Abstract: Objective: To systematically review the efficacy and complications of impacted mandibular third molar extraction with combined application of piezosurgery and rotary instrument. Methods: CNKI, WanFang Data, VIP, SinoMed, PubMed and Web of Science databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and complications of combined application of piezosurgery and rotary instrument (experimental group) versus rotary instrument alone (control group) in extracting impacted mandibular third molar from inception to December 24th, 2024. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Then, a meta-analysis was performed by using Revman 5.3 software and Stata 11.0 software. Results: A total of 11 RCTs involving 454 cases in experimental group and 454 cases in control group were included. The results of meta-analysis showed that the operation duration was shorter in experimental group based on Chinese RCTs and longer based on English RCTs, the pain Visual Analog Scale (VAS) was lower in post-operative 1st and 2nd day and the MIO (maximal interincisal opening) was larger in experimental group in post-operative 1st and 3rd day. Within 1 week, the incidences of trismus and facial swelling were lower in experimental group, but there were no significant differences between two groups in facial swelling degree in post-operative 1st, 3rd day. Conclusions: Current evidence shows that combined application of piezosurgery and rotary instrument may not consistently shorten the operation duration and reduce postoperative facial swelling, but it can reduce the degree of postoperative pain reaction and restriction of mouth opening.

Key words: piezosurgery, rotary instrument, impacted mandibular third molar, treatment outcome, meta-analysis