A Novel Approach to Laser-Assisted, Atraumatic Tooth Extractions

Objectives: Elderly patients, especially females, present with brittle jaw bones due to osteoporosis and are at high risk for fractures during tooth extractions. We hypothesized that surgical lasers could provide a minimally invasive approach to ablate tooth-supporting structures, including gingival tissue, periodontal ligaments, and crestal alveolar bone, enabling atraumatic extractions.
Methods: Following UB IACUC approval (#PROTO201800212), we utilized pig jaws to evaluate the efficacy of the Er,Cr:YSGG laser (8.00W, 20Hz, dispensing 3.6mLof water/min), CO₂ (3-6W, superpulse, dispensing 6.8mL of water/min), and Diode (8W, CW, dispensing 6.5mL of water/min) for atraumatic tooth extraction. Mucoperiosteal flaps were raised to expose the bone using a periosteal elevator following a vertical release incision All laser tips were operated at a constant speed parallel to the cementum surface. Tooth mobility and extraction force were assessed using Miller Mobility Index, digital images, thermal imaging and force transducers. Histological examination, post-extraction, is being performed.
Results: We observed that laser ablation of the tooth-surrounding tissues induce grade 2 mobility of the teeth, enabling atraumatic tooth extractions for both the Er,Cr:YSGG, and CO₂ while the diode laser only achieved grade 1 mobility. When analyzing different modalities, laser extractions required 11N (CO₂), 16N (Er,Cr:YSGG), and 28N (diode), compared to 40N for surgical extraction. We noted minimal charring of the surrounding alveolar bone for Er,Cr:YSGG, increased charring by CO₂ and the diode demonstrating the highest degree of charring of the surrounding tissues. Current studies are examining tissue histology.
Conclusions: These results demonstrate the potential for a laser-assisted procedure to enable atraumatic tooth extractions. This approach avoids fracturing brittle jaw bones in geriatric patients. This minimally invasive process enables optimal healing and preservation of the bone support, accelerating rehabilitation with dentures or implants in aging populations.