Diferenças no pós-operatório de terceiros molares consoante o instrumental de osteotomia

: uma revisão sistemática

Abstract

Introduction: The surgical extraction of impacted mandibular third molars is a common procedure in oral surgery and is frequently associated with postoperative pain, swelling, and trismus. Among the factors influencing these complications, the osteotomy method used plays a significant role. This systematic review aims to compare the clinical outcomes of rotary instruments, piezosurgery and Er:YAG laser, in order to support clinical decision-making. Materials and Methods: A systematic search was conducted in the PubMed, Scopus, Cochrane Library, and ScienceDirect databases using the MeSH terms: “Third Molar,” “Osteotomy,” “Postoperative Complications,” and “Postoperative Pain.” Study selection followed PRISMA guidelines, and the risk of bias was assessed using the Cochrane RoB2 tool. Only randomized clinical trials, published in English within the past 20 years were included. Results: Of the 615 studies initially identified, 11 met the inclusion criteria. In terms of postoperative pain, 6 studies demonstrated statistically significant differences: 5 favoring piezosurgery and 1 favoring the Er:YAG laser. Postoperative swelling was assessed in 8 studies, with statistically significant differences observed in 6 using piezosurgery and 2 using laser. Trismus was also reported in 6 studies, all showing statistically significant differences, with less functional limitation in the piezo group (4 studies) and in the laser group (2 studies). Patient satisfaction was evaluated in 2 studies using piezosurgery, both reporting statistically significant improvements. Surgical time was significantly longer with piezosurgery in 5 studies and with laser in 2, particularly in complex procedures or those performed by less experienced operators. Conclusion: Osteotomy performed using piezo-electric and Er:YAG laser reduced postoperative morbidity compared to the rotary technique, particularly in more complex surgical cases.

Date of Award	4 Jul 2025
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Bruno Almeida (Supervisor) & Tiago Borges (Co-Supervisor)