Research Article| Volume 50, ISSUE 6, P556-561, September 2012

Comparative evaluation of surgical outcome after removal of impacted mandibular third molars using a Piezotome or a conventional handpiece: a prospective study

Published:November 16, 2011DOI:


      Our aim was to compare the use of a conventional rotary handpiece and a Piezosurgical unit for extraction of lower third molars. We studied 40 patients, who were allocated alternately to have the third molar removed with either the handpiece or the Piezosurgical unit. Pain, trismus, and oedema were evaluated at baseline and then postoperatively, together with paraesthesiae, on postoperative days 1, 3, 5, 7, and 15. Damage to surrounding tissue was checked on the same day whereas dry socket was evaluated from postoperative day 3 onwards. More patients complained of pain in the conventional group, they also required more analgesics, and they developed trismus more often than in the Piezosurgery group. There was also significantly more postoperative swelling in the conventional group. Patients were also evaluated using the subjective Postoperative Symptom Severity (PoSSe) scale. Our results suggest that apart from some inherent limitations with the Piezotome, it is a valuable alternative for extraction of third molars.


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        • Renton T.
        • Smeeton N.
        • McGurk M.
        Factors predictive of difficulty of mandibular third molar surgery.
        Br Dent J. 2001; 190: 607-610
        • Akadiri O.A.
        • Obiechina A.E.
        Assessment of difficulty in third molar surgery – a systematic review.
        J Oral Maxillofac Surg. 2009; 67: 771-774
        • Santamaria J.
        • Arteagoitia M.D.
        Radiologic variables of clinical significance in the extraction of impacted mandibular third molars.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 84: 469-473
        • Garcia A.G.
        • Sampedro F.G.
        • Rey J.G.
        • Vila P.G.
        • Martin M.S.
        Pell–Gregory classification is unreliable as a predictor of difficulty in extracting impacted lower third molars.
        Br J Oral Maxillofac Surg. 2000; 83: 585-587
        • Yuasa H.
        • Kawai T.
        • Sugiura M.
        Classification of surgical difficulty in extracting impacted third molars.
        Br J Oral Maxillofac. 2002; 40: 26-31
        • Praveen G.
        • Rajesh P.
        • Neelakandan R.S.
        • Nandagopal C.M.
        Comparison of morbidity following the removal of mandibular third molar by lingual split, surgical bur and simplified split bone technique.
        Indian J Dent Res. 2007; 18: 15-18
        • Kerawala C.J.
        • Martin I.C.
        • Allan W.
        • Williams E.D.
        The effect of operator technique and bur design on temperature during osseous preparation for osteosynthesis self-tapping screws.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88: 145-150
        • Torella F.
        • Pitarch J.
        • Cabanes G.
        • Anitua E.
        Ultrasonoic ostectomy for the surgical approach of the maxillary sinus: a technical note.
        Int J Oral Maxillofac Implants. 1998; 13: 697-700
        • Scott J.
        • Huskisson E.C.
        Graphic representation of pain.
        Pain. 1976; 2: 175-184
        • Ustun Y.
        • Erdogan O.
        • Esen E.
        • Karsli E.D.
        Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 96: 535-539
        • Grossi G.B.
        • Maiorana C.
        • Garromone R.A.
        • Borgonovo A.
        • Farronato D.
        Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study.
        J Oral Maxillofac Surg. 2007; 65: 2218-2226
        • Schultze-Mosgau S.
        • Schmelseizen R.
        • Frölich J.C.
        • Schmele H.
        Use of ibuprofen and methylprednisolone for the prevention of pain and swelling after removal of impacted third molars.
        J Oral Maxillofac Surg. 1995; 53: 2-8
        • Al-Khateeb T.H.
        • Nusair Y.
        Effect of the proteolitic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars.
        Int J Oral Maxillofac Surg. 2008; 37: 264-268
        • Ruta D.A.
        • Bissias E.
        • Ongston S.
        • Ogden G.R.
        Assessing health outcomes after extraction of third molars: the postoperative symptom severity (PoSSe) scale.
        BrJ Oral Maxillofac Surg. 2000; 38: 480-487
      1. Anne Pedersen. Interrelations of complaints after removal of impacted mandibular third molars. Int J. Oral Surg.1985; 14; 241-244.

        • Oikarinen K.
        Postoperative pain after mandibular third-molar surgery.
        Acta Odontol Scand. 1991; 49: 7-13
        • Benediktsdóttir I.
        • Wenzel A.
        • Petersen J.K.
        • Hintze H.
        Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 97: 438-446
        • RobionyM
        • Polini F.
        • Costa F.
        • Vercellotti T.
        • Politi N.
        Piezoelectric bone cutting in multipiece maxillary osteotomies.
        J Oral Maxillofac Surg. 2004; 62: 759-761
        • Leclercq P.
        • Zenati C.
        • Amrand S.
        • Dohan D.M.
        Ultrasonic bone cut Part 1: State-of-the-art technologies and common applications.
        J Oral Maxillofac Surg. 2008; 66: 177-182
        • Garg A.K.
        Using the Piezosurgery device: basics and possibilities.
        Dent Implantol Update. 2007; 18: 1-4
        • Gruber R.M.
        • Kramer F.J.
        • Merten H.A.
        • et al.
        Ultrasonic surgery – An alternative way in orthognathic surgery of the mandible. A pilot study.
        Int J Oral Maxillofac Surg. 2005; 34: 590
        • Gonzalez-Garcia A.
        • Diniz-Freitas M.
        • Somoza-Martin M.
        • Garcia- Garcia A.
        Ultrasonic osteotomy in oral surgery and implantology.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 360-367
        • Crosetti E.
        • Battiston B.
        • Succo G.
        Piezosurgery in head and neck onco-logical and reconstructive surgery: personal experience on 127 cases.
        Acta Otorhinolaryngol Ital. 2009; 29: 1-9
        • Beziat J.L.
        • Bera J.C.
        • Levandier B.
        • Gleizal A.
        Ultrasonic osteotomy as a new technique in craniomaxillofacial surgery.
        Int J Oral Maxillofac Surg. 2007; 36: 493-500