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Re:Dot Watch – A braille and tactile smartwatch by DanBC on Wednesday March 01, 2017 @01:08PM (#13766448)
> Modern actuators are piezo-electric. I have no idea what "ceramic substrate"

The piezo crystals are the ceramic. This new device claims not to use piezo crystals, and that's why it's smaller.

There's a possibility it's using electroactive polymers in a closed bubble together with latches. This would be much cheaper than piezo systems, and also smaller.

N. Di Spigna, P. Chakraborti, D. Winick, P. Yang, T. Ghosh and P. Franzon, “The Integration of Novel EAPBased Braille Cells for Use in a Refreshable Tactile Display,” Proceedings of the 12th International Conference on Electroactive Polymer Actuators and Devices, San Diego, March 2010, p. 9.

Re:Dot Watch – A braille and tactile smartwatch by AstralStorm on Wednesday March 01, 2017 @02:51PM (#13767595)
That said, modern piezo actuators can get really small. And there was some other work on non-ceramic piezo systems.