Cutting bone with drills, burs, lasers and piezotomes: A comprehensive systematic review and recommendations for the clinician

Background: New tools for bone-cutting were introduced to oral and maxillofacial surgery in the last decade, such as lasers and piezotomes. Purpose: to evaluate most recent evidence, when surgical procedures performed with drills or burs are compared with laserand/or piezotome-surgical procedures in experimental and clinical studies and to assess possible advantages of their use in daily practice. Methods: a systematic search of various medical databases with specifi c keywords was performed, excluding studies published before 2006 for their possible invalidity by technological progress. Systematic reviews were assigned to Group 1, experimental studies ex vivo to Group 2, in vivo to Group 3 and clinical studies to Group 4. All studies in each of the groups 2 – 4 were appraised regarding their evidence, starting with a value of 0 for no evidence of advantages of lasers and/or piezotomes compared to rotary instruments, 1 for moderate evidence with verifi ed clinical impact and 2 for strong evidence and signifi cant clinical impact and statistically processed for their Evidence Value (EV) in each group and their Overall mean Evidence Value (OmEV). Results: 129 studies were fi nally included for evaluation. Two systematic reviews concluded lack of evidence for lasers to be advantageous over burs/drills. Nine reviews for piezotomes reveal strong evidence piezotome-surgery to signifi cantly reduce morbidity and to enhance soft-tissue preservation. Comparative experimental and clinical studies of burs/drills vs lasers revealed a low EV in Group 2 (EV:0,8), Group 3 (EV:0,5) and Group 4 (EV:0,5) with an OmEV of 0,6. Comparative studies burs/drills vs piezotomes resulted in a signifi cant EV in all groups (Group 2: 1,4, Group 3: 1,3, Group 4: 1,59) with an OmEV of 1,4. Conclusions: the results suggest too little evidence to establish lasers as an alternative to rotary instruments. Piezotomes seem to defi ne a possible new gold-standard in bone cutting due to their improved bone-healing, almost bone-lossless and precise osteotomy design, precise depth-control, softtissue protection as well as reduced intrasurgical and post-surgical morbidity. Review Article Cutting bone with drills, burs, lasers and piezotomes: A comprehensive systematic review and recommendations for the clinician Angelo Troedhan1*, Ziad Tarek Mahmoud2, Marcel Wainwright3 and Mohamed Moataz Khamis4 1Institute for Oral & Maxillofacial Surgery and Dentistry, General Hospital “Krankenhaus Hietzing” of the City of Vienna, Vienna 2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Egypt 3School of Dentistry, University of Seville, Spain 4Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Egypt Dates: Received: 29 July, 2017; Accepted: 12 August, 2017; Published: 14 August, 2017 *Corresponding author: Angelo Troedhan, Krankenhaus Hietzing, Institute for Oral & Maxillofacial Surgery and Dentistry, Wolkersbergenstraße 1, 1130 Vienna, Austria, Tel: 0043 664 5009246; Fax: 0043 1 544912821; Email: