Feasibility of atraumatic extractions with surgical lasers: A pilot study in porcine jaws

Objectives: The positive increases in human lifespan have resulted in an increasing incidence of chronic diseases in the geriatric population. Elderly patients, especially females, often present with brittle jaw bones due to osteoporosis that have significantly increased risk of fractures during routine tooth extractions. The aim of this study was to examine the feasibility of utilizing surgical dental lasers to achieve minimally invasive, atraumatic tooth extraction. Methods: In this study we utilized 64 porcine premolars (16 per group) and examined the feasibility of using Er,Cr:YSGG (8 W, 20 Hz), CO₂ (3 to 6 W, super-pulsed), and diode (8 W, CW) lasers with air-water cooling to assist with tooth extractions. Mucoperiosteal flaps were raised following a vertical release incision, and laser tips were aligned parallel to the cementum surface. Tooth mobility and extraction force were assessed using the Miller Mobility Index, digital and thermal imaging, and force transducers. Histological analysis was performed to evaluate tissue changes. Results: We noted laser ablation of surrounding tissues enabled Grade 2 mobility with the Er,Cr:YSGG and CO₂ lasers enabling extractions with lower manual force (16 and 11 N respectively), while the diode laser could only achieve Grade 1 mobility (28 N). Minimal charring of alveolar bone was seen with the Er,Cr:YSGG laser, while the CO₂ and Diode lasers displayed most prominent charring. Conclusions: Together, these results suggest that laser-assisted extractions in vulnerable patients could improve overall quality of care. Clinical Significance: Laser-assisted tooth extraction can provide a potent atraumatic approach in geriatric populations with high risk of jaw fractures and complications from osteoporosis or osteonecrosis. This approach represents a minimally invasive approach for routine extractions resulting in less pain and discomfort, and improved healing and overall patient experience.