Laser in the management of jaw bone pathologies

OBJECTIVES Technological innovations are increasingly frequent in the medical field, and in particular in dentistry. In the last decade, lasers have assumed a prominent role in oral surgery, both mucosal and bone, offering many advantages both for the operator (technical advantages) and for the patient (clinical and biological advantages). This Module aims to describe how photobiomodulation and laser ablation technique can be advantageous in jawbone surgery, especially in some clinical situations reported in this work. MATERIALS AND METHODS Laser bone surgery can be conservative (laser vaporization of bone tissue) or resective (debridement, sequestrectomy, resection of larger portions of bone). An intraoperative support during laser bone surgery is represented by bone autofluorescence (AF), which is able to highlight the pathological tissues through a decrease in fluorescence. According to literature and based on the clinical practice of the authors, there are many indications for the use of laser surgery. Laser photobiomodulation, combined with antibiotic prophylaxis and a possible bone vaporization with an erbium laser, is very useful for surgery in patients at risk (e.g., cancer and/or osteometabolic). In tooth extractions or implant removal, the use of erbium and neodymium lasers is recommended for disinfection and clot stabilization processes. Intra-and post-operative photobiomodulation and erbium laser bone ablation are indicated in the extractions of impacted teeth, in benign bone pathologies, osteomyelitis and osteonecrosis of the jaws, while erbium laser bone vaporization is additionally recommended in malignant bone pathologies. RESULTS Literature data shows how laser bone surgery in patients at risk leads to a reduction of osteonecrosis; in dental or implant extractions there is a faster bone remineralization and less post-operative discomfort. In the extraction of impacted teeth and in the incisional and/or excisional biopsy of benign and malignant bone pathologies, laser surgery allows has more technical, clinical and biological advantages compared to the traditional rotary technique; furthermore, in the presence of osteomyelitis and jaw osteonecrosis, the laser has a bactericidal effect, favors the new bone vascularization and the adhesion of covering tissues. CONCLUSIONS The use of laser, both in photobiomodulation and ablative modality, has superior capabilities to the surgical bur in terms of precision and cleanliness of the cut, with consequent positive effects on healing and on the postoperative course. CLINICAL SIGNIFICANCE According to current perspectives, the application of the different laser wave-lengths appears to be considerably advantageous both for the operator and for the patient, during oro-maxil-lo-facial surgery.