Cutting characteristics of ultrasonic surgical instruments

Prévia do material em texto

Cutting characteristics of ultrasonic
surgical instruments
Dipesh Parmar
Malveen Mann
A. Damien Walmsley
Simon C. Lea
Authors’ affiliations:
Dipesh Parmar, Malveen Mann, A. Damien Walmsley,
Simon C. Lea, School of Dentistry, The University of
Birmingham, Birmingham, UK
Corresponding author:
Prof A. Damien Walmsley
School of Dentistry
The University of Birmingham
St Chad’s Queensway
Birmingham B4 6NN
UK
Tel.:þ1 21 237 2824
Fax: þ 1 21 625 8815
e-mail: a.d.walmsley@bham.ac.uk
Key words: laser vibrometry, surface analysis, surgical instrumentation, ultrasonic
Abstract
Objective: Ultrasonic surgical devices are becoming increasingly popular and work is required to
understand the performance of the cutting tips. This experimental study looks to investigate the way
in which ultrasonic bone cutting tools oscillate and how this oscillation is modified when contacted
against bone surfaces with varying loads. The defects produced in instrumented bone surfaces were
measured and related to the tip motion.
Methods: An ultrasonic cutting probe was scanned, unloaded, using a scanning laser vibrometer to
determine its free oscillation pattern and amplitude. This probe tip was then contacted against bone
under various loads to assess the modification in oscillation characteristics. Cuts were performed over a
period of 10 s. The cut bone surfaces were assessed using laser profilometry to determine defect
depths.
Results: The average vibration displacement amplitude at the probe tip, under load, was o12mm in
the longitudinal direction and was greatest for the cortical cutting mode. Elliptical probe motion was
successfully mapped out under the range of loads tested. Defect depths of up to 0.36 mm were
detected and were greatest when the tip was in contact with the bone with a load of 100 g.
Conclusions: This work showed that the nature of the surface being cut may significantly alter the
mode shape and magnitude of the probe oscillation. The maximum depth of cut with minimum
restraining of tip motion was achieved at 100 g contact load.
An ultrasonic drill was first used to cut cavities
in teeth in conjunction with abrasive slurry as
early as the 1950s (McFall et al. 1961). However,
with the development of high-speed rotary drills,
the technique failed to develop further although it
has recently enjoyed a revival in minimal cavity
preparation (Schmidlin et al. 2007). The main
use of ultrasonics in dentistry is as an oscillating
metal probe used to remove plaque and calculus
deposits from external tooth surfaces (Lea &
Walmsley 2009). These instruments, known as
ultrasonic scalers, work at kHz frequencies and
remove the attached deposits by the impact of the
oscillating probe with contribution from cavita-
tional forces produced in the cooling water that
flows over the tip (Felver et al. 2009). Another
main use of ultrasound in Dentistry is in endo-
dontics where an oscillating wire is used to clean
out debris and bacteria from within the root canal
of the tooth. Unlike ultrasonic scalers, endodon-
tic uses commonly rely on the biophysical forces
generated around a non-contacting file. This
technique is known as passive ultrasonic irriga-
tion (van der Sluis et al. 2007).
The principle of using a modified dental ultra-
sonic scaler to cut bone has been used in dental
surgical applications both in apical surgery and to
remove third molar teeth (Richman 1957; Hor-
ton & Tarpley 1981; Sortino et al. 2008). These
reports revealed that these ultrasonic instruments
provide several benefits in cutting bone including
better cutting control and the need for less pres-
sure (Horton & Tarpley 1981; Khambay &
Walmsley 2000a, 2000b). Additional benefits
may be obtained from the associated biophysical
phenomena such as cavitational activity and
acoustic microstreaming that are often associated
with the dental ultrasonic scaler (Felver et al.
2009; Lea & Walmsley 2009). Furthermore,
following the surgical removal of teeth (ultraso-
nically), the cut bone was smooth and not burn-
ished, bone healing was quicker and there was
less facial swelling following ultrasonic cutting
compared with rotary burs (Horton & Tarpley
1981; Sortino et al. 2008). It was also noted that
there was little residual debris and less bleeding at
the site (Horton & Tarpley 1981). This latter
effect is a probable result of the platelet disruption
attributed to the mechanical forces of acoustic
microstreaming (Walmsley et al. 1987). Re-
searchers have found that the removal of bone
with an ultrasonic handpiece takes place in a
Date:
Accepted 31 October 2010
To cite this article:
Parmar D, Mann M, Walmsley AD, Lea SC. Cutting
characteristics of ultrasonic surgical instruments.
Clin. Oral Impl. Res. 22, 2011; 1385–1390.
doi: 10.1111/j.1600-0501.2010.02121.x
c� 2011 John Wiley & Sons A/S 1385
mailto:a.d.walmsley@bham.ac.uk
single plane (longitudinal direction) compared
with the rotary drill, which has both a push and
pulling action (Khambay & Walmsley 2000b).
When cutting bone with an ultrasonic chisel,
both low forces and cutting rates are required
and cutting action is a result of a high long-
itudinal force. During the cutting process, the
instrument should be held at a low rake angle to
provide an adequate depth of cut (Khambay &
Walmsley 2000b). High temperature production
may prove to be a problem but careful control of
the cutting parameters may reduce the problem
(Cardoni et al. 2006). In general ultrasonic in-
struments are often designed to reflect conven-
tional bone instruments such as chisels, rotary
devices, files, ronguers or oscillating saws.
In the last decade, a novel family of ultrasonic
devices has been created to dissect hard tissue in
various maxillofacial surgical operations (Vercellotti
2004). This surgical technique is known as Piezo-
surgery and uses an adapted ultrasonic transducer
and generator that are capable of driving a range of
cutting inserts. This technique has become popular
in dental implantology where the preservation of
bone is required and the precise nature of the
piezoelectric handpiece serves this purpose well.
It is particularly useful in an open sinus lift surgical
procedure before the placement of implants (Tos-
cano et al. 2010). The popularity and usefulness of
the instrument has successfully found application
in other areas such as hand and otologic surgery
(Arnez et al. 2009; Salami et al. 2009).
Knowledge of how such cutting tools oscillate,
either freely in air or subsequently under a range
of loads may provide a more useful insight into
the cutting mechanisms in bone rather than a
qualitative appraisal of their working actions.
Previous work using scanning laser vibrometry
has demonstrated the oscillation characteristics
of powered instruments such as ultrasonic scalers
in both one-dimensional (1D) and 3D (Lea et al.
2003, 2009a, 2009b) and endodontic files (Lea et
al. 2004, 2010). Such information has proved
useful in understanding the nature of the contact
between scaler and tooth and any resulting
defects that occur following impact (Lea et al.
2009a, 2009b).
The aims of this study were to investigate the
oscillation behaviour of a Piezosurgery bone tip
under a range of operating conditions and to
correlate the vibration patterns of the tip with
the defects produced on bone. The Null Hypoth-
esis was that contact load would have no influ-
ence on the cutting characteristics of the
instrument or on the resulting bone defect.
Material and methods
A Piezosurgery ultrasound cutting unit/generator
was utilised for the investigation (Mectron
S.p.A., Carasco, Italy). Two of this system’s cut-
ting modes or ‘‘power settings’’ were tested; ‘‘cor-
tical’’ and ‘‘spongious’’. The handpiece of the
system was connected to an OT7 cutting probe
(Fig. 1), which was clamped with the probe’s
anterior surface facing the camera of a 1D scanning
laser vibrometer unit (model PSV-300-F/S HighFrequency Scanning Vibrometer System, Polytec
GmbH, Waldbronn, Germany). The laser beam
from the vibrometer was brought into focus on the
anterior surface of the metal probe to enable the
longitudinal oscillation pattern to be determined.
The phase-related vibration data for the lateral
component of the oscillation was recorded simul-
taneously with the longitudinal oscillation, via the
use of a first surface reflecting mirror positioned to
the side of the target object, as described previously
(Lea & Landini 2010). The surgical tip was oper-
ated, unloaded, in the ‘‘cortical’’ and ‘‘spongious’’
cutting settings of the system. Ten repeat scans
were performed, with and without water flow to
provide baseline readings with which to evaluate
the effect of applied load.
Loaded measurements
Bovine bone samples were cut, using a bone saw,
to provide cortical and spongious surfaces to
allow analysis of the corresponding settings on
the unit under the different loads. Keeping the
handpiece clamped in the same position as for the
unloaded part of the investigation, the piezoelec-
tric insert tip was loaded against the bone at 50 g.
Scans were again performed of the longitudinal
and lateral vibration axes of the tip (Fig. 2). Load
was maintained using a pan balance and applied
for a fixed duration of 10 s. Five repeat measure-
ments were performed for each bone cutting
setting and load, giving a total of 30 potential
markings. These experiments were repeated for
loads of 100 and 200 g.
The resulting bone sample defects were
scanned using a TaiCaan Xyris 4000 WL/CL
3D metrology system (TaiCaan Technologies
Ltd, Southampton, UK) as has been described
previously (Lea et al. 2009a, 2009b). The laser
profilometry enabled the depth of the resulting
instrumentation defects to be measured.
Statistical analysis
All vibration and defect data were analysed using
SPSS v17.0 (SPSS, Chicago, IL, USA). The sig-
nificance of variations in lateral and longitudinal
displacement amplitude and defect depth owing
to differences in equipment power setting and the
application of a load, were tested using univariate
analysis of variance (general linear model) and
using multiple post hoc comparisons (Tukey test)
at a significance level of P¼0.05, with the
dependent variables being displacement ampli-
tude and defect depth.
Results
Oscillation of unloaded piezoelectric insert
The cortical and spongious cutting modes of the
ultrasound system were tested. For both settings,
under unloaded conditions, the maximum oscil-
lation amplitude occurred at the free end or tip of
the metal probe. With no water flowing over the
metal probe, there was no significant difference
in the average magnitude of the longitudinal
vibrations at the tip of the probe for the cortical
(14.6mm) and spongious (12.6mm) bone cutting
settings (P¼0.064). Similarly, with water flow-
ing over the probe (at a rate of 20 ml/min) there
was no significant difference in the maximum
magnitude of the longitudinal vibrations (11.7mm;
cortical and 11.3mm; spongious) for the two bone
cutting modes (P¼0.942). For the lateral vibra-
tions, with or without water flow there is no
significant difference between the cortical and
spongious settings (P � 0.918).
Oscillation of loaded piezoelectric insert
Amplitude at the first antinode or free end of the
instrument
Fig. 1. An OT7 ultrasonic bone cutting tip.
Parmar et al �Cutting characteristics of ultrasonic surgical instruments
1386 | Clin. Oral Impl. Res. 22, 2011 / 1385–1390 c� 2011 John Wiley & Sons A/S
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The probe exhibited a node – antinode pattern, in
the longitudinal direction, along its length. Un-
der load, the cortical and spongious generator
settings (with the probe contacting cortical and
spongious bone surfaces, respectively) produced
significantly different vibration displacement
amplitudes at the probe tip (P¼0.003).
Cortical setting
For the cortical bone cutting setting, the aver-
age maximum displacement amplitudes (mea-
sured at the tip of the probe) were 11.4, 9.97
and 2.88mm at loads of 50, 100 and 200 g,
respectively (Table 1). The corresponding max-
imum lateral vibrations were 1.5, 0.70 and
0.57mm. Considering the longitudinal and lateral
data together, there were no significant differ-
ences in the maximum probe displacement am-
plitudes under loads of 50 and 100 g (P¼0.266).
However, the application of 200 g load resulted in
a significant reduction in maximum displace-
ment amplitude (Po0.0001).
Spongious setting
For the spongious setting, maximum displace-
ment amplitudes of 2.81, 3.04 and 3.53mm at
loads of 50, 100 and 200 g, were measured at the
probe tip, respectively (Table 1). The correspond-
ing maximum lateral vibrations were 1.91, 1.48
and 1.67mm. Considering the longitudinal and
lateral data together, there were no significant
differences in the maximum probe displacement
amplitudes under any of the loads tested
(P � 0.474).
Amplitude at the second antinode
The vibration amplitudes at the second antinode
were also measured (Table 1). For the cortical
bone setting it was found that the magnitude of
the oscillation at the second antinode was as great
as at the first antinode (P � 0.63). However, for
the spongious setting, the magnitude of the
oscillation at the second antinode was signifi-
cantly larger than at the tip (Po0.0001).
Measurement of bone defects
The defects produced by the insert tip on cortical
bone under the three loads were analysed using
laser profilometry. These scans produced colour-
graduated surface profiles (Fig. 3) through which
it was possible to determine defect depth (Table
1). The average maximum defect depths at 50,
100 and 200 g load were 0.12, 0.36 and 0.33 mm,
respectively. The defect depths produced under
50 g load were significantly shallower than those
produced at 10 and 200 g (Po0.0001). There
were no differences in defect depth produced
under 100 and 200 g load (P¼0.411). The defects
produced on the spongious bone could not be
detected using laser profilometry and hence any
analysis of the resulting defects was not possible.
Discussion
Ultrasonic surgical devices are beginning to
gain popularity although this is the first study
to investigate the mechanics of the interac-
tions between the oscillating probe and the bone
surface.
Unloaded probe oscillations
When the probe was operated in air there were no
significant differences in the longitudinal or lat-
eral vibration amplitudes between the cortical
and spongious bone cutting settings. This was
somewhat unexpected as it is common to observe
differences in unloaded probe oscillation charac-
teristics where there are distinct functions for a
system (Lea et al. 2003). However, this system is
designed to be used under contact with a bone
surface and so differences in system performance
may not become apparent until cutting of bone is
attempted.
Loaded probe oscillations
Loading was applied to the ultrasonic tip using
bone surfaces appropriate to the cutting mode of
the instrument; that is, cortical bone was used
with the cortical bone cutting setting and spon-
gious bone with the spongious ultrasound setting.
In the cortical bone cutting mode, loads of 50 and
100 g did not reduce the longitudinal vibration
amplitude of the probe at its tip (P � 0.301).
The application of 200 g load did, however,
Fig. 2. The ultrasonic bone cutting tip is shown operating while in contact against a bone surface and a scanning laser vibrometer
laser measurement is takingplace. A first surface reflecting mirror enables vibration data to be simultaneously acquired.
Table 1. Average maximum vibration magnitudes (� 1 standard deviation) at the first and second
antinodes under various loads for both generator settings. Bone defect depths for the cortical setting
are also provided
Generator setting Load (g) Vibration amplitude
first antinode (mm)
Vibration amplitude
second antinode (mm)
Defect
depth (mm)
Cortical 50 11.42 � 1.4 8.99 � 1 0.12 � 0.03
100 9.97 � 2.77 8.12 � 3.6 0.36 � 0.07
200 2.88 � 2.18 0.38 � 0.17 0.33 � 0.03
Spongious 50 2.81 � 0.33 11.23 � 1.29 –
100 3.04 � 0.86 13 � 2.61 –
200 3.53 � 0.49 12.65 � 1.99 –
Parmar et al �Cutting characteristics of ultrasonic surgical instruments
c� 2011 John Wiley & Sons A/S 1387 | Clin. Oral Impl. Res. 22, 2011 / 1385–1390
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significantly reduce the maximum vibration am-
plitude (Po0.0001). In the spongious mode it
was found that all loads tested significantly
reduced the longitudinal displacement amplitude
(Po0.0001).
For loads of 50 and 100g, longitudinal displace-
ment amplitude at the probe tip is smaller for
the spongious setting than the cortical setting
(Po0.0001). It is not known whether this differ-
ence in vibration amplitude is due to the ultra-
sound generator setting or to the nature of the
surface being cut. In the first instance, the gen-
erator may have a power feedback mechanism in
the cortical setting which, when the probe tip is
applied to bone causes an increase in power result-
ing in the observed larger vibration displacement
amplitude. As cancellous bone is a less dense
structure, power feedback may be less desirable
and so there is the reduction in amplitude with
load application. Another theory is that the trabe-
cular bone structure causes the ultrasonic cutting
blade to become trapped and reduces its ability to
oscillate fully. Further investigation of the poten-
tial bone structure causing damping is merited.
Oscillation mode shape
The mode shapes of the probe oscillations, under
the various load and ultrasound mode settings,
strengthen the theory that the cancellous bone
structure may be trapping the teeth of the probe
(Fig. 4). For the cortical setting, increasing the
load on the probe causes a reduction in the
measured displacement amplitude. However,
the reduction in the vibration displacement am-
plitude at 50 and 100 g loads was not significant
(P¼0.508). The vibrations at 200 g load are
significantly smaller than those at the lower
loads (Po0.001). The oscillation of the tip re-
vealed the presence of nodes and antinodes along
the length of the tip, i.e. points of minimum and
maximum displacement amplitudes during oscil-
lation, respectively. For the spongious setting,
load did not affect the tip displacement amplitude
(P¼1).
For the cortical bone setting, the greatest dis-
placement amplitude is located at the tip of the
cutting probe, directed in the longitudinal direc-
tion (Fig. 4a). For the spongious setting, cutting
against a cancellous bone surface, there was also a
vibration antinode at the probe tip. However, this
was not the position of the maximum vibration
amplitude. This was seen to occur further up the
probe length at a second antinode (Fig. 4b). The
teeth of the cutting blade may be becoming
trapped in the trabecular structure of the cancel-
lous bone. Because the generator is still trying to
supply the same amount of energy to the insert,
which can no longer oscillate as effectively at its
tip, larger vibrations are generated further up the
probe at the second antinode, leading to the
observed modification in the oscillation mode
shape.
When the ultrasonic insert was operated under
200 g load in the cortical setting, the resulting
mode shape was quite different from the mode
shapes obtained at lower loads. The greatest
magnitude of oscillation still occurred at the tip
of the insert but was significantly reduced from
the values obtained at 50 and 100 g. Further up
the probe, beyond the nodal point, the vibration
amplitude flattens out to a near-zero value. Pre-
Height[mm]
–5.8577
–5.9000
–6.0000
–6.1000
–6.2000
–6.3000
–6.4000
–6.5140
Fig. 3. Surface profile of the instrumented cortical bone surface obtained using laser profilometry. The colour scale shows the
variation in depth across the surface of the bone and the defects produced through instrumentation.
50
40
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10
0 1 2 3 4 5 6 7 8 9 10
–10
–20
–30
–40
–50
50
40
30
20
10
0
–10
–20
–30
–40
–50
V
ib
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tio
n 
di
sp
la
ce
m
en
t a
m
pl
itu
de
 (
m
ic
ro
m
et
re
s)
V
ib
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tio
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di
sp
la
ce
m
en
t a
m
pl
itu
de
 (
m
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ro
m
et
re
s)
50g
100g
200g
50g
100g
200g
a
b
Scan point along probe length
Scan point along probe length
Fig. 4. Maximum oscillation magnitude, along the length of the probe, for both the cortical (a) and spongious (b) bone cutting
settings (all load conditions). Although the position of the node remains constant for the two settings, the mode shapes are
otherwise quite different.
Parmar et al �Cutting characteristics of ultrasonic surgical instruments
1388 | Clin. Oral Impl. Res. 22, 2011 / 1385–1390 c� 2011 John Wiley & Sons A/S
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icense
vious work with endosonic files revealed that the
flattening of the oscillation mode shape was due to
poor coupling between the file and the handpiece
(Lea et al. 2010). With the piezosurgery unit,
increased load on the insert tip may be causing
extra strain at the point where the insert and
handpiece are connected leading to reduced ultra-
sound transmission to the insert. This warrants
further investigation as there appears to be reduced
efficiency of the unit under increasing loads.
3D probe motion
The 3D motion of the free end of the insert
tip under loads of 50, 100 and 200 g was plotted
(Fig. 5). The graph was produced by plotting
longitudinal and lateral displacement amplitudes,
provided through use of the first surface reflect-
ing mirror, at 201 phase intervals to produce
a 3601 oscillation pattern. As load is increased,
the ultrasonic tip retains an elliptical oscillation
pattern.
Defect depth
The average maximum probe tip displacement
amplitude and defect depth were plotted as a
function of load (Fig. 6). As load is doubled
from 50 to 100 g, the defect depth increases
significantly (Po0.0001) while the vibration dis-
placement amplitude is only reduced by 13%,
from 11.42 to 9.97mm which was not significant
(P¼0.508). However, increasing the load to
200 g significantly reduced the tip displacement
amplitude and defect depth (Po0.0001). There-
fore, our Null Hypothesis, that contact load
would have no influence on the cutting charac-
teristics of the instrument or on the resulting
bone defect, was rejected.
Piezoelectric surgery has been shown to be a
useful technique for cutting bone during various
surgical procedures (Horton & Tarpley 1981;
Vercellotti 2004; Sortino et al. 2008; Arnez et
al. 2009; Toscano et al. 2010). The majority of
these articles have focussed on the surgical tech-
nique and it advantage over rotary burs. Theuse
of piezoelectric surgery may be slower than con-
ventional techniques (Sortino et al. 2008) but it is
the precision of the procedure that is attractive to
the surgeon as it is less destructive to the bone.
This work shows that more work is needed to
understand how the ultrasonic tool operates. This
study focussed on one universal cutting tip and
showed that light pressure is needed to maximise
cutting of bone in vitro. Loads of around 200 g
produce changes in the oscillation of the tip and
may lead to strain being concentrated towards the
join between probe and transducer. The vibration
of the probe is not only longitudinal in direction
but is elliptical. This work also suggests that the
bone structure may play a part in the cutting
process. Against cortical bone the cutting process
is easily identified. However, when cutting into
cancellous bone the trabecular structure tends to
dampen the movement at the tip which may lead
to less effective surgery. Therefore this study
suggests that more work on the piezoelectric
surgery cutting tool is required and surgeons
should only use light pressure. When cutting
through cancellous bone the tip should not be
allowed to be buried in the structure in order to
prevent damping from occurring.
Conclusions
This work showed that the nature of the surface
being cut may significantly alter the mode shape
and magnitude of the probe oscillation. The
maximum depth of cut with minimum restrain-
ing of tip motion was achieved at 100 g contact
load. Higher loading of the probe results in
modified oscillation shapes, which reduce oscil-
lation amplitude and depth of cut.
Acknowledgements: This work was
supported by a grant from the UK Engineering
and Physical Science Research Council (EP/F0
20090). The laser profilometer was loaned by
the EPSRC Engineering Instrument Pool.
References
Arnez, Z., Papa, G., Renzi, N., Ramella, V., Panizzo,
N. & Toffanetti, F. (2009) Use of piezoelectric bone
scalpel in hand and reconstructive microsurgery. Acta
Chirurgiae Plasticae 51: 27–31.
Cardoni, A., Macbeath, A. & Lucas, M. (2006)
Methods of reducing cutting temperature in
ultrasonic cutting of bone. Ultrasonics 44:
e37–e42.
Felver, B., King, D.C., Lea, S.C., Price, G.J. & Walms-
ley, A.D. (2009) Cavitation occurrence around ultra-
sonic dental scalers. Ultrasonics Sonochemistry 16:
692–697.
15
10
5
0
0
–5
–10
–15
–1.5 –1 –0.5 0.5 1 1.5
Longitudinal
vibrations
(micrometers)
Lateral vibrations (micrometres)
50g load
100g load
200g load
Fig. 5. Three-dimensional motion detected at the tip of the probe for various load conditions (cortical setting).
15
10
5
0
0 50 100 150 200 250
0
1
2
3
V
ib
ra
tio
n 
di
sp
la
ce
m
en
t a
m
pl
itu
de
 (
m
ic
ro
m
et
re
s)
D
ef
ec
t d
ep
th
 (
m
m
)
Load (grams)
Fig. 6. Plot demonstrating the effect of load on vibration displacement amplitude and defect depth (cortical bone cutting
setting). Maximum cut depth occurs under 100 g while maximum vibration amplitude is also maintained.
Parmar et al �Cutting characteristics of ultrasonic surgical instruments
c� 2011 John Wiley & Sons A/S 1389 | Clin. Oral Impl. Res. 22, 2011 / 1385–1390
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iley.com
/doi/10.1111/j.1600-0501.2010.02121.x by U
niversity E
stadual D
e C
am
pina, W
iley O
nline L
ibrary on [24/04/2024]. See the T
erm
s and C
onditions (https://onlinelibrary.w
iley.com
/term
s-and-conditions) on W
iley O
nline L
ibrary for rules of use; O
A
 articles are governed by the applicable C
reative C
om
m
ons L
icense
Horton, J.E. & Tarpley, T.M. (1981) Clinical applica-
tions of ultrasonic instrumentation in the surgical
removal of bone. Oral Surgery 51: 236–42.
Khambay, B.S. & Walmsley, A.D. (2000a) Investiga-
tions into the use of an ultrasonic chisel to cut bone.
Part 1 – forces applied by clinicians. Journal of
Dentistry 28: 31–37.
Khambay, B.S. & Walmsley, A.D. (2000b) Investigations
into the use of an ultrasonic chisel to cut bone. Part 2 –
cutting ability. Journal of Dentistry 28: 39–44.
Lea, S.C., Felver, B., Landini, G. & Walmsley, A.D.
(2009a) Three-dimensional analyses of ultrasonic
scaler oscillations. Journal of Clinical Periodontology
36: 44–50.
Lea, S.C., Felver, B., Landini, G. & Walmsley, A.D.
(2009b) Ultrasonic scaler probe oscillations and tooth
surface defects. Journal of Dental Research 88:
229–234.
Lea, S.C. & Landini, G. (2010) Reconstruction of dental
ultrasonic scaler 3D vibration patterns from phase-
related data. Medical Engineering and Physics 32:
673–677.
Lea, S.C., Landini, G. & Walmsley, A.D. (2003) Ultra-
sonic scaler tip performance under various load condi-
tions. Journal of Clinical Periodontology 30: 876–881.
Lea, S.C. & Walmsley, A.D. (2009) Mechano-
physical and biophysical properties of power driven
scalers – driving the future of powered instrument
design and evaluation. Periodontology 2000 51:
63–78.
Lea, S.C., Walmsley, A.D. & Lumley, P.J. (2010)
Analyzing endosonic root canal file oscillations
within a water tank environment. Journal of Endo-
dontics 36: 880–883.
Lea, S.C., Walmsley, A.D., Lumley, P.J. & Landini, G.
(2004) A new insight into the oscillation character-
istics of endosonic files used in dentistry. Physics in
Medicine and Biology 49: 2095–2102.
McFall, T.A., Yamane, G.M. & Burnett, G.W. (1961)
Comparison of the cutting effect on bone of an
ultrasonic cutting device and burs. Journal of Oral
Surgery, Anesthesia and Hospital Dental Services 1:
200–209.
Richman, M.J. (1957) The use of ultrasonics in root
canal therapy and root resection. Journal of Dental
Medicine 12: 12–18.
Salami, A., Dellepiane, M., Proto, E. & Mora, R. (2009)
Piezosurgery in otologic surgery: four years of experi-
ence. Otolaryngology Head and Neck Surgery 140:
412–418.
Schmidlin, P.R., Wolleb, K., Imfeld, T., Gygax, M. &
Lussi, A. (2007) Influence of beveling and ultrasound
application on marginal adaptation of box-only Class
II (slot) resin composite restorations. Operative Den-
tistry 32: 291–297.
Sortino, F., Pedullà, E. & Masoli, V. (2008) The Piezo-
electric and rotatory osteotomy technique in im-
pacted third molar surgery: comparison of
Postoperative Recovery. Journal of Oral and Max-
illofacial Surgery 66: 2444–2448.
Toscano, N.J., Holtzclaw, D. & Rosen, P.S. (2010) The
effect of piezoelectric use on open sinus lift perfora-
tion: a retrospective evaluation of 56 consecutively
treated cases from private practices. Journal of Perio-
dontology 81: 167–171.
van der Sluis, L.W., Versluis, M., Wu, M.K. & Wesse-
link, P.R. (2007) Passive ultrasonic irrigation of the
root canal: a review of the literature. International
Endodontic Journal 40: 415–426.
Vercellotti, T. (2004) Technological characteristics and
clinical indications of piezoelectric bone surgery.
Minerva Stomatologica 53: 207–214.
Walmsley, A.D., Laird, W.R.E. & Williams, A.R. (1987)
Intra-vascular thrombosis associated with dental ul-
trasound. Journal of Oral Pathology 16: 256–259.
Parmar et al �Cutting characteristics of ultrasonic surgical instruments
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