Objective: The aim of this randomized controlled clinical study was to evaluate the efficacy of a new technique fully based on the use of a piezoelectric device for third molar root extraction versus the conventional technique based on the use of manual and rotary instruments. Method and materials: Patients referred to the hospital of Bolzano for third molar extraction were randomly divided into two groups and treated by two experienced oral surgeons. In the test group all the procedures were performed using piezoelectric instruments and a specially designed piezoelectric lever, whereas in the control group conventional manual and rotary instruments were used. The main outcome measure was patient's pain perception, and the secondary outcome measures were complications, duration of the surgical treatment, and soft tissue healing. The study had a 1-week follow-up. Results: Fifty patients (23 females and 27 males) out of 90 were included in the study, and 100 third molars (50 maxillary and 50 mandibular) were extracted. All patients completed the expected follow-up. No differences were found between the two groups regarding patient's pain perception, complications, and soft tissue healing. However, the new piezoelectric extraction technique took less than half the time when compared to the conventional technique (4.6 ± 4.5 minutes versus 10.2 ± 13.1 minutes; P = .049). Conclusions: The new piezoelectric third molar root extraction technique allowed third molar extraction in less than one half the surgical time required by the traditional technique. The advantages seem to be more pronounced in difficult cases. However, both surgeons who performed the procedures were very experienced and all the patients were young. Therefore, caution should be given to the generalization of the results. Multicenter studies with a larger variety of patients are needed to confirm the promising results of this study. Keywords: extraction, oral surgery, piezoelectric, randomized clinical trial, third molar