title: Er:YAG laser osteotomy directed by sensor controlled systems.
abstract: BACKGROUND
  Great efforts have been taken in the past to develop laser systems suitable for bone cutting. Laser systems emitting light in the infrared spectrum (2.9, 3.0 microm) have been found to be ideal for efficient bone ablation with very little carbonization.
  
  
  OBJECTIVE
  To evaluate a new laser bone cutting system enabling the automatic detection of different tissue qualities by an integrated sensor to avoid damage to sensitive structures such as blood vessels or nerves.
  
  
  METHODS
  An Erbium:YAG laser containing an integrated closed-loop control system, was constructed and tested on dissected bone. Process emissions such as resonance changes caused by the interaction of laser light and various tissue structures can be used for a controlled system. Sensor signals from a photodiode and a piezo-electric accelerometer were received and processed to guide the laser osteotomy.
  
  
  METHODS
  Tests were performed on dissected bone specimens from rabbit femur (14) and minipig jaw (6). After laser application, the bone specimens were evaluated macroscopically and histologically.
  
  
  RESULTS
  The specimens were evaluated histomorphometrically for the depth of cortical bone ablation when the closed-loop control system switched off the laser. Mean courses of 97.45% (pig) and 97.83% (rabbit) showed that the systems work with precision.
  
  
  CONCLUSIONS
  After penetrating the cortical bone layer, the laser beam was promptly interrupted due to extreme changes of the signal character received by the sensor system. The in vitro tests of this new laser closed-loop control system were successful.
authors.affiliation: Department of Oral and Cranio-Maxillofacial Surgery, Erlangen-Nuremberg University, Erlangen-Nuremberg, Germany. stephan.rupprecht@mkg.imed.uni-erlangen.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Rupprecht
authors.forename: Katja
authors.initials: K
authors.lastname: Tangermann
authors.forename: Peter
authors.initials: P
authors.lastname: Kessler
authors.forename: Friedrich Wilhelm
authors.initials: FW
authors.lastname: Neukam
authors.forename: Joerg
authors.initials: J
authors.lastname: Wiltfang
mesh_terms: D000538:Aluminum Silicates; D000818:Animals; D004581:Electronics / Q000295:instrumentation; D004867:Equipment Design; D004871:Erbium; D005269:Femur / Q000473:pathology / Q000601:surgery; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods*; D008027:Light; D008334:Mandible / Q000473:pathology / Q000601:surgery; D055095:Optics and Photonics / Q000295:instrumentation; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D011817:Rabbits; D012371:Robotics / Q000295:instrumentation; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D013552:Swine; D013556:Swine, Miniature; D015019:Yttrium
chemical_list: D000538:Aluminum Silicates; D015019:Yttrium; D004871:Erbium