Er:YAG laser osteotomy for removal of impacted teeth: clinical comparison of two techniques

In contrast to many techniques currently employed for osteotomy, like saws, drills or modulated ultrasound, lasers offer non-contact and low-vibration bone cutting. Therefore, this report examines the benefits to laser osteotomy in oral surgery using two different short-pulsed Er:YAG laser systems.

Er:YAG lasers, using either a fiber-optic delivery system and an articulated arm delivery system, were used to remove impacted teeth in 30 patients. In 15 patients an Er:YAG laser utilizing a fiber-optic delivery system was applied for cutting bone, with a pulse energy of 500 mJ, a pulse duration of 250 microseconds and frequency of 12 Hz (energy density 177 J/cm(2)). The other 15 patients were treated with an Er:YAG laser utilizing an articulated arm delivery system, with a pulse energy of 1,000 mJ, a pulse duration of 300 microseconds and a frequency of 12 Hz (energy density 157 J/cm(2)).

In all cases the lasers allowed precise bone ablation without any visible, negative, thermal side-effects. Since the laser tip was used in a non-contact mode and could be positioned freely, unrestricted cut geometries were feasible. Adjacent soft tissue structures could be preserved and were not harmed by the laser beam. However, osteotomies were time consuming, especially if teeth had to be separated. The level of water irrigation limited the use of the laser. In 20% of the cases in which the articulated arm delivery laser was used to section teeth, it was necessary to use a conventional dental drill to finish the procedure.

This bone ablation technique, using short Er:YAG laser pulses and water spray, produced good clinical results without any impairment to wound healing. However, for now, the lack of depth control and the time required to perform the necessary osteotomy limit routine clinical application.