Surgical extraction of the impacted third molar is one of the most performed surgical procedures in the field of Oral and Maxillofacial Surgery. Assessment of third molars surgery in terms of indications, surgical techniques, symptoms, and postoperative sequelae becomes a necessity to offer patients high quality care and minimize their suffering. One of the most important steps in mandibular third molar surgery is the removal of the covering bone or osteotomy, for which many techniques are used. The most recent technique includes the use of Piezo-surgery. The piezoelectric instrument produces a modulated ultrasonic frequency of 24–29 kHz and a microvibration amplitude between 60 and 200 mm/s. The amplitude of these microvibrations allows a clean, precise cut. Piezoelectric surgery is very efficient for osteotomy because it works selectively—the soft tissues, including nerves and blood vessels, are unaffected. This represents a significant advantage over the use of a bur. In addition, the use of anti-inflammatory medications is the prevalent attitude to decrease postoperative complications. Corticosteroids are one of the most widely employed medications administered to control these complications. Dexamethasone is known to be more powerful than other anti-inflammatory drugs because of its extended duration of action. The rationale of this study is to see if there a difference in post operative sequelae using Piezo-surgery, Piezo-surgery with submucosal Dexamethasone, Piezo-surgery with surgical drain after the extraction of impacted mandibular third molars.