What is electrosurgery? The Servotome is a High-Frequency (HF >100kHz – alternating current) device used for: incision of soft gingival tissue, coagulation of blood vessels, arteries … Used by: General practitioners (abscess incision, gingival eviction,…) Prosthodontists (widening of sulcus, crown lengthening,…) Periodontists (crown lengthening, gingivectomy, gingivoplasty…) Implantologists (coagulation, impacted tooth exposure…)

What is electrosurgery? The thermal effect created by the activation of an electric current generates the incision and the coagulation of tissue through high frequency amplitude oscillations. The human does not feel the harmful effect of current from 100kHz. There is only a thermal action. « d’Arsonval 1891 »

What is electrosurgery? With over 30 years of experience in this field, SATELEC® has mastered the electrosurgery technology. The section action is determined by the important and quick increase of heat produced which will induce cell explosion. The coagulation action generates an electric discontinuous wave which will create less heat (+/- 70°C). That is why current quality has an important impact on cutting or coagulating effects.

Incision Coagulation The current quickly generates a strong heat which explodes the cellular membrane when it is applied to the tissue. Slower heating shrinks the tissues but does not destroy the cellular membrane. Pulsed Constant

Techniques comparison Electrocautery Scalpel Electrosurgery Laser “Light Amplification by stimulated Emission of Radiation” Incision & coagulation Incision only « Hot » surgery (heat conduction) Filament heated to incandescence by electric current « Cold » surgery Manual pressure high frequency current CO2 Heat and tissue burning Tissue dilapidation Good healing Cell volatilization Prevents the transmission of bacteria. Whenever the current is on, the electrode is sterile. Cell volatilization and carbonization Burn the upper surface to slowly go deeper Induces local 3rd degree burning = irritation, bad healing, tissue carbonization, etc) Precise but creating tissue dilapidation and no coagulation effect performed. Bacteria transportation. Good-quality healing An extreme precision Less bleeding High price Slow penetration in the tissues (water absorption)

Monopolar versus bipolar technology Electrosurgery: Monopolar versus bipolar technology Extract from: Implementing AORN Recommended Practices for Electrosurgery  Original Research Article. AORN Journal, Volume 95, Issue 3, March 2012, Pages 373-387, Lisa Spruce, Melanie L. Braswell. “The monopolar electrosurgical circuit is composed of the generator, the active electrode, the patient, and the patient dispersive electrode”. “In bipolar electrosurgery, current flows between the two poles and back to the electrosurgery unit without the need for a dispersive electrode”.

Composition Servotome is composed of: Unit, Electrode holder and its cord, 10 electrodes, Single footswitch, Conductive bracelet.

Setting up

Do we need current return path? A common objective: Monopolar electrosurgery (such as Servotome®) units require current return path to obtain good performances. Indeed, current concentration will create much better results than current dispersion in the entire body. Limiting leakage current

Impedance Capacitive plate Conductive bracelet (Old generation) When current is applied on the body, tissues create a corporal resistance also called impedance. In high frequencies, current is not going around but through cells. To get a reproducible protocol, we should limit resistance factors . On return path zone: strong hair zones, bony prominences, fat, scar tissues, etc On treated area: excess of saliva , etc. Capacitive plate (Old generation) Conductive bracelet (New generation) Should be placed behind patient’s right shoulder to get maximum efficiency. Should be placed on right wrist, in direct contact with the patient’s skin.

Plate/Bracelet comparison Capacitive plate (Old generation) Conductive bracelet (New generation) Higher leakage current than with the bracelet, Recommended placement not often respected, Can move easily on the chair which will increase the resistance and decrease performances, Placed between chair and patient’s clothes. Clothes thickness can create a resistance and have an impact on the yield. Focus the return of the current at a given point , Limits leakage current and resistance as it is in direct contact with the patient, Compliant with the latest safety certifications (IEC 60601-2-2).

Bracelet benefits The bracelet system is the best compromise for safety and convenience: - Easy to install to enhance patient acceptance, - Conductive (in direct contact with the patient’s skin), - Easily disinfected, - Adjusted to a contact region with a low resistance, Perfect size to avoid concentration of heat.

30 Watts is enough! With higher yield compared to the capacitive plate, the bracelet system needs less Wattage (30Watts instead of 50Watts) providing more safety and less risk of burning the tissues. Decreased Wattage for greater efficiency. This bracelet can concentrate the current at a given point offering: - Controlled power, More reliable and reproducible settings, High performance and better yield, - Less energy loss.

Techniques of use The Servotome allows independent activation of incision and coagulation from 1 to 10. 2 potentiometers (incision ; coagulation )

Incision Control of cutting power from 1 to 10 (Max 30W / 600Ω) The incision depends on: the power chosen, the strength applied, the tissue, the speed of the surgical movement, the patient’s size, the size of the electrode (the smaller it is, the more the power is concentrated). Incision

Coagulation Control of coagulation from 1 to 10 with progressive increase of the temperature without damage to underlying tissues. Coagulation

Effects of electrosurgery Incision with coagulation Incision: for a clean and smooth cut Fulguration: for heating the superficial tissue Coagulation: for a deep hemostatic effect Cutting with coagulation: for an incision with better visibility, accompanied by deep and immediate coagulation.

SPARK (HEATING OF TISSUE) Cutting advice WHITENING (SHRIVELLED TISSUE) ELECTRODE STICKS ELECTRIC ARC (BURNT TISSUE) SPARK (HEATING OF TISSUE) POWER TOO LOW POWER TOO HIGH  Check and/or protect if the patient for any conductive element on him. Place the bracelet. Insert an electrode on the electrode holder. Avoid excess saliva. Adjust the potentiometers according to the clinical act, the electrode chosen, the patient size, etc. Exert an easy and smooth movement. CORRECT POWER MOVING SMOOTHLY (NO SPARK) 

Recommendations for use Aspiration of excess saliva for optimal efficiency. Metal surfaces such as: implants, amalgams, inlay, onlay, brackets. Should be insulated using plastic mylar.

INCISION/ FULGURATION FULGURATION/COAGULATION Electrodes INCISION Ø 0.40 mm (RODS) INCISION Ø 0.22 mm (NEEDLES) EXCISION Ø 0.22 mm (LOOPS) Abscess incision, exposure of impacted tooth, cutting of peri-coronary sac, hemostasis, exposure of crown lengthening, gingivoplasty, gingivectomy, frenectomy, tissue ablation before impression, stripping, etc. INCISION/ FULGURATION Ø 1 mm CONICAL) FULGURATION/COAGULATION Ø 2.5 mm - Ø 3.2 mm (SPHERICAL)

Clinical cases Frenectomy Gingival eviction & gingivectomy Plasty

Clinical cases Exposure of impacted tooth: circular incision for a clean and successful exposure Dental neck exposure Abscess incision & drainage Exposure of fractured tooth

Gingivectomy Crest plasty Gingival eviction Soft tissue eviction

Accessories Electrode-holder is lightweight and handy. A broad choice of electrodes which are all insulated (only the active part touches the soft tissue). A fast and safe assembly of electrodes on the electrode-holder.

Accessories An orange light and an audible alarm (conform to the norm 60601-2-2) indicate when the HF is activated. Controlled by means of a footswitch. Hand button activation can create a lack of precision.

Table settings The settings depends on: Recommended settings: the clinical act, the electrode chosen, the patient’s size, etc. Recommended settings: Incision electrodes: Incision button: 6-8 Coagulation button: 3-4 Coagulation electrodes: Incision button: 5-6 Coagulation button: 1-2

Sterilization Clean with disinfectant wipes: the device, the electrode-holder, the cord. Brush the electrodes with sandpaper or metallic brush Place the electrodes in an ultrasonic tank Place the electrodes and electrode-holder in the autoclave Note: for your information, even if the electrosurgery allows an instant sterilization of the electrodes thanks to HF current, you should sterilize them prior utilization.

SERVOTOME New impulse in Electrosurgery SUM UP SERVOTOME New impulse in Electrosurgery Compliant with new standards and dental environment constraints Main objective: Decrease leakage currents for more safety What’s new? A bracelet is replacing the capacity coupler Electronics modifications Decreased Wattage (30 watts) Safer with better performance!

THANK YOU! Safer with better performance!