Background: The aim of the study was to evaluate the effect of platelet-rich fibrin and piezo surgery on impacted mandibular third molar surgery outcomes. Methods: This study was performed over total sample of 20 lower 3^rd molar teeth of 10 patients using split mouth technique. This study compared the surgical outcomes (pain, number of analgesics taken, swelling, trismus) after extraction of mandibular third molars using PRF and piezosurgery combined with PRF compared to standard rotating handpiece. Results: The use of PRF combined with piezo surgery, significantly reduced pain and number of analgesics taken. Both operations also significantly decreased trismus 24 h after the surgery.  Conclusion: The use of PRF, and PRF combined with piezo surgery, significantly reduced pain, decreased the number of analgesics taken, and decreased trismus 24 h after the surgery. The results of this study clearly indicate that PRF is significantly better in healing dental sockets and decrease bone reduction of the socket after third molar surgical extraction in comparison to that without PRF.