Journal Reading

A prospective split-mouth clinical

study: comparison of piezosurgery
and conventional rotary instruments
in impacted third molar surgery

Menziletoglu, D., Basturk, F., Isik, B.K., Esen, A. 2020. A prospective split-
mouth clinical study: comparison of piezosurgery and conventional
rotary instruments in impacted third molar surgery. Oral and
Maxillofacial Surgery 24. p 51-55.

Presentan : Saskia Paramita

Supervisor : Dr. drg. Vera Julia, Sp.BM (K)
A Purpose Our purpose was to compare the effects of piezosurgery and conventional rotary
instruments on postoperative pain, swelling, trismus, and patients’ comfort after mandibular

b third molar surgery.

Methods Thirty patients (27 women and 3 men) with bilateral impacted mandibular third
molars were included in this splitmouthclinical study. Sixty impacted third molars were
s divided into a control group (n = 30), in which the osteotomies were performed using a
conventional rotary handpiece technique and an experimental group (n = 30), in which the

t osteotomies were done by piezosurgery technique. Duration of the procedure was recorded.
Postoperative pain was assessed using a visua analogue scale (VAS). All the patients were
given a form containing verbal rating scale for evaluating the swelling. Trismus was
r evaluated using a caliper at maximum mouth opening (cm). In postoperative seventh day,
patients were asked to fill a global quality of life (QoL) scale as well.

a Results There was no significant difference in postoperative pain, trismus, and swelling
between control and experimental groups (p > 0.05). However, time of the procedure
increased in control group (p < 0.05).
c Conclusion Piezosurgery is a safe way for performing the osteotomies during third molar
surgery. However, regarding the postoperative morbidity, it does not have an advantage

t over conventional rotary instruments. Piezosurgery took longer to complete the osteotomy
than the rotary handpiece technique.
 • Removal of impacted third molars
is one of the most performed oral
surgical operations.
Introduction • Partially or fully impacted third
molars can be associated with
pericoronitis, pain, odontogenic
infections, trismus, cysts, or even
tumors
 Post operative complications

Pain Trismus Nerve Bleeding Dry Socket

Damage

Patient’s post operative quality of life

 Attempts to decrease post
operative complications
Preoperative or
platelet-rich plasma
postoperative cryotherapy
application
use of antibiotics

wound drainage corticosteroids

different flap different osteotomy

laser
techniques techniques
 Rotary handpieces Piezosurgery

used for elevating maxillary sinus floor,

used for removing the bone over
expanding alveolar crest, periodontal
impacted third molars and other
surgery, orthognathic surgery, cyst, and
impacted teeth as well
tumor removal

Purpose : to compare the effects of piezosurgery and conventional rotary

instruments on postoperative pain, swelling, trismus, and patients’ comfort
after mandibular thirdmolar surgery
Method and • Prospective and split-mouth study

Materials • Thirty patients were randomly

selected

Inclusion Criteria Exclusion Criteria

Older than 18 of age Alcohol abuse
Asymptomatic bilateral Smoking
mesioangular impacted Pregnancy
mandibular third molar (Pell Smoking
and Gregory class II, position B) presence of acute severe
fully covered with the mucosa periodontitis
and bone
Medically healthy
 1 side =
30 Patients (age MIO was noted Experimental
18-26; 3 M 27 F) before surgery group ; the other
= control group

Control Group:
Experimental
rotary handpiece 1 month to the
Group:
and tungsten 2nd Surgery
Piezosurgery
carbide burs
Method
• Before the surgery, patients used 10% povidone-iodine mouthwash for 1 min
• Inferior alveolar block and buccal anesthesia were performed with 2 mL of
4% articain HCl and 1:200.000 epinephrine solution.
• A fullthickness envelope flap with a vertical releasing incision was reflected
• carbide surgical burs were used for tooth sectioning.
• Extraction wounds were closed with 3-0 silk sutures.
• Patients were postoperatively prescribed a 5-day:
100 mg flurbiprofen twice daily,
1 g amoxicillin twice daily
0.12% chlorhexidine gluconate antiseptic mouthwash every 8 h
Method
Pain Swelling MIO QoL
In postoperative
global quality of life
Pain was A form containing seventh day, when
(QoL) scale to
selfevaluated verbal rating scale the patients came for
evaluate their
daily by using a ranging from 0 to 5, removing the
general well-being
visual analogue showing the degree sutures, MIO was
during the first
scale (VAS) of swelling measured to assess
postoperative week
trismus

Daily, during 1st Daily, during 1st 7th day postoperative 7th day postoperative
postoperative week postoperative week

The data were tested for normality by using Shapiro-Wilk test. Wilcoxon test was used for
comparing pain, swelling, and QoL.MIO and DO were compared with paired t-test.
Significance level was set as .0.5.
Results
 Results
• There was no statistically significant difference
experimental and control groups (p > 0.05) regarding
postoperative pain and swelling
• In the experimental group, preoperative MIO was 37.73 ±
5.6 mm, and postoperative MIO was 34.83 ± 5.8 mm. In
the control group, preoperative MIO was 38.13 ± 5.3 mm
and postoperative 33.93 ± 6.45 mm. Although the
decrease in MIO was less in experimental group, the
difference was not statistically significant (p = 0.393)
Preoperative and postoperative mean mouth opening values
 Results
• There was no significant difference between QoL of two
groups (mean values 77.33 ± 14.49 in experimental group
and 77.17 ± 13.63 in control group, p = 0.909)
• The only significant difference was found between DO of
two groups (14.03 ± 4.23 min in experimental group, 10.6 ±
2.74 min in control group, p < 0.01)
Discussion
Tools for removing bone
rotary
piezosurgery
handpieces
 Tools for removing bone :
Rotary handpiece vs Piezosurgery
Authors Variable Result
pain, swelling, and trismus Piezosurgery Less
Mantovani (1890)
Duration of operation Piezosurgery More

pain, swelling, and trismus Piezosurgery Less

Arakji (2016)
Duration of operation Piezosurgery More

pain, swelling, and trismus Piezosurgery Less

Al-Moraisi (2016)
Duration of operation Piezosurgery More

Goyal (2012) pain, swelling, and trismus Piezosurgery significantly reduced

trismus and swelling, Piezosurgery Less

Barone (2010)
Postop pain Similar
 Prolonged operation time in piezosurgery
group might have reduced the benefits of
In this research the technique.
Although a more atraumatic surgery can be
done with the piezosurgery, it requires an

No Significant extended period of soft tissue

retraction,leading more edema and more

differences swelling. There was also no significant

difference between two groups in
postoperative trismus. This may be due to
age factor. Our patients were relatively
younger, and their ages were fairly close to
each other, which probably accelerated the
healing process.
 Tools for removing bone :
Rotary handpiece vs Piezosurgery
Authors Variable Result
trismus and swelling, Piezosurgery Less
Barone (2010)
Postop pain Similar

pain, swelling, and

Piezosurgery Less
trismus
Arakji (2016)
Duration of operation Piezosurgery More

pain, swelling, and

Piezosurgery Less
trismus
Al-Moraisi (2016)
Duration of operation Piezosurgery More

pain, swelling, and Piezosurgery significantly

Goyal (2012)
trismus reduced
Conclusion
Piezosurgery is a safe way for performing the osteotomies during third
molar surgery. However, regarding the postoperative morbidity, it does
not have an advantage over classical rotary instruments.

Nonetheless, if the risk of damaging vital structures seems to be high

and/or if the surgeon is less experienced, piezosurgery may be a valid
alternative in impacted third molar operations
Thank You