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Lasers in Dentistry: Minimally Invasive Instruments for the Modern Practice
Oral Surgery

Course Author(s): Steven R. Pohlhaus, DDS

Oral Surgery

CO2 lasers have been popular in oral surgery due to their precise incisions and excellent haemostasis. 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
  • Alveoplasty
  • Incision and Drainage
  • Operculectomies
  • Treatment of peri-implantitis
  • Pre-Prosthetic
    • Ridge preparation/hyperplasic tissue reduction
    • Frenectomies
    • Tuberosity reductions
    • Vestibuloplasty
    • Tori Removal

Nd:YAG and diodes have biostimulative properties that can be used to promote healing, osteogenesis, and post-operative comfort.10 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 bisphosphonate induce osteonecrosis of the jaw (BONJ). BONJ 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 traumatised 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.
This image depicts a fractured crown on tooth number 9. The Er:YAG is used in a flapless approach to resect bone and make space in the periodontal ligament for judicious elevation.
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.
2
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.
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