Piezoelectric compared with conventional rotary osteotomy for the prevention of postoperative sequelae and complications after surgical extraction of mandibular third molars: a systematic review and meta-analysis

The purpose of this review was to determine if postoperative sequelae (facial swelling, trismus, pain) and neurological complications are reduced when mandibular third molars are surgically extracted using a piezoelectric device for osteotomy compared with conventional rotary burs, and to determine if there is a difference in operating time between the two techniques. Clinical trials were identified through a search (April 2015) on the PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases. Studies were assessed by study type, characteristics of participants, sample size, surgical technique, cointerventions, outcomes, risk of bias, and findings. We calculated a Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) rating of confidence in the effect estimates. We identified 2515 citations and found 15 eligible clinical trials. Patients who had osteotomies with the piezoelectric device had less facial swelling (standard mean difference -1.15; 95% CI -2.02 to -0.27; p<0.0001), trismus (greater maximum mouth opening, standard mean difference 0.78; 95% CI 0.56 to 1.00; p=0.33) and pain (standard mean difference -0.84; 95% CI -1.55 to -0.13; p<0.0001) at day 1, less facial swelling at day 7 (standard mean difference -0.98; 95% CI -1.52 to -0.44; p=0.05), and a reduced risk of neurological complications (odds ratio (OR) 0.28; 95% CI 0.09 to 0.89; p=0.79). Trismus at day 7 and pain at day 5 did not differ significantly between the two methods. Operating time was longer with the piezoelectric device (standard mean difference 0.83; 95% CI 0.57 to 1.09; p=0.001). The confidence in the effect estimates was low or very low across all outcomes. The findings raise the possibility of an improved clinical healing response to osteotomy with the piezoelectric device compared with one done with conventional rotary burs for surgical extractions of mandibular third molars.