INTRODUCTION: piezosurgery device was originally developed for the atraumatic cutting of bone as it produces microvibrations and specific ultrasound frequency (25-29 kHz). This new ultrasonic cutting method will be an alternative to conventional methods of oral surgery. OBJECTIVES: This study compares the use of piezosurgery and conventional technique in mandibular radicular cyst enucleation and this was estimated by clinical and radiographic analysis. MATERIALS AND METHODS: This study was conducted on fourteen patients selected from the Out-patient Clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University. Patients with radicular cyst in jaw region were diagnosed clinically and radiographically. The patients were randomly divided into two groups, seven patients were treated using piezosurgery and other seven patients were treated using conventional surgical procedures. Intraoperative and postoperative evaluation was carried out to monitor soft tissue damage, manipulation complexity, pain, infection and tissue dehiscence at 1st, 2nd, 7th day and after one month postoperatively. The bone healing and bone density was determined radiographically after 3 and 6 months postoperatively using Cone Beam Computed tomography. RESULTS: no soft tissue damage or manipulation complexities were observed in both groups, less bleeding was observed intraoperatively in piezosurgery group. Healing was uneventful with no signs of dehiscence in piezosurgery group with lower pain score than in control group. There was a significant decrease in the surface area of the bone defect in the piezosurgery group compared to control group along the follow up period. The improvement in the bone density was greater in the piezosurgery group than in the control group, with percent of difference 33.42% on the 3rd month and 63.84% on the 6th month. CONCLUSIONS: Piezosurgery is effective in cyst enucleation as it accelerates bone healing and reduces intraoperative and postoperative complications