Recent studies have investigated the use of dexmedetomidine (DEX) as an adjuvant to local anesthetic solutions.Building on this emerging evidence, this study aimed to assess the efficacy of adding DEX to local anesthetics in patients undergoing impacted third molar surgery. A systematic search was conducted across four electronic databases, PubMed, ScienceDirect, Web of Science, and the Cochrane Library, using a combination of Medical Subject Headings terms and free-text keywords related to impacted third molar surgery. Six studies comprising 266 patients were included in the qualitative systematic review, and only four of them, involving 200 patients, were included in the quantitative meta-analysis. The random-effects model demonstrated statistically significant reductions in anesthetic onset time (mean difference [MD] = –0.96 min; 95% confidence interval [CI]: –1.52 to –0.39; P = 0.0009), systolic blood pressure (MD = –3.58 mmHg; 95% CI: –6.58 to –0.58; P = 0.020), and pain at 6 and 12 h postoperatively (MD = –2.32, 95% CI: –2.85 to –1.78; P = 0.0001) in the local anesthesia + DEX group compared with local anesthesia alone. The findings indicated that incorporating DEX into local anesthesia for impacted third molar surgery resulted in statistically significant improvements in the onset of anesthetic effects and postoperative pain scores.