Ultrasonic Bone Scalpel vs Turbine Drill in Mandibular Third Molar Extraction: Impact on Postoperative Pain and Inflammation

To compare postoperative outcomes between ultrasonic bone scalpel and turbine drill techniques for impacted mandibular third molar extraction, focusing on pain, inflammation, and recovery parameters. This retrospective cohort study analyzed 109 patients treated between 2020 and 2022, divided into an ultrasonic group (n=55; piezoelectric osteotomy) and a turbine group (n=54; high-speed drilling). Primary outcomes included operative time, intraoperative blood loss, facial swelling, maximum mouth opening, and pain scores assessed using the Visual Analog Scale (VAS) at 6, 24, and 72 hours postoperatively. Gingival crevicular fluid samples were collected preoperatively and on postoperative day 3 to quantify levels of calcitonin gene-related peptide (CGRP), substance P (SP), serotonin (5-hydroxytryptamine, 5-HT), tumor necrosis factor-alpha (TNF-α), intercellular adhesion molecule-1 (ICAM-1), and myeloperoxidase (MPO). The ultrasonic group demonstrated 35% shorter operative time (20.04 vs 31.06 min; P<0.001, Cohen's d=2.84), 21% less blood loss (7.94 vs 10.01 mL; P<0.001, d=2.95), significantly lower VAS scores at 24h (3.25 vs 3.65; P=0.036) and 72h (0.52 vs 0.85; P=0.009), and 40% reduced analgesic use (2.1 vs 3.5 tablets; P<0.001), alongside biomarker reductions including 41% lower CGRP and 33% lower TNF-α (P<0.001). The ultrasonic bone scalpel demonstrates superior clinical outcomes including reduced operative duration, attenuated pain/inflammation, and faster recovery, though limitations include retrospective design and short-term follow-up.