title: Use of the Er:YAG laser for improved plating in maxillofacial surgery: comparison of bone healing in laser and drill osteotomies.
abstract: OBJECTIVE
  Surgical reconstruction of bony defects in the maxillofacial region involves fixation of bony fragments with mini and micro plates. Bone stabilization during hole drilling is often challenging due to the need to apply pressure when using a conventional mechanical Hall drill. In addition, fragmentation of the fragile bones may occur and complicate the reconstruction. The pulsed Er:YAG laser offers an attractive alternative drilling modality because it does not require physical contact with the bone in order to drill holes, cuts bone with minimal thermal damage, and allows precise control of bone cutting. The objective of this study was to investigate the pulsed Er:YAG laser as an alternative to the mechanical bur by comparing bone healing using both modalities.
  
  
  METHODS
  Bone healing in an inferior border defect of the rat mandible was examined using either an Er:YAG laser or a mechanical bur for drilling. The healing of osteotomies in facial bones and of screw holes for plate stabilization of free bone fragments was studied.
  
  
  RESULTS
  All defects healed by 4 weeks postoperatively. Histologic evaluation demonstrated no difference in the amount of newly formed woven bone at the osteotomy site or screw holes made by either the laser or the drill. The extent of thermal damage at the osteotomy sites was comparable in laser and mechanically cut bone fragments.
  
  
  CONCLUSIONS
  On the basis of this study we suggest that the Er: YAG laser can be used clinically in thin, fragile bones in the maxillofacial region.
authors.affiliation: Orthopaedic Research Laboratory, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: K U
authors.initials: KU
authors.lastname: Lewandrowski
authors.forename: C
authors.initials: C
authors.lastname: Lorente
authors.forename: K T
authors.initials: KT
authors.lastname: Schomacker
authors.forename: T J
authors.initials: TJ
authors.lastname: Flotte
authors.forename: J W
authors.initials: JW
authors.lastname: Wilkes
authors.forename: T F
authors.initials: TF
authors.lastname: Deutsch
mesh_terms: D000538:Aluminum Silicates; D000818:Animals; D001860:Bone Plates; D016723:Bone Remodeling; D001862:Bone Resorption / Q000473:pathology; D001863:Bone Screws; D004871:Erbium; D005147:Facial Bones / Q000473:pathology / Q000601:surgery*; D006358:Hot Temperature; D007431:Intraoperative Complications; D053685:Laser Therapy / Q000295:instrumentation; D008297:Male; D008334:Mandible / Q000473:pathology / Q000601:surgery*; D016348:Osseointegration; D010012:Osteogenesis; D010027:Osteotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011312:Pressure; D051381:Rats; D017207:Rats, Sprague-Dawley; D014945:Wound Healing; D015019:Yttrium
chemical_list: D000538:Aluminum Silicates; D015019:Yttrium; D004871:Erbium