الفهرس 
Introduction.Only 14 pages are availabe for public view
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Abstract
Cystic lesions of the jaw have been under research for various treatment modalities. Yet, the procedures of enucleation and marsupialization are still considered the blueprint of cystic lesions treatment in the maxillofacial practice.
Complete elimination of the pathology, restoration of function, form, and esthetics along with the protection of adjacent vital structures and improving the patient’s quality of life postoperatively are considered the main goals set by the surgeon during treatment planning. Enucleation is still the most performed procedure for the treatment of cystic lesions of the jaws and is considered satisfactory for small lesions with a relatively simpler procedure with less morbidity and fewer post-operative complications as long as it is performed correctly, for larger lesions other options are proposed, such as decompression or marsupialization.
For extremely large lesions with a known tendency for recurrence, resection has been the option with the most favorable results in terms of treatment but with larger morbidity factors. Treatment planning for cystic lesions has also taken great advantage of the progress and recent advances in maxillofacial radiology, where cone-beam computed tomography has been a great advent for the ac curate estimation of the size, extension, and relation to neighboring structures of cystic lesions, which has brought a lot more success to treatment planning and accurate choice of the surgical technique.
Piezosurgery is a freshly introduced surgical maneuver for cutting hard tissue by targeting mineralized tissue and at the same time being gentle on the adjacent soft tissues such as the brain, nerves, vessels, and mucosa working based on ultrasound micro-vibrations. Piezotome can be used in multiple oral and maxillofacial procedures such as dentoalveolar procedures (impactions and cyst removal), sinus floor elevation, alveolar ridge splitting, lateralization of the inferior alveolar nerve, bone graft harvesting, and orthognathic surgery, aesthetic facial surgery and temporomandibular joint surgeries.
The merits of using piezosurgery in oral surgery are the preservation of soft tissue and neurovascular bundles, the absence of vibrations making it more tolerable by the patient, and Improved survival of os teocytes compared to other bone harvesting methods leading to an earlier increase in BMP-4 and TGF-2 proteins and fewer pro- inflammatory cytokines in bone.
In cyst removal, either odontogenic or non-odontogenic, the use of piezoelectric derives showed more efficacy regarding bone healing after cyst removal and safety on the adjacent vital structures. Despite the extended duration of the procedure, piezosurgery surpassed conventional surgery in terms of intraoperative bleeding, epithelial lining perforation, and also after surgery; complications, and recurrence.
Surgical guides have been introduced into the field of oral and maxillofacial surgery to eliminate drawbacks associated with complicated anatomy previously managed by the skill of the operator. There are two types of guides: dynamic or static, the former provides the operator with a chance to apply the preplanned treatment to work while viewing it simultaneously on a screen while the latter is constructed using 3D printing using computed tomography or cone-beam computed tomography.
In oral and maxillofacial surgery templates have been involved in procedures including facial reconstruction secondary to trauma or pathology, orthognathic surgery, or implantology to help the operator perform bone cutting or drilling in the most accurate position and angulation or guide the condyle into its proper position. Templates used as a guide for cutting using piezotome to create a bone lid have shown promising outcomes regarding the duration of operation and preservation of anatomic structure for removal of pathological lesions or impacted teeth.
Although templates play a role in the success of surgical procedures, they have been associated with some complications including high cost and extra time needed after processing.
The bone lid technique is another approach to the removal of mandibular lesions, where a window is cut within the bone using regular rotary instruments, micro–saws, or piezoelectric devices. The bone removed is preserved and then placed again with mini plates, trans- fixation screws, or adhesive acrylic tissue.
The advantage of using this technique is avoiding large bony defects after the removal of intra-bony lesions. Micro plates and screws are used to stabilize the bony window after placement and prevent fracture risk. This approach can also be used in the case of surgical endodontic treatment, removal of any fractured or failed implants, or deeply impacted teeth