Conventional drilling versus ultrasound and laser osteotomy in mandibular third molar surgery: A comparative study

Abstract

BackgroundThere are few research works with in‐depth studies and direct simultaneous comparisons of the effects on tissue reactions and patients' recovery following in vivo conventional drilling, ultrasound‐ and laser‐assisted osteotomy in humans.ObjectiveThe current study aims to compare bone cutting duration, pain, swelling, and trismus in patients following surgical mandible third molar extraction by bone removal using three different osteotomes—a conventional rotary device, an ultrasonic unit, and an Er:YAG laser.MethodsA prospective, randomized three‐group comparative clinical trial was performed. As an experimental setting for the study, аn open mandible third molar surgery was chosen because osteotomy is included in its protocol. Patients were divided into three groups according to the used device for bone removal. Bone cutting time intraoperatively, facial swelling, trismus, and pain on the first, second, and third postoperative days were assessed. The statistical analyses were performed using the SPSS v. 17.0—Kolmogorov–Smirnov test, one‐way ANOVA, Student's t‐test, Mann–Whitney test, and χ2 test. Statistical results were considered significant at p < 0.05 (confidence interval of difference, 95% CI).ResultsEighty patients (34 males and 46 females with an average age of 25.18 years) were included in the study. The average time for bone removal by the conventional low‐speed device (4.95 min), by the ultrasonic unit (5.13 min), and by the Er:YAG laser (9.00 min) differed significantly (p = 0.001). The mean postoperative facial swelling showed a marked difference between the groups (p < 0.05), in favor of the laser and piezo groups. The osteotome proved to influence pain intensity not only immediately after surgery (p = 0.002), but also during the followed‐up period (p = 0.001), again in favor of the two above‐mentioned groups. No association was found between trismus and the osteotome used by the followed‐up patients (p > 0.05).ConclusionBone‐cutting mechanism and the biological influence of the laser beam and ultrasound on living tissues proved to be favorable factors for patients' pain levels and tissue swelling postoperatively independent of the longer osteotomy duration compared to conventional drilling.

Evaluation of the Dimensional Accuracy of Robot-Guided Laser Osteotomy in Reconstruction with Patient-Specific Implants—An Accuracy Study of Digital High-Tech Procedures

“…Neodymium–doped Yttrium Aluminum Garnet (Nd:YAG) lasers, on the other hand, are associated with adverse thermal effects, while carbon-dioxide (CO 2 ) lasers are associated with bone sequestration, coagulation, and carbonization of the tissue [ 15 , 17 ], whereas the Er:YAG laser works below the critical bone temperature so that no carbonization occurs. With its wavelength of 2940 nm, which is the wavelength absorbed by water and used to cut hydroxyapatite, the laser is indicated where the cutting of hard mineralized tissue is required [ 1 , 15 , 24 , 25 , 26 ]. The Er:YAG laser induces a photothermic effect, resulting in photoablation; specifically, the water content of the tissue absorbs the laser energy, causing a corresponding increase in pressure that leads to microexplosions.…”