Er:YAG Laser Osteotomy: Preliminary Clinical and Histological Results of a New Technique for Contact-Free Bone Surgery

Abstract

Background: The purpose of this retrospective study was to evaluate the surgical performance, clinical usability and outcome of a new variable square pulsed (VSP) Er:YAG laser for bone cutting in oral and maxillofacial surgery. Materials and Methods: In 40 patients an Er:YAG laser with pulse energy of 1,000 mJ, pulse duration of 300 μs and a frequency of 12 Hz was used for different intraoral osteotomies. The spot size was 0.9 mm, and the handpiece was kept at a distance of 10 mm from the bone surface. Additionally, histological analyses of the fresh osteotomy rims of lasered bone were performed. Results: Er:YAG laser osteotomy revealed a remarkable cutting efficiency without any visible, negative, thermal side effects. There was no damage of adjacent soft tissue structures. However, depth control was limited to visual inspection. Histologically, a 5- to 10-μm-wide zone of a characteristic laser fingerprint appeared on the cut edges. However, there was no sign of thermal tissue damage to the underlying bone structures. Conclusions: VSP Er:YAG laser osteotomy is clinically practicable without any signs of charred tissue and wound healing disturbances. However, the lack of depth control and the necessity for careful handling are still technical limitations to be overcome.

Histological in vitro evaluation of the effects of Er:YAG laser on oral soft tissues

“…Stübinger et al evaluated the thermal damage caused by the Er:YAG laser in hard tissue. The study showed no signs of charred tissue or wound healing 1 2 3 4 5 1 1 1 1 2 2 2 2 1 1 1 3 3 1 1 1 2 2 4 1 1 2 2 2 S 2 1 1 2 3 6 1 1 1 2 2 7 2 2 2 2 3 8 2 1 1 1 2 9 1 1 1 2 3 disturbances during osteotomy, demonstrating that the device is safe for use during hard tissue maxillofacial surgery [18]. Another study by Romeo et al demonstrated that the Er:YAG laser can be used safely in hard tissue in contrast to traditional cutting systems which cause peripheral bone damage.…”

Advances in bone surgery: the Er:YAG laser in oral surgery and implant dentistry

“…Noncontact bone cutting with the VSP Er:YAG laser revealed not only convincing clinical results, but also allowed new and forward-looking treatment regimes. A histological analysis of fresh human bone specimen after VSP Er:YAG laser ablation disclosed that the laser left behind a 5–10 μm superficial demarcation zone as a characteristic fingerprint, in which the homogenous lamellar bone matrix structure was changed to a diffuse fibrous-like structure 148. Osteocyte lacunae directly adjacent to the laser fingerprint contained osteocytes with normal structural characteristics.…”

Guidance of hard tissue ablation by forward-viewing optical coherence tomography

“…The resultant non-deterministic tissue cutting/ablation process greatly hinders the use of lasers during such surgeries. For example, several authors have recently highlighted that practical laser osteotomy (surgical procedure to cut bone) is several limited by a lack of laser depth control 1,2 . The potential benefit of precise removal of tissue may provide significant clinical impact in this and other areas of surgical oncology and implantation.…”