W&H Impex
The impact of piezotechnology on surgical outcomes
Interview with v.Prof.OA Dr.Dr. Angelo Troedhan, and Dr António Matos da Fonseca.
Precision is key in maxillofacial surgery. With piezoelectric technology, surgeons can perform highly accurate osteotomies while safeguarding delicate soft tissue and vital anatomical structures. We delve deeper into the topic with two internationally renowned experts – v.Prof.OA Dr.Dr. Angelo Troedhan from Vienna and Dr António Matos da Fonseca from Lisbon – who offer valuable perspectives from both scientific research and practical clinical experience. In this interview, they explain how piezotechnology improves clinical outcomes, and reshapes surgical routines.
- Lisbon, Portugal
- Vienna, Austria
Dr. Troedhan, let us start by talking about you. You are an internationally leading surgeon and implantologist – what is your focus?
Dr Troedhan: I currently run a private clinic in Vienna, specialising in maxillofacial surgery, including bone augmentation and implantology. I also perform reconstructive procedures at two hospitals. My research into piezoelectric devices over the past 20 years has significantly enriched my practice, offering exceptional precision and patient benefits.
Dr Matos da Fonseca, you are director of the Clínica da Face in Lisbon and specialised in the treatment of dentofacial deformities. May you please briefly introduce yourself?
Dr Matos da Fonseca: I’ve been dedicated to facial surgery for 47 years, with a particular focus on orthognathic procedures. At Clínica da Face in Lisbon, my team and I prioritise preserving vital structure, especially facial nerves. As my colleague Dr Troedhan knows, mandibular surgery can be complex, but with piezoelectric instruments, we achieve precise results while protecting vital structures.
Dr Troedhan, Dr Matos da Fonseca, in your opinion, how has maxillofacial surgery evolved in recent years?
Dr Troedhan: The first piezoelectric devices in 2005 lacked the necessary power, which meant that procedures took longer than with rotary instruments. Now, thanks to improved technology and a certain learning curve, piezoelectric surgery is already comparable while simultaneously enhancing precision and soft tissue preservation. While piezoelectric surgery was once met with scepticism, today, it is increasingly making its way into maxillofacial procedures. The progress took two decades – and the development continues.
Dr Matos da Fonseca: All the technology is being developed to further improve the quality of patient treatment. And piezoelectric surgery contributes very well to treatment outcomes. For us, it is necessary to know how to use it, and the younger generation, in particular, needs to be trained how to deal with the new method. I share my colleague’s view – there’s still a long way to go.
Dr. Troedhan: Another aspect is time. I used to aim for speed in surgery, but with piezo technology, that’s changed. A maxillary osteotomy that used to take 5 seconds now takes 4 minutes. It’s slower – but the precision, control, and ability to shape osteotomies make it worthwhile. Preserving vital structures, especially nerves, is our priority. Piezoelectric surgery may be slower, but the benefits in terms of reduced morbidity and complications are obvious.
Time used to be my priority in surgery, but piezo techniques shifted that focus. Though slower, they offer unmatched precision, the ability to shape osteotomies and help preserve vital structures like nerves. After 20 years of moving from intuition to evidence, the benefits – reduced morbidity and fewer complications – are clear.
v.Prof.OA Dr.Dr. Angelo Troedhan
You’ve both tested the new W&H Med Console, which combines piezo and rotary technology. How do you think this 2-in-1 solution fits into daily surgical routines?
Dr Matos da Fonseca: The ability to use both drive types without switching devices is essential. Time loss during surgery, especially from changing setups or pedals, can be disruptive – but this solution streamlines the process. When removing larger bone volumes, rotary instruments are more efficient. The combined system saves time and offers flexibility. In my opinion, coordination of both technologies is essential, as piezo alone doesn’t yet match the full performance of a dual setup.
The ability to use both drive types – piezo and rotary drive – with the W&H Med Console without switching devices is essential. Time loss during surgery, especially from changing setups or pedals, can be disruptive. The W&H solution significantly streamlines the work process.
Dr António Matos da Fonseca
Dr Troedhan: I fully agree with Dr Matos da Fonseca. Back in 2006, I believed piezo devices would replace rotary instruments within a decade. That didn’t happen. Rotary instruments are still indispensable for tasks like drilling screw holes that require system-specific precision. A combined piezo-rotary device is therefore a must – and having both in one device saves time and space in the OR.
A combined piezo-rotary device like the W&H Med Console is indispensable – having both in one device saves time and space in the OR.
v.Prof.OA Dr.Dr. Angelo Troedhan
How widespread is piezoelectric surgery in the field of maxillofacial surgery in the DACH region in Portugal or across Europe? Is it something that has definitely arrived at the clinics?
Dr Troedhan: In the DACH region, progress is slow due to rigid hierarchies. If senior university leaders don’t support piezoelectric surgery, younger surgeons rarely get hands-on experience – learning only through congresses and peers. Although acceptance is increasing, our 2006 dream of universal use of piezo devices remains a distant prospect. Perhaps in another 20 years.
Dr Matos da Fonseca: It’s essential to show results and train both students and surgeons in new technologies. Years ago, I was invited by university to lead a master’s program in orthognathic surgery, and today, our graduates work in 24 countries. We also teach in English, welcoming participants to Portugal for hands-on experience: seeing piezoelectric surgery in action – its precision and cutting quality – leaves a lasting impression.
Dr Troedhan: In my teaching experience across the Middle East and Asia, I’ve seen a very different mindset. These regions are progressive and very open to new technologies, because they want to be on top in science. In countries like Egypt, piezoelectric surgery is already standard.
What are the main challenges in introducing innovative surgical technologies like piezoelectric surgery adopted in clinical practice?
Dr Troedhan: Some procedures or minimally invasive surgical protocols wouldn’t be possible without piezoelectric surgery. I'm trying to convince people that it is necessary to change the shape and the quality of the osteotomy. But in medicine, everything must be proven. Even if a new technique significantly outperforms traditional methods, it can take years – first for scientific validation and then for a wider acceptance. That’s the challenge: progress takes time because patient safety demands solid evidence.
Surgical procedures often result in swelling and bruising. What has been your experience regarding postoperative healing following the use of piezo surgical techniques?
Dr Troedhan: Our first study on impacted molar surgery showed that using piezo techniques reduced pain and swelling by almost 50%. Initially met with scepticism, it took years – and repeated double-blind studies by universities worldwide – to confirm our findings. Today, piezoelectric surgery is recognised for significantly lowering complications and improving outcomes, especially in procedures such as molar extraction and it has been proven effective in all types of maxillofacial surgery. The advantages are clear: greater precision, less bleeding, and fewer complications during surgery, as well as lower morbidity, less pain and swelling for patients afterward.
The healing benefits of piezoelectric surgery are also well-supported by research. A professor friend of mine was able to demonstrate faster bone healing compared to rotary instruments, and subsequent studies showed up to four times higher osteoblast activity in piezo-treated sites. There is no longer any question: piezoelectric surgery has been proven to significantly improve bone healing – faster and with better quality.
Dr Matos da Fonseca: In orthognathic surgery, it’s difficult to scientifically prove faster healing, as we can’t ethically re-enter the bone after a year. Therefore, I rely on clinical experience. Post-operative recovery with piezoelectric surgery is consistently smooth – no infections, minimal discomfort – which strongly suggests improved healing.
It’s essential to show results and train both students and surgeons in new technology. Experiencing piezoelectric surgery in action – its precision and cutting quality – leaves a lasting impression.
Dr António Matos da Fonseca
What developments or trends do you foresee for the future of maxillofacial surgery?
Dr Matos da Fonseca: Technically, facial surgery is unlike to change much in the coming years. However, diagnosis and planning will evolve significantly thanks to artificial intelligence. Since each face requires a personalised approach based on individual anatomical features, AI will be a powerful tool for adapting treatment plans. While surgical techniques inside the face are unlikely to see major breakthroughs in the next 15 to 20 years.
Dr Troedhan: I believe the future lies in virtual reality planning. Every surgical step will be simulated in VR, with the handpieces tracked and guided by the system. The computer will assist in executing each step precisely – this could redefine hand-driven surgery.
What personally fascinates you about your profession?
Dr Matos da Fonseca: I entered the faculty at 17, and from the moment I saw my first patient in a hospital, my life changed. Since then, I’ve worked daily in medicine and surgery – my true passion. I’m deeply committed to this field. My wife and my family are fantastic, they always gave me space. What drives me most is helping people with facial deformities; I love turning sadness into joy.
Dr Troedhan: Maxillofacial surgery was an easy choice – it offers one of the broadest scopes in medicine, from tumour and orthognathic surgery to trauma care and reconstruction. I enjoy the flexibility it gives me: I can work independently on most procedures, and rely on clinical support for complex cases. It allows me to shape my career according to my interests at any stage of life, which is exactly why I chose it.
Thank you for the interview.
About the interviewees
- Vienna, Austria
- Specialist in Dental, Oral and Maxillofacial Surgery
- Visiting Professor at the Faculty of Dentistry, Health Science University Vientiane, and the Faculty of Dentistry, Alexandria University
- Member of the Austrian Society for Oral, Maxillofacial Surgery
- Consulting CMF Specialist of the Traumatology Department of the Wilhelminen-Hospital of the City of Vienna
- Consulting CMF Specialist of the Hospital "Brothers of Mercy" of the Federal City of Eisenstadt
- permanent attending Specialist of the private clinic "Confraternitaet", Vienna
- President of the International Academy for Ultrasonic Surgery and Implantology (IAUSI)
- Member of the TKW Research Group (Dr Troedhan, Dr. Kurrek/GER, Dr Wainwright GER/USA): Development of surgical techniques based on ultrasonic surgery; co-inventor of the INTRALIFT, Crest-Split, and Piezo-Rhinoplasty procedures
- Moderator in accordance with the continuing education guidelines of the Austrian Dental Association for Quality Circles in Dentistry, Oral, and Maxillofacial Surgery
- Lecturer at the University Clinic for Dentistry and Maxillofacial Surgery at the International University of Medicine in Vientiane, Laos and Alexandria, Egypt
Prof. OA Dr. Dr. Troedhan is an internationally leading ultrasonic surgeon and implantologist. As the developer of patient-friendly ultrasonic surgical procedures, implantation techniques, and bone augmentation methods, he is a highly sought-after scientist, live surgeon, speaker, and lecturer at universities, congresses, and workshops worldwide (Switzerland, France, Denmark, Norway, Sweden, Finland, Spain, Netherlands, Germany, Russia, Ukraine, Bulgaria, Croatia, Greece, Egypt, India, Lebanon, Singapore, Laos, Cuba, Colombia, etc.). He also looks back on a long scientific career as the author of scientific articles and textbooks.
Since 2007, he has served as President of the International Academy for Ultrasonic Surgery and Implantology (IAUSI) and is co-editor of the International Journal of Craniomaxillofacial Science, as well as editorial board member of the „Alexandria Dental Journal“ and the „Journal of Surgery & Surgical Procedure“. His most recent scientific focus is research on the advanced applications of artificial intelligence in CBCT-based diagnostics and surgical planning, as well as on the development of CBCT-based digital workflow in dentistry.
- Lisbon, Portugal
Medical Education
- Degree in Medicine from the Faculty of Medicine of Lisbon – 1971–1977.
Professional Experience
- Specialist in Maxillofacial Surgery – Hospital de S. José, Lisbon – 1982–2003.
- Consulting Physician in Maxillofacial Surgery.
- Director of Clínica da Face, Lisbon.
- Maxillofacial Surgery Consultant at the Pediatric Hospital D. Estefânia – 1998–2003.
- Chair of Special Therapeutics at the Higher Institute of Health Sciences – Lisbon, 1999–2006.
Affiliations
- Honorary Consulting Professor at Maimónides University – Buenos Aires, Argentina.
- Honorary Professor at Alfonso X University – Madrid, Spain.
- Visiting Professor at the University of Murcia – Spain.
- Member of the Lisbon Society of Medical Sciences.
- Member of the Portuguese Association of Cranio-Maxillofacial Surgery.
- Member of the Spanish Society of Oral and Maxillofacial Surgery.
- Member of the Portuguese Society of Plastic, Reconstructive and Aesthetic Surgery.
- Member of the International Association of Oral and Maxillofacial Surgeons.
- Member of the Ibero-Latin American Federation of Plastic Surgery.
- Member of the International College of Surgeons.
Awards and Recognitions
- Member of the European Board of Maxillofacial Surgery – 1996.
Conference Activity
- International speaker on the topic “Dentofacial Deformities and Aesthetic Surgery of the Facial Skeleton.”
Publications
- Co-author of the book: ”Ortodontia e Cirurgia Ortognática – Diagnóstico e Planificação", published in Spanish, Portuguese, Italian, and English.
Areas of Specialisation
- His work focuses particularly on the field of craniofacial dysmorphias.
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