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Facial swelling was objectively quantified using three-dimensional facial scans at 2 and 7\u00a0days postoperatively. Secondary outcomes included postoperative pain, maximum mouth opening, bleeding, surgical time, analgesic intake, complications, and patient-reported outcomes assessed using the PoSSe scale. Statistical analysis was performed using paired comparisons and regression models (\u03b1\u2009=\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ninety-four extractions were analyzed. After 2\u00a0days, lower facial swelling was significantly reduced in TG compared with CG (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01), together with less pronounced trismus (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016). Pain was consistently lower in the TG at all timepoints, while postoperative bleeding and analgesic intake were significantly higher in the CG (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Surgical time was longer in TG than in CG (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The piezosurgery protocol significantly reduced interference with daily activities and resulted in higher patient satisfaction. Regression analyses showed a direct association between swelling and PoSSe scale in both groups. No permanent neurological complications were observed; alveolitis occurred in 3 CG and 2 TG sites.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This split-mouth randomized controlled trial suggests that piezosurgery for MA-HM3M extraction effectively reduces early postoperative inflammatory sequelae, improving patient-centered outcomes and quality of life, despite longer operative times.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance<\/jats:title>\n                    <jats:p>The proposed piezoelectric protocol could represent a minimally invasive alternative to conventional rotary techniques, particularly in complex MA-HM3M extractions, enhancing patient comfort and quality of life during the most critical postoperative period while supporting a more controlled and refined surgical approach.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Registry:<\/jats:bold>\n                      ClinicalTrials.gov, TRN: NCT06212232, Registration date: 25 January 2024.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00784-026-06982-w","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T02:22:39Z","timestamp":1781749359000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Piezosurgery-assisted protocol for impacted mandibular third molar removal with 3D facial swelling analysis: a randomized split-mouth clinical trial on post-surgical sequelae"],"prefix":"10.1007","volume":"30","author":[{"given":"Alessandro","family":"Antonelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Brunello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Salviati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selene","family":"Barone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bennardo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason Motta","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amerigo","family":"Giudice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"issue":"8","key":"6982_CR1","doi-asserted-by":"publisher","first-page":"5143","DOI":"10.1007\/s00784-022-04482-1","volume":"26","author":"Y Shi","year":"2022","unstructured":"Shi Y, Wang Y, Ge H et al (2022) Comprehensive characterization of epidemiological and 3D radiographic features of non-third molar impacted teeth in a Chinese dental population. 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