A review of the physiological and histological effects of laser osteotomy

Gunaratne, G. D. Rajitha; Khan, Riaz J.K.; Fick, Daniel; Robertson, Brett W.; Dahotre, Narendra B.; Ironside, C. N.

doi:10.1080/03091902.2016.1199743

Cited by 34 publications

(33 citation statements)

References 82 publications

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“…Only two very recent systematic reviews were found comparing rotary instruments with lasers in general [14,15], pointing out that "additional research is necessary to evaluate different laser types with appropriate laser setting variables to increase ablation rates, with control of depth, change in bone type and damage to adjacent soft tissue " [14] and "because of the lack of clinical studies, it is not possible to make a conclusive result whether there is superiority of laser osteotomy in clinical practice" [15].…”

Section: Group 1 (Systematic Reviews and Meta-analyses)mentioning

confidence: 99%

Cutting bone with drills, burs, lasers and piezotomes: A comprehensive systematic review and recommendations for the clinician

Troedhan¹,

Mahmoud²,

Wainwright³

et al. 2017

Int J Oral Craniofac Sci

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Background: New tools for bone-cutting were introduced to oral and maxillofacial surgery in the last decade, such as lasers and piezotomes. Purpose: to evaluate most recent evidence, when surgical procedures performed with drills or burs are compared with laser-and/or piezotome-surgical procedures in experimental and clinical studies and to assess possible advantages of their use in daily practice. Methods: a systematic search of various medical databases with specifi c keywords was performed, excluding studies published before 2006 for their possible invalidity by technological progress. Systematic reviews were assigned to Group 1, experimental studies ex vivo to Group 2, in vivo to Group 3 and clinical studies to Group 4. All studies in each of the groups 2-4 were appraised regarding their evidence, starting with a value of 0 for no evidence of advantages of lasers and/or piezotomes compared to rotary instruments, 1 for moderate evidence with verifi ed clinical impact and 2 for strong evidence and signifi cant clinical impact and statistically processed for their Evidence Value (EV) in each group and their Overall mean Evidence Value (OmEV). Results: 129 studies were fi nally included for evaluation. Two systematic reviews concluded lack of evidence for lasers to be advantageous over burs/drills. Nine reviews for piezotomes reveal strong evidence piezotome-surgery to signifi cantly reduce morbidity and to enhance soft-tissue preservation. Comparative experimental and clinical studies of burs/drills vs lasers revealed a low EV in Group 2 (EV:0,8), Group 3 (EV:0,5) and Group 4 (EV:0,5) with an OmEV of 0,6. Comparative studies burs/drills vs piezotomes resulted in a signifi cant EV in all groups (

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Section: Group 1 (Systematic Reviews and Meta-analyses)mentioning

confidence: 99%

Cutting bone with drills, burs, lasers and piezotomes: A comprehensive systematic review and recommendations for the clinician

Troedhan¹,

Mahmoud²,

Wainwright³

et al. 2017

Int J Oral Craniofac Sci

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“…Thermal damage to an ablation target is a concern that is explored in multiple studies, as excessive thermally-induced necrosis will prevent or delay healing [16][17][18][19]. Ablation in the thermal regime is limited by excessive heat accumulation and diffusion into tissue.…”

Section: Topical Chromophoresmentioning

confidence: 99%

Optimization of laser osteotomy at 1064 nm using a graphite topical absorber and a nitrogen assist gas jet

Jivraj

Chen

Barrows³

et al. 2019

Biomed. Opt. Express

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Laser ablation of bone for the purposes of osteotomy is not as well understood as ablation of homogeneous, non-biological materials such as metals and plastics. Ignition times and etch rate can vary during ablation of cortical bone. In this study, we propose the use of two techniques to optimize bone ablation at 1064nm using a coaxial nitrogen jet as an assist gas and topical application of graphite as a highly absorbing chromophore. We show a two order of magnitude reduction in mean time to ignition and variance by using the graphite topical chromophore. We also show that an increase in volumetric flow rate of the assist gas jet does show an initial increase in etch rate, but increased pressure beyond a certain point shows decreased return. This study also demonstrates a 2 nd order relationship between exposure time, volumetric flow rate of nitrogen, and etch rate of cortical bone. The results of this study can be used to optimize the performance of laser ablation systems for osteotomy. This is a companion study to an earlier one carried out by Wong et al. [Biomedical Opt. Express 6, 1 (2015)].

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“…Over the past several years, there has been a particular interest in the development of laser surgery systems due to the advantages offered by laser-based cutting, including minimal invasiveness, noncontact interaction, precise and small cuts, functional cut geometry as well as less trauma. [1][2][3][4][5][6] Moreover, in comparison to other mechanical procedures, such as conventional surgery, bone showed faster healing after interventions with laserosteotomes. 7 Studying the effect of different laser parameters on quality and efficiency of laser cutting in both soft and hard tissues is a topic of present interest.…”

Section: Introductionmentioning

confidence: 98%

Laser-induced breakdown spectroscopy as a potential tool for autocarbonization detection in laserosteotomy

et al. 2018

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In laserosteotomy, it is vital to avoid thermal damage of the surrounding tissue, such as carbonization, since carbonization does not only deteriorate the ablation efficiency but also prolongs the healing process. The state-of-the-art method to avoid carbonization is irrigation systems; however, it is difficult to determine the desired flow rate of the air and cooling water based on previous experiments without online monitoring of the bone surface. Lack of such feedback during the ablation process can cause carbonization in case of a possible error in the irrigation system or slow down the cutting process when irrigating with too much cooling water. The aim of this paper is to examine laser-induced breakdown spectroscopy as a potential tool for autocarbonization detection in laserosteotomy. By monitoring the laser-driven plasma generated during nanosecond pulse ablation of porcine bone samples, carbonization is hypothesized to be detectable. For this, the collected spectra were analyzed based on variation of a specific pair of emission line ratios in both groups of samples: normal and carbonized bone. The results confirmed a high accuracy of over 95% in classifying normal and carbonized bone.

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A review of the physiological and histological effects of laser osteotomy

Cited by 34 publications

References 82 publications

Cutting bone with drills, burs, lasers and piezotomes: A comprehensive systematic review and recommendations for the clinician

Cutting bone with drills, burs, lasers and piezotomes: A comprehensive systematic review and recommendations for the clinician

Optimization of laser osteotomy at 1064 nm using a graphite topical absorber and a nitrogen assist gas jet

Laser-induced breakdown spectroscopy as a potential tool for autocarbonization detection in laserosteotomy

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