Aims and background: To evaluate the effect of the piezosurgery device as a recent modality for bone removal of impacted mandibular third molars in comparison to the high-speed handpiece, along with the efficacy of hyaluronic acid (HA) regarding its effect on postoperative pain, trismus, dry socket, and swelling. Materials and methods: This prospective study involved 40 patients divided into four groups with 10 patients in each group. Group I and group II included 10 patients each, where third molar removal was done using conventional technique (carbide burs) with or without placement of HA soaked in gelfoam in the socket, respectively. Group III and group IV included 10 patients each, where third molar removal was done using piezosurgery with or without placement of HA soaked in gelfoam in the socket, respectively, and no gelfoam was placed. All patients were followed up clinically at 1, 3, 5, and 7 days postoperatively. The parameters included swelling, trismus, pain, and dry socket. Data were recorded and statistically analyzed. Results: There were no significant differences in postoperative swelling on the 1st, 3rd, and 5th postoperative days in all the groups. However, on day 7, a significant difference was found, highest in group I and lowest in group II patients. Trismus was significantly lower in group IV, having lower third molar disimpaction using piezosurgery with HA gelfoam placed. Conclusion: Hyaluronic acid with gelfoam is effective in controlling trismus and dry socket postoperatively after mandibular third molar extraction with the conventional bur technique. However, our results showed no significant changes in the case of pain and swelling. Clinical significance: Hyaluronic acid is a biomaterial introduced as an alternative approach to enhance wound healing. Trismus and dry socket are the most common sequelae following impacted third molar surgical extraction. Applying HA with gelfoam can reduce the severity of unhealed socket and trismus, which could be useful in surgeons’ daily practice.