Piezoelectric Versus Conventional Rotary Techniques for Impacted Third Molar Extraction: A Meta-analysis of Randomized Controlled Trials

Abstract

Impacted third molars are frequently encountered in clinical work. Surgical removal of impacted third molars is often required to prevent clinical symptoms. Traditional rotary cutting instruments are potentially injurious, and piezosurgery, as a new osteotomy technique, has been introduced in oral and maxillofacial surgery. No consistent conclusion has been reached regarding whether this new technique is associated with fewer or less severe postoperative sequelae after third molar extraction.The aim of this study was to compare piezosurgery with rotary osteotomy techniques, with regard to surgery time and the severity of postoperative sequelae, including pain, swelling, and trismus.We conducted a systematic literature search in the Cochrane Library, PubMed, Embase, and Google Scholar.The eligibility criteria of this study included the following: the patients were clearly diagnosed as having impacted mandibular third molars; the patients underwent piezosurgery osteotomy, and in the control group rotary osteotomy techniques, for removing impacted third molars; the outcomes of interest include surgery time, trismus, swelling or pain; the studies are randomized controlled trials.We used random-effects models to calculate the difference in the outcomes, and the corresponding 95% confidence interval. We calculated the weighted mean difference if the trials used the same measurement, and a standardized mean difference if otherwise.A total of seven studies met the eligibility criteria and were included in our analysis. Compared with rotary osteotomy, patients undergoing piezosurgery experienced longer surgery time (mean difference 4.13 minutes, 95% confidence interval 2.75-5.52, P < 0.0001). Patients receiving the piezoelectric technique had less swelling at postoperative days 1, 3, 5, and 7 (all Ps ≤0.023). Additionally, there was a trend of less postoperative pain and trismus in the piezosurgery groups.The number of included randomized controlled trials and the sample size of each trial were relatively small, double blinding was not possible, and cost analysis was unavailable due to a lack of data.Our meta-analysis indicates that although patients undergoing piezosurgery experienced longer surgery time, they had less postoperative swelling, indicating that piezosurgery is a promising alternative technique for extraction of impacted third molars.

FIGURE 1

Flow diagram of the literature search and selection process. Please refer to the “Methods” section for more details.

FIGURE 2

Assessment of risk of bias of included studies.

FIGURE 3

Forest plot for meta-analysis of the difference in surgery time between piezosurgery versus rotary osteotomy technique in third molar extraction.

FIGURE 4

Forest plot for meta-analysis of the difference in postoperative pain between piezosurgery versus rotary osteotomy technique in third molar extraction. A, Day 1 after surgery; B, day 3 after surgery; C, day 5 after surgery; D, day 7 after surgery.

FIGURE 5

Forest plot for meta-analysis of the difference in postoperative trismus between piezosurgery versus rotary osteotomy technique in third molar extraction. A, Day 1 after surgery; B, day 3 after surgery; C, day 5 after surgery; D, day 7 after surgery.

FIGURE 6

Forest plot for meta-analysis of the difference in postoperative swelling between piezosurgery versus rotary osteotomy technique in third molar extraction. A, Day 1 after surgery; B, day 3 after surgery; C, day 5 after surgery; D, day 7 after surgery.