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Application of Advanced Technologies in Facial Cosmetic Surgery: History, Denition…
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9 Piezoelectric
The use of piezoelectric devices can be considered as the advanced ultrasonic technology instead of doing osteoplasty or osteotomy using conventional rotating
devices. It has superiority over conventional methods due to loss of micro-vibrations, ease of use, and more secure cutting, especially in complicated parts of the
body. Its mechanical and physical features obtain numerous clinical advantages
including accurate cutting, blood-free surgical eld, and sparing the vital neurovascular bundles. The piezoelectric device is more efcacious in the bone healing by
promoting bone morphogenetic protein consumption, stimulating bone remodeling,
and controlling the inammatory procedure [23]. The piezoelectric effect used for
the ultrasonic cutting of bone was rst described in 1880. This the high frequency
vibration of a metallic tip used to selectively cut bone while sparing surrounding
soft tissues. The term “piezo” originates from the Greek word piezein, which means,
“to press tight, squeeze.” Jacques and Pierre Curie rst discovered piezoelectricity
in the year 1880 who found that applying pressure on various crystals, ceramics, or
bone created electricity. This piezo effect is based on physical interactions and phenomena of basic electric and mechanical dimensions such as electric eld strength,
polarization, tension, and extension in the crystalline eld, which states that deformation in crystals on passing electric current results in oscillations of ultrasonic
frequency. The vibrations obtained are amplied and transferred to a vibration tip
which when applied with slight pressure on bone tissue results in cavitation phenomena, which is a cutting effect exclusively on mineralized tissue. In other words,
the damaging of soft tissues happens at frequencies above 50kHz. Piezoelectric
devices have the irrigation uids with an adjustable jet of 0–60mL/min through a
peristaltic pump. Debris will be removed with precise cutting. It also provides a
blood-free operating site because of the cavitation effect. Piezo surgery’s insert
motion should be forward and backward continually at high speed with less pressure.
The prominent advantages of piezo surgery are the following:
• Hemostasis and clear surgical eld via the cavitation effect.
• Bone surgery with micrometric precision.
• Avoidance of damaging adjacent vital structure.
• Rapid healing due to preceding bone morphogenetic protein release.
• Convenient harvesting of intra- or extraoral bone graft. It may be efciently utilized in regions challenging to see and reach because of its inserts with
diverse angles.
• There are not macro-vibrations and annoying feeling for patients in ofce-based
procedures.
• High cost, time consumption, and a learning curve are piezo surgery’s main disadvantages [23].
The piezoelectric device could be applied in different steps of rhinoplasty sur-
gery, from the dissection to septoplasty and bony part manipulation. With piezoelectric device, lateral osteotomy could be performed along the osteotomy line, with or
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Fig. 19 Internal lateral
osteotomy with the piezo
surgical device [24].
(Fallahi etal. Piezo surgery
Versus Conventional
Osteotomy. J Oral
Maxillofacial Surg 2019)
S. O. Keyhan et al.
Fig. 20 Pre- and 1-year postoperative photographs of rhinoplasty utilizing a piezoelectric device
without subperiosteal tunneling. Also, any sharp spicules or edges can be directly
excised using piezoelectric device, even on detached bones. Piezo surgery can precisely select the target tissue, providing the optimal periosteum detachment and
dissection of soft-tissue layers.
Intact periosteum preserves its function; therefore, ecchymosis, bleeding, and
edema become negligible. Bone coagulation necrosis does not occur and, compared
to the traditional periosteal elevators, improves the postsurgical microcirculation
[23] (Figs.19, 20, and 21).
Application of Advanced Technologies in Facial Cosmetic Surgery: History, Denition…
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Fig. 21 Photographs of a 21-year-old woman who beneted from bimaxillary surgery and simultaneous minimally invasive rhinoplasty with dorsal preservation using a piezoelectric device
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S. O. Keyhan et al.
10 Plasma Science
Plasma is the fourth state of matter and consists of ionized atoms created through
charged particles in conducting medium (Fig.22).
Dr. Irving Langmuir described the “plasma” as ionized gas for the rst time, in
1929. Currently, investigation has been expanded on the plasma interaction with
eukaryotic cells, applications in skin resurfacing, wound healing, dermatologic disorder, and controlling some cancers by induced apoptosis. At atmospheric pressure,
there are two types of plasmas: thermal and nonthermal. In primary plasma applications, the desired effect is caused by the thermal energy of the plasma, in fact high
temperature and heat. Thermal plasma (below 80 °C) has been used for tissue
destruction, ablation, cauterization, cutting, and sterilization of thermally stable
medical instruments. It is now also used for aesthetic procedures. Cold atmospheric
plasma (CAP) is a hopeful new therapeutic technology in medicine for sterilization,
wound healing, hemostasis, cancer treatments, dental procedure, alopecia treatment, skin rejuvenation, and treatment of dermatologic disorders such as rhinophyma, eczema, scar, pruritic disorder, and supercial bacterial or fungal skin
infections. Plasmas are extensively administered in dermatology, and additional
potential indications will be revealed in multidisciplinary study.
The germicidal aspect of plasma is determined, and clinical reports demonstrate
positive nding in management of superinfected wounds or dermatitis for any reason. The main advantages of cold atmospheric plasma are (1) the low potential for
surrounding tissue to be damaged, (2) minimal depth of thermal penetration, (3)
Melting
SOLID
Fig. 22 Four states of matters, created by Hoffmann etal. (2013) (Drawing by A.Babaei, 2021,
reproduced with permission)
Ionization
Condensation
Vaporization
Sublimation
Deposition
Add Heat
LIQUID GAS PLASMA
DeionizationFreezing
Application of Advanced Technologies in Facial Cosmetic Surgery: History, Denition…
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manipulable plasma stream length at the micron level, (4) lesser degree of eschar
and odor, (5) conductive currents not required, and (6) prociency for any tissue
condition.
Early in 2012, the cold helium plasma equipment was commercially in an FDA-
approved design for coagulation, ablation, and cutting of soft tissue. Also, the nitrogen-based plasma tool (portrait) has the approval of the Food and Drug Administration
(FDA) for the handling of facial and non-facial rhytids, scars, acne, and supercial
benign skin lesions such as seborrheic keratoses, viral papillomata, and actinic keratoses in Fitzpatrick skin types I to IV.Recently, the helium plasma tool and nitrogen
plasma tool have been compared. The helium plasma tool demonstrated lower
depths of thermal effect and more notable percentages of skin tissue contraction
compared to the nitrogen plasma equipment. Additionally, its possible pertinency
was proposed for skin resurfacing procedure application.
Although minimal complication related to plasma in medical application has
been reported, fundamental biological and invivo researches are essential for comprehending various interactions between living cells and plasma, as well as particular plasma applications. Plasma medicine may become a dominant instrument for
disease control in the future [25].
References
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Facial Plast Surg. 2020;36(06):684–7.
2. Jo YJ, Choi JS, Kim J, Kim HJ, Moon SY.Virtual reality (VR) simulation and augmented
reality (AR) navigation in orthognathic surgery: a case report. Appl Sci. 2021;11(12):5673.
3. Kokosis G, Davidson EH, Pedreira R, Macmillan A, Dorafshar AH.The use of computer-aided
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2018;76(5):1036–43.
4. Keyhan SO, Azari A, Youse P, Cheshmi B, Fallahi HR, Valipour MA.Computer-assisted horizontal translational osseous genioplasty: a simple method to correct chin deviation. Maxillofac
Plast Reconstr Surg. 2020;42(1):1–5.
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10. Zhang X, Han CY, Dai MJ, Chen JL, Zheng XH, Long J, Tang W, Tian WD, Liu L.Application
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11. Herford AS, Miller M, Lauritano F, Cervino G, Signorino F, Maiorana C. The use of virtual surgical planning and navigation in the treatment of orbital trauma. Chin J Traumatol.
2017;20(1):9–13.
12. Ramezanzade S, Keyhan SO, Tuminelli FJ, Fallahi HR, Youse P, Lopez-Lopez J.Dynamicassisted navigational system in zygomatic implant surgery: a qualitative and quantitative systematic review of current clinical and cadaver studies. J Oral Maxillofac Surg.
2021;79(4):799–812.
13. Fallahi HR, Keyhan SO, Cheshmi B, Zandian D, Moghadam PJ.Augmented reality: new horizons in oral and maxillofacial surgery. In: Integrated procedures in facial cosmetic surgery.
Cham: Springer; 2021. p.593–7.
14. Kazan R, Cyr S, Hemmerling TM, Lin SJ, Gilardino MS.The evolution of surgical simulation: the current state and future avenues for plastic surgery education. Plast Reconstr Surg.
2017;139(2):533e–43e.
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procedures in facial cosmetic surgery. Cham: Springer; 2021. p.853–5.
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Surg Clin North Am. 2021;33(1):23–30.
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S. O. Keyhan et al.
Fabricating Dental Implants
https://t.me/medicina_free
withPredesigned Structure
SeiedOmidKeyhan, ShaqayeqRamezanzade,
AbbasAzari, ParisaYousefi, andHamidRezaFallahi
1 Introduction
Oral rehabilitation using dental implants is a widely accepted treatment by both
dental practitioners and patients due to its reliable functional and aesthetic outcomes and long-term success rates. However, modern treatment with screw-type
implants acts poorly in addressing cases with severely atrophic jaws since adequate
bone quantity and quality are necessary for successful treatment [1].
S. O. Keyhan (*)
College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
Department of Oral and Maxillofacial Surgery, University of Florida, College of Medicine,
Jacksonville, FL, USA
Maxillofacial Surgery and Implantology and Biomaterial Research Foundation, Tehran, Iran
S. Ramezanzade
Maxillofacial Surgery and Implantology and Biomaterial Research Foundation, Tehran, Iran
Department of Odontology, University of Copenhagen, Copenhagen, Denmark
e-mail: shaqayeq.ramezanzade@sund.ku.dk
A. Azari
Tehran University of Medical Sciences, Tehran, Iran
e-mail: azari@tums.ac.ir
P. Youse
Department of Prosthodontics, Dental College, Isfahan University of Medical Science,
Isfahan, Iran
H. R. Fallahi
Maxillofacial Surgery and Implantology and Biomaterial Research Foundation, Tehran, Iran
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
A. Khojasteh et al. (eds.), Emerging Technologies in Oral and Maxillofacial
Surgery, https://doi.org/10.1007/978-981-19-8602-4_12
223
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S. O. Keyhan et al.
In the absence of proper bone, there will be a few workable solutions:
(a) Bone reconstruction using different techniques such as onlay/inlay bone graft-
ing, alveolar ridge split, sinus augmentation, guided bone regeneration, etc.
Despite the successful results, bone augmentation techniques, complexity of
the procedures, postsurgical complications and discomfort, and (sometimes)
the need for a graft donor site are the main drawbacks of these techniques [2, 3].
(b) Endosseous implants as graft-less solutions such as short, narrow, tilted, zygo-
matic, and pterygomaxillary implants [4–6]. Despite their high survival rate,
they are not common clinically yet.
(c) Fabrication of custom-made implants which are perfectly adapted to the mor-
phology and anatomy of edentulous sites in severbone bone resorption, when
the cases are unable/unwilling to undergo bone regeneration, this technique
using modern digital technologies represents a viable treatment option. This is
specically useful for elderly who need a xed prosthetic restoration but cannot
tolerate complex regenerative surgeries [7].
2 Customized Implants
Since the concept of osseointegration, dental implants have been considered as a
reliable treatment for oral rehabilitation. Considering the individual phenotype
characteristics of each patient’s alveolar bone and the need for increasing the accuracy of dental implant placement, a new therapeutic concept has been introduced in
recent years based on patient-specic implant dentistry which is based on computeraided design and computer-aided manufacturing technology (Figs.1 and 2).
Fig. 1 Considering the
individual phenotype
characteristics of each
patient’s alveolar bone and
the need for increasing the
accuracy of dental implant
placement, patient-specic
implants have been
introduced
Fabricating Dental Implants withPredesigned Structure
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Fig. 2 Considering the
individual phenotype
characteristics of each
patient’s alveolar bone and
the need for increasing the
accuracy of dental implant
placement, patient-specic
implants have been
introduced (designed by
Kaveh Software; Azari,
Abbasi, Keyhan, Iran)
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3 The Subperiosteal 3D-Printed Prosthesis andAdditively
Manufactured Subperiosteal Jaw Implants (AMSJI®)
The anchorage mechanism of osseointegrated dental implants makes them suitable
for subsequent suprastructure attachment. The high success rate and not very complicated clinical procedure make this treatment approach well adopted in edentulous
rehabilitation purposes (Fig.3).
The severely atrophic maxilla is always a challenging therapeutic problem; bone
augmentation is often required to enable placement of a sufcient number of
implants. On the other hand, extreme posterior alveolar resorption combined with
increased maxillary sinus pneumatization often leaves insufcient bone for implant
anchorage. More challenging cases may be occurred in presence of cleft deformities, maxillary sinus aplasia, and maxillectomy defects with discontinuity [8].
Several treatment options have been introduced for treatment of severely atrophic maxilla: subperiosteal implant, implants in the parasinus region, pterygoid
implants, short implants, and zygomatic implants and standard implants along with
grafting techniques [9].
Different bone augmentation techniques have their own merit and troubles. One
treatment commonly applied for major bone augmentation is using extraoral donor
sites. Extraoral harvest sites for bone reconstruction typically include the iliac crest,
the proximal tibia, the calvarium, and the rib. The complications associated with
bone graft harvesting techniques are hematoma, seroma, paresthesia, cosmetic
deformity of donor site, infection, and persistent pain [10].
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Fig. 3 The poor contour
of the alveolar bone makes
it very difcult to use
commercial root form
dental implants
S. O. Keyhan et al.
Some methodologies like zygomatic/pterygoid implants are very technique sensitive and several complications reported for them. For instance, a few cases of
serious complications are numbered for zygomatic implants including temporal
injuries of the infraorbital nerve (infraorbital nerve paresthesia) and penetration of
the orbital cavity during the surgical procedure. Late complications include loss of
osseointegration, chronic sinusitis, soft tissue infections, and oroantral communications [5, 6]. Ramezanzade etal. reported that the failure rates for zygomatic implants
in the literature ranged from 0 to 5% except for resected maxillas, which established
higher failure rates up to 21.43% [5].
Large and advanced bone and bone substitute graft techniques also show many
benets; larger alveolar augmentations and jaw reconstructions can use extraoral
harvesting sites such as the proximal tibia, the iliac crest, the calvarium, and the rib.
The volume of extraoral harvested bone varies based on the size, age, and gender of
the patient. Different sources are named for cortical and cancellous bone; for example, calvarium is a large source for cortical bone, the tibia for cancellous bone, and
the iliac crest for both cancellous and cortical bones [10]. Bone grafts in large parts
show different creeping action and shrinkage and even morbidity over time which
make them unpredictable in time [11].
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