Piezoelectric surgery in the extraction of impacted mandibular third molars
Abstract
The extraction of impacted third molars (commonly known as “wisdom teeth”) represents one of the most frequent procedures in oral and maxillofacial surgery. Traditional extraction methods, including the use of elevators, chisels, and rotary burs, are often associated with significant postoperative pain, edema, trismus (difficulty in mouth opening), injury to the inferior alveolar nerve, and infections. Piezoelectric surgery, a technology based on selective ultrasonic vibrations, has emerged over the last decade as a valuable alternative. This scientific article aims to provide a comprehensive analysis of the basic principles of piezosurgery, its clinical application protocol in third molar extraction, its advantages and limitations, as well as a review of data from recent studies. Available evidence suggests that piezosurgery, although associated with slightly longer operative times, significantly reduces postoperative complications, improves surgical precision, and offers a better patient experience, making it particularly valuable in complex cases and in proximity to critical anatomical structures.Keywords:
Third molars, Oral surgery, PiezosurgeryDownloads
References
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Vercellotti, T. 2000. “Piezoelectric Surgery in Implantology: A Case Report—A New Piezoelectric Ridge Expansion Technique.” International Journal of Periodontics & Restorative Dentistry.
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Rizzato, A., et al. 2022. “Piezoelectric Versus Conventional Rotary Techniques for Third Molar Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.” Clinical Oral Investigations.
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Sivolella, S., et al. 2021. “Piezoelectric Bone Surgery for Third Molar Extraction: Impact on Postoperative Sequelae and Quality of Life. A Randomized Clinical Trial.” Journal of Cranio-Maxillofacial Surgery.
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Barone, A., et al. 2019. “A Randomized Clinical Trial on the Use of Piezoelectric Surgery for the Removal of Impacted Mandibular Third Molars.” Journal of Oral and Maxillofacial Surgery.
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Geha, H., and F. G. Mangano. 2016. “Piezoelectric Surgery for the Extraction of Impacted Mandibular Third Molars: A Systematic Review.” The Journal of Oral Implantology.
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Pavlíková, G., et al. 2018. “Piezosurgery in Oral and Maxillofacial Surgery.” International Journal of Oral and Maxillofacial Surgery.
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Eggers, G., J. Klein, J. Blank, and S. Hassfeld. 2004. “Piezosurgery: An Ultrasound Device for Cutting Bone and Its Use and Limitations in Maxillofacial Surgery.” Br. J. Oral Maxillofac. Surg. 42:451–453.
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Ergina, P. L., J. A. Cook, J. M. Blazeby, I. Boutron, P.-A. Clavien, B. C. Reeves, C. M. Seiler, Balliol Collaboration, D. G. Altman, J. K. Aronson, et al. 2009. “Challenges in Evaluating Surgical Innovation.” Lancet 374:1097–1104.
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Arakji, H., M. Shokry, and N. Aboelsaad. 2016. “Comparison of Piezosurgery and Conventional Rotary Instruments for Removal of Impacted Mandibular Third Molars: A Randomized Controlled Clinical and Radiographic Trial.” Int. J. Dent. 2016:8169356.
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de Freitas Silva, L., E. N. Ribeiro de Carvalho Reis, B. C. Oliveira Souza, L. S. Egas, A. M. Aranega, and D. Ponzoni. 2019. “Alveolar Repair After the Use of Piezosurgery in the Removal of Lower Third Molars: A Prospective Clinical, Randomised, Double-Blind, Split-Mouth Study.” Br. J. Oral Maxillofac. Surg. 57:1068–1073.
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Posnick, J. C., E. Choi, and A. Chavda. 2016. “Operative Time, Airway Management, Need for Blood Transfusions, and In-Hospital Stay for Bimaxillary, Intranasal, and Osseous Genioplasty Surgery: Current Clinical Practices.” J. Oral Maxillofac. Surg. 74:590–600.
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Yamamoto, R., A. Nakamura, K. Ohno, and K. Michi. 2002. “Relationship of the Mandibular Canal to the Lateral Cortex of Mandibular Ramus as a Factor in the Development of Neurosensory Disturbance After Bilateral Sagittal Split Osteotomy.” J. Oral Maxillofac. Surg. 60:490–495.
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Ow, A., and L. K. Cheung. 2010. “Bilateral Sagittal Split Osteotomies Versus Mandibular Distraction Osteogenesis: A Prospective Clinical Trial Comparing Inferior Alveolar Nerve Function and Complications.” Int. J. Oral Maxillofac. Surg. 39:756–760.
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Spinelli, G., D. Lazzeri, M. Conti, T. Agostini, and G. Mannelli. 2014. “Comparison of Piezosurgery and Traditional Saw in Bimaxillary Orthognathic Surgery.” J. Craniomaxillofac. Surg. 42:1211–1220.
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Landes, C. A., S. Stübinger, A. Ballon, and R. Sader. 2008. “Piezoosteotomy in Orthognathic Surgery Versus Conventional Saw and Chisel Osteotomy.” Oral Maxillofac. Surg. 12:139–147.
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Raj, H., M. Singh, and A. K. Shah. 2022. “Piezo-osteotomy in Orthognathic Surgery: A Comparative Clinical Study.” Natl. J. Maxillofac. Surg. 13:276–282.
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Reyneke, J. P. 2003. Essentials of Orthognathic Surgery. Chicago: Quintessence Pub. Co., Inc.
References
Vercellotti, T. 2000. “Piezoelectric Surgery in Implantology: A Case Report—A New Piezoelectric Ridge Expansion Technique.” International Journal of Periodontics & Restorative Dentistry.
Rizzato, A., et al. 2022. “Piezoelectric Versus Conventional Rotary Techniques for Third Molar Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.” Clinical Oral Investigations.
Sivolella, S., et al. 2021. “Piezoelectric Bone Surgery for Third Molar Extraction: Impact on Postoperative Sequelae and Quality of Life. A Randomized Clinical Trial.” Journal of Cranio-Maxillofacial Surgery.
Barone, A., et al. 2019. “A Randomized Clinical Trial on the Use of Piezoelectric Surgery for the Removal of Impacted Mandibular Third Molars.” Journal of Oral and Maxillofacial Surgery.
Geha, H., and F. G. Mangano. 2016. “Piezoelectric Surgery for the Extraction of Impacted Mandibular Third Molars: A Systematic Review.” The Journal of Oral Implantology.
Pavlíková, G., et al. 2018. “Piezosurgery in Oral and Maxillofacial Surgery.” International Journal of Oral and Maxillofacial Surgery.
Eggers, G., J. Klein, J. Blank, and S. Hassfeld. 2004. “Piezosurgery: An Ultrasound Device for Cutting Bone and Its Use and Limitations in Maxillofacial Surgery.” Br. J. Oral Maxillofac. Surg. 42:451–453.
Ergina, P. L., J. A. Cook, J. M. Blazeby, I. Boutron, P.-A. Clavien, B. C. Reeves, C. M. Seiler, Balliol Collaboration, D. G. Altman, J. K. Aronson, et al. 2009. “Challenges in Evaluating Surgical Innovation.” Lancet 374:1097–1104.
Arakji, H., M. Shokry, and N. Aboelsaad. 2016. “Comparison of Piezosurgery and Conventional Rotary Instruments for Removal of Impacted Mandibular Third Molars: A Randomized Controlled Clinical and Radiographic Trial.” Int. J. Dent. 2016:8169356.
de Freitas Silva, L., E. N. Ribeiro de Carvalho Reis, B. C. Oliveira Souza, L. S. Egas, A. M. Aranega, and D. Ponzoni. 2019. “Alveolar Repair After the Use of Piezosurgery in the Removal of Lower Third Molars: A Prospective Clinical, Randomised, Double-Blind, Split-Mouth Study.” Br. J. Oral Maxillofac. Surg. 57:1068–1073.
Posnick, J. C., E. Choi, and A. Chavda. 2016. “Operative Time, Airway Management, Need for Blood Transfusions, and In-Hospital Stay for Bimaxillary, Intranasal, and Osseous Genioplasty Surgery: Current Clinical Practices.” J. Oral Maxillofac. Surg. 74:590–600.
Yamamoto, R., A. Nakamura, K. Ohno, and K. Michi. 2002. “Relationship of the Mandibular Canal to the Lateral Cortex of Mandibular Ramus as a Factor in the Development of Neurosensory Disturbance After Bilateral Sagittal Split Osteotomy.” J. Oral Maxillofac. Surg. 60:490–495.
Ow, A., and L. K. Cheung. 2010. “Bilateral Sagittal Split Osteotomies Versus Mandibular Distraction Osteogenesis: A Prospective Clinical Trial Comparing Inferior Alveolar Nerve Function and Complications.” Int. J. Oral Maxillofac. Surg. 39:756–760.
Spinelli, G., D. Lazzeri, M. Conti, T. Agostini, and G. Mannelli. 2014. “Comparison of Piezosurgery and Traditional Saw in Bimaxillary Orthognathic Surgery.” J. Craniomaxillofac. Surg. 42:1211–1220.
Landes, C. A., S. Stübinger, A. Ballon, and R. Sader. 2008. “Piezoosteotomy in Orthognathic Surgery Versus Conventional Saw and Chisel Osteotomy.” Oral Maxillofac. Surg. 12:139–147.
Raj, H., M. Singh, and A. K. Shah. 2022. “Piezo-osteotomy in Orthognathic Surgery: A Comparative Clinical Study.” Natl. J. Maxillofac. Surg. 13:276–282.
Reyneke, J. P. 2003. Essentials of Orthognathic Surgery. Chicago: Quintessence Pub. Co., Inc.
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