Comparative evaluation of acute stress and clinical efficacy between piezosurgery and conventional rotatory technique in transalveolar extraction of impacted mandibular third molars-A randomized controlled trial.

BACKGROUND: Surgical extraction of impacted mandibular third molars is commonly associated with postoperative pain, swelling, and trismus. Conventional rotatory osteotomy, though widely used, may cause thermal and mechanical trauma. Piezosurgery has emerged as a minimally invasive alternative that may improve clinical outcomes and reduce physiological stress, which can be objectively assessed using salivary biomarkers. PURPOSE: To compare acute stress response and clinical efficacy between piezosurgery and conventional rotatory technique in transalveolar extraction of impacted mandibular third molars. STUDY DESIGN, SETTING, SAMPLE: A prospective randomized controlled clinical trial was conducted on 60 patients (aged 19-40 years) requiring transalveolar extraction. Participants were randomly allocated into piezosurgery (n = 30) and conventional rotatory groups (n = 30). PREDICTOR/EXPOSURE: Type of osteotomy technique (piezosurgery vs conventional rotatory). MAIN OUTCOME MEASURES: Primary outcomes were salivary cortisol and salivary alpha-amylase levels. Secondary outcomes included postoperative pain (VAS), facial swelling, mouth opening, duration of surgery, and patient comfort. COVARIATES: Age, gender, impaction difficulty (Pederson's difficulty index), type of impaction, and duration of surgery. ANALYSES: Data were analyzed using an independent t-test with a significance level of p < 0.05. RESULTS: Postoperative pain showed no significant difference between groups (p > 0.05). The piezosurgery group demonstrated significantly reduced postoperative swelling with a mean difference of approximately 2.07 mm (95% CI: -3.21 to -0.93, p = 0.001) and reduced trismus with improved mouth opening (mean difference: 0.31-0.70 cm across time points, 95% CI: approximately 0.19 to 0.88, p < 0.001). Additionally, higher patient comfort scores (mean difference: 0.87, 95% CI: 0.59 to 1.14, p < 0.001) and lower postoperative salivary cortisol and alpha-amylase levels (p < 0.001) were observed in the piezosurgery group. However, surgical duration was significantly longer in the piezosurgery group. CONCLUSIONS AND RELEVANCE: Piezosurgery offers improved postoperative outcomes and reduced physiological stress compared to conventional techniques, despite longer operative time, making it a valuable alternative in third molar surgery.