Minimally Invasive Techniques and Emerging Diagnostics in Mandibular Third Molar Surgery: A Narrative Review

Abstract

  The extraction of impacted mandibular third molars is a common oral surgical procedure often associated with postoperative conditions, including pain, edema, trismus, and inferior alveolar nerve (IAN) injury. In recent years, the introduction of advanced technologies, namely piezoelectric surgery and artificial intelligence (AI), has transformed diagnostic and surgical approaches, offering new possibilities to enhance safety, precision, and treatment outcomes. A narrative review was conducted by searching PubMed (Medline) for relevant studies published between January 1, 2015, and January 31, 2025. The search followed the PCC framework and was complemented by manual exploration through Google Scholar. The PRISMA 2020 statement was followed to select the included studies. A total of 58 records were identified through electronic and manual searches. No duplicates were identified, and no records were excluded before screening; therefore, 58 records were screened. Following title and abstract screening, 23 articles were assessed for full-text eligibility. Of these, seven were excluded, resulting in 7 studies being included in the final review. The reviewed studies highlight that artificial intelligence enables accurate and predictive assessment of the anatomical relationship between impacted third molars and critical anatomical structures, particularly the inferior alveolar nerve. Concurrently, piezoelectric surgery demonstrates clear advantages over conventional rotary instruments by reducing postoperative complications and enhancing both patient comfort and bone healing. The diagnostic performance of artificial intelligence varies based on the type of imaging data provided, the design of the deep learning model, and the use of semantic annotation. While AI can match expert-level accuracy on panoramic radiographs, particularly when semantic segmentation is employed, its most valuable role may be in identifying cases that would benefit from CBCT imaging, rather than replacing advanced imaging altogether. Piezoelectric techniques, on the other hand, offer a safer and more conservative surgical alternative, contributing to reduced morbidity and improved clinical outcomes. Surgical Navigation serves as a valid tool, but its applicability remains limited to selected cases due to increased costs and operating times. Overall, the integration of these technologies represents a step forward toward safer, more personalized, and minimally invasive approaches in third molar surgery.