Introduction: The temporomandibular joint (TMJ) is the most active joint of the body. Limitations of the mouth opening can be caused by bony or fibrous ankylosis of the TMJ as a sequela to trauma, infection, autoimmune disease or failed surgery. A significant effect of TMJ ankylosis is obstructive sleep apnea (OSA) which can progressively worsen and the symptoms associated with OSA can dominate sidelining the primary disorder itself. Aim/Objectives: The purpose of this study was to investigate and compare the use of conventional rotary bur technique and piezosurgery unit for gap arthroplasty in TMJ ankylosis. Method Used: Twenty patients were examined clinically and radiologically for the treatment. Out of the twenty patients, ten patients were operated using conventional rotary bur technique (Group A) and the remaining ten patients were operated using piezosurgery unit (Group B). Two major parameters that is blood loss and duration of surgery were evaluated intraoperatively and other parameters like pain, mouth opening, swelling and paraesthesia were evaluated on Post Operative Day (POD)-1, 5, 10, 15. Result: We observed that there was a significant reduction in blood loss intraoperatively with the piezosurgery unit though the operating time was prolonged. Post-operative physiotherapy had increased the inter-incisal distance in both groups. Pain levels and swelling were significantly higher in Group A. Other complications like paresthesia were not observed in either of the groups. Conclusion: This comparative study suggests piezosurgery can be a valuable alternative method to the bur technique due to its efficacy in the evaluated parameters.