Piezoelectric osteotomy has emerged as a promising alternative to traditional rotary osteotomies in maxillofacial surgery, offering precise bone cutting with minimal soft tissue trauma. This randomized controlled trial (RCT) aims to compare postoperative pain, swelling, and healing outcomes between piezoelectric and traditional osteotomies. A total of 100 patients requiring bony osteotomies for orthognathic or reconstructive procedures were enrolled and randomly assigned to either the piezoelectric or traditional rotary osteotomy group. Postoperative pain was assessed using a visual analog scale (VAS), swelling was measured via three dimensional photogrammetry, and healing was evaluated using radiographic bone density and histological markers at follow-up intervals. Results demonstrated significantly lower pain scores (p < 0.001) and reduced swelling (p = 0.002) in the piezoelectric group. Bone healing rates were superior, with higher radiographic density and histological evidence of enhanced osteogenesis (p = 0.004). These findings highlight the clinical advantages of piezoelectric osteotomy in reducing postoperative morbidity and enhancing bone healing. Future studies should further investigate its long-term impact on maxillofacial procedures