POST-SURGICAL NEUROSENSORY DYSFUNCTION OF INFERIOR ALVEOLAR NERVE IN BILATERAL SAGITTAL SPILT OSTEOTOMY OF THE MANDIBLE USING SAW VERSUS PIEZOTOME: A SYSTEMATIC REVIEW AND META-ANALYSIS.

ABSTRACT

PURPOSE: The purpose of this systematic review was to compare neuro-sensory dysfunction incidence between saw and piezotomes in patients requiring bilateral sagittal split osteotomy. METHODS: Searches were performed electronically in 4 databases (PubMed, LILACS, Cochrane Library, and grey literature) up to September 2020 and manually to identify studies addressing the subject. Randomized and non-randomized clinical trials were included. RESULTS: Six studies met the eligibility criteria with a total number of 284 participants. The risk of bias assessment for randomized clinical trials was high, and for non-randomized clinical trials was critical and serious. Regarding inferior alveolar neuro-sensory dysfunction, the meta-analysis showed no significant difference between saw and piezotome 1 week [RR = 0.99, 95% CI (0.90, 1.08) P = 0.79], and 3 months [RR = 0.39, 95% CI (0.09, 1.75) P = 0.22], post-operatively. CONCLUSIONS: For patients requiring bilateral sagittal split osteotomy, piezotomes seem to offer no advantage over conventional saws regarding the incidence of neurosensory disturbance. Follow-up periods longer than 3 months may reveal faster physiologic regain of sensations. They seem to be safer than conventional saws regarding blood loss. However, proper training for using the device is mandatory, while considering the longer operating time required. Further RCTs are still recommended to improve the level of evidence.