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Er:YAG laser osteotomy for intraoral bone grafting procedures: a case series with a fiber-optic delivery system
Stefan Stübinger1, Constantin Landes, Oliver Seitz
1Department of Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Frankfurt am Main, Germany. sstuebinger@uhbs.ch
Background:
With a wavelength of 2.94 mum, the erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser is suitable for cutting vital osseous tissue. To analyze the benefit of laser osteotomy in implant dentistry, a fiber-guided Er:YAG laser was used for harvesting intraoral bone grafts.
Methods:
In 10 consecutive patients (six males and four females), 12 block grafts were obtained from the ramus (nine cases), chin (two cases), and tuberosity (one case) region. For the osteotomies, the laser settings included a pulse energy of 500 mJ, a pulse duration of 250 microseconds, and a pulse frequency of 12 Hz. During osteotomy, the laser fiber tip was kept 1 to 2 mm away from the bone surface.
Results:
Cut efficiency was satisfactory with almost no constraint on the positioning of the laser tip. Laser osteotomy was precise and allowed the blocks to be prepared with minimal waste of bone. The risk for accidentally injuring adjacent soft tissues was minimal. The postoperative wound-healing process was not impaired, and there were no signs of carbonization; however, the surgical procedures were time consuming.
Conclusions:
Using the Er:YAG laser with the aforementioned settings, successful laser osteotomy was achieved without any complications. However, because laser osteotomy was time-intensive and offered no depth control, it demonstrated only slight advantages for intraoral bone-grafting procedures. If the ablation process could be accelerated, the Er:YAG laser would be a promising alternative to conventional instruments for this surgical technique.