[Evaluation of the efficacy of three different bone removal methods in the extraction of mesial and low impacted mandibular wisdom teeth].

PURPOSE: To evaluate the effect of Er:YAG laser, piezosurgery and high-speed turbine drill in the extraction of mesial and low impacted mandibular wisdom teeth. METHODS: A total of 119 patients with mesial and low mandibular impacted wisdom teeth who were admitted from April 2021 to July 2023 were selected and divided into group A(n=38), group B(n=40) and group C(n=41) according to different bone removal methods. Group A was treated with high-speed turbine drilling, group B was treated with Er:YAG laser and group C was treated with piezosurgery. Postoperative indexes, visual analogue score (VAS) of postoperative pain, facial swelling, mouth opening limitation, complications and postoperative satisfaction were compared among the three groups. RESULTS: The intraoperative blood loss in group C was significantly lower than that in groups A and B (P＜0.05), and that in group B was significantly lower than that in group A (P＜0.05). The tooth extraction time in group B was significantly longer than that in groups A and C(P＜0.05), and that in group C was significantly longer than that in group A (P＜0.05). Pain VAS of the three groups on the 7th day after surgery was significantly lower than that on the 1st day after surgery (P＜0.05), and pain VAS of groups B and C were significantly lower than that of group A (P＜0.05), but there was no significant difference between group B and C (P＞0.05). The degree of facial swelling on the 7th day after surgery in the three groups was significantly lower than that on the 3rd day after surgery(P＜0.05), and groups B and C were significantly lower than group A(P＜0.05), but there was no significant difference between groups B and C(P＞0.05). The degree of mouth opening limitation on the 7th day after surgery in the three groups was significantly lower than that on the 3rd day after surgery (P＜0.05), and groups B and C were significantly lower than group A (P＜0.05), but there was no significant difference between groups B and C(P＞0.05). There was no significant difference in the total incidence of complications among the three groups(P＞0.05). The postoperative satisfaction of group C was significantly higher than group A and group B(P＜0.05), and the postoperative satisfaction of group B was significantly higher than group A(P＜0.05). Multivariate logistic regression analysis revealed that operation time ＜20 min, intraoperative blood loss＜5 mL and intraoperative pain VAS ＜2 were independent protective factors for the improvement of patients' satisfaction (P＜0.05). CONCLUSIONS: Compared with Er:YAG laser, high-speed turbine drill and piezosurgery have better effects in the extraction of mesial and low mandibular impacted wisdom teeth. Both of them can reduce postoperative pain and intraoperative trauma, improve the degree of facial swelling and mouth opening limitation of patients. Moreover, compared with high-speed turbo drill and Er:YAG laser, piezosurgery can improve patients' satisfaction.