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Chen W, Yuan F, Zhang Z, Yan L, Li X, Shi X. High-Precision Implant Cavity Fabrication Using Femtosecond Lasers. Photobiomodul Photomed Laser Surg 2024; 42:541-549. [PMID: 39178411 DOI: 10.1089/photob.2023.0147] [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] [Indexed: 08/25/2024] Open
Abstract
Objective: This study aims to enhance the precision of implant cavity preparation, addressing a notable challenge in the current state of the field by utilizing femtosecond lasers. Background: The application of femtosecond lasers in implant cavity preparation heralds a noninvasive and efficient technique, characterized by diminished thermal damage and high biocompatibility. Despite these promising attributes, the realization of precise cavity preparation remains a significant challenge in the contemporary domain. Materials and Methods: Our research group devised a specialized femtosecond laser microsurgery robotic system tailored for sophisticated implant cavity preparation. This system facilitated the meticulous analysis of sheep shank bone samples, enabling precise three-dimensional cutting. The analysis included an extensive examination of ablation effects, using a laser scanning microscope and VK Analyzer software. This investigation spanned the phases of laser flux calibration and experimental validation, offering a critical evaluation of the automated preparation process. Results: The study delineated that at the focus position of our custom-made oral clinical femtosecond laser microsurgery robotic system, the laser spot diameter is 75.69 μm, and ascertained the ablation threshold for sheep shank cortical bone to be 1.47 J/cm2. Utilizing low laser flux with minimal ablation craters overlap compromised the sidewall precision of the implant cavity, whereas employing high laser flux with extensive ablation craters overlap resulted in an enlarged ablation angle. At a laser energy setting of 2.2362 J/cm2 and a 50% ablation crater overlap, an implant cavity was successfully crafted featuring a top diameter of 4.41 mm, a bottom diameter of 3.98 mm, and a depth of 3 mm, devoid of any adverse thermal effects such as cracking or carbonization. Conclusions: The oral clinical femtosecond laser microsurgery robotic system can achieve automated and precise implant cavity preparation. This advancement promotes the broader application of femtosecond lasers in the field of orthopedics.
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Affiliation(s)
| | - Fusong Yuan
- Center of Digital Dentistry/Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | | | - Lei Yan
- Beijing Forestry University, Beijing, China
| | - Xiang Li
- Beijing Forestry University, Beijing, China
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Msallem B, Veronesi L, Beyer M, Halbeisen FS, Maintz M, Franke A, Korn P, Dragu A, Thieringer FM. Evaluation of the Dimensional Accuracy of Robot-Guided Laser Osteotomy in Reconstruction with Patient-Specific Implants-An Accuracy Study of Digital High-Tech Procedures. J Clin Med 2024; 13:3594. [PMID: 38930123 PMCID: PMC11204867 DOI: 10.3390/jcm13123594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objective: With the rapid advancement in surgical technologies, new workflows for mandibular reconstruction are constantly being evaluated. Cutting guides are extensively employed for defining osteotomy planes but are prone to errors during fabrication and positioning. A virtually defined osteotomy plane and drilling holes in robotic surgery minimize potential sources of error and yield highly accurate outcomes. Methods: Ten mandibular replicas were evaluated after cutting-guided saw osteotomy and robot-guided laser osteotomy following reconstruction with patient-specific implants. The descriptive data analysis summarizes the mean, standard deviation (SD), median, minimum, maximum, and root mean square (RMS) values of the surface comparison for 3D printed models regarding trueness and precision. Results: The saw group had a median trueness RMS value of 2.0 mm (SD ± 1.7) and a precision of 1.6 mm (SD ± 1.4). The laser group had a median trueness RMS value of 1.2 mm (SD ± 1.1) and an equal precision of 1.6 mm (SD ± 1.4). These results indicate that robot-guided laser osteotomies have a comparable accuracy to cutting-guided saw osteotomies, even though there was a lack of statistical significance. Conclusions: Despite the limited sample size, this digital high-tech procedure has been shown to be potentially equivalent to the conventional osteotomy method. Robotic surgery and laser osteotomy offers enormous advantages, as they enable the seamless integration of precise virtual preoperative planning and exact execution in the human body, eliminating the need for surgical guides in the future.
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Affiliation(s)
- Bilal Msallem
- University Center for Orthopedics, Trauma and Plastic Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, DE-01307 Dresden, Germany;
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (L.V.); (M.B.); (M.M.); (F.M.T.)
| | - Lara Veronesi
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (L.V.); (M.B.); (M.M.); (F.M.T.)
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland
| | - Michel Beyer
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (L.V.); (M.B.); (M.M.); (F.M.T.)
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland
| | - Florian S. Halbeisen
- Surgical Outcome Research Center, Department of Clinical Research, University of Basel c/o University Hospital of Basel, CH-4001 Basel, Switzerland;
| | - Michaela Maintz
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (L.V.); (M.B.); (M.M.); (F.M.T.)
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts Northwestern Switzerland, CH-4132 Muttenz, Switzerland
| | - Adrian Franke
- Department of Oral and Maxillofacial Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, DE-01307 Dresden, Germany; (A.F.); (P.K.)
| | - Paula Korn
- Department of Oral and Maxillofacial Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, DE-01307 Dresden, Germany; (A.F.); (P.K.)
| | - Adrian Dragu
- University Center for Orthopedics, Trauma and Plastic Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, DE-01307 Dresden, Germany;
| | - Florian M. Thieringer
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (L.V.); (M.B.); (M.M.); (F.M.T.)
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland
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Sandhu R, Kumar H, Dubey R, Vyas D, Shahi AK. Comparative Study of the Surgical Excision of Impacted Mandibular Third Molars Using Surgical Burs and an Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) Laser. Cureus 2023; 15:e49816. [PMID: 38169690 PMCID: PMC10758536 DOI: 10.7759/cureus.49816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
Background The use of lasers has increased in the field of dentistry in recent years. However, in the field of oral and maxillofacial surgery, the use of lasers has been largely restricted to soft tissue, and less focus is placed on the use of lasers for hard tissues. Aim The present study aimed to comparatively evaluate the efficacy of a erbium-doped yttrium aluminum garnet (Er:YAG) laser for cutting the bone while removing the impacted mandibular third molar with the use of a surgical bur. Methods The study assessed 80 subjects undergoing removal of impacted mandibular third molars. The subjects were recruited from the Department of Oral and Maxillofacial Surgery, Luxmi Bai Institute of Dental Sciences and Hospital, Patiala, Punjab, India. They were randomly divided into two groups, each consisting of 40 subjects. Group I used an Er:YAG laser to remove the bone, while Group II used a surgical bur. Assessments and comparisons were made for complications, wound healing, trismus, edema, bleeding, and pain. Results The study examined the efficacy of the Er:YAG laser for cutting the bone and extracting the impacted mandibular third molars using a surgical bur in two groups of 80 patients each. When the laser was used in place of a surgical bur, Group I patients experienced less edema, bleeding, and discomfort; nevertheless, the difference was not statistically significant. Time taken by laser for bone cutting was significantly higher compared to the surgical bur. In Group I (laser), trismus existed for a longer time. For mouth opening, the preoperative mouth opening was comparable in the two groups with p = 0.87. Conclusion Pain, hemorrhage, and edema were lesser, and the time required for bone cutting was substantially longer in the laser group. Apart from these, laser-assisted intra-oral bone cutting should be preferred because of its less invasive nature, simpler procedure, and simpler osteotomy when compared to traditional surgical burs and also in anxiety-prone patients.
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Affiliation(s)
- Rameet Sandhu
- Department of Oral and Maxillofacial Surgery, Luxmi Bai Institute of Dental Sciences and Hospital, Patiala, IND
| | - Harsh Kumar
- Department of Dentistry, Patna Medical College and Hospital, Patna, IND
| | - Rashi Dubey
- Department of Pedodontics and Preventive Dentistry, Sharad Pawar Dental College and Research Centre, Wardha, IND
| | - Divya Vyas
- Department of Pedodontics and Preventive Dentistry, Himachal Institute of Dental Sciences, Paonta Sahib, IND
| | - Ajoy K Shahi
- Department of Oral and Maxillofacial Surgery, Dental Institute Rajendra Institute of Medical Sciences, Ranchi, IND
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Hamidi A, Bayhaqi YA, Drusová S, Navarini AA, Cattin PC, Canbaz F, Zam A. Multimodal feedback systems for smart laser osteotomy: Depth control and tissue differentiation. Lasers Surg Med 2023; 55:900-911. [PMID: 37870158 DOI: 10.1002/lsm.23732] [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: 07/06/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES The study aimed to improve the safety and accuracy of laser osteotomy (bone surgery) by integrating optical feedback systems with an Er:YAG laser. Optical feedback consists of a real-time visual feedback system that monitors and controls the depth of laser-induced cuts and a tissue sensor differentiating tissue types based on their chemical composition. The developed multimodal feedback systems demonstrated the potential to enhance the safety and accuracy of laser surgery. MATERIALS AND METHODS The proposed method utilizes a laser-induced breakdown spectroscopy (LIBS) system and long-range Bessel-like beam optical coherence tomography (OCT) for tissue-specific laser surgery. The LIBS system detects tissue types by analyzing the plasma generated on the tissue by a nanosecond Nd:YAG laser, while OCT provides real-time monitoring and control of the laser-induced cut depth. The OCT system operates at a wavelength of 1288 ± 30 nm and has an A-scan rate of 104.17 kHz, enabling accurate depth control. Optical shutters are used to facilitate the integration of these multimodal feedback systems. RESULTS The proposed system was tested on five specimens of pig femur bone to evaluate its functionality. Tissue differentiation and visual depth feedback were used to achieve high precision both on the surface and in-depth. The results showed successful real-time tissue differentiation and visualization without any visible thermal damage or carbonization. The accuracy of the tissue differentiation was evaluated, with a mean absolute error of 330.4 μm and a standard deviation of ±248.9 μm, indicating that bone ablation was typically stopped before reaching the bone marrow. The depth control of the laser cut had a mean accuracy of 65.9 μm with a standard deviation of ±45 μm, demonstrating the system's ability to achieve the pre-planned cutting depth. CONCLUSION The integrated approach of combining an ablative laser, visual feedback (OCT), and tissue sensor (LIBS) has significant potential for enhancing minimally invasive surgery and warrants further investigation and development.
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Affiliation(s)
- Arsham Hamidi
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Yakub A Bayhaqi
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Sandra Drusová
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Alexander A Navarini
- Digital Dermatology, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, Center for medical Image Analysis and Navigation (CIAN), University of Basel, Allschwil, Switzerland
| | - Ferda Canbaz
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Azhar Zam
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Division of Engineering, New York University Abu Dhabi, Abu Dhabi, UAE
- Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Tandon School of Engineering, New York University, Brooklyn, New York, USA
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Semez G, Cescato A, Luca RE, Tonetti L, Todea DC. A Comparative Analysis Regarding the Osseointegration of Immediate Loaded Implants Using Two Different Implant Site Preparations: Erbium:Yttrium-Aluminum-Garnet Laser Versus Surgical Conventional Way-An In Vivo and Histological Animal Study. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 39:70-80. [PMID: 33332212 DOI: 10.1089/photob.2020.4889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: The aim of the study is to evaluate the possibility of preparing the implant site using the erbium:yttrium-aluminum-garnet (Er:YAG) laser scanner prototype and to reduce and/or eliminate time between primary (mechanical) stability and secondary (biological) stability, looking to the immediate occlusal loading in a single implant. Background: A prerequisite for successful osseointegration is the establishment of direct bone-to-implant contact without interposition of nonbone or connective tissue. In recent years, the use of laser radiation was presented as an alternative/adjunctive treatment for bone tissue ablation due to vaporization of the tissues in the absence of a smear layer. Methods: The experimental protocol included six minipigs, which underwent tooth extraction, followed (after 2 months) by implant bed preparation in two methods: using a conventional bur kit and using an Er:YAG laser scanner (X runner) protocol. Four implants were placed in positions 34, 37, 44, and 47 on each animal. The animals underwent the second surgical procedure for bone sample collection (including the implant) before their sacrifice at 45-60-90-120 days. The newly formed bone was evaluated on the bone samples using histological examination and quantitative evaluations of different histological parameters based on microscopical analysis. Results: The results that we obtained allow some interesting comparison in terms of different bone composition, depending on the method of implant site preparation and on healing periods. Moreover, it was possible to compare the bone composition, at different time stages, of implant sites prepared in the same way. Conclusions: Our research allowed us to demonstrate that the use of Er:YAG laser compared with traditional drill leads to the presence of a greater share of lamellar bone and a lower necrotic share in the implant site. We also showed the possibility of applying immediate occlusal loading on an in vivo animal model.
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Affiliation(s)
- Gianfranco Semez
- Department of Oral Rehabilitation and Dental Emergencies, School of Dental Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Semez SRL Private Practice, Trieste, Italy
| | | | - Ruxandra Elena Luca
- Department of Oral Rehabilitation and Dental Emergencies, School of Dental Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Luca Tonetti
- Department of Oral Rehabilitation and Dental Emergencies, School of Dental Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Tiemme-Dental SRL, Udine, Italy
| | - Darinca Carmen Todea
- Department of Oral Rehabilitation and Dental Emergencies, School of Dental Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
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Civak T, Ustun T, Yilmaz HN, Gursoy B. Postoperative evaluation of Er:YAG laser, piezosurgery, and rotary systems used for osteotomy in mandibular third-molar extractions. J Craniomaxillofac Surg 2020; 49:64-69. [PMID: 33298388 DOI: 10.1016/j.jcms.2020.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 08/04/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study compared patient postoperative pain, swelling, and trismus after usage of rotary instruments, piezosurgery, and Er:YAG lasers in mandibular third-molar extraction. MATERIALS AND METHODS This prospective study was executed with class II and position B vertically impacted mandibular third molars. Patients were divided into three groups according to the osteotomy system used to remove retentive bone: rotary instruments, piezosurgery, and Er:YAG laser. Postoperative pain was evaluated using VAS questionnaires at 12 h, 24 h, 48 h, and 7 days after procedures. Trismus was evaluated by measuring the distance between the maxillary and mandibular incisors at maximum mouth opening, and comparing preoperative measurements with those for postoperative days 2 and 7. Analyses of swelling were carried out via a stereophotogrammetry system. Operation times were measured using a digital stopwatch from the initial incision to the final suture. RESULTS There were no statistically significant differences between the groups in terms of pain, trismus, or swelling (p > 0.05). Pain persisted more in the rotary instrument group 24 h later (0 ± 1.3; p = 0.001). The pain scores obtained after 48 h for the piezosurgery (1.81 ± 2.29) and rotary (2.2 ± 2.12) groups were observed at 24 h in the laser group (2.19 ± 1.52). The mean operation time was highest using the laser (19.1 ± 3.85 min; p = 0.001) and lowest using rotary instruments (9.88 ± 2.97 min; p = 0.001). CONCLUSION Piezosurgery and Er:YAG laser are good alternatives to rotary instrument systems in third-molar extraction, but both systems are slower than traditional rotary instruments.
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Affiliation(s)
- Tayfun Civak
- Oral and Maxillofacial Surgery, Istanbul Yeni Yuzyil University, Faculty of Dentistry, Istanbul, Turkey.
| | - Tugba Ustun
- Orthodontist, Private Practice, Istanbul, Turkey
| | - Hanife Nuray Yilmaz
- Department of Orthodontics, Marmara University, Faculty of Dentistry, Istanbul, Turkey
| | - Bahar Gursoy
- Oral and Maxillofacial Surgery, University of Kyrenia, Faculty of Dentistry, Kyrenia, Cyprus
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Temperature Threshold Values of Bone Necrosis for Thermo-Explantation of Dental Implants-A Systematic Review on Preclinical In Vivo Research. MATERIALS 2020; 13:ma13163461. [PMID: 32781597 PMCID: PMC7476012 DOI: 10.3390/ma13163461] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Very high or low temperatures will lead to bone damage. The objective of this review was to analyze threshold values for thermal bone necrosis. METHODS Histological animal studies evaluating thermal effects on bone necrosis were selected via electronic and hand searches in English and German language journals until 1 November 2019. The outcome measures were temperature-exposure intervals and laser settings effecting bone damage. Furthermore, investigated parameters were the bone-to-implant contact ratios (BIC) and infrabony pockets around dental implants after thermal treatment. For quality assessment of studies, the CAMARADES study quality checklist was applied. RESULTS A total of 455 animals in 25 animal studies were included for data extraction after screening of 45 titles from 957 selected titles of the MEDLINE (PubMed), The Cochrane Library, Embase and Web of Science search. The threshold values for bone necrosis ranged between 47 °C and 55 °C for 1 min. A threshold value for cryoinsult and laser treatment has not yet been defined. However, temperatures in the vicinity of 3.5 °C produce a histologically proven effect on the bone and in the surrounding tissue. At 50 °C for 1 min, BIC values significantly decreased and infrabony pockets increased. Bone quality had an influence on the outcome, as cancellous bone suffered higher bone damage from thermal treatment compared to cortical bone. CONCLUSION No clear threshold value for bone necrosis is available according to the current literature for warm and cold stimuli. More in-depth and clinical studies are required to provide further insights in assessing the potential of thermal necrosis for implant removal.
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Evolution of surface morphology of Er:YAG laser-machined human bone. Lasers Med Sci 2019; 35:1477-1485. [PMID: 31828574 DOI: 10.1007/s10103-019-02927-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
The extensive research on the laser machining of the bone has been, so far, restricted to drilling and cutting that is one- and two-dimensional machining, respectively. In addition, the surface morphology of the laser machined region has rarely been explored in detail. In view of this, the current work employed three-dimensional laser machining of human bone and reports the distinct surface morphology produced within a laser machined region of human bone. Three-dimensional laser machining was carried out using multiple partially overlapped pulses and laser tracks with a separation of 0.3 mm between the centers of consecutive laser tracks to remove a bulk volume of the bone. In this study, a diode-pumped pulse Er:YAG laser (λ = 2940 nm) was employed with continuously sprayed chilled water at the irradiation site. The resulting surface morphology evolved within the laser-machined region of the bone was evaluated using scanning electron microscopy, energy dispersive spectroscopy, and X-ray micro-computed tomography. The distinct surface morphology involved cellular/channeled scaffold structure characterized by interconnected pores surrounded by solid ridges, produced within a laser machined region of human structural bone. Underlying physical phenomena responsible for evolution of such morphology have been proposed and explained with the help of a thermokinetic model.
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Troedhan A, Mahmoud ZT, Wainwright M, Khamis MM. Cutting bone with drills, burs, lasers and piezotomes: A comprehensive systematic review and recommendations for the clinician. ACTA ACUST UNITED AC 2017. [DOI: 10.17352/2455-4634.000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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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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Zeitouni J, Clough B, Zeitouni S, Saleem M, Al Aisami K, Gregory C. The effects of the Er:YAG laser on trabecular bone micro-architecture: Comparison with conventional dental drilling by micro-computed tomographic and histological techniques. F1000Res 2017; 6:1133. [PMID: 29416849 PMCID: PMC5782408 DOI: 10.12688/f1000research.12018.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/20/2022] Open
Abstract
Background: The use of lasers has become increasingly common in the field of medicine and dentistry, and there is a growing need for a deeper understanding of the procedure and its effects on tissue. The aim of this study was to compare the erbium-doped yttrium aluminium garnet (Er:YAG) laser and conventional drilling techniques, by observing the effects on trabecular bone microarchitecture and the extent of thermal and mechanical damage. Methods: Ovine femoral heads were employed to mimic maxillofacial trabecular bone, and cylindrical osteotomies were generated to mimic implant bed preparation. Various laser parameters were tested, as well as a conventional dental drilling technique. The specimens were then subjected to micro-computed tomographic (μCT) histomorphometic analysis and histology. Results: Herein, we demonstrate that mCT measurements of trabecular porosity provide quantitative evidence that laser-mediated cutting preserves the trabecular architecture and reduces thermal and mechanical damage at the margins of the cut. We confirmed these observations with histological studies. In contrast with laser-mediated cutting, conventional drilling resulted in trabecular collapse, reduction of porosity at the margin of the cut and histological signs of thermal damage. Conclusions: This study has demonstrated, for the first time, that mCT and quantification of porosity at the margin of the cut provides a quantitative insight into damage caused by bone cutting techniques. We further show that with laser-mediated cutting, the marrow remains exposed to the margins of the cut, facilitating cellular infiltration and likely accelerating healing. However, with drilling, trabecular collapse and thermal damage is likely to delay healing by restricting the passage of cells to the site of injury and causing localized cell death.
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Affiliation(s)
| | - Bret Clough
- Department of Medical Physiology, College of Medicine, Texas A&M Health Science Center, Temple, TX, USA
| | - Suzanne Zeitouni
- Department of Molecular and Cellular Medicine, Institute for Regenerative Medicine, College of Medicine, Texas A&M Health Science Center, College Station, TX, USA
| | | | | | - Carl Gregory
- Department of Molecular and Cellular Medicine, Institute for Regenerative Medicine, College of Medicine, Texas A&M Health Science Center, College Station, TX, USA
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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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Assessment of Temperature Rise and Time of Alveolar Ridge Splitting by Means of Er:YAG Laser, Piezosurgery, and Surgical Saw: An Ex Vivo Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9654975. [PMID: 27957502 PMCID: PMC5121450 DOI: 10.1155/2016/9654975] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/06/2016] [Accepted: 10/13/2016] [Indexed: 11/18/2022]
Abstract
The most common adverse effect after bone cutting is a thermal damage. The aim of our study was to evaluate the bone temperature rise during an alveolar ridge splitting, rating the time needed to perform this procedure and the time to raise the temperature of a bone by 10°C, as well as to evaluate the bone carbonization occurrence. The research included 60 mandibles (n = 60) of adult pigs, divided into 4 groups (n = 15). Two vertical and one horizontal cut have been done in an alveolar ridge using Er:YAG laser with set power of 200 mJ (G1), 400 mJ (G2), piezosurgery unit (G3), and a saw (G4). The temperature was measured by K-type thermocouple. The highest temperature gradient was noted for piezosurgery on the buccal and lingual side of mandible. The temperature rises on the bone surface along with the increase of laser power. The lower time needed to perform ridge splitting was measured for a saw, piezosurgery, and Er:YAG laser with power of 400 mJ and 200 mJ, respectively. The temperature rise measured on the bone over 10°C and bone carbonization occurrence was not reported in all study groups. Piezosurgery, Er:YAG laser (200 mJ and 400 mJ), and surgical saw are useful and safe tools in ridge splitting surgery.
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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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Rajitha Gunaratne GD, Khan R, Fick D, Robertson B, Dahotre N, Ironside C. A review of the physiological and histological effects of laser osteotomy. J Med Eng Technol 2016; 41:1-12. [DOI: 10.1080/03091902.2016.1199743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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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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Sella VRG, do Bomfim FRC, Machado PCD, da Silva Morsoleto MJM, Chohfi M, Plapler H. Effect of low-level laser therapy on bone repair: a randomized controlled experimental study. Lasers Med Sci 2015; 30:1061-8. [PMID: 25596935 DOI: 10.1007/s10103-015-1710-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/05/2015] [Indexed: 01/28/2023]
Abstract
The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on bone repair in femoral fractures. Sixty adult Wistar rats were randomly assigned into one of two groups: group A (ostectomy + LLLT) or group B (ostectomy + sham laser). An experimental model of complete bone fracture was surgically created by removing a 2-mm fragment from the middle third of the femoral shaft. Data were analyzed on days 8, 13, and 18 after the fracture (subgroups 1, 2, and 3). Samples were assessed for changes in inflammatory infiltration; trabecular bone matrix, periosteal, and new bone formations; and changes in the expression of particular osteogenic-related proteins (osteocalcin, osteopontin, and osteonectin). Microscopic analysis revealed a significant decrease in inflammatory infiltration, intense trabecular bone matrix and periosteal formation, and an increase in newly formed bone after laser irradiation. We also found an increase in the expression of bone matrix proteins with LLLT, with a significant difference measured for osteocalcin in the LLLT group at day 8 (p = 0.007). We show that LLLT plays an important role in augmenting bone tissue formation, which is relevant to fracture healing. LLLT may therefore be indicated as an adjunct therapeutic tool in clinical practice for the treatment or recovery of nonunion injuries.
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Affiliation(s)
- Valéria Regina Gonzalez Sella
- Department of Surgery, Division of Operative Technique and Experimental Surgery, Universidade Federal de São Paulo [Federal University of São Paulo] - UNIFESP, São Paulo, SP, Brazil,
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de Oliveira T, Santos-Pinto A, Gabrielli M, Pereira Filho V. Lack of bone healing: an unusual complication following surgically assisted rapid palatal expansion. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ors.12095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T.F.M. de Oliveira
- Department of Orthodontics; Araraquara Dental School; UNESP - Univ Estadual Paulista; Araraquara São Paulo Brazil
| | - A. Santos-Pinto
- Department of Orthodontics; Araraquara Dental School; UNESP - Univ Estadual Paulista; Araraquara São Paulo Brazil
| | - M.F.R. Gabrielli
- Department of Oral and Maxillofacial Surgery; Araraquara Dental School; UNESP - Univ Estadual Paulista; Araraquara São Paulo Brazil
| | - V.A. Pereira Filho
- Department of Oral and Maxillofacial Surgery; Araraquara Dental School; UNESP - Univ Estadual Paulista; Araraquara São Paulo Brazil
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Jowett N, Wöllmer W, Reimer R, Zustin J, Schumacher U, Wiseman PW, Mlynarek AM, Böttcher A, Dalchow CV, Lörincz BB, Knecht R, Miller RJD. Bone ablation without thermal or acoustic mechanical injury via a novel picosecond infrared laser (PIRL). Otolaryngol Head Neck Surg 2013; 150:385-93. [PMID: 24376121 DOI: 10.1177/0194599813517213] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE A precise means to cut bone without significant thermal or mechanical injury has thus far remained elusive. A novel non-ionizing ultrafast pulsed picosecond infrared laser (PIRL) may provide the solution. Tissue ablation with the PIRL occurs via a photothermal process with thermal and stress confinement, resulting in efficient material ejection greatly enhanced through front surface spallation photomechanical effects. By comparison, the Er:YAG laser (EYL) ablates via photothermal and cavitation-induced photomechanical effects without thermal or acoustic confinement, leading to significant collateral tissue injury. This study compared PIRL and EYL bone ablation by infrared thermography (IRT), environmental scanning electron microscopy (ESEM), and histology. STUDY DESIGN Prospective, comparative, ex vivo animal model. SETTING Optics laboratory. SUBJECTS AND METHODS Ten circular area defects were ablated in ex vivo chicken humeral cortex using PIRL and EYL at similar average power (~70 mW) under IRT. Following fixation, ESEM and undecalcified light microscopy images were obtained and examined for signs of cellular injury. RESULTS Peak rise in surface temperature was negligible and lower for PIRL (1.56 °C; 95% CI, 0.762-2.366) compared to EYL ablation (12.99 °C; 95% CI, 12.189-13.792) (P < .001). ESEM and light microscopy demonstrated preserved cortical microstructure following PIRL ablation in contrast to diffuse thermal injury seen with EYL ablation. Microfractures were not observed. CONCLUSION Ablation of cortical bone using the PIRL generates negligible and significantly less heat than EYL ablation while preserving cortical microstructure. This novel laser has great potential in advancing surgical techniques where precision osseous manipulation is required.
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Affiliation(s)
- Nathan Jowett
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada
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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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Apicoectomy Using Er:YAG Laser in Association with Microscope: A Comparative Retrospective Investigation. Photomed Laser Surg 2013; 31:110-5. [DOI: 10.1089/pho.2012.3393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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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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