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Wojcik T, Morawska M, Ferri J, Müller-Gerbl M, Nicot R. Robotic calvarial bone sampling. J Craniomaxillofac Surg 2023; 51:603-608. [PMID: 37806905 DOI: 10.1016/j.jcms.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
The aim of this study was to assess the feasibility of complex unicortical calvarial harvesting by using the Cold Ablation Robot-Guided Laser Osteotome (CARLO® primo+). A cadaveric study was performed with a progressive complexity of the bone harvesting. This preliminary study on the cadaveric cranial vault area examined the tracking precision, the strategies, settings and durations of harvesting, the accuracy of the unicortical bone cutting, and the risk of dura exposition. All sampling was realised with no more difficulty than that experienced during the standard procedure. No bicortical cutting occurred during CARLO® primo + robot-guided laser cutting. During the second sampling, dura was partially exposed due to improper angulation of the curved osteotome during harvesting. Complex unicortical calvarial harvesting using robot-guided laser appears to be feasible and safe. In the future, robotic approaches will probably replace current surgical techniques using cutting guides and help reduce intraoperative inaccuracies due to the human factor.
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Affiliation(s)
- Thomas Wojcik
- Univ. Lille, CHU Lille, INSERM, Oral and Maxillo-Facial Surgery Department, U1008 - Advanced Drug Delivery Systems, F-59000, Lille, France.
| | | | - Joël Ferri
- Univ. Lille, CHU Lille, INSERM, Oral and Maxillo-Facial Surgery Department, U1008 - Advanced Drug Delivery Systems, F-59000, Lille, France.
| | | | - Romain Nicot
- Univ. Lille, CHU Lille, INSERM, Oral and Maxillo-Facial Surgery Department, U1008 - Advanced Drug Delivery Systems, F-59000, Lille, France; Univ. Lille, Centrale Lille, CNRS, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France.
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Genç BGÇ, Orhan K, Or S. A Clinical Comparison of Er:YAG Laser, Piezosurgery, and Conventional Bur Methods in the Impacted Third Molar Surgery. Photobiomodul Photomed Laser Surg 2023; 41:283-290. [PMID: 37335617 DOI: 10.1089/photob.2022.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Objective: The aim of this study is to investigate whether Er:YAG laser and piezosurgery methods can be an alternative to the conventional bur method. Background: The purpose of this study is to compare the postoperative pain, swelling, trismus and patient satisfaction between Er:YAG laser, piezosurgery device, and conventional bur methods that are used to remove bone barrier during extraction of the impacted lower third molar. Methods: Thirty healthy patients who have bilateral, asymptomatic, vertically impacted mandibular third molar teeth according to Pell and Gregory classification Class II and Winter Class B were selected. Patients were randomly divided into two groups. In 30 patients one side of the bony cover around the tooth was removed by the conventional bur technique, on the other side 15 patients were treated with the Er:YAG laser (VersaWave dental laser; HOYA ConBio) 200 mJ, 30 Hz, 4.5-6 W, noncontact mode, SP and R-14 handpiece tip, under air and saline solution, and 15 patients with the piezosurgery technique (VarioSurg Piezo; NSK) with frequency 20-100 kHz, 10-80% power range in Surgery (S), continuous mode, with SG17 and SG5 handpiece tip blade. Preoperative, 48th hour and 7th day measurements were made and recorded about pain, swelling, and trismus. At the end of the treatment, patients were asked to fill out a satisfaction questionnaire. Results: The pain observed at the postoperative 24th hour was statistically significantly lower in the laser group than in the piezosurgery group (p < 0.05). Only in the laser group swelling was seen with statistically significant differences between preoperative and postoperative 48th h (p < 0.05). Postoperative 48th h trismus value was seen as the highest in the laser group than others. Patient satisfaction was found to be higher in the laser and piezo technique compared with the bur technique. Conclusions: Er:YAG laser and piezo methods can be a good alternative to the conventional bur method when postoperative complications are compared. We believe that laser and piezo methods will be preferred for patients due to increased patient satisfaction. Clinical Trial Registration number: B.30.2.ANK.0.21.63.00/08 date: 28.01.10 no:150/3.
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Affiliation(s)
- Bedriye Gizem Çelebioğlu Genç
- Department of Oral and Maxillofacial Surgery, Cyprus University of Health and Social Sciences, Morphou, TRNC, Mersin, Turkey
- Department of Oral and Maxillofacial Surgery, Dr. Burhan Nalbantoglu Government Hospital, Nicosia, TRNC, Mersin, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
- Ankara University Medical Design Application and Research Center (MEDITAM), Ankara, Turkey
| | - Selahattin Or
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Yi Y, Li L, Li J, Shu X, Kang H, Wang C, Chang Y. Use of lasers in gastrointestinal endoscopy: a review of the literature. Lasers Med Sci 2023; 38:97. [PMID: 37022519 DOI: 10.1007/s10103-023-03755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
Lasers emit highly directional light with consistent wavelengths, and recent studies have demonstrated their successful applications in gastrointestinal endoscopic therapy. Although argon plasma coagulators (APC) became the preferred treatment option due to improved safety profile and lower costs, advancements in laser and optic fiber manufacturing have reignited interest in laser treatment. Different laser wavelengths have distinct features and applications based on their tissue absorption coefficient. Lasers with shorter wavelengths are effectively absorbed by hemoglobin, resulting in a good coagulation effect. Near-infrared lasers have ability to ablate solid tumors, while far-infrared lasers can make precise mucosal incisions without causing peripheral thermal damage. Lasers have proven to be highly applicable to endoscopy devices such as endoscopes, endoscopic ultrasound (EUS), double-balloon enteroscopes (DBE), and endoscopic retrograde cholangiopancreatography (ERCP), making them a potent tool to enhance the effectiveness of endoscopic treatments with minimal adverse events. This review aims to help readers understand the applications and effectiveness of lasers in gastrointestinal endoscopy, with the potential to promote the development and application of laser technology in the medical field.
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Affiliation(s)
- Yun Yi
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Lurao Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Jianghui Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Xiawen Shu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Hui Kang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Chun Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Ying Chang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China.
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Razavi P, Jafari A, Vescovi P, Fekrazad R. Efficacy of Adjunctive Photobiomodulation in the Management of Medication-Related Osteonecrosis of the Jaw: A Systematic Review. Photobiomodul Photomed Laser Surg 2022; 40:777-791. [PMID: 36507770 DOI: 10.1089/photob.2022.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse medication response that manifests as progressive bone necrosis in the craniofacial area. There is still no clear treatment protocol for the management of MRONJ. The purpose of this study was to conduct a systematic review to assess the efficacy of photobiomodulation (PBM) as an adjunct to MRONJ therapy. Methods: In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, a literature search was performed on PubMed/MEDLINE, Scopus, Web of Science, and Cochrane databases. Two examiners examined eligibility and risk of bias separately before extracting data. Results: Two hundred sixty-nine articles were found through electronic search, out of which only 11 met the inclusion criteria and were included in qualitative synthesis (9 retrospectives, 1 prospective, and 1 case series). A total number of 759 patients and a mean age ranging from 54 to 74 years were reviewed. Females were the most frequent gender in all of the selected studies (72% females to 28% males), and the most frequent stage in the studies mentioned above was stage II (66%). Most of the studies had shown a significant improvement when PBM was used as an adjunctive treatment. Conclusions: Based on the results of this study, PBM as an adjuvant therapy can significantly improve the outcomes of each treatment plan. However, surgical intervention for the complete healing of the lesions is suggested.
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Affiliation(s)
- Pouyan Razavi
- Student Research Committee, Dental Faculty, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Aryan Jafari
- Student Research Committee, Dental Faculty, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Paolo Vescovi
- Unit of Oral Medicine, Oral Surgery and Laser therapy, Department of Medicine and Surgery, University Center of Dentistry, University of Parma, Parma, Italy
| | - Reza Fekrazad
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran.,International Network for Photo Medicine and Photodynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Sales PHDH, Barros AWP, Silva PGDB, Vescovi P, Leão JC. Is the Er: YAG Laser Effective in Reducing Pain, Edema and Trismus After Removal of Impacted Mandibular Third Molars? A Meta-Analysis. J Oral Maxillofac Surg 2021; 80:501-516. [PMID: 34793714 DOI: 10.1016/j.joms.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/20/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Removal of impacted third molars, can be associated with complications such as pain, edema, trismus, that can increase the morbidity of this procedure. The purpose of this study is to determine whether the Er: YAG laser is effective in reducing pain, swelling and trismus compared to rotary instruments in removing impacted lower third molars (3 LM`s). METHODS For this systematic review the searches were carried out independently by 2 researchers and the articles were selected according to the inclusion and exclusion criteria previously established. The predictor variable was the study group (Er: YAG laser versus rotatory instruments). The main outcome was the analysis of post-operative pain, edema and trismus after third molars extractions. Data analysis included the risk of bias evaluation (RoB 2 Cochrane) and meta-analysis with random effects I2 based heterogeneity and 95% confidence. RESULTS In the initial results, 1,371 articles were found and 6 RCT were selected to compose this study. A total of 299, 3 LM`s were removed, 126 with the Er: YAG laser, 142 with a drill and 31 with a piezoelectric instrument. The results of this meta-analysis showed that in the laser group there was a significant reduction in edema (1.82 [CI95% = -3.06 to -0.57] cm (P = .004)) and complications (P = .0004), a slight reduction in pain after 2 days (P = .030) and there was no variation in trismus (P = .200) when compared to the drill group. The surgery and/or osteotomy time was shorter in the drill group. Only 1 study presented low risk of bias. CONCLUSIONS The Er: YAG laser has been shown to be effective in reducing edema, pain and complications in impacted lower third molar surgeries. however due to the lack of standardization in Er: YAG laser therapy, new controlled and standardized studies should be performed with the aim of proving the efficacy of this therapeutic modality.
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Affiliation(s)
- Pedro Henrique da Hora Sales
- Student, Department of Prothesis and Oral and Maxillofacial Surgery, Federal University of Pernambuco (UFPE), Recife, P E, Brazil..
| | - Ana Waleska Pessoa Barros
- Student, Department of Prothesis and Oral and Maxillofacial Surgery, Federal University of Pernambuco (UFPE), Recife, P E, Brazil
| | | | - Paolo Vescovi
- Assistant Professor, Unit of Oral Medicine, Oral Surgery and Laser therapy, University Center of Dentistry - Department of Medicine and Surgery, University of Parma, Italy
| | - Jair Carneiro Leão
- Full Professor, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco (UFPE), Recife, PE, Brazil
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Sundaram P, Kandasamy S, John RR, Sri KCK. Comparison of the efficiency of arm force versus arm force plus wrist movement in closed method extractions an observational study. Natl J Maxillofac Surg 2021; 12:250-254. [PMID: 34483585 PMCID: PMC8386269 DOI: 10.4103/njms.njms_212_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/02/2021] [Accepted: 02/27/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGOUND Atraumatic dental extraction preserves not only the bone, but also maintains the gingival architecture, hence allows immediate or late dental implant placement. The incidence of fracture of roots and buccal cortical plates increases when wrong force is used. Currently, there is insufficient literature evidence with regard to the appropriate method for application of arm and wrist force at the time of dental extraction. AIM Therefore, the aim of the present study was to compare the efficiency of arm force only versus arm force plus wrist movement during closed extractions. MATERIALS AND METHODS The patients who underwent extractions of right upper molars (n = 50) in the Oral and Maxillofacial Surgery Department were selected for the study after obtaining Informed Consent. The patients with grossly decayed broken teeth and mobile teeth were excluded. The procedure was carried out by interns and was observed by three maxillofacial surgeons of more than 5 years of experience independently. RESULTS It was observed that 30% of the trainees used arm only force during dental extraction and were unaware about it. The time taken for tooth removal in the group which used arm and wrist force was significantly lesser (P < 0.001). It was also observed that the breakage of tooth and alveolar bone fracture was more common with the group who used only arm force. CONCLUSION From the results of the present study, it can be concluded that during exodontia procedures, the principle of using arm and wrist facilitates safe and easy removal of tooth with less time.
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Affiliation(s)
- Prashanth Sundaram
- Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Missions Research Foundation, Deemed to be University, Salem, Tamil Nadu, India
| | - Saravanan Kandasamy
- Department of Oral Maxillofacial Surgery, Vinayaka Missions Sankarachariyar Dental College, Salem, Tamil Nadu, India,Address for correspondence: Dr. Saravanan Kandasamy, Department of Oral and Maxillofacial Surgery, Vinayaka Missions Sankarachariyar Dental College and Hospital, Ariyanoor, Salem - 636 308, Tamil Nadu, India. E-mail:
| | - Reena Rachel John
- Department of Oral Maxillofacial Surgery, Vinayaka Missions Sankarachariyar Dental College, Salem, Tamil Nadu, India
| | - K. C. Keerthana Sri
- Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Missions Research Foundation, Deemed to be University, Salem, Tamil Nadu, India
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Momesso GAC, Lemos CAA, Santiago-Júnior JF, Faverani LP, Pellizzer EP. Laser surgery in management of medication-related osteonecrosis of the jaws: a meta-analysis. Oral Maxillofac Surg 2020; 24:133-144. [PMID: 32056052 DOI: 10.1007/s10006-020-00831-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/10/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy of laser therapy on medication-related osteonecrosis of the jaw (MRONJ) treatment. METHODS This study followed PRISMA standards, and an electronic search was performed on the PubMed/MEDLINE, Scopus, and Cochrane databases. Eighty-nine articles were found. After reading the manuscripts, 15 articles remained for the review. Three of them were selected for meta-analysis. RESULTS Female gender was predominant (72.5%), and mean age was 66.5 years. Follow-up varied between 3 and 80 months, and the most used bisphosphonate was zoledronic acid (71.6%). Stage II of MRONJ was the most prevalent (68.9%), and the mandible was the most affected site (64.5%). Qualitative data showed that treatment with laser surgery (Er:YAG) was most effective regarding complete healing of the lesion (90%) compared with other treatments. Meta-analysis data showed that low-level laser therapy (LLLT) was more effective than medical treatment (P = 0.006), and surgical treatment was more effective than LLLT (P = 0.008). CONCLUSION Laser surgery was significantly superior to LLLT (p < 0.00001). Therefore, laser surgical therapy seems to be a great management strategy for MRONJ treatment from stage II. LLLT was shown to improve conservative management in earlier MRONJ stages.
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Affiliation(s)
| | - Cleidiel Aparecido Araújo Lemos
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Sao Paulo, Brazil
| | | | - Leonardo Perez Faverani
- Department of Diagnosis and Surgery, Aracatuba Dental School, São Paulo State University (UNESP), Sao Paulo, Brazil.
| | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Sao Paulo, Brazil
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Hadzi-Petrushev N, Gjorgievska E, Gabric D, Dinescu S, Mitrokhin V, Mladenov M. Circulatory leukotriene changes during bone healing following osteotomies prepared with Er:YAG laser and piezosurgery: an animal study. BIOTECHNOL BIOTEC EQ 2019. [DOI: 10.1080/13102818.2019.1577171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Nikola Hadzi-Petrushev
- Faculty of Natural Sciences and Mathematics, Institute of Biology “Ss. Cyril and Methodius” University, Skopje, Republic of Macedonia
| | - Elizabeta Gjorgievska
- Department of Pediatric and Preventive Dentistry Faculty of Stomatology, “Ss. Cyril and Methodius University”, Skopje, Republic of Macedonia
| | - Dragana Gabric
- Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Sorina Dinescu
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Vadim Mitrokhin
- Department of Fundamental and Applied Physiology, Russian National Research Medical University, Moscow, Russia
| | - Mitko Mladenov
- Faculty of Natural Sciences and Mathematics, Institute of Biology “Ss. Cyril and Methodius” University, Skopje, Republic of Macedonia
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Abstract
PURPOSE The aim of this study was to review the scientific evidence about the laser osteotomy in implant bed preparation. METHODS An electronic search was performed on relevant English articles up to April 2016 in the PubMed, Scopus, and Google Scholar databases. RESULTS Twenty-two articles (1 clinical, 13 animal, and 8 ex vivo studies) were included. Implant sites prepared by erbium family lasers and drill showed comparable results regarding the percentage of bone-to-implant contact, values of biomechanical tests, and healing process. Selection of proper laser wavelength and parameters was of paramount importance to minimize the risk of thermal bone damage. Lack of depth control and long time needed for implant site osteotomy with laser were the most challenging concerns for its clinical applicability. Computer-guided laser osteotomy showed promise for future use of laser osteotomy in clinical settings. CONCLUSION Evidence from animal studies shows promising results regarding laser osteotomy in implant site preparation. However, 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.
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Tong DC. Surgical management in dentistry: the interdisciplinary relationship between periodontology and oral and maxillofacial surgery. Periodontol 2000 2017; 74:168-175. [DOI: 10.1111/prd.12196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 11/29/2022]
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Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki AA, Romanos GE, Taniguchi Y, Sasaki KM, Zeredo JL, Koshy G, Coluzzi DJ, White JM, Abiko Y, Ishikawa I, Izumi Y. Periodontal and peri-implant wound healing following laser therapy. Periodontol 2000 2017; 68:217-69. [PMID: 25867988 DOI: 10.1111/prd.12080] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 12/18/2022]
Abstract
Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO2 , neodymium-doped yttrium-aluminium-garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft-tissue management. With development of the erbium-doped yttrium-aluminium-garnet (Er:YAG) and erbium, chromium-doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft-tissue management to hard-tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri-implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti-inflammatory agents, phototherapy using lasers and light-emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low- and high-level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri-implant diseases. This article discusses the outcomes of laser therapy in soft-tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri-implant treatment, focusing on postoperative wound healing of periodontal and peri-implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.
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Effects on Bone Tissue After Osteotomy with Different High-Energy Lasers: AnEx VivoStudy. Photomed Laser Surg 2016; 34:291-6. [DOI: 10.1089/pho.2015.3917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Landa FJO, Deán-Ben XL, Montero de Espinosa F, Razansky D. Noncontact monitoring of incision depth in laser surgery with air-coupled ultrasound transducers. OPTICS LETTERS 2016; 41:2704-2707. [PMID: 27304268 DOI: 10.1364/ol.41.002704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Lack of haptic feedback during laser surgery makes it difficult to control the incision depth, leading to high risk of undesired tissue damage. Here, we present a new feedback sensing method that accomplishes noncontact real-time monitoring of laser ablation procedures by detecting shock waves emanating from the ablation spot with air-coupled transducers. Experiments in soft and hard tissue samples attained high reproducibility in real-time depth estimation of the laser-induced cuts. The advantages derived from the noncontact nature of the suggested monitoring approach are expected to advance the general applicability of laser-based surgeries.
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Panduric DG, Juric IB, Music S, Molčanov K, Sušic M, Anic I. Morphological and ultrastructural comparative analysis of bone tissue after Er:YAG laser and surgical drill osteotomy. Photomed Laser Surg 2016; 32:401-8. [PMID: 24992274 DOI: 10.1089/pho.2014.3711] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to analyze morphological, chemical, and crystallographic changes of bone tissue after osteotomy performed with an erbium:yttrium-aluminium-garnet (Er:YAG) laser and a low speed pilot drill. MATERIALS AND METHODS Bone blocks were prepared from porcine ribs, and on each block, two tunnel preparations were performed using the Er:YAG laser (pulse energy: 1000 mJ, pulse duration: 300 μs, pulse repetition rate: 20 Hz) or the low-speed surgical pilot drill. The morphological changes of the cortical and the spongious surface of the tunnel preparations were analyzed under the field emission scanning electron microscopy (FE-SEM) at low and high resolution. The distribution and the level of chemical elements in the treated surfaces were evaluated by qualitative and semiquantitative energy dispersive x-ray analysis (SEM-EDX). Diffraction x-ray analysis was used to detect any differences and thermally induced modifications of hydroxyapatite crystals. RESULTS FE-SEM revealed sharp edges of the Er:YAG preparations, with empty intertrabecular spaces and no signs of carbonization. In the drill group, the surface of the preparations was smooth, completely covered with smear layer and microcracks, and with hairy-like irregularities on the edges. SEM-EDX analysis did not reveal any differences in the number of specific chemical elements between the laser and the drill group. There were no thermally induced modifications of hydroxyapatite crystal structure in the bone tissue in either group. CONCLUSIONS The Er:YAG laser ablation did not cause any chemical or crystallographic changes of the bone tissue. Compared with the drill, Er:YAG laser created well-defined edges of the preparations, and cortical bone had no smear layer.
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Affiliation(s)
- Dragana Gabric Panduric
- 1 Department of Oral Surgery, School of Dental Medicine, University of Zagreb , Zagreb, Croatia
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Evaluation of Bone Healing After Osteotomies Prepared With Er:YAG Laser in Contact and Noncontact Modes and Piezosurgery—An Animal Study. J Oral Maxillofac Surg 2016; 74:18-28. [DOI: 10.1016/j.joms.2015.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 12/23/2022]
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Split-mouth comparison of Physics forceps and extraction forceps in orthodontic extraction of upper premolars. Br J Oral Maxillofac Surg 2014; 52:e137-40. [DOI: 10.1016/j.bjoms.2014.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 06/18/2014] [Indexed: 11/22/2022]
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Plötz C, Schelle F, Bourauel C, Frentzen M, Meister J. Ablation of porcine bone tissue with an ultrashort pulsed laser (USPL) system. Lasers Med Sci 2014; 30:977-83. [PMID: 24458532 DOI: 10.1007/s10103-014-1520-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/08/2014] [Indexed: 11/29/2022]
Abstract
Ultrashort pulsed lasers (USPLs) represent a new generation of laser systems in the field of biophotonical applications. In terms of a pilot project, the study was carried out to evaluate the ablation parameters of bone tissue regarding the medical use of such a laser technology in dentistry. Specimens from ribs of freshly slaughtered pigs were assembled and irradiated with an USP Nd:YVO4 laser (pulse duration 8 ps at 1,064 nm with repetition rates between 50 and 500 kHz) using eligible average output powers in the range of 3.5-9 W and fluences between 1 and 2.5 J/cm(2). Square-shaped cavities of 1-mm edge length in the bone compacta were created employing a scanner system. Cavities were analyzed with an optical profilometer to determine the ablated volume. Ablation rate was calculated by the ablated volume and the recorded irradiation time by the scanner software. Additionally, samples were examined histologically to investigate side effects of the surrounding tissue. Formed cavities showed a precise and sharp-edged appearance in bone compacta. Optimized ablation rate of 5.2 mm(3)/min without any accompanying side effects was obtained with an average output power of 9 W, a pulse repetition rate of 500 kHz, and an applied fluence of 2.5 J/cm(2). Provided that the used laser system will be advanced and adjusted for clinical applications, the outcome of this study shows auspicious possibilities for the use of USPL systems in the preparation of bone tissue.
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Affiliation(s)
- Christina Plötz
- Department of Operative and Preventive Dentistry, Dental Faculty, Bonn University, Welschnonnenstrasse 17, 53111, Bonn, Germany
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de Ávila Kfouri F, Duailibi MT, Bretos JLG, Carvalho AB, Pallos D, Duailibi SE. Piezoelectric osteotomy for the placement of titanium implants in rabbits: histomorphometry study. Clin Oral Implants Res 2013; 25:1182-8. [DOI: 10.1111/clr.12229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Flávio de Ávila Kfouri
- Pos-Graduate Program; Division of Plastic Surgery; Universidade Federal de São Paulo (UNIFESP); São Paulo SP Brazil
| | - Monica Talarico Duailibi
- Division of Plastic Surgery; Department of Surgery; Universidade Federal de São Paulo (UNIFESP); São Paulo SP Brazil
| | - José Luis Gonçalves Bretos
- Division of Plastic Surgery; Department of Surgery; Universidade Federal de São Paulo (UNIFESP); São Paulo SP Brazil
| | - Aluizio Barbosa Carvalho
- Division of Nephrology; Department of Medicine; Universidade Federal de São Paulo (UNIFESP); São Paulo SP Brazil
| | - Debora Pallos
- Department of Periodontics and Implantology; School of Dentistry; University of Santo Amaro; São Paulo SP Brazil
| | - Silvio Eduardo Duailibi
- Division of Plastic Surgery, Department of Surgery and Institute of Science and Technology; Universidade Federal de São Paulo (UNIFESP); São José dos Campos SP Brazil
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A report on the use of Er:YAG laser for pilot hole drilling prior to miniscrew insertion. Lasers Med Sci 2013; 30:605-9. [PMID: 23793415 DOI: 10.1007/s10103-013-1374-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
Abstract
The aim of the present in vitro study was to investigate the required time period of the Er:YAG laser that is used for drilling through cortical bone when pilot hole drilling is needed before miniscrew insertion. Even though Er:YAG laser is used in various in vivo and in vitro studies, there is no accepted procedure of laser for depth control during drilling through cortical bone. The study sample consisted of 120 cortical bone segments having 1.5 and 2.0 mm of cortical bone thickness. An Er:YAG laser, with a spot size of 1.3 mm and an air-water spray of 40-50 ml/min, was used. The laser was held 2 mm away from and perpendicular to the bone surface with different laser settings. Twelve specimens were prepared for each subgroup. As the cortical bone thickness increased, the time needed to drill through the bone increased. Frequency increase directly caused a decrease in irradiation duration. When three different frequency, three different energy, and four different power values were tested for both the 1.5- and 2-mm cortical bone thicknesses, the shortest duration needed to drill through cortical bone was seen in the 3.6-W (300 mJ-12 Hz) setting. When pilot holes are drilled prior to miniscrew placement in 1.5 to 2 mm of cortical bone using Er:YAG laser, the most appropriate value is found with the 3.6-W (300 mJ-12 Hz) setting.
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Laser vs bur for bone cutting in impacted mandibular third molar surgery: A randomized controlled trial. J Oral Biol Craniofac Res 2013; 3:57-62. [PMID: 25737885 DOI: 10.1016/j.jobcr.2013.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 03/31/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the feasibility of Er: YAG laser in bone cutting for removal of impacted lower third molar teeth and compare its outcomes with that of surgical bur. MATERIALS & METHODS The study comprised 40 subjects requiring removal of impacted mandibular third molar, randomly categorized into two equal groups of 20 each, who had their impacted third molar removed either using Er: YAG laser or surgical bur as per their group, using standard methodology of extraction of impacted teeth. Clinical parameters like pain, bleeding, time taken for bone cutting, postoperative swelling, trismus, wound healing and complications were compared for both groups. OBSERVATION & RESULT Clinical parameters like pain, bleeding and swelling were lower in laser group than bur group, although the difference was statistically not significant. However, postoperative swelling showed significant difference in the two groups. Laser group required almost double the time taken for bone cutting with bur. Trismus persisted for a longer period in laser group. Wound healing and complications were assessed clinically and there was no significant difference in both the groups. CONCLUSION Based on the results of our study, the possibility of bone cutting using lasers is pursued, the osteotomy is easily performed and the technique is better suited to minimally invasive surgical procedures. The use of Er: YAG laser may be considered as an alternative tool to surgical bur, specially in anxious patients.
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Urich A, Maier RRJ, Yu F, Knight JC, Hand DP, Shephard JD. Flexible delivery of Er:YAG radiation at 2.94 µm with negative curvature silica glass fibers: a new solution for minimally invasive surgical procedures. BIOMEDICAL OPTICS EXPRESS 2013; 4:193-205. [PMID: 23413120 PMCID: PMC3567706 DOI: 10.1364/boe.4.000193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 12/14/2012] [Accepted: 12/19/2012] [Indexed: 05/24/2023]
Abstract
We present the delivery of high energy microsecond pulses through a hollow-core negative-curvature fiber at 2.94 µm. The energy densities delivered far exceed those required for biological tissue manipulation and are of the order of 2300 J/cm(2). Tissue ablation was demonstrated on hard and soft tissue in dry and aqueous conditions with no detrimental effects to the fiber or catastrophic damage to the end facets. The energy is guided in a well confined single mode allowing for a small and controllable focused spot delivered flexibly to the point of operation. Hence, a mechanically and chemically robust alternative to the existing Er:YAG delivery systems is proposed which paves the way for new routes for minimally invasive surgical laser procedures.
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Affiliation(s)
- A. Urich
- Applied Optics and Photonics group, School of Engineering and
Physical Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - R. R. J. Maier
- Applied Optics and Photonics group, School of Engineering and
Physical Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - Fei Yu
- Centre for Photonics and Photonic Materials, Department of Physics,
University of Bath, Bath, BA2 7AY, UK
| | - J. C. Knight
- Centre for Photonics and Photonic Materials, Department of Physics,
University of Bath, Bath, BA2 7AY, UK
| | - D. P. Hand
- Applied Optics and Photonics group, School of Engineering and
Physical Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - J. D. Shephard
- Applied Optics and Photonics group, School of Engineering and
Physical Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
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Comparison of Er:YAG laser and surgical drill for osteotomy in oral surgery: an experimental study. J Oral Maxillofac Surg 2012; 70:2515-21. [PMID: 23078821 DOI: 10.1016/j.joms.2012.06.192] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 06/27/2012] [Accepted: 06/27/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE High-energy lasers have been proposed as an alternative to the conventional surgical drill in oral and maxillofacial surgery. The aims of this study were to compare thermal changes of the bone surface, procedure time, and volume of the removed bone after drilling with an erbium (Er):yttrium-aluminum-garnet (YAG) laser versus a low-speed surgical drill. The bone sections were observed under light microscopy and examined histologically. MATERIAL AND METHODS Thirty bone blocks were prepared from porcine ribs. On each block 2 holes (tunnel preparations) were performed using a low-speed, 1.0-mm-wide, surgical pilot drill and an Er:YAG laser (pulse energy, 1,000 mJ; pulse duration, 300 μs; frequency, 20 Hz). The temperature induced by the preparation techniques was measured using an infrared camera. The removed bone volume was calculated by a modified mathematical algorithm. The time required for the preparation was measured with a digital stopwatch and a time-measurement instrument integrated within the computer program. The cortical and spongiose surfaces of the specimens were examined microscopically and histologically under a light microscope with a high-resolution camera. RESULTS The Er:YAG laser removed significantly more bone tissue than the drill (P < .01) in a significantly shorter time (P < .01). The temperature was statistically lower during the laser preparation (P < .01). Cavities prepared with the laser were regular with clear sharp edges and knifelike cuts. In the drill group, the preparations exhibited irregular edges full of bone fragments and fiberlike debris. Histologic examination of the laser sides showed a 30-μm-thick altered sublayer. The tissue in the drill group was covered with a smear layer without any alterations. CONCLUSIONS The Er:YAG laser produced preparations with regular and sharp edges, without bone fragments and debris, in a shorter time, and with less generated heat. Thermal alterations in the treated surface were minimal.
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Urich A, Maier RRJ, Mangan BJ, Renshaw S, Knight JC, Hand DP, Shephard JD. Delivery of high energy Er:YAG pulsed laser light at 2.94 µm through a silica hollow core photonic crystal fibre. OPTICS EXPRESS 2012; 20:6677-6684. [PMID: 22418551 DOI: 10.1364/oe.20.006677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this paper the delivery of high power Er:YAG laser pulses through a silica hollow core photonic crystal fibre is demonstrated. The Er:YAG wavelength of 2.94 µm is well beyond the normal transmittance of bulk silica but the unique hollow core guidance allows silica to guide in this regime. We have demonstrated for the first time the ability to deliver high energy pulses through an all-silica fibre at 2.94 µm. These silica fibres are mechanically and chemically robust, biocompatible and have low sensitivity to bending. A maximum pulse energy of 14 mJ at 2.94 µm was delivered through the fibre. This, to our knowledge, is the first time a silica hollow core photonic crystal fibre has been shown to transmit 2.94 μm laser light at a fluence exceeding the thresholds required for modification (e.g. cutting and drilling) of hard biological tissue. Consequently, laser delivery systems based on these fibres have the potential for the realization of novel, minimally-invasive surgical procedures.
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Affiliation(s)
- A Urich
- Applied Optics and Photonics group, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK.
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Jung MK, Kim SG, Oh JS, Jin SC, Lee SY, Jang ES, Piao ZG, Lim SC, Jeong MA. A Comparative Histological Study of Bone Healing in Rat Calvarial Defect Using the Erbium-Doped Yttrium Aluminum Garnet Laser and Rotary Instruments. JAPANESE JOURNAL OF APPLIED PHYSICS 2012. [DOI: 10.1143/jjap.51.01ae02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery? Lasers Med Sci 2011; 26:815-23. [DOI: 10.1007/s10103-011-0974-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 07/18/2011] [Indexed: 11/26/2022]
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Weiss A, Stern A, Dym H. Technological advances in extraction techniques and outpatient oral surgery. Dent Clin North Am 2011; 55:501-viii. [PMID: 21726686 DOI: 10.1016/j.cden.2011.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
There have been several exciting technological advances in extraction techniques and outpatient oral surgery within the last decade. A variety of new instruments and techniques are revolutionizing the fields of oral and maxillofacial surgery and dentistry. This article reviews the newer innovations in dentistry including the powered periotome, piezosurgery, the Physics Forceps, laser therapy, orthodontic techniques, and use of polyurethane foam.
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Affiliation(s)
- Adam Weiss
- Department of Dentistry and Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA.
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Vescovi P, Romeo U, Merigo E, Del Vecchio A, Palaia G, Meleti M, Nammour S. L’impiego del laser nelle patologie delle ossa mascellari. DENTAL CADMOS 2011. [DOI: 10.1016/j.cadmos.2010.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stübinger S, Nuss K, Pongratz M, Price J, Sader R, Zeilhofer HF, von Rechenberg B. Comparison of Er:YAG laser and piezoelectric osteotomy: An animal study in sheep. Lasers Surg Med 2011; 42:743-51. [PMID: 20886507 DOI: 10.1002/lsm.20946] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES It was the aim of this study to compare the feasibility of complete osteotomy of long bones in sheep using a newly designed variable square pulsed Er:YAG laser and piezoelectric surgery. In addition to uneventful bone healing after laser osteotomy, the goal was to assess the possibility to cut thick bony structures with both techniques in a surgically acceptable time frame of 2-3 minutes. MATERIAL AND METHODS A tibia midshaft osteotomy was performed in 24 sheep using either an Er:YAG laser (n = 12) or piezoelectric device (n = 12). Laser and piezoelectric groups were divided in two subgroups (n = 6) with sheep sacrificed after 2 and 3 months, respectively. A complete radiological, histological and histomorphometric analysis was performed to compare the course of bone/fracture healing and remodelling. RESULTS Laser and piezoelectric osteotomies of the sheep tibia up to a depth of 22 mm were possible without any thermal damage. Radiological and histological results after 2 months showed primary gap healing with distinct periosteal callus formation on the transcortex. After 3 months, radiological and histological analysis revealed less callus formation on the transcortex, with almost no visible osteotomy gap and a distinct formation of lamellar bone crossing the original osteotomy gap. CONCLUSION Er:YAG laser osteotomy can successfully be used in long bones with a depth of up to 22 mm, thus challenging the dogma of adverse effects of laser osteotomy due to thermal or other damages.
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Affiliation(s)
- Stefan Stübinger
- Competence Center for Applied Biotechnology and Molecular Medicine, University of Zürich, Winterthurerstr. 190, CH-8057 Zürich, Switzerland.
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Stübinger S, Biermeier K, Bächi B, Ferguson SJ, Sader R, von Rechenberg B. Comparison of Er:YAG laser, piezoelectric, and drill osteotomy for dental implant site preparation: A biomechanical and histological analysis in sheep. Lasers Surg Med 2010; 42:652-61. [DOI: 10.1002/lsm.20944] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Akyol U, Güngörmüş M. Er:YAG Laser Ablation of Bone in Experimental Diabetics. Photomed Laser Surg 2010; 28:477-82. [DOI: 10.1089/pho.2008.2479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Utkan Akyol
- Ataturk University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Erzurum, Turkey
| | - Metin Güngörmüş
- Ataturk University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Erzurum, Turkey
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Stübinger S, Nuss K, Sebesteny T, Saldamli B, Sader R, von Rechenberg B. Erbium-doped yttrium aluminium garnet laser-assisted access osteotomy for maxillary sinus elevation: a human and animal cadaver study. Photomed Laser Surg 2010; 28:39-44. [PMID: 19708794 DOI: 10.1089/pho.2008.2442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the usability of a variable square pulse (VSP) erbium-doped yttrium aluminium garnet (Er:YAG) laser for a lateral access osteotomy to the maxillary sinus in the course of a sinus elevation procedure. MATERIALS AND METHODS In six formalin-fixed human heads and six fresh sheep heads, a VSP Er:YAG laser was used to perform a bilateral maxillary access osteotomy. For the osteotomies, the Er:YAG laser was applied with a pulse energy of 1000 mJ, a pulse duration of 300 mus, and a frequency of 12 Hz. The spot size was 0.9 mm, and the handpiece was kept approximately 10 mm from the bone surface. RESULTS In all 24 sites investigated, the Er:YAG laser osteotomy was possible without any visible carbonization or thermal damage. The average time required for laser osteotomy for 12 standardized rectangular lateral windows in human cadavers was 39 s. No anatomical structures limited laser osteotomy, yet a critical evaluation of any membrane perforations was not possible because the postmortem fixation method caused partial detachment and fractional destruction. Laser-access osteotomy in six fresh sheep heads (12 sites) revealed major disruptions and perforations (<8 mm) of the sinus membrane (100%). CONCLUSION Even though VSP Er:YAG laser osteotomy showed convincing results for efficient bone cutting without thermal damage, applied laser parameters do not seem to be practicable for any clinical sinus elevation procedure. Missing depth control resulted in uncontrollable severe damage of the underlying membrane.
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Affiliation(s)
- Stefan Stübinger
- Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Basel, Switzerland.
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Romeo U, Del Vecchio A, Palaia G, Tenore G, Visca P, Maggiore C. Bone damage induced by different cutting instruments--an in vitro study. Braz Dent J 2009; 20:162-8. [PMID: 19738951 DOI: 10.1590/s0103-64402009000200013] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 02/13/2009] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to compare the peripheral bone damage induced by different cutting systems. Four devices were tested: Er:YAG laser (2.94 mm), Piezosurgery, high-speed drill and low-speed drill. Forty-five bone sections, divided into 9 groups according to different parameters, were taken from pig mandibles within 1 h post mortem. Specimens were fixed in 10% buffered formalin, decalcified and cut in thin sections. Four different parameters were analyzed: cut precision, depth of incision, peripheral carbonization and presence of bone fragments. For statistical analysis, the Kruskal-Wallis test was applied to assess equality of sample medians among groups. All sections obtained with the Er:YAG laser showed poor peripheral carbonization. The edges of the incisions were always well-shaped and regular, no melting was observed. Piezosurgery specimens revealed superficial incisions without thermal damage but with irregular edges. The sections obtained by traditional drilling showed poor peripheral carbonization, especially if obtained at lower speed. There was statistically significant differences (p<0.01) among the cutting systems for all analyzed parameters. Er:YAG laser, gave poor peripheral carbonization, and may be considered an effective method in oral bone biopsies and permits to obtain clear and readable tissue specimens.
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Affiliation(s)
- Umberto Romeo
- Department of Odontostomatological Science, Sapienza University of Rome, Rome, Italy.
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Ishikawa I, Aoki A, Takasaki AA, Mizutani K, Sasaki KM, Izumi Y. Application of lasers in periodontics: true innovation or myth? Periodontol 2000 2009; 50:90-126. [PMID: 19388956 DOI: 10.1111/j.1600-0757.2008.00283.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Yoshino T, Aoki A, Oda S, Takasaki AA, Mizutani K, Sasaki KM, Kinoshita A, Watanabe H, Ishikawa I, Izumi Y. Long-term histologic analysis of bone tissue alteration and healing following Er:YAG laser irradiation compared to electrosurgery. J Periodontol 2009; 80:82-92. [PMID: 19228093 DOI: 10.1902/jop.2009.080097] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser is reportedly useful for periodontal therapy. However, the potential thermal damage that Er:YAG laser irradiation can produce on bone tissue has not been fully clarified. The purpose of this study was to histologically examine the effects of the Er:YAG laser on bone tissue and subsequent wound healing compared to electrosurgery in a long-term study. METHODS Calvarial bone from 30 rats was exposed to contact and non-contact Er:YAG laser irradiation (115 mJ/pulse, 10 Hz) without water coolant, or electrode contact. The treated surfaces were analyzed by scanning electron microscopy (SEM), and the healing process was histologically observed until 12 months post-surgery. RESULTS Contact irradiation resulted in substantial bone ablation, whereas non-contact irradiation produced slight tissue removal. Histologic and SEM analyses of the lased surface showed no severe thermal damage, except for the production of a superficially affected layer with a microstructured surface. The layer did not inhibit new bone formation, and the ablated defect was repaired uneventfully. Although the thickness of the layer gradually decreased, it generally remained in the cortical bone through the observation period. Electrosurgery produced a large area of thermal necrosis without ablation, and the damaged area was not replaced with new bone. CONCLUSIONS Unlike electrosurgery, Er:YAG laser irradiation without water coolant easily ablated bone tissue, and thermal alteration in the treated surface was minimal. The superficially affected layer did not interfere with the ensuing bone healing, resulting in favorable repair of the defect.
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Affiliation(s)
- Toshiaki Yoshino
- Section of Periodontology, Department of Hard Tissue Engineering, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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Stübinger S, Dissmann JP, Pinho NC, Saldamli B, Seitz O, Sader R. A preliminary report about treatment of bisphosphonate related osteonecrosis of the jaw with Er:YAG laser ablation. Lasers Surg Med 2009; 41:26-30. [DOI: 10.1002/lsm.20730] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Stübinger S, Nuss K, Landes C, von Rechenberg B, Sader R. Harvesting of intraoral autogenous block grafts from the chin and ramus region: Preliminary results with a variable square pulse Er:YAG laser. Lasers Surg Med 2008; 40:312-8. [DOI: 10.1002/lsm.20639] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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