A comparison of piezoelectric surgery and conventional techniques in the enucleation of cysts and tumors in the jaws: a systematic review and meta-analysis

TL;DR

This study compares piezoelectric surgery and traditional methods for removing jaw cysts and tumors, finding minor benefits with piezoelectric surgery but no major differences in outcomes.

Contribution

A systematic review and meta-analysis comparing piezoelectric surgery and conventional techniques for jaw lesion enucleation.

Findings

Piezosurgery reduced intraoperative hemorrhage and postoperative pain compared to conventional surgery.

No significant difference in recurrence rates, epithelial perforation, or soft tissue damage between the two techniques.

Conventional surgery was faster than piezoelectric surgery.

Abstract

Despite the comprehensive classifications provided by the WHO, the most common lesions include radicular cysts, dentigerous cysts, odontogenic keratocysts, ameloblastomas, and odontomas. The piezoelectric technique has shown effectiveness in removing intraosseous pathologies by relying on ultrasonic microvibrations, which help preserve soft and vascular tissues. Precision in manipulating intraosseous pathology can impact the prognosis and improve the surgical procedure by controlling hemorrhage and promoting microscopic benefits. While previous research has compared the advantages of piezoelectric surgery and rotational methods, a systematic review is needed to consolidate the available information on this specific clinical issue.

A search strategy was developed with de PRISMA statement. PubMed, Web of Science, Scopus, and Embase electronic databases were searched. The bibliographic search was conducted in December 2023. The methodological quality of the studies followed the Joanna Briggs Institute (JBI) critical evaluation tool for randomized clinical trials.

The final sample comprised 5 clinical trials, involving 231 cysts and 120 tumors in the experimental group. The mean age of participants was 30.6 years, with 196 men and 141 women included in the study. However, conventional surgery is faster than piezosurgery, both techniques exhibited similarities in epithelial perforation, soft tissue damage, edema, postoperative infections, and occurrences of paresthesia. Regarding recurrence, no statistically significant difference was observed between the two techniques (p-value=0.339; 95% confidence interval, -0.093-0.270).

The surgical removal of benign odontogenic cysts and tumors in the jaws using piezosurgery yielded slight intraoperative and postoperative advantages compared to conventional rotary surgery, except for the duration of surgical procedures. It shows reduced intraoperative hemorrhage and postoperative pain but similar outcomes in other variables. The results should be interpreted with caution, more studies are needed to obtain a more robust result.

Key words:Piezosurgery, maxillofacial surgery, radicular cyst, dentigerous cyst, ameloblastoma, odontoma, systematic review.

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