MicroSaw and Piezosurgery in Harvesting

Mandibular Bone Blocks from the Retromolar Region:

A Randomized Split-Mouth Prospective Clinical Trial
Thomas Hanser, DMD1/Romain Doliveux, DMD1

Purpose: The aim of this randomized prospective split-mouth clinical trial was to evaluate the outcome of bone
block harvesting from the retromolar region using the MicroSaw and Piezosurgery. Materials and Methods:
Fifty-three patients for extensive bilateral bone grafting procedures with or without concomitant implant
placement in the maxilla and/or mandible were scheduled. In each patient, bone blocks were harvested in
the retromolar area within the external oblique ridge of the mandible. Using a randomized protocol, bone
blocks were harvested with the MicroSaw and Piezosurgery either from the right or the left side. Clinical
outcome parameters were the comparison of osteotomy time; volume of block graft; and clinical determination
of intraoperative complications such as hemorrhage, nerve injury, pain, swelling, and healing of the donor
site. Results: The mean osteotomy time for harvesting including luxating a bone block was 5.63 (± 1.37)
minutes using the MicroSaw and 16.47 (± 2.74) minutes using Piezosurgery (P < .05). A mean graft volume
of 1.62 (± 0.27) cm3 was measured with the MicroSaw and 1.26 (± 0.27) cm3 with the piezoelectric surgical
device (P < .05). No heavy bleeding at the donor site occurred in any of the cases. Complications due to injury
of adjacent teeth or nerve lesion of the mandibular nerve were not observed in any cases. According to a scale,
there was little postoperative pain with both instruments, and it decreased within 14 days postoperatively
(P > .05). Swelling did not appear significantly different either (P > .05), and none of the donor sites showed
primary healing complications. Conclusion: The data described in this randomized prospective split-mouth
clinical trial indicate that the MicroSaw and Piezosurgery allowed efficient and safe bone block harvesting
from the external oblique ridge. Clinically, concerning harvesting time and volume of the grafts, the MicroSaw
performed significantly better, whereas pain, swelling, and healing did not appear to be considerably different.
Given the improved visibility, precise cut geometries, and the margin of safety afforded by the MicroSaw and
Piezosurgery, they are both instruments of choice when harvesting bone from the retromolar area. Int J Oral
Maxillofac Implants 2018;33:365–372. doi: 10.11607/jomi.4416

Keywords: autogenous bone graft, bone block graft, bone harvesting, external oblique ridge bone graft,
mandibular bone graft, MicroSaw, piezoelectric surgical device, Piezosurgery, ramus bone graft, retromolar
bone graft

S ufficient bone volume in height and width is essen-

tial for long-term esthetic and functional implant
success.1–3 In particular, in larger bony defects, osseo-
regenerative capacity. This is why autogenous bone,
especially in larger lateral or vertical defects, is still the
gold standard in bone reconstructive measures.4
promoting techniques are needed. The superiority of Autogenous bone is typically harvested from in-
autogenous bone has been demonstrated with respect traoral or extraoral sources.3–7 Proximity of the donor
to other bone substitutes on a biologic, immunologic, and recipient sites, convenient surgical access, low
and even medico-legal basis. An autogenous bone morbidity, and elimination of hospital stay are advan-
graft would be osteoinductive, osteogenic, and os- tages of intraoral sources.4,6 Cortico-cancellous bone
teoconductive to form new bone, giving it significant block grafts, suitable for two- or three-dimensional
reconstructions of alveolar ridge defects, can be har-
1Private
vested from the mandibular symphysis (chin area), the
Clinic Schloss Schellenstein, International Dental
Implant Center, Olsberg, Germany. retromolar area (external oblique ridge), or edentulous
sections.4
Correspondence to: Dr Thomas Hanser, Am Schellenstein 1, Previous studies reported a higher complication rate
59939 Olsberg, Germany. Fax: +49-2962-9719-22. when grafts were harvested from the chin.4,6,8,9 Complica-
Email: dr.hanser@gmx.de
tions included wound dehiscence as well as paresthesia
©2018 by Quintessence Publishing Co Inc. of the chin area and mandibular anterior teeth. Due to

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less patient morbidity, retromolar bone block removal has The study was performed in accordance with the
been shown to be the donor site of choice.3,5,6,10 principles stated in the Declaration of Helsinki and the
Currently, there are several types of techniques Good Clinical Practice Guidelines.
and instruments used to obtain intraoral grafts from
the retromolar area. Bone block grafts are mostly Clinical Design
harvested with trephine11 or fissure burs6 of different Two experienced oral surgeons (T.H. and R.D.) were in-
forms and diameters, diamond discs,4 or a piezoelec- volved in the study and performed all reconstructive inter-
tric device.12,13 ventions. All bone harvesting procedures were performed
The MicroSaw (Dentsply Implants) developed by by only one surgeon. The harvested bone was used in the
Khoury et al has been in clinical use since 1984.4,14–16 maxilla and/or mandible for lateral or vertical bone graft-
The MicroSaw technique was described for different ing procedures as well as for sinus floor elevation. Only pa-
osteotomies such as bony lid preparation and bone tient cases of bilateral identical grafting procedures and
splitting, as well as for bone harvesting from different implant rehabilitation were included in the study.
intraoral regions.4,14–16 To compare the clinical outcome of the MicroSaw and
Piezosurgery3 (Mectron), a piezoelectric device pre- Piezosurgery, both instruments were used either on the
sented by Vercellotti, which was developed in 1988 right or left external oblique line at the retromolar area
for oral bone surgery, uses a modulated ultrasonic fre- of the mandible in the same patient. One of the external
quency (29 kHz) for hard tissue cutting.17,18 In dental oblique lines belonged to the test group because bone
implant surgery, it can be used for different osteoto- block harvesting was performed with Piezosurgery. The
mies such as bone splitting,17,19 bone block harvest- opposite external oblique line belonged to the control
ing,13 and implant site preparation.20 group because bone block harvesting was carried out
The aim of this randomized split-mouth prospective with the MicroSaw. To avoid bias during the allocation
clinical trial was to compare the clinical outcome of the process, before starting the surgery, a sealed opaque en-
MicroSaw and Piezosurgery for harvesting mandibular velope was opened, indicating which instrument to use
bone block grafts from the external oblique ridge in according to a pretrial randomization allocation either
the same patient receiving extensive bilateral bone on the right or left external oblique ridge.
grafting procedures. Both instruments were used ac- Digital palpation of the donor site allowed a preliminary
cording to a randomized protocol either on the right or estimation of the morphologic contours, and panoramic
left donor site. Diagnostic means, clinical performance radiographs were used to supplement information. A cone
of instruments, and harvesting technique are present- beam computed tomography (CBCT) scan (Galileos) was
ed; indications and complications are discussed. additionally performed to obtain a three-dimensional view.
This study was performed following the STROBE Preoperative antibiotic administration was per-
(Strengthening the Reporting of Observational Studies formed and continued up to 10 days postopera-
in Epidemiology, http://www.strobe-statement.org) tively.23,24 Patients were under general anesthesia or
guidelines.21 sedation during the surgical procedure.
The harvesting protocol of the MicroSaw as de-
scribed in the literature includes vertical and horizon-
MATERIALS AND METHODS tal osteotomies.4,15 Once the osteotomy lines were
positioned basally of the level of the alveolar nerve,
This randomized prospective split-mouth clinical trial the maximum cutting of the diamond disc of 3.2 mm
was conducted between January 2014 and June 2017 in was not used completely, especially in the distal sec-
a private clinic specialized in advanced implant rehabili- tion of the donor site. Bone grafts were dislocated us-
tation. The study was independently reviewed and ap- ing a fine chisel and hammer (Fig 1b).
proved by the ethical board related to the institution. All The Piezosurgery was set to maximum (boost). Ver-
patients were provided with a detailed description of the tical and horizontal osteotomies were performed as
procedure and informed that their data will be used for described in the literature.13,18 The cutting depth was
statistical analysis. Only patients giving their informed controlled by the laser marking along the shaft of the
consent to the treatment were included in the study. instrument and was supposed to be all the way through
The health status of patients was classified according to the cortical plate (Fig 1a). Bone block luxation was
the Physical Status Classification System corresponding achieved by manipulation with a chisel and hammer.
to the American Society of Anesthesiologists.22
Patients with general contraindications to implant Clinical Evaluation
surgery, poor oral hygiene (full-mouth plaque and This study evaluated the clinical results of bone block
bleeding score ≥ 20%), active periodontal lesions, and harvesting from the retromolar area with the MicroSaw
lack of motivation were excluded from the study. and Piezosurgery.

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 Hanser/Doliveux

Fig 1  Bone block preparation in one

patient using the (a) Piezosurgery and (b)
MicroSaw with minimal bleeding tendency
of the surgical site, comfortable visibility,
and a clean and precise osteotomy. The
MicroSaw’s soft tissue protector helps to
protect the neighboring soft tissues even
in areas with difficult access.

a b

The outcome measures were: postoperative pain, swelling after the operation, and
healing of the surgical site between harvesting one
• Osteotomy time: Measured from the moment of with a diamond-tipped disc (MicroSaw, Dentsply
starting the osteotomy until the luxation of the Sirona Implants) and a piezoelectric device (Piezosur-
bone block gery, Mectron).
• Volume of block graft: Measured by the Archimedes All results were evaluated with descriptive statis-
law while maintaining aseptic conditions in a 0.9% tical methods. The statistical power of the study was
saline solution4 evaluated, and the minimum number of patients was
• Clinical determination of intraoperative complications calculated according to the guidelines for the design
such as fracture of the instrument, heavy bleeding, and statistical analysis.25,26 Outcome assessment was
nerve exposure, or nerve injury (paresthesia, clinically conducted by blinded examiners and was
hypoesthesia, anesthesia) therefore independent.
• Postoperative pain classified in four levels: heavy pain The patient was the statistical unit of the analysis.
with the patient taking a total of more than eight The data analysis was carried out according to the
painkillers (Ibuprofen 400); moderate pain when preestablished analysis plan. The surgeon was aware
the patient took between four and eight painkillers; of the instrument used and the donor site, while the
little pain when the patient needed less than four clinical examiner was kept blinded to the allocation
painkillers; and no pain when no painkiller was used10 and instrument.
• Swelling after the operation, the following day, and Without knowing the codes, a biostatistician ana-
approximately 2 weeks later on the day of suture lyzed the data. Differences of means at the patient level
removal. The baseline for measurement was the for continuous outcomes and changes were compared
preoperative distance from the lower border of the with paired t test data. All statistical comparisons were
earlobe to the middle of the chin, and the distance conducted at the .05 level of significance.
from the mandibular angle to the outer eyelid margin.
• Healing of the surgical site: Determined clinically
by the primary healing of the soft tissue over the RESULTS
harvested area such as tissue necrosis, suppuration,
or bone exposure. The soft tissue was supposed Fifty-three patients (22 men, 31 women) for ex-
to show normal color without any inflammation 2 tensive bilateral bone grafting procedures with or
weeks after the surgery (removal of the sutures). without concomitant implant placement in the max-
illa and/or mandible were scheduled. Patients were a
Statistical Analysis mean 59.5 ± 5.2 years of age. In 37 patients, the health
The study tested the null hypothesis of no difference in status was ASA Physical Status 1–a, and in 16 patients,
osteotomy time of bone blocks, volume of block grafts, it was ASA Physical Status 2–a. There were four smok-
clinical determination of intraoperative complications, ers with a smoking habit of 10 to 20 cigarettes per day.

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Hanser/Doliveux

Osteotomy time (min) 25

20
15
10
5
0
Microsaw Piezosurgery
Osteotomy device
Fig 2   Comparison of bone block harvest- Fig 3   Harvested bone blocks with their corticocancellous morphology. The graft har-
ing time measured from the moment of vested with the MicroSaw from the left external oblique line is larger in height compared
starting the osteotomy until the luxation of with the block harvested with Piezosurgery.
the bone block (paired t test data).

2.0
Graft volume (cm3)

1.5

1.0

0.5

0
Microsaw Piezosurgery
Osteotomy device

Fig 4   Comparison of bone block volume

(paired t test data).

Fig 5  (Right) Osteotomy lines were posi-

tioned basally of the level of the alveolar
nerve on the left and right donor site.

Most of the patients (49 patients) were treated un- case showed a fracture of the lingual bone wall that
der general anesthesia and four patients under intra- occurred while luxating the bone block with the
venous sedation. chisel again using Piezosurgery. The fractured piece
The MicroSaw and Piezosurgery allowed bone block remained attached to the periosteum and could be
harvesting from the mandibular retromolar area with repositioned without additional fixation to ensure
comfortable visibility as well as a clean and precise os- proper healing. No heavy bleeding at the donor site
teotomy (Fig 1). with a separate effort for controlling such as electro-
The mean osteotomy time for harvesting including coagulation or compression occurred in any of the
luxating a bone block from the mandibular retromolar cases. Despite harvesting a large part of the external
area was 5.63 (± 1.37) minutes using the MicroSaw and oblique ridge, no esthetic or functional deficiencies
16.47 (± 2.74) minutes using Piezosurgery. The mean resulted. One patient was restless under sedation by
difference in harvesting time was 10.85 (± 0.43) min- the vibration noise of the piezoelectric surgery de-
utes and was statistically significantly different (P < .05) vice and the necessary irrigation.
(Fig 2). In 34 patients, osteotomy lines were positioned
A mean graft volume harvested from the external basally of the level of the alveolar nerve on the left
oblique ridge of 1.62 (± 0.27) cm3 was measured after and right donor sites in the same patient (Fig 5). In
removal with the MicroSaw and 1.26 (± 0.27) cm3 with four of those cases, mandibular alveolar nerve expo-
the piezoelectric surgical device. In this area, bone sition occurred with the MicroSaw and in two cas-
block quality was normally cortical, with little cancel- es using the piezoelectric device. Exposed nerves
lous bone (Fig 3). The mean difference in bone block showing transient hypoesthesia lasted for a maxi-
volume was 0.36 (± 0.26) cm3 and was statistically sig- mum of 6 weeks in one case using Piezosurgery and
nificantly different (P < .05) (Fig 4). two cases using the diamond disc. No major nerve
Intraoperative complications such as fracture of lesion of the mandibular nerve with permanent
the instrument tip occurred in the use of the piezo- anesthesia was observed in any case (Figs 6 to 10).
electric device in three patients and in another Complications due to injury of the adjacent teeth
three patients using the MicroSaw. Overheating of with the diamond disc or piezoelectric device were
the bone occurred in three other patients, and one not observed in any case.

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 Hanser/Doliveux

Fig 6   (Left) Nerve exposure after bone block harvesting using the MicroSaw. In the
area of the distal ascending branch, the nerve runs closer to the surface.

Fig 7   (Center) Hollow of the nerve within the bone graft where osteotomies have been
positioned below the level of the inferior alveolar nerve.

Fig 8   (Right) The cross section of the graft shows the superficial position of the nerve
and the reduced cutting depth of the diamond disc in the area of the level of the nerve.

Fig 9  (Left) Preparation of a bone block

graft in the left mandible using Piezosur-
gery below the level of the inferior alveolar
nerve.

Fig 10  (Right) Partial exposure of the

nerve after bone block luxation.

Postoperatively, on average, little pain was ob- the diamond disc and up to 1.78 cm with the piezosur-
served using the MicroSaw (level: 1.03) and using gical device. Two weeks after the operation, swelling
Piezosurgery (level: 1.17). One day after the operation, had almost disappeared in both instruments (Micro-
the mean pain level was 0.61 with the diamond disc Saw, 0.44 cm; and Piezosurgery, 0.36 cm) (Fig 12).
and 0.68 with the piezosurgical device. Two weeks af- The swelling performance after the operation con-
ter the grafting procedure, on average, hardly any pain cerning the preoperative distance from the mandibu-
was present with the MicroSaw (0.25) and Piezosurgery lar angle to the outer eyelid margin increased 0.97 cm
(0.23). No statistically significant difference (P > .05) using the MicroSaw and 1.00 cm using Piezosurgery.
was found between the two instruments (Fig 11). One day after the surgery, swelling again increased
The swelling performance after the operation com- compared to the baseline with the diamond disc (1.38
pared with the baseline before the grafting procedure cm) and piezosurgical device (1.34 cm). Two weeks af-
concerning the preoperative distance from the lower ter the operation, swelling had almost disappeared in
border of the earlobe to the middle of the chin in- both instruments (MicroSaw, 0.44 cm; and Piezosur-
creased 1.10 cm using the MicroSaw and 1.39 cm us- gery, 0.35 cm) (Fig 13).
ing Piezosurgery. One day after the surgery, swelling The swelling performance between the two instru-
increased up to 1.40 cm compared to the baseline with ments after the operation, 1 day after the surgery, and

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3.0 Microsaw 2.0 Microsaw

Piezosurgery 1.8 Piezosurgery

Swelling, earlobe to chin (cm)

2.5
1.6
1.4
2.0
Pain scale

1.2
1.5 1.0
0.8
1.0
0.6
0.4
0.5
0.2
0 0.0
0 1 14 0 1 14
Days postoperative Days postoperative

Fig 11   Pain scale (level 0–3) showing decreasing pain level in Fig 12  Swelling performance in centimeters concerning the
both instruments (n = 10). preoperative distance from the lower border of the earlobe to
the middle of the chin (n = 53).

from the moment of starting the osteotomy until the

1.6 Microsaw
Piezosurgery
luxation of the bone block was a mean 5.63 (± 1.37)
Swelling, mandibualr angle to

1.4 minutes. The time for harvesting using a piezosurgi-

1.2 cal device was a mean 16.47 (± 2.74) minutes and thus
eyelid margin (cm)

1.0 significantly (P < .05) longer compared with the per-

formance of the MicroSaw, with a mean difference in
0.8
harvesting time of 10.85 (± 0.43) minutes. The penetra-
0.6 tion power of a diamond disc enables quicker osteoto-
0.4 mies compared with a piezosurgical device (Fig 2).28–30
0.2
Bone grafts harvested with the piezosurgical device
were a mean 1.26 (± 0.27) cm3. Grafts obtained with the
0
0 1 14 MicroSaw were 1.62 (± 0.27) cm3 and therefore statisti-
Days postoperative cally significantly (P < .05) larger, with a mean difference
in bone block volume of 0.36 (± 0.26) cm3 (Fig 4). One
Fig 13  Swelling performance in centimeters concerning the study13 using the piezoelectric surgical device showed
preoperative distance from the mandibular angle to the outer
eyelid margin (n = 53). a mean graft size of 1.15 cm3 with a maximum of 2.4
cm3, and another study of 3,032 bone grafts using the
2 weeks later was not shown to be statistically signifi- MicroSaw demonstrated a mean volume of 1.9 cm3 and
cantly different (P > .05). a maximum value of 4.4 cm3.10 The difference might be
None of the donor sites showed primary healing explained by the MicroSaw’s thin diamond disc leading
complications. to less bone loss and its basally extended vertical oste-
otomies in comparison4,31 (Fig 3).
The Piezosurgery and the MicroSaw perform better
DISCUSSION than conventional rotating instruments such as fissure
burs, which obtained a mean ramus graft of 0.9 cm3 in
The mandibular retromolar area is favorable to obtain a study of 50 patients6 and allow bone block prepara-
large-sized mandibular bone block grafts for lateral and tion, which is suitable for three-dimensional alveolar
vertical alveolar reconstructions.27 The proximity of the crest reconstructions.4,13
intraoral donor and grafted sites reduces the surgical Clinical determination of intraoperative complica-
and anesthetic periods, leading to ideal conditions for tions showed three fractures of the instrument tip in
implant surgery using autogenous bone grafts.4,6,28 In both instruments. Three cases of bone overheating were
spite of the anatomical variation of each donor site, the observed using Piezosurgery. The irrigation of the instru-
piezosurgical device as well as the MicroSaw fit the indi- ment tip seems to be less effective in the piezosurgical
vidual morphology and allowed bone block harvesting device compared with the direct disc irrigation of the Mi-
from the mandibular retromolar area with comfortable croSaw’s diamond, especially in areas with difficult access.
visibility as well as a clean and precise osteotomy.15 Heavy bleeding at the donor site with a separate ef-
The time for harvesting a mandibular bone block fort for controlling such as electrocoagulation or com-
from the external oblique ridge with the MicroSaw pression did not occur in any of the harvesting cases.

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 Hanser/Doliveux

It has been noted that hemorrhage from surgical sites distal retromolar area when the osteotomies are located
was minimal or absent using Piezosurgery.13,32,33 These below the level of the nerve, as the nerve cannot dodge
findings are confirmed by this study. the instrument tip within the mandibular bone (Figs 7
The luxation of bone blocks when using Piezosurgery and 8). Nevertheless, according to the low complica-
could be achieved with gentle manipulation with a chis- tion rate reported in different studies in the use of both
el when the osteotomy is completed all the way through instruments, the described clinical and radiologic diag-
the cortical plate, or additionally using a hammer. Never- nostic seems to be sufficient for safe bone block harvest-
theless, bone blocks could only be removed by entering ing following the presented protocol.4,13,15,31–33
the chisel into deeper bone layers to achieve a better le- The postoperative situation after bone harvesting
ver approach. Another study stated that this might have from the retromolar area is clinically comparable to
been the reason for neurosensory disturbance, as it was that observed after an osteotomy of impacted wis-
assumed that the chisel injured the nerve.13 dom teeth concerning edema, hematoma, and pain,
The protocol of the MicroSaw is based on creating for example.4,10 There was little postoperative pain on
a fracture line without entering deeper bone struc- average with both instruments on the day of opera-
tures.4 On the other hand, the diamond disc should tion. Similar results with decreasing pain were found
possibly be set perpendicular to the wall of the jaw, 1 day after the operation. Two weeks after bone har-
so that no undercut sectional areas generated will vesting, subjective pain had almost disappeared
hinder the dislocation of the block due to the thin os- (Fig 11). No statistically significant difference (P > .05)
teotomy. Undercuts have arisen primarily in the area was shown between the MicroSaw and Piezosurgery.
of ​​mesial vertical osteotomy due to a false angulation It was shown that the integrity of the bony structure
of the diamond disk, which might make it difficult to observed with histologic evaluations after the ultra-
further dislocate the block.4 sonic technique may favor the bone healing process,
One patient was restless under sedation by the vibra- thus leading to little pain sensation.29
tion noise of the piezoelectric surgery device and the Postoperative swelling did not appear to be signifi-
necessary irrigation. The patients’ perception of vibra- cantly different either (P > .05) using Piezosurgery and the
tion during ultrasonic instrumentation and the need for MicroSaw. The osteotomy technique with a piezoelec-
intense irrigation to avoid overheating the bone seems tric instrument has been shown to produce a significant
to be a disadvantage compared with the smooth and reduction in facial swelling compared with conventional
fast cutting with the MicroSaw, which helps to reduce rotary instruments. However, a slight lengthening of sur-
the stress for the patient.4,34 Nevertheless, piezoelectric gical time has also been recorded, compared with the
surgery produces less vibration and noise because it use of conventional rotary instruments.29
uses microvibration, in contrast to the macrovibration In both instruments, patients considered swelling to
and noise that occur with conventional surgical saws or be a stronger postoperative discomfort than pain.40,41
burs, especially under local anesthesia.12 In this study, no wound healing disturbance oc-
Additional CBCT scans35 were used in this study. This curred in any case. Generally, harvesting bone with the
information is important especially if the osteotomies MicroSaw or the piezoelectric device does not seem to
are located underneath the level of the mandibular be affiliated with major wound healing disturbance, as
nerve.36–39 In this study, in 34 patients (64%), donor site other research showed wound healing disturbance in
osteotomy lines were positioned basally of the level of only about 1.0% of the cases.4,13 Another study found
the alveolar nerve on both sides of the mandible. This fewer postoperative complications using Piezosurgery
led to mandibular alveolar nerve exposition in four compared with a traditional bur.29 These findings indi-
donor sites using the MicroSaw and in two using the cate that there were fewer primary healing complica-
piezoelectric surgical device, generally in the distal area tions in bone harvesting from the ramus area (1.58%)
of the donor site. Hypoesthesia of the inferior alveolar than infections from the extraction of wisdom teeth (6%
nerve was observed in one patient using Piezosurgery to 8%).4 This could be related to the presence of a lamina
and two patients using the MicroSaw. Nerves recov- dura, peri-coronally and around the root of the wisdom
ered completely, and irritations did not last longer than tooth, which can have a negative influence on blood
6 weeks (Figs 6, 9, and 10). Other studies demonstrated support, bleeding capacity, and the healing process.
altered sensitivity of the lower lip following harvesting Smoking did not have a negative impact on healing in
of bone from the external oblique ridge with the Mic- this; however, in view of the small number of cases, that
roSaw and piezoelectric device in approximately 1.0% is not representative.
of the patients.4,13 Generally, the reported complication rate in this
The authors recommend not only using the MicroSaw study using both instruments is low and comparable
in full cutting depth, but also only superficially entering to the results of previous reports concerning intraoral
the cortical bone structures with Piezosurgery in the bone harvesting.4,6,8,13,37

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Hanser/Doliveux

CONCLUSIONS 15. Khoury F. The bony lid approach in pre-implant and implant sur-
gery: A prospective study. Eur J Oral Implantol 2013;6:375–384.
16. Khoury F. Surgical aspects and results to improve the bone site be-
The data and experience from this randomized split- fore implant measures [in German]. Implantologie 1994;3:237–247.
mouth prospective clinical trial indicate that the described 17. Vercellotti T. Piezoelectric surgery in implantology: A case
report—A new piezoelectric ridge expansion technique. Int J
diagnostic and surgical protocol using the MicroSaw and Periodontics Restorative Dent 2000;20:358–365.
Piezosurgery allowed efficient and safe bone block har- 18. Vercellotti T. Technological characteristics and clinical indications
of piezoelectric bone surgery. Minerva Stomatol 2004;53:207–214.
vesting from the external oblique ridge. Clinically, con- 19. Belleggia F, Pozzi A, Rocci M, Barlattani A, Gargari M. Piezoelectric
cerning harvesting time and volume of the grafts, the surgery in mandibular split crest technique with immediate implant
MicroSaw performed better, whereas pain, swelling, and placement: A case report. Oral Implantol (Rome) 2008;1:116–123.
20. Stacchi C, Costantinides F, Biasotto M, Di Lenarda R. Relocation of a
healing did not appear to be considerably different. malpositioned maxillary implant with piezoelectric osteotomies: A
In both instruments, it is essential to respect the case report. Int J Periodontics Restorative Dent 2008;28:489–495.
anatomical structures and location of the inferior man- 21. von Elm E, Altman DG, Egger M, et al. The Strengthening the
Reporting of Observational Studies in Epidemiology (STROBE)
dibular nerve, especially if the osteotomies are per- statement: Guidelines for reporting observational studies. J Clin
formed underneath the level of the nerve. Epidemiol 2008;61:344–349.
22. Merchant R, Chartrand D, Dain S, et al. Guidelines to the Practice of
Given the improved visibility, precise and virtually Anesthesia—Revised Edition 2014. Can J Anaesth 2014;61:46–59.
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