Piezoelectric osteotomy is based on ultrasonic vibration of an osteotomic device that permits precise cutting of bone structures without cutting adjacent soft tissues. To date, however, there have been no studies of the outcome and complications of alveolar distraction for piezoelectric osteotomy versus conventional osteotomy. The present study evaluated piezoelectric versus conventional osteotomy in alveolar distraction. Materials and Methods: A retrospective study was performed on all patients of the auothors who requested dental implants and who after preliminary evaluation were judged to require alveolar distraction osteogenesis for rehabilitation of edentulous mandibular regions. The distraction was performed using the same distraction system in all cases, but with the osteotomy performed either by conventional techniques using rotary instruments and chisels (conventional osteotomy group, n = 11), or by piezoelectric osteotomy using the Piezosurgery system (Mectron Medical Technology; Carasco, Genoa, Italy; n = 6). The 17 distractions were compared with respect to patient age, patient sex, intra- and postoperative complications, degree of surgical difficulty, postdistraction morphology of the alveolar ridge, and rehabilitation success rate. Results: Both surgical difficulty (as measured by the number of surgical instruments required) and the incidence of intraoperative complications were significantly lower in the piezoelectric osteotomy group than in the conventional osteotomy group. However, postdistraction morphology of the alveolar ridge (as determined at implant placement) was worse in the piezoelectric osteotomy group than in the conventional osteotomy group (P = .072). The overall rehabilitation success rate was 100% in the conventional osteotomy group versus only 66.7% (4 of 6 cases) in the piezoelectric osteotomy group. Conclusions: The use of piezoelectric osteotomy in alveolar distraction appears to simplify surgery and reduce the incidence of intraoperative complications. However, results also suggest that piezoelectric osteotomy increases the risk of postoperative and postdistraction complications and reduces the overall rehabilitation success rate. Keywords: bone surgery, distraction osteogenesis, piezoelectric surgery