Problem statement: The need to develop an alternative surgical tools facilitates cyst enucleation with minimal recurrence risk has introduced piezosurgery as a recent treatment modality for enucleation of radicular cyst especially, when cyst remnants are localized in inaccessible area. So, this study was based to assess postoperative sequelae of radicular cyst enucleation using ultrasonic bone surgery (piezosurgery) in comparison with conventional surgical treatment modality.   Patients and methods: Twenty patients were randomly divided into two equal groups for treatment of radicular cystic lesion of size ranged between 2-4cm. Ten Patients included within 1st   group were subjected to surgical enucleation of cystic lesion with classical application of conventional rotary instruments. While, ten patients included within 2nd  group were subjected to surgical enucleation of cystic lesion with application of piezosurgery. All patients were evaluated intraoperatively in terms of bleeding either at 24 hours and 7 days. Pain and swelling were assessed after 2 and 7 days. Bone mineral density was recorded immediately, 6 and 12 months.   results: No statistical significant difference was recorded between both groups regarding to severity of intra-operative bleeding and pain severity after 2 days (P=0.068- 0.111 respectively). A statistical significant difference was recorded between both groups regarding to summation of swelling and BMD after 2 days of follow up (P=.001-0.015 respectively). Additionally, a statistical significant difference was recorded between both groups regarding to inter-incisal distance (IID) after 24 hours and 2 days (P=0.002- 0.035respectively) and time of surgery (P=0.013). conclusion: Although, piezosurgery can be represented as technique sensitive maneuver affected seriously by several factors either related to operator experience or device adoption by itself. However, the collective findings of this study declared their positive impact on reducing the postoperative sequelae of radicular cyst enucleation compared with conventional treatment modality.