Introduction: Surgical removal of deeply impacted third molar is complicated most times with inferior alveolar nerve injury and developing large bony defects because of the deep situation of impacted tooth and limited visibility. Buccal bone lid technique using the piezoelectric device is a recent technique for surgical removal of such an impacted tooth to avoid these complications. As it allows accessibility and the accuracy of piezoelectric tips to cut through bone only without damaging adjacent tissues.
Objectives:  The main aim of this study was to evaluate the efficiency of buccal lid technique using piezotome surgery in removal of deeply impacted third molar.
Materials and methods: Ten patients with deeply impacted lower third molar were subjected to surgical extraction using buccal lid technique. Clinical follow up was conducted after a 24-hours, 72-hours, one week, six months. Also, a radiographic investigation was performed immediately postoperative and after six months to estimate the mean bone density at the buccal bone.
Results: By the end of the follow- up period, all cases showed normal lower lip sensation, the decrease in level of pain intensity score based on the Visual Analogue Scale (VAS) and an uneventful wound healing with no records of developed infection. Mean bone density after six months showed a statistically significant change in buccal bone density (p < 0.005) and statically non-significant difference in crestal bone density (p>0.005).
Conclusion: This study deduced that the use of buccal lid technique in extraction of mandibular bony impacted wisdom results in a predictable and satisfactory outcome, to achieve inferior alveolar nerve preservation and reduce bone defect.