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
• The current quickly
generates a strong
heat which explodes
the cellular membrane
when it is applied to
the tissue.
Constant
Coagulation
• Slower heating shrinks
the tissues but does not
destroy the cellular
membrane.
Pulsed
Techniques comparison
Electrocautery
Scalpel
Electrosurgery
Laser
“Light Amplification by stimulated
Emission of Radiation”
Incision &
coagulation
Incision only
Incision & coagulation
Incision &
coagulation
« Hot » surgery
(heat conduction)
« 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)
Filament heated to
incandescence by
electric current
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
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)
•
Should be placed behind
patient’s right shoulder to get
maximum efficiency.
Conductive bracelet
(New generation)
•
Should be placed on right wrist,
in direct contact with the
patient’s skin.
Plate/Bracelet comparison
Capacitive plate
(Old 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.
Conductive bracelet
(New generation)
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,
Incision
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).
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.
Cutting advice

WHITENING
(SHRIVELLED TISSUE)
ELECTRODE
STICKS
POWER TOO LOW

MOVING SMOOTHLY
(NO SPARK)
CORRECT POWER
ELECTRIC ARC
(BURNT TISSUE)
SPARK (HEATING OF
TISSUE)
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.
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.
Electrodes
INCISION
Ø 0.40 mm (RODS)
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.
EXCISION
Ø 0.22 mm (LOOPS)
INCISION
Ø 0.22 mm (NEEDLES)
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
Exposure of fractured tooth
Abscess incision
& drainage
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:
•
•
•
•
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.
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!