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Comparative Study
. 2024 Dec 12;60(12):2049.
doi: 10.3390/medicina60122049.

The Comparative Efficacy of Burs Versus Piezoelectric Techniques in Third Molar Surgery: A Systematic Review Following the PRISMA Guidelines

Rocco Franco  1 , Mattia Di Girolamo  1 , Carlo Franceschini  1 , Sofia Rastelli  1 , Mario Capogreco  1 , Maurizio D'Amario  1
Affiliations
Comparative Study

The Comparative Efficacy of Burs Versus Piezoelectric Techniques in Third Molar Surgery: A Systematic Review Following the PRISMA Guidelines

Rocco Franco et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Third molar (wisdom tooth) extraction is one of the most common surgical procedures in oral and maxillofacial surgery. Traditional rotary instruments and burs have long been the standard tools for this procedure. However, recent advancements in surgical techniques, such as piezoelectric surgery, have gained popularity due to their purported advantages in terms of precision, safety, and postoperative outcomes. This systematic review aims to evaluate the efficacy, safety, and clinical outcomes of third molar surgery performed using burs versus piezoelectric surgery. Materials and Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed using the PubMed, Scopus, Web of Science, and Cochrane databases to identify relevant studies published up until October 2024. Randomized controlled trials (RCTs), clinical trials, and comparative studies assessing third molar surgery using either burs or piezoelectric instruments were included. The primary outcomes evaluated were surgical time, postoperative pain, swelling, nerve damage, and healing time. The data extraction and quality assessment were performed independently by two reviewers using standardized tools, and any discrepancies were resolved by a third reviewer. Results: A total of five studies met the inclusion criteria, and the meta-analysis revealed that piezoelectric surgery resulted in significantly lower postoperative pain and swelling compared to traditional bur techniques (p < 0.05). Additionally, the incidence of nerve injury was lower in the piezoelectric group, though the difference was not statistically significant. Surgical time was found to be longer with piezoelectric devices, but this was offset by improved healing outcomes and patient comfort. Conclusions: Piezoelectric surgery offers a less traumatic alternative to traditional burs for third molar extraction, with reduced postoperative morbidity and enhanced patient outcomes. Although the longer surgical duration may be a drawback, the overall benefits, particularly in terms of pain management and tissue preservation, support the adoption of piezoelectric techniques in clinical practice. Further high-quality randomized trials are recommended to strengthen the evidence base for these findings.

Keywords: PRISMA; bur technique; healing time; nerve damage; piezoelectric surgery; postoperative pain; third molar surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Forest plot evaluating VAS scores between two methods [26,27,28,29,30].
Figure 3
Figure 3
Forest plot evaluating swelling between two methods [27,29].
Figure 4
Figure 4
Bias assessment [26,27,28,29,30]. Green +: low risk of bias; red -: high rilsk of bias.
See this image and copyright information in PMC

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