6.4 MARPE Piezo Problems
Cutting your palate with a saw is obviously risky
This is Chapter 6.4 of the JawHacks ebook. See the full Table of Contents here.
MARPE Piezotome Problems
Necrosis
The first major piezotome complication is necrosis, which is tissue death. This occurs when tissue is overheated. Piezo has the potential to overheat bone tissue because it operates by vibrating ultrasonically, which generates heat.
Mitigation
The key to preventing necrosis with piezo is motion and lubrication. The provider must keep the knife tip wet and in constant motion.
Think of a masonry saw. When masons and tilers cut stone, they use a saw with an integrated hydration system and water basin. As the saw encounters the stone, the blade is wetted in order to cool the site.
Similarly, the piezotome tip needs to be hydrated with a liquid such as saliva as it is dipped in and out of the bone.
This constant dipping in and out of the surgical site also prevents the piezotome from contacting any one area of bone too long to the point that it overheats and kills it.
Poor Healing of Palatal Mucosa
The second major piezotome complication is poor healing of the palatal mucosa. This occurs if the palatal skin, which must be penetrated in order for the piezo to reach the palatal bone, does not heal after surgery.
If the unhealed mucosa is hidden beneath the expander, then this can cause treatment failure, requiring removal of the appliance to treat the mucosal wound.
This exact problem occurred with a prominent New York dentist who was being treated with a Custom MARPE. He had his appliance removed and then decided not to try again, quitting on treatment completely.