Piezoelectric Versus Conventional Osteotomy Instruments in Bimaxillary Orthognathic Surgery: A Narrative Review of Surgical Efficiency, Safety, and Clinical Outcomes

Instrument selection in bimaxillary orthognathic surgery must balance cutting efficiency, measured blood loss, and injury to adjacent structures. This narrative review distinguishes the evidence from combined Le Fort I and bilateral sagittal split osteotomy (BSSO) procedures from the evidence concerning individual osteotomies. A targeted PubMed update through 24 September 2026, supplemented by reference tracing and publisher and repository records, informed a study-level appraisal. Several comparative studies and meta-analyses report lower measured blood loss with piezoelectric instrumentation, but a non-significant pooled comparison and methodological limitations prevent a uniform estimate of benefit. A reduction in transfusion or major vascular injury has not been established. Neurosensory findings are favorable in some studies but inconsistent across tests and follow-up intervals; time to functional sensory recovery, degree of recovered function, and persistent disturbance are distinct outcomes. Operative-time results also conflict, partly because studies measure different intervals. Operator experience is a possible contributor rather than a demonstrated explanation. Evidence for clinically important improvements in pain, swelling, bone healing, or skeletal stability remains limited. Technical reports support the feasibility of selective or hybrid instrumentation, but comparative superiority of a hybrid workflow has not been established. Current evidence supports cautious, procedure-specific interpretation and further comparative trials rather than a universal replacement of conventional instruments.