Maxillary osteotomy complications in piezoelectric surgery compared to conventional surgical techniques: a systematic review

A systematic review was conducted to investigate the available evidence on maxillary complications related to piezoelectric and conventional surgery. Seven databases were searched. A total of 996 maxillary osteotomies were analysed, 864 performed with conventional tools and 132 with a piezoelectric device. One hundred and fifty-six complication events were reported. The complications, in descending order of overall prevalence, were as follows: neurosensory disturbance (64.7%), haemorrhage (8.3%), oroantral communication (7.7%), soft tissue injury (7.7%), tooth injury (5.1%), infection (3.2%), osteonecrosis (1.9%), and permanent nerve injury (1.3%). Among the complications, the results showed the highest prevalence for neurosensory disturbance, and haemorrhage was the most reported complication and the second most prevalent complication. A three-fold meta analysis was performed. Using GRADEpro, the level of evidence was determined for each complication. The current low level of evidence suggests that piezoelectric bone surgery reduces critical and important complications during maxillary osteotomy procedures, such as neurosensory disturbance, haemorrhage, oroantral communication, tooth injury, and permanent nerve injury. However, an effective comparison between the two techniques was difficult to perform with the current available literature. Due to the small sample sizes in the piezoelectric surgery studies, caution should be exercised when considering almost non-existent reported complications.