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The piezoelectric procedure resulted in a significantly longer procedural duration compared to the rotatory surgery ( 0.001). Piezoelectric surgery is considered a viable alternative technique compared to the conventional rotary systems and can improve a patient's quality of life. Thus, piezoelectric surgery might be a preferred modality for patients undergoing complicated surgical extraction of impacted lower third molars. Piezoelectric surgery is considered a viable alternative technique compared to the conventional rotary systems