***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Piezoelectric surgery ( PES ) uses a modulated ultrasonic frequency that permits highly precise and safe hard tissue cutting . A retrospective study on a series of  spiral family implants  inserted with or without PES split crest was performed to verify if implants inserted into crests split using PES have a comparable outcome to those inserted into unsplit bone . MATERIAL AND METHODS In the period from May 2004 to November 2007 , 86 patients ( 55 women and 31 men , median age 53 yrs ) were operated on and 234 spiral family implants were inserted . Among these , 21 were inserted into PES split crest . Mean follow-up was 13 months ( 3 to 35 months ) . The Kaplan-Meier algorithm was used to compare the 2 groups in survival and clinical success ( ie , decreased bone resorption around implant neck ) . RESULTS Only 9 of 234 implants were lost ( ie , survival rate 96.2 % ) , all of which belonged to the unsplit group but no statistical difference was demonstrated . To detect if PES split crest produces a better clinical outcome in comparison with fixtures inserted into unsplit alveolar ridges , crestal bone loss was compared in the remaining loaded implants ( 234 - -9 lost--5 not prosthetized = 220 ) . No statistical significant difference was detected by comparing implants inserted into PES split crests with untreated alveolar ridges , although a better trend was visible for fixtures inserted into PES split crests . CONCLUSION PES split crests provide several advantages and clinical outcomes that are not worse in terms of bone remodeling , if compared with st and ard procedures Purpose : This study compares implant primary stability achieved in cancellous bone after placement in piezoelectric prepared sites versus conventionally drilled sites . Material s and Methods : Four bovine ribs were r and omly assigned and placed in a water bath at 36.5 ° C . Five sites per rib ( total n = 20 sites ) were prepared using piezoelectric system ( test ) or conventional drills ( control ) with twenty 10 × 3.6-mm Implantium implants placed . Using Osstell Mentor quantitative analysis , 5 resonance frequency analysis [ implant stability quotient { ISQ } ] values per implant were recorded at 5 locations for a total of 100 measurements . Results : Independent t test analysis indicated significant difference in primary stabilities between groups : t ( 17 ) = 2.637 , P = 0.17 , with equal variance assumption satisfied ( P = 0.196 ) . Examination of means indicated a higher mean ISQ  for piezoelectric than for conventional : 58.9 ( + 8.55 ) versus 49.2 ( + 7.33 ) , respectively . Analysis of variance indicated a significant difference in mean ISQ value by rib . Tukey test indicated significantly higher ISQ values for rib A ( test ) than ribs B , C ( control ) , and D ( test ) . Conclusion : Implant site preparation using the piezoelectric system gives higher implant primary stability in cancellous bone . However , variations in quality across bones may have affected the results PURPOSE The objective of the present investigation was to longitudinally monitor stability changes of  implants inserted using traditional rotary instruments or piezoelectric inserts , and to follow their variations during the first 90 days of healing . MATERIAL S AND METHODS A r and omized , controlled trial was conducted on 20 patients . Each patient received two identical , adjacent implants in the upper premolar area : the test site was prepared with piezosurgery , and the control site was prepared using twist drills .  Resonance frequency analysis measurements were taken by a blinded operator on the day of surgery and after 7 , 14 , 21 , 28 , 42 , 56 , and 90 days . RESULTS At 90 days , 39 out of 40 implants were osseointegrated ( one failure in the control group ) . Both groups showed an initial decrease in mean implant stability quotient ( ISQ ) values : a shift in implant stability to increasing ISQ values occurred after 14 days in the test group and after 21 days in the control group . The lowest mean ISQ value was recorded at 14 days for test implants ( 97.3 % of the primary stability ) and at 21 days for the control implants ( 90.8 % of the primary stability ) . ISQ variations with respect to primary stability differed significantly between the two groups during the entire period of observation : from day 14 to day 42 , in particular , the differences were extremely significant ( p < .0001 ) . All 39 implants were in function successfully at the visit scheduled 1 year after insertion . CONCLUSIONS The findings from this study suggest that ultrasonic implant site preparation results in a limited decrease of ISQ values and in an earlier shifting from a decreasing to an increasing stability pattern , when compared with the traditional drilling technique . From a clinical point of view , implants inserted with the piezoelectric technique demonstrated a short-term clinical success similar to those inserted using twist drills OBJECTIVES To date , there have been no studies on the outcome of osseointegration of alveolar bone  around dental implants inserted with piezoelectric osteotomy versus conventional osteotomy . The aim of this study was to compare the radiographic differences , through evaluation of peri-implant bone density , between implant insertion using traditional surgical technique and piezoelectric technique . METHOD AND MATERIAL S Forty patients were selected whose treatment consisted of a minimum of two implants placed in nonpathologic native bone . A single type of implant surface ( SLA ) was chosen . The implants were placed following the manufacturer protocol for traditional surgical technique and piezoelectric technique . Radiographs were taken following surgery and 30 , 60 , and 90 days after surgery . The bone density was studied with the densitometry application . RESULTS AND CONCLUSION All patients completed the study period with success . Despite a limited number of treated patients , the results of this pilot study demonstrated that ( 1 ) piezoelectric implant site preparation promotes better bone density and osteogenesis , and ( 2 ) the piezoelectric technique is predictable , with a 100 % success rate in this study AIM To evaluate the effect of piezoelectric surgery ( PS ) implant osteotomy on biochemical and radiological parameters of crestal bone ( CB ) loss .  MATERIAL AND METHODS In this r and omized , controlled , clinical study , 38 osteotomies were prepared with PS and drilling in the posterior maxilla in a split-mouth design . Implants were placed and left for non-submerged healing . Osteotomy time , insertion torque , pain perception , probing depth , and modified gingival and plaque indices were recorded . Peri-implant sulcular fluid ( PISF ) was collected from four sites of each implant at 2 , 4 , 8 , 12 , and 24 weeks . PISF sample s were analyzed by ELISA for receptor activator of nuclear factor kappa-B-lig and ( RANKL ) and osteoprotegerin . CB loss was assessed on periapical radiographs at the 12th and on cone beam computed tomography ( CBCT ) at the 24th weeks . The influence of time and osteotomy method on biochemical and radiological parameters of CB loss employed statistical method of Brunner-Langer . RESULTS Osteotomy time for PS group was significantly longer than the drill group ( P < 0.05 ) . Pain perception that was lower in the PS than in the drill group depended on osteotomy method ( P < 0.05 ) . PS group had lower RANKL total amount than the drill group ( P < 0.05 ) . Mean CB loss on periapical radiographs at the 12th week for PS and drill groups were 0.11 and 0.18 mm , respectively ( P > 0.05 ) . At the 24th week , PS and drill groups showed 0.11 and 0.12 mm CB losses on CBCT , respectively ( P > 0.05 ) . However , CB loss values did not depend on osteotomy modality ( P > 0.05 ) . CONCLUSION PS may modify and reduce bone-destructive inflammatory response during implant osseointegration . Therefore , on the molecular level , it might be a less traumatic osteotomy modality than drilling although this was not reflected by CB loss values in the present study PURPOSE Piezo-osteotomy feasibility as a substitute for the conventional saw in orthognathic surgery was evaluated regarding operative technique , blood loss , time requirement , and nerve and vessel integrity . PATIENTS AND METHODS Fifty patients had orthognathic surgery procedures in typical distribution using piezosurgical osteotomy : 22 ( 44 % ) monosegment , 26 ( 52 % ) segmented Le Fort I osteotomies ; 48 ( 48 % ) sagittal split osteotomies , 6 ( 12 % ) symphyseal , and 4 ( 4 % ) m and ibular body osteotomies . Controls were 86 patients with conventional saw and chisel osteotomies : 57 ( 66 % ) monosegment , 25 ( 29 % ) segmented Le Fort I osteotomies , 126 ( 73 % ) sagittal split , and 4 ( 5 % ) symphyseal osteotomies .  RESULTS Piezosurgical bone osteotomy permitted individualized cut design s , enabling segment interdigitation after repositioning . Angulated tools weakened the pterygomaxillary suture ; auxiliary chisels were required in 100 % of cases for the nasal septum , and lateral nasal walls as 46 % pterygoid processes . After downfracture , the dorsal maxillary sinus wall and pterygoid processes were easily reduced . Hemorrhage was successfully avoided with average blood loss of 541 + /- 150 mL versus 773 + /- 344 mL ( P = .001 ) for a conventional bimaxillary procedure . Sagittal m and ibular osteotomy required considerable time ( auxiliary saw in 13 % ) ; the lingual dorsal osteotomy was mostly performed tactile . Time investment remained unchanged : 227 + /- 73 minutes per bimaxillary st and ard osteotomy versus 238 + /- 61 minutes ( P = .5 ) ; clinical courses and reossification were unobtrusive . Alveolar inferior nerve sensitivity was retained in 95 % of the study collective versus 85 % in the controls ( P = .0003 ) at 3 months postoperative testing . CONCLUSIONS Piezoelectric osteotomy reduced blood loss and inferior alveolar nerve injury at no extra time investment . Single cases require auxiliary chiseling or sawing . Piezoelectric drilling for screw insertion and complex osteotomy design s may be developed to maintain bone contact or interdigitation after repositioning and minimize need for osteofixation AIM The first aim of the present experiment was to compare bone healing at implants installed in recipient sites prepared with conventional drills or a piezoelectric device . The second aim was to compare implant osseointegration onto surfaces with and without dendrimers coatings . MATERIAL AND METHODS Six Beagles dogs were used in this study . Five implants with two different surfaces , three with a ZirTi ( ® ) surface ( zirconia s and blasted , acid etched ) , and two with a ZirTi( ® )-modified surface with dendrimers of phosphoserine and polylysine were installed in the right side of the m and ible . In the most anterior region ( P2 , P3 ) , two recipient sites were prepared with drills , and one implant ZirTi ( ® ) surface and one coated with dendrimers implants were installed at r and om . In the posterior region ( P4 and M1 ) , three recipient sites were r and omly prepared : two sites with a Piezosurgery ( ® ) instrument and one site with drill and two ZirTi ( ® ) surface and one coated with dendrimers implants installed . Three months after the surgery , the animals were sacrificed for histological analysis . RESULTS No complications occurred during the healing period . Three implants were found not integrated and were excluded from analysis . However , n = 6 was obtained . The distance IS-B at the buccal aspect was 2.2 ± 0.8 and 1.8 ± 0.5 mm , while IS-C was 1.5 ± 0.9 and 1.4 ± 0.6 mm at the Piezosurgery ( ® ) and drill groups , respectively . Similar values were obtained between the dendrimers-coated and ZirTi ( ® ) surface implants . The BIC% values were higher at the drill ( 72 % ) compared to the Piezosurgery ( ® ) ( 67 % ) sites . The BIC% were also found to be higher at the ZirTi ( ® ) ( 74 % ) compared to the dendrimers-coated ( 65 % ) implants , the difference being statistically significant . CONCLUSION This study has revealed that oral implants may osseointegrate equally well irrespective of whether their bed was prepared utilizing conventional drills with abundant cooling or Piezosurgery ( ® ) . Moreover , the surface coating of implants with dendrimers phosphoserine and polylysine did not improve osseointegration We used resonance frequency analysis to evaluate the implant stability quotient ( ISQ ) of dental implants that were installed in sites prepared by either conventional drilling or piezoelectric tips . We studied 30 patients with bilateral edentulous areas in the maxillary premolar region who were r and omised to have the implant inserted with conventional drilling , or with piezoelectric surgery .  The stability of each implant was measured by resonance frequency analysis immediately after placement to assess the immediate stability ( time 1 ) and again at 
    Output:
    
A statistically significant difference in the operating time was also shown between the 2 techniques with more time required using PED .
With the limitations of this review in mind , PEDs appear to be a viable alternative to traditional drilling techniques for ISP .
With the exception of prolonged operating time associated with the use of PEDs , both techniques were comparable in terms of the marginal bone level changes and the risk of implant failure .