Stübinger Stefan, von Rechenberg vet Brigitte, Zeilhofer Hans-Florian, Sader Robert, Landes Constantin
University Clinic for Reconstructive Surgery, Department of Cranio- and Maxillofacial Surgery, University Hospital Basel, Spitalstr 21, CH-4031, Basel, Switzerland.
Lasers Surg Med. 2007 Aug;39(7):583-8. doi: 10.1002/lsm.20528.
In contrast to many techniques currently employed for osteotomy, like saws, drills or modulated ultrasound, lasers offer non-contact and low-vibration bone cutting. Therefore, this report examines the benefits to laser osteotomy in oral surgery using two different short-pulsed Er:YAG laser systems.
Er:YAG lasers, using either a fiber-optic delivery system and an articulated arm delivery system, were used to remove impacted teeth in 30 patients. In 15 patients an Er:YAG laser utilizing a fiber-optic delivery system was applied for cutting bone, with a pulse energy of 500 mJ, a pulse duration of 250 microseconds and frequency of 12 Hz (energy density 177 J/cm(2)). The other 15 patients were treated with an Er:YAG laser utilizing an articulated arm delivery system, with a pulse energy of 1,000 mJ, a pulse duration of 300 microseconds and a frequency of 12 Hz (energy density 157 J/cm(2)).
In all cases the lasers allowed precise bone ablation without any visible, negative, thermal side-effects. Since the laser tip was used in a non-contact mode and could be positioned freely, unrestricted cut geometries were feasible. Adjacent soft tissue structures could be preserved and were not harmed by the laser beam. However, osteotomies were time consuming, especially if teeth had to be separated. The level of water irrigation limited the use of the laser. In 20% of the cases in which the articulated arm delivery laser was used to section teeth, it was necessary to use a conventional dental drill to finish the procedure.
This bone ablation technique, using short Er:YAG laser pulses and water spray, produced good clinical results without any impairment to wound healing. However, for now, the lack of depth control and the time required to perform the necessary osteotomy limit routine clinical application.
与目前用于截骨术的许多技术（如锯、钻或调制超声）不同，激光提供非接触式且低振动的骨切割。因此，本报告使用两种不同的短脉冲铒激光系统，研究激光截骨术在口腔外科手术中的益处。
使用光纤传输系统和关节臂传输系统的铒激光，用于拔除30例患者的阻生牙。15例患者使用光纤传输系统的铒激光进行骨切割，脉冲能量为500 mJ，脉冲持续时间为250微秒，频率为12 Hz（能量密度177 J/cm²）。另外15例患者使用关节臂传输系统的铒激光进行治疗，脉冲能量为1000 mJ，脉冲持续时间为300微秒，频率为12 Hz（能量密度157 J/cm²）。
在所有病例中，激光均能实现精确的骨消融，且无任何可见的负面热副作用。由于激光头以非接触模式使用且可自由定位，不受限制的切割几何形状是可行的。相邻的软组织结构得以保留，未受到激光束的损伤。然而，截骨术耗时较长，尤其是在需要分离牙齿时。水冲洗的程度限制了激光的使用。在20%使用关节臂传输激光进行牙齿切割的病例中，有必要使用传统牙科钻来完成手术。
这种使用短脉冲铒激光和喷水的骨消融技术产生了良好的临床效果，且对伤口愈合无任何损害。然而，目前缺乏深度控制以及进行必要截骨术所需的时间限制了其常规临床应用。
