Franco Rocco, Di Girolamo Mattia, Franceschini Carlo, Rastelli Sofia, Capogreco Mario, D'Amario Maurizio
Department of Life, Health and Environmental Sciences, School of Dentistry, University of L'Aquila, 67100 L'Aquila, Italy.
Medicina (Kaunas). 2024 Dec 12;60(12):2049. doi: 10.3390/medicina60122049.
: Third molar (wisdom tooth) extraction is one of the most common surgical procedures in oral and maxillofacial surgery. Traditional rotary instruments and burs have long been the standard tools for this procedure. However, recent advancements in surgical techniques, such as piezoelectric surgery, have gained popularity due to their purported advantages in terms of precision, safety, and postoperative outcomes. This systematic review aims to evaluate the efficacy, safety, and clinical outcomes of third molar surgery performed using burs versus piezoelectric surgery. : This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed using the PubMed, Scopus, Web of Science, and Cochrane databases to identify relevant studies published up until October 2024. Randomized controlled trials (RCTs), clinical trials, and comparative studies assessing third molar surgery using either burs or piezoelectric instruments were included. The primary outcomes evaluated were surgical time, postoperative pain, swelling, nerve damage, and healing time. The data extraction and quality assessment were performed independently by two reviewers using standardized tools, and any discrepancies were resolved by a third reviewer. : A total of five studies met the inclusion criteria, and the meta-analysis revealed that piezoelectric surgery resulted in significantly lower postoperative pain and swelling compared to traditional bur techniques ( < 0.05). Additionally, the incidence of nerve injury was lower in the piezoelectric group, though the difference was not statistically significant. Surgical time was found to be longer with piezoelectric devices, but this was offset by improved healing outcomes and patient comfort. : Piezoelectric surgery offers a less traumatic alternative to traditional burs for third molar extraction, with reduced postoperative morbidity and enhanced patient outcomes. Although the longer surgical duration may be a drawback, the overall benefits, particularly in terms of pain management and tissue preservation, support the adoption of piezoelectric techniques in clinical practice. Further high-quality randomized trials are recommended to strengthen the evidence base for these findings.
第三磨牙（智齿）拔除术是口腔颌面外科最常见的外科手术之一。长期以来，传统的旋转器械和牙钻一直是该手术的标准工具。然而，近年来手术技术的进步，如压电手术，因其在精度、安全性和术后效果方面据称的优势而受到欢迎。本系统评价旨在评估使用牙钻与压电手术进行第三磨牙手术的疗效、安全性和临床结果。
本系统评价按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。使用PubMed、Scopus、科学网和Cochrane数据库进行了全面的文献检索，以确定截至2024年10月发表的相关研究。纳入了评估使用牙钻或压电器械进行第三磨牙手术的随机对照试验（RCT）、临床试验和比较研究。评估的主要结局包括手术时间、术后疼痛、肿胀、神经损伤和愈合时间。由两名评价者使用标准化工具独立进行数据提取和质量评估，任何差异由第三名评价者解决。
共有五项研究符合纳入标准，Meta分析显示，与传统牙钻技术相比，压电手术导致术后疼痛和肿胀显著降低（<0.05）。此外，压电组神经损伤的发生率较低，尽管差异无统计学意义。发现使用压电设备的手术时间较长，但这被改善的愈合结果和患者舒适度所抵消。
压电手术为第三磨牙拔除术提供了一种比传统牙钻创伤更小的替代方法，术后发病率降低，患者结局得到改善。虽然较长的手术时间可能是一个缺点，但总体益处，特别是在疼痛管理和组织保存方面，支持在临床实践中采用压电技术。建议进一步开展高质量的随机试验，以加强这些发现的证据基础。
