (SMD = 0, 95% CI = 0, and p-value = 0.119) and the random effects (SMD = 0, 95% CI = 0, and p-value = 0.181) indicate that the standardized mean difference between the test and control groups in MBL is not significant. However, a significant heterogenic inconsistency (Q = 11.2739; df = 3; p = 0.0103; I² = 73.39%; and 95% CI for I = 25.25–90.53) was observed, but without the publication bias (Fig. 3). When sensitivity analysis was performed excluding an outliner study by Emera et al. this heterogeneity was reduced to a considerable extent with nonsignificant p-value (Q = 0.3191; df = 2; p = 0.8525; I² = 0%; and 95% CI for I² = −18.6053–16.1343). Estimated SMD from both fixed (SMD = 0, 95% CI = 0, and p= 0.589) and random effects (SMD = −0, 95% CI = 0.589, and p = 0.589) also got stabilized with nonsignificant p-values. Publication bias was not found significant in sensitivity analysis. As a result, there has been no difference in the mean change in MBL measurements between the test and control groups (Fig. 3).

Figs 3A and B: Forest plot (fixed and random-effects model). MBL at baseline/time 0 and at 6 months. (A) Considering four studies; (B) Sensitivity analysis excluding study by Emera et al. CD, conventional drilling; CI, confidence interval; I², inconsistency; PO, piezoelectric osteotomy

DISCUSSION

The goal of this review was to see how alterations among ISQ and MBL were performed using PO or CD. By regulating irrigation as well as cooling the bone tissue throughout both treatments, care must be taken to minimize heat injury to tissues. According to several researchers, CD produces coagulation, which leads to necrosis and the rupturing of the vasculature.¹⁵ As a result, the current meta-analysis examined the benefits of PO and CD in ISP, as well as the differences in ISQ and MBL values at 3 and 6 months for each approach. The ISQ and MBL parameters were investigated in this review. PO seems to make the surgery easier and prevent intraoperative problems. The PO was discovered to overcome the limitations which are involved in CD. Because it can cut thin or delicate bone structures with great precision, this newly developed PO made it easier to cut thin or delicate bone structures. Another downside of CD is that it necessitates a firm grip and manual pressure, which can lead to bony fenestration and alveolar bone atrophy. Therefore, we can switch to PO as minimum or maximum ISQs were more uniform in the PO group.¹⁷ Many clinical procedures were utilized to assess implant stability, including percussion, mobility tests, and radiography, but they may have certain shortcomings, such as a lack of standardization, reduced specificity, and susceptibility to operator-related factors. For the assessment and evaluation of stability, a noninvasive and recently established diagnostic approach known as resonance frequency analysis (RFA) is being employed. The benefits of employing RFA include the fact that it is a quick, simple, and painless process that may be performed as part of a normal clinical procedure with no patient discomfort.¹⁶

For ISQ total of four articles¹⁵–¹⁷^,²¹ met the inclusion criteria. A rise in ISQ values presumably reflects new bone apposition at the implant-bone interface, and RFA was preferred as a noninvasive and efficient method for assessing variations in implant stability over time, which is in direct relation to the stiffness of the implant in the surrounding bone during healing.¹⁷ Stacchi et al. study’s was removed from this review due to a nonsignificant p-value (p = 0.05) and various limitations, including a small sample size, a single operator’s surgical approach, and a nonsignificant p-value (p= 0.05). The findings of this study suggest that ultrasonic ISP resulted in a limited reduction in implant stability quotient (ISQ) values and a faster transition from a reducing to an increasing stability pattern.¹⁵ da Silva Neto et al., when comparing the ISQ at the same time interval for both the PO and conventional group came to the result that the piezosurgery group consistently had better stability than the conventional group.¹⁶ Within the limits of his pilot investigation (relatively small sample, short follow-up), Canullo et al. discovered that when implant site osteotomy was performed using a mixed drilling/ultrasonic method, implant stability may increase considerably faster.¹⁷ Emera et al. also came to the conclusion that within the limitation of this study, ISQ was increased in PO than in the CD group.²¹ In the current study, only da Silva Neto et al.¹⁶ found significantly improved primary and secondary stability (ISQ values) by PO vs CD, but two other studies found higher values for PO-prepared implants throughout the osseointegration process.¹⁵^,¹⁷ Only one research, that of Canullo et al., utilized a mixed algorithm (PO and CD), which may have influenced the comparison outcomes in this meta-analysis.¹⁷ At 3 months, there were no differences in ISQ among implants done by PO or CD, according to this meta-analysis.

Peker Tekdal et al. showed no significant group variation in MBL at 12 weeks when calculated by periapical X-ray (0.110.23 vs 0.180.33, p > 0.05) or at 24 weeks when measured by CBCT (0.110.20 vs 0.120.16, p > 0.05); Gürkan et al. found highly similar MBL results at 24 weeks when measured by CBCT computed tomography.²⁰ After 6 months of loading, Stacchi et al. discovered that mean MBL in the test group was 1.391.03 and 1.421.16 mm in the control group (p > 0.05), and after 1 year, 1.921.14 and 2.141.55 mm in the test and control groups, respectively (p > 0.05). In immediately loaded dental implants, there were no differences in survival rate or MBL between PO and conventional site preparation with rotary instruments—PO, including its features of improved surgical control and safety in areas close to delicate structures, will be used as a reliable alternative to traditional drilling systems.¹⁹ Emera et al. evaluated the two different groups as per MBL using only a series of CBCTs and found that the study group’s MBL readings were significantly lower than the control group’s (p = 0.05) during the follow-up period at 3- and 6-month intervals.²¹ At 6 months, there were no differences in MBL between implants done by PO or CD, according to this meta-analysis.

All seven studies combined had a minimal risk of bias, according to the overall evaluation. More high-quality study is required to assess the values of these two approaches’ long-term stability and bone loss, as well as to look into the security of piezoelectric surgery during rapid loading procedures. More clinical trials with larger sample sizes and longer term investigations are needed to explain these findings.

CONCLUSION

Piezoelectric surgery is a safe and effective alternative to standard drilling in implant bed preparation, with equivalent ISQ and MBL values. More high-quality research is needed to evaluate the long-term stability and bone loss values of these two approaches, as well as to investigate the safety of piezoelectric surgery in rapid loading procedures. To clarify these findings, more clinical trials with bigger samples and longer-term studies are required.

Authors’ Contributions

Dr Supriya Kaule: Contributed to conception, design, literature search, analysis and interpretation, and drafted the manuscript.
Dr Surekha Rathod: Contributed to conception, design, literature search, analysis and interpretation, and drafted the manuscript.
Dr Pranjali Bawankar: Contributed to literature search, analysis, interpretation, and critically revised the manuscript.
Dr Abhay Kolte: Contributed to literature search, interpretation, and critically revised the manuscript.

REFERENCES

1. Jayesh RS, Dhinakarsamy V. Osseointegration. J Pharm Bioallied Sci 2015;7(Suppl 1):S226–S229. DOI: 10.4103/0975-7406.155917

2. Atieh MA, Alsabeeha NHM, Tawse-Smith A, et al. Piezoelectric versus conventional implant site preparation: a systematic review and meta-analysis. Clin Implant Dent Relat Res 2018;20(2):261–270. DOI: 10.1111/cid.12555

3. Eriksson A, Albrektsson T, Grane B, et al. Thermal injury to bone. A vital-microscopic description of heat effects. Int J Oral Surg 1982;11(2):115–121. DOI: 10.1016/s0300-9785(82)80020-3

4. Abouzgia MB, James DF. Temperature rise during drilling through bone. Int J Oral Maxillofac Implants 1997;12(3):342–353.

5. Davidson SR, James DF. Drilling in bone: modeling heat generation and temperature distribution. J Biomech Eng 2003;125(3):305–314. DOI: 10.1115/1.1535190

6. Sener BC, Dergin G, Gursoy B, et al. Effects of irrigation temperature on heat control in vitro at different drilling depths. Clin Oral Implants Res 2009;20(3):294–298. DOI: 10.1111/j.1600-0501.2008.01643.x

7. Rashad A, Kaiser A, Prochnow N, et al. Heat production during different ultrasonic and conventional osteotomy preparations for dental implants. Clinical Oral Implants Res 2011;22(12):1361–1365. DOI: 10.1111/j.1600-0501.2010.02126.x

8. Möhlhenrich SC, Modabber A, Steiner T, et al. Heat generation and drill wear during dental implant site preparation: systematic review. Br J Oral Maxillofac Surg 2015;53(8):679–689. DOI: 10.1016/j.bjoms.2015.05.004

9. Vercellotti T. Piezoelectric surgery in implantology: a case report–a new piezoelectric ridge expansion technique. Int J Periodontics Restorative Dent 2000;20(4):358–365.

10. Vercellotti T, De Paoli S, Nevins M. The piezoelectric bony window osteotomy and sinus membrane elevation: introduction of a new technique for simplification of the sinus augmentation procedure. Int J Periodontics Restorative Dent 2001;21(6):561–567.

11. Blus C, Szmukler-Moncler S. Atraumatic tooth extraction and immediate implant placement with piezosurgery: evaluation of 40 sites after at least 1 year of loading. Int J Periodontics Restorative Dent 2010;30(4):355–363.

12. Di Alberti L, Donnini F, Di Alberti C, et al. A comparative study of bone densitometry during osseointegration: piezoelectric surgery versus rotary protocols. Quintessence Int 2010;41(8):639–644.

13. Sakuma S, Piattelli A, Baldi N, et al. Bone healing at implants placed in sites prepared either with a sonic device or drills: a split-mouth histomorphometric randomized controlled trial. Int J Oral Maxillofac Implants 2020;35(1):187–195. DOI: 10.11607/jomi.7481

14. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928. DOI: 10.1136/bmj.d5928

15. Stacchi C, Vercellotti T, Torelli L, et al. Changes in implant stability using different site preparation techniques: twist drills versus piezosurgery. A single-blinded, randomized, controlled clinical trial. Clin Implant Dent Relat Res 2013;15(2):188–197. DOI: 10.1111/j.1708-8208.2011.00341.x

16. da Silva Neto UT, Joly JC, Gehrke SA. Clinical analysis of the stability of dental implants after preparation of the site by conventional drilling or piezosurgery. Br J Oral Maxillofac Surg 2014;52(2):149–153. DOI: 10.1016/j.bjoms.2013.10.008

17. Canullo L, Peñarrocha D, Peñarrocha M, et al. Piezoelectric vs. conventional drilling in implant site preparation: pilot controlled randomized clinical trial with crossover design. Clin Oral Implants Res 2014;25(12):1336–1343. DOI: 10.1111/clr.12278

18. Peker Tekdal G, Bostanci N, Belibasakis GN, et al. The effect of piezoelectric surgery implant osteotomy on radiological and molecular parameters of peri-implant crestal bone loss: a randomized, controlled, split-mouth trial. Clin Oral Implants Res 2016;27(5):535–544. DOI: 10.1111/clr.12620

19. Stacchi C, Lombardi T, Baldi D, et al. Immediate loading of implant-supported single crowns after conventional and ultrasonic implant site preparation: a multicenter randomized controlled clinical trial. Biomed Res Int 2018;2018:6817154. DOI: 10.1155/2018/6817154

20. Gürkan A, Tekdal GP, Bostancı N, et al. Cytokine, chemokine, and growth factor levels in peri-implant sulcus during wound healing and osseointegration after piezosurgical versus conventional implant site preparation: randomized, controlled, split-mouth trial. J Periodontol 2019;90(6):616–626. DOI: 10.1002/JPER.18-0216

21. Emera AM, Aly TM, Elsheikh SA. Piezoelectric versus conventional surgical drilling for implant placement in anterior maxilla. Alex Dent J 2018;43(1):111–117.

________________________
© The Author(s). 2023 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.