CO2 lasers have been popular in oral surgery due to their precise incisions and excellent hemostasis. Erbium lasers are capable of cutting bone in a less traumatic fashion and can be quite useful for the following procedures:
Surgical Extractions with less traumatic flaps and bone removal
Incision and Drainage
Treatment of peri-implantitis
Ridge preparation/hyperplasic tissue reduction
Nd:YAG and diodes have biostimulative properties that can be used to promote healing, osteogenesis, and post-operative comfort. They also have been shown to have potent inhibitory effects on bacteria and fungi.29 Nd:YAG lasers can also form fibrin rapidly in an extraction site creating a quick and more durable clot. An interesting application of dental lasers is in the treatment of medication-related osteonecrosis of the jaw (MRONJ). MRONJ occurs because the drugs inhibit osteoclastic activity which is needed whenever bone is surgically manipulated. When the necrotic bone is removed with an Er:YAG laser the remaining bone is so minimally traumatized that osteoclastic needs are minimized. Nd:YAG biostimulation can be used concurrently or separately to promote bone healing as well. Recent studies have shown superior results when compared to traditional surgical approaches when lasers are used.11,14,15,17
Figure 36. Oral Surgery.
A 79-year-old female fractured off a crown on tooth number 9 in a car accident. The Er:YAG is used in a flapless approach to resect bone and make space in the periodontal ligament for judicious elevation. No sutures were needed.
Figure 37. Er:YAG and Nd:YAGE.
Er:YAG and Ndx:YAG Assisted Extraction of Vertical Root Fractured Premolar- The Er:YAG allows for conservative removal of alveolar bone resulting in a minimmaly invasive extraction via elevation. The extraction site blood is coagulated with th Nd:YAG laser prior to placement of bone graft material.