Objective This study aims to compare the sedative effects of remimazolam and midazolam during im-pacted tooth extraction to provide a comfortable sedation treatment for patients with dental anxiety.Methods A pro-spective randomized controlled trial was conducted,in which 60 patients undergoing intravenous sedation for mandibular impacted third molar extraction were evenly divided into either the remimazolam or midazolam group.Prior to receiving a nerve blocker,the patients were sedated with remimazolam or midazolam.Various parameters were recorded and ana-lyzed,including onset time,awakening time,recovery time,modified dental anxiety scale(MDAS)scores before and af-ter surgery,patient-doctor satisfaction levels,postoperative side effects within 24 hours,heart rate(HR),and mean arteri-al pressure(MAP)at different time points.Results Compared with the midazolam group,patients in the remimazolam group demonstrated significantly shorter onset,awakening,and recovery times as well as lower postoperative MDAS scores and higher levels of patient-doctor satisfaction.Fewer postoperative side effects were reported in the remimazol-am group,although the differences were not statistically significant.Conclusion The use of remimazolam demon-strates faster onset and recovery,superior efficacy in reducing dental anxiety,and enhanced satisfaction among patients and doctors,thereby presenting distinct advantages for sedation treatment for patients with dental anxiety.