Baek Kyung-Won, Deibel Waldemar, Marinov Dilyan, Griessen Mathias, Dard Michel, Bruno Alfredo, Zeilhofer Hans-Florian, Cattin Philippe, Juergens Philipp
Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.
Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Schanzenstrasse 46, Basel, 4031, Switzerland.
Lasers Surg Med. 2015 Jul;47(5):426-32. doi: 10.1002/lsm.22352. Epub 2015 May 6.
Despite of the long history of medical application, laser ablation of bone tissue became successful only recently. Laser bone cutting is proven to have higher accuracy and to increase bone healing compared to conventional mechanical bone cutting. But the reason of subsequent better healing is not biologically explained yet. In this study we present our experience with an integrated miniaturized laser system mounted on a surgical lightweight robotic arm.
STUDY DESIGN/MATERIALS AND METHODS: An Erbium-doped Yttrium Aluminium Garnet (Er:YAG) laser and a piezoelectric (PZE) osteotome were used for comparison. In six grown up female Göttingen minipigs, comparative surgical interventions were done on the edentulous mandibular ridge. Our laser system was used to create different shapes of bone defects on the left side of the mandible. On the contralateral side, similar bone defects were created by PZE osteotome. Small bone samples were harvested to compare the immediate post-operative cut surface.
The analysis of the cut surface of the laser osteotomy and conventional mechanical osteotomy revealed an essential difference. The scanning electron microscopy (SEM) analysis showed biologically open cut surfaces from the laser osteotomy. The samples from PZE osteotomy showed a flattened tissue structure over the cut surface, resembling the "smear layer" from tooth preparation.
We concluded that our new finding with the mechanical osteotomy suggests a biological explanation to the expected difference in subsequent bone healing. Our hypothesis is that the difference of surface characteristic yields to different bleeding pattern and subsequently results in different bone healing. The analyses of bone healing will support our hypothesis.
尽管骨组织激光消融术的医学应用历史悠久，但直到最近才取得成功。与传统机械骨切割相比，激光骨切割已被证明具有更高的精度并能促进骨愈合。但后续愈合更好的原因尚未从生物学角度得到解释。在本研究中，我们展示了在手术用轻型机器人手臂上安装集成微型激光系统的经验。
研究设计/材料与方法：使用掺铒钇铝石榴石（Er:YAG）激光和压电骨凿进行比较。在六只成年雌性哥廷根小型猪身上，对无牙下颌牙槽嵴进行了对比手术干预。我们的激光系统用于在下颌骨左侧制造不同形状的骨缺损。在对侧，用压电骨凿制造类似的骨缺损。采集小骨样本以比较术后即刻的切割表面。
激光截骨术和传统机械截骨术切割表面的分析显示出本质差异。扫描电子显微镜（SEM）分析显示激光截骨术的切割表面在生物学上是开放的。压电截骨术的样本在切割表面显示出扁平的组织结构，类似于牙齿预备中的“玷污层”。
我们得出结论，机械截骨术的这一新发现为后续骨愈合预期差异提供了生物学解释。我们的假设是，表面特征的差异导致不同的出血模式，进而导致不同的骨愈合。骨愈合分析将支持我们的假设。
