Laser biomodification of the bone bed surface for placement of spiral dental implants: a study based on scanning electron microscopy

Abstract

Introduction: Various rotary and mechanical instruments are used in conventional oral surgery for osteotomies. Despite the implementation of effective cooling systems, it is difficult to prevent thermal damage to the adjacent bone caused by heat generated during the procedure. A smear layer forms on the surface, which can impede the interaction of blood elements with the underlying tissue, resulting in a delayed healing process. Aim: This study explores the possibility of overcoming these drawbacks by combining conventional methods with a pulsed Er:YAG laser. By examining the osteotomy surfaces using scanning electron microscopy (SEM), we investigated the potential synergistic effects that could benefit conventional implantology. Materials and methods: Split osteotomies were performed on mandibles of freshly euthanized domestic pigs (Sus scrofa domestica). With osteotomy surface examination, the experimental comparison involved two groups: group A - standard technique, and group B - surface ablation using an Er:YAG laser by applying our own method. The samples from both groups were examined using scanning electron microscopy (SEM). Results: In group A samples, the bone surface was smooth, with an amorphous layer and microcracks all over it. The thickness of this layer ranged from 21.77 µm to 136.2 µm, completely obstructing the Volkmann’s and Haversian canals. In group B, the borders were smooth and well defined. The bone structure remained unchanged, with empty intratrabecular spaces, no signs of carbonization, and open canals reaching the surface. The smear layer measured between 3.054 µm and 47.26 µm, with complete absence observed in some places. Conclusions: The present study provides evidence that ablation of the osteotomy surface using an Er:YAG laser leads to biomodification by eliminating the smear layer without altering the parameters of the bone bed.