Piezosurgery-assisted protocol for impacted mandibular third molar removal with 3D facial swelling analysis: a randomized split-mouth clinical trial on post-surgical sequelae

Objectives This split-mouth randomized controlled trial aimed to compare a novel piezosurgery protocol versus a conventional rotary technique for the extraction of mesio-angulated and horizontally impacted mandibular third molars (MA-HM3Ms), evaluating postoperative inflammatory sequelae and patient-centered outcomes. Materials and methods Forty-seven healthy adult patients underwent bilateral MA-HM3M extraction with piezosurgery protocol (test group, TG) and, contralaterally, with conventional rotary instruments and manual elevators (control group, CG). Facial swelling was objectively quantified using three-dimensional facial scans at 2 and 7 days postoperatively. Secondary outcomes included postoperative pain, maximum mouth opening, bleeding, surgical time, analgesic intake, complications, and patient-reported outcomes assessed using the PoSSe scale. Statistical analysis was performed using paired comparisons and regression models (α = 0.05). Results Ninety-four extractions were analyzed. After 2 days, lower facial swelling was significantly reduced in TG compared with CG ( p = 0.01), together with less pronounced trismus ( p = 0.016). Pain was consistently lower in the TG at all timepoints, while postoperative bleeding and analgesic intake were significantly higher in the CG ( p < 0.05). Surgical time was longer in TG than in CG ( p < 0.001). The piezosurgery protocol significantly reduced interference with daily activities and resulted in higher patient satisfaction. Regression analyses showed a direct association between swelling and PoSSe scale in both groups. No permanent neurological complications were observed; alveolitis occurred in 3 CG and 2 TG sites. Conclusions This split-mouth randomized controlled trial suggests that piezosurgery for MA-HM3M extraction effectively reduces early postoperative inflammatory sequelae, improving patient-centered outcomes and quality of life, despite longer operative times. Clinical relevance The proposed piezoelectric protocol could represent a minimally invasive alternative to conventional rotary techniques, particularly in complex MA-HM3M extractions, enhancing patient comfort and quality of life during the most critical postoperative period while supporting a more controlled and refined surgical approach. Registry: ClinicalTrials.gov, TRN: NCT06212232, Registration date: 25 January 2024.