Vertical ramus osteotomy with Er:YAG laser: a feasibility study

The general advantages of laser surgery, such as decreased bleeding and dry surgical field, reduced postoperative pain and less oedema, have led to a continuous interest in laser applications for bone cutting. The ability to cut bone with a laser beam would also be of great technical benefit in minimally invasive maxillofacial surgery (endoscopic). The Erbium:yttrium aluminum garnet (Er:YAG) laser has been demonstrated to result in minimal thermal damage of bone, precise cutting, rapid osseous healing and osteoinduction. The purpose of this study was to assess the feasibility of using Er:YAG laser to perform vertical ramus osteotomy, and to determine the most efficient energy per pulse for its completion. Two fresh pig mandibles, one pig cadaver head and one human mandible were used. A different energy per pulse (0.5, 1, 1.5 and 2J/pulse) was used for each osteotomy on the pig mandibles (n=4). Vertical ramus osteotomy was feasible with all energy settings but time decreased considerably from 28 to 5.33 min as the energy per pulse increased. The human and the pig cadaver head mandibles were osteotomized bilaterally with 2000 mJ/pulse that was the most efficient in terms of time. Bone cuts were smooth with no carbonization in all cases.