COMPARATIVE ANALYSIS OF THE EFFECT OF PIEZOSURGICAL AND ROTATIONAL PROTOCOLS ON THE REGENERATION OF THE JAW BONE DEFECT IN THE SURGICAL TREATMENT OF RETENTION AND DYSTOPIA OF THE LOWER THIRD MOLARS

Abstract

Introduction. The traditional technique of atypical extraction involves the use of rotary instruments with carbide or diamond burs. An alternative is piezoelectric surgery, which uses ultrasonic microvibrations (24–36 kHz). Despite the above positive characteristics inherent in piezosurgery, at present, in our opinion, the literature remains insufficiently covered the issues of long-term results of reparative regeneration of the mandibular bone tissue in the defect area according to densitometry data (Hounsfield units), especially in complex extractions under retention conditions and medial or horizontal position of the lower third molars. Purpose of the study. To conduct a comparative analysis of the results of the use of rotary and piezosurgical methods of atypical extraction of the impacted lower third molar. Materials and Methods. The study involved 100 patients who sought elective surgical care for the removal of lower third molars. All patients were randomly divided into two clinical groups. Group 1 (control, n=50) – osteotomy was performed using rotational systems. Group 2 (main, n=50) – a piezosurgical device was used to perform osteotomy. Analysis of intraoperative parameters. The average duration of tooth extraction in the first group was 22.4±4.1 min, whereas in the second group it was significantly higher — 28.6±5.3 min (p≤0.05). The increase in time by 18–22% is associated with the technical features of the piezotome, which requires slower, reciprocating movements without excessive pressure to maintain the amplitude of the nozzle oscillations. When analyzing the severity of the pain syndrome (as measured by the VAS visual analog scale), piezosurgery showed a significant advantage. Probing of the distal surface of the second molar after 6 months showed that the average pocket depth in the control group, under the conditions of using rotational systems, was 4.5±0.7 mm, which could be considered signs of a pathological periodontal pocket, while in the main group, where tooth extraction was performed using a piezotome, it was 2.8±0.3 mm, which was a sign of the physiological norm. Conclusions. Atypical removal of the lower third molar using piezoelectric technology is a gentler method than the traditional rotational technique, despite an average increase in surgical duration of 6 minutes. The use of ultrasound during surgical intervention significantly reduces the risk of postoperative complications: pain intensity decreases by 40%, edema regresses more quickly, and the risk of alveolitis is minimized.