Ultrasonic piezotome surgery: is it a benefit for our patients and does it extend surgery time? A retrospective comparative study on the removal of 100 impacted mandibular 3rd molars

Aim of the study was to evaluate if there is a constant and significant reduction in traumaticity when massively traumatic oral surgical procedures such as the removal of third molars are conducted with only ultrasonic surgical devices (Piezotomes) expressed in a reduction of postsurgical pain and swelling on the patient’s side since such clinical experiences by the authors suggested this. Since oral surgeons criticize a higher time consumption for surgeries with Piezotomes also the objective time consumption was evaluated and compared to the traditional methods. Material and Methods: 56 female and male patients were selected that already underwent a removal of an impacted third mandibular molar on one side with rotary instruments by bone destructive burring with a still persisting comparable third mandibular molar on the contralateral side complaining about recurrent pain episodes and were already documented for pain and swelling before. The ultrasonic surgical removal with the Piezotome was conducted with a buccal osteotomy of the compacta lateral to the impacted third molar, preservation of the resected compacta in saline solution, removal of the third molar by single or multiple dentotomy and full anatomical restitution of the surgical site with the preserved buccal compacta. The swelling was documented by kephalometry 24/48/72 hours and 1 week post surgery, the pain index by the total consumption of ibuprofen-400 mg— tablets. Lesions of the mandible nerve were documented. Netto surgery time was taken from the first incision to the last suture of the procedure. Results: 6 patients had to be excluded from evaluation due to incomplete post surgical follow up. A signifycant (***, p > 0.999) decrease in pain and swelling of 50% was detected both for the parameters swelling and pain with Piezotome-surgery. No lesions of the mandible nerve were detected with Piezotome surgery whereas surgery with rotary instruments resulted in 16% hypesthesia at least up to one week. Although netto surgery time was approximately 50% longer when done with the Piezotome at the beginning the time consumption normalized with the growing experience of the surgeons back to the time schedule when surgery was performed with rotary instruments revealing no significant differences (-, p < 0.73). Conclusions: The results of this retrospective study suggest that Piezotome-surgery is superior in atraumaticity and soft-tissue safety compared to traditional procedures with burs and grants the patients significantly less post surgical pain and swelling. Although—as it is with all new surgical tools and protocols—surgery time is longer at the beginning when purely working with ultrasonic surgical devices time consumption reduces to normal values after a learning curve.