Comparison of Intraoperative Blood Loss in Piezoelectric versus Conventional Technique Surgeries: A Systematic Review and Meta-analysis

Sina Ahmadi¹Sahar Rajaei²Farnoosh Alimohammadi³Melika Mokhtari⁴Alireza Mokhtari Sakhvidi⁵Sijia Na^6*Junbo Tu^7*

• ¹Xi'an Jiaotong University, Xi'an, China
• ²Dentist, Faculty of Dentistry, Yazd University of Medical Sciences,, Yazd, Iran
• ³Department of Oral Medicine, School of Dentistry, Arak University of Medical Sciences,, Arak, Iran
• ⁴Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University,, Tehran, Iran
• ⁵Dental Faculty, Tehran Medical Sciences, Islamic Azad University,, Tehran, Iran
• ⁶Department of Oral and Maxillofacial Surgery, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
• ⁷Department of Oral and Maxillofacial Surgery, College of Stomatology, Xi'an Jiaotong University, Xi'an, China

Comparison of Intraoperative Blood Loss in Piezoelectric versus Conventional Technique Surgeries: A Systematic Review and Meta-analysis Abstract Background and aim: Orthognathic surgeries often involve significant blood loss due to the high vascularity of the maxillofacial region. Conventional tools like saws and burrs, while effective, can cause tissue damage and heat that may delay healing. Piezosurgery, a newer technique using ultrasonic vibrations, allows precise bone cutting while protecting soft tissues and nerves. This review aimed to compare intraoperative blood loss between piezosurgery and conventional osteotomy methods. Materials and Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted up to 5 October 2025, following PRISMA guidelines. Studies involving orthognathic surgery patients using either piezosurgery or conventional tools, with reported blood loss data, were included. Six studies with 144 participants and 252 surgeries met the criteria. Data were analyzed using STATA 18 to calculate the weighted mean difference (WMD). Heterogeneity was assessed, and publication bias was evaluated with funnel plots. Results: Piezosurgery significantly reduced blood loss compared to conventional methods, with a WMD of -81.73 mL (95% CI: -97.30 to -66.16, P < 0.001). Sensitivity analysis confirmed the reliability of these results, and formal statistical tests indicated no significant publication bias. Conclusion: Piezosurgery significantly reduces intraoperative blood loss during orthognathic surgeries, likely due to its precision and minimal tissue damage. Although it is costlier and takes more time, it offers a safer alternative, particularly in complex cases. Further research with larger samples is needed to confirm these findings.