Title Piezoelectric Techniques for Surgical Extraction of Third Molars Shows Improved Healing Outcomes Compared to That of Conventional Rotary Burs
Clinical Question When surgically extracting a third molar, does the use of Piezosurgery devices lead to better healing outcomes compared to conventional rotary burs?
Clinical Bottom Line For patients with impacted mandibular third molars, the use of Piezosurgery devices is more effective in reducing post-operative swelling than conventional rotary bur techniques. This is supported by a meta-analysis of 7 randomized controlled trials that showed a statistically significant reduction in post-operative swelling with the Piezosurgery group on all post-operative days measured, and also by a randomized controlled trial that showed a statistically significant decrease in postoperative pain and trismus. Piezosurgery techniques are within the realm of an oral surgeon’s experience as well as any general dentists who are familiar with the devices, and are likely to be accepted by the average patient population.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
26469902Jiang / 2015281 patients with impacted mandibular third molars in 7 included studies Meta-Analysis
Key resultsThe meta-analysis showed that there was significantly reduced facial swelling in the Piezosurgery group compared to the rotary group on all postoperative days (all p-values < 0.023). There was a trend towards less postoperative pain in the Piezosurgery group as compared to the rotary group; however, this data was not statistically significant (p-values ranging from 0.052 to 0.078).
28050988Basheer / 201730 patients with impacted lower third molars.Randomized Controlled Trial
Key resultsThere was a statistically and clinically significant decrease in postoperative pain in the Piezosurgery group compared to the rotary group on postoperative days 2 (p = 0.005), 3 (p = 0.011), and 4 (p = 0.044). Postoperative days 1, 5, 6, and 7 had no statistically significant data on pain level. There was a statistically and clinically significant increase in the range of opening with the Piezosurgery group compared with the rotary surgery group on all postoperative days measured, which were days 3, 5, and 7 (all p-values <0.001).
Evidence Search PubMed: Piezosurgery third molar extractions
Comments on
The Evidence
All studies included in Jiang et al. were randomized controlled trials. The statistically significant results from each study were fairly similar, including the results on post-operative swelling. For the overall effect, both boundaries of the confidence interval indicated statistically and clinically significant effects for Piezosurgery. Four of the seven studies had random sequence generation to prevent selection bias. The rest of the studies showed an unclear risk of selection bias. Double blinding was not possible in this situation, so performance bias for all included studies is unknown. Considering the overall risk of bias, one study (Sortino et al, 2008) was unclear for five domains, including selection, performance, and detection biases. Another study (Piersanti et al, 2014) was unclear for four domains including selection, performance, and detection biases. The rest of the studies did not exceed three domains at unclear risk of bias. This review was conducted according to PRISMA guidelines. Confidence in the overall effect is lowered by the small number of RCTs included, small sample sizes, and lack of double-blinding. Basheer et al. included only males 25-33 years old to minimize the role of postoperative complications due to hormonal changes in females. There were no dropouts in the selected sample. Patients were randomized between the control and the experimental group to reduce selection bias. The inclusion and exclusion criteria for patient selection and the relatively small sample size may limit generalizability of the results to the patient population at large. The authors do not discuss possible limitations of their study in depth, which decreases confidence in the results. Also, these results do not closely align with those of the systematic review and meta-analysis by Jiang et al.
Applicability If the results can be generalized to a larger population of patients, then the likely treatment benefits would outweigh the potential harms and costs. The lack of larger sample sizes puts the ability to extrapolate these results to the larger general population in question. However, because postoperative complications can be burdensome, the possibility of significantly decreasing the amount of swelling would be well worth the cost of a longer surgery appointment that may result from the use of Piezosurgery. This is a hinderance that should be noted to patients, but length of surgery can be reduced by more experienced surgeons. This would leave the patient and the doctor more satisfied in the weeks following the surgery. The inclusion for the randomized controlled trial by Basheer et al. were listed as healthy individuals over 20 years of age with various types of third molar impactions. The exclusion criteria included systemic conditions that could affect healing, those who have taken antibiotics in the previous 6 weeks, those who need an antibiotic prophylaxis before surgery, and those with an acute infection involving the impacted teeth. This shows us that extrapolating this information to a larger patient pool may be difficult, especially given the fact that many patients will need an antibiotic prophylaxis prior to the surgery or have a systemic disease that would affect healing.
Specialty (General Dentistry) (Oral Surgery)
Keywords Piezosurgery, Third molar extractions
ID# 3461
Date of submission 04/20/2021
E-mail hubera1@livemail.uthscsa.edu
Author Aidan Huber
Co-author(s) e-mail
Faculty mentor Dr. Ernest Luce
Faculty mentor e-mail lucee@livemail.uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available