Erbium Yttrium-Aluminum-Garnet Laser Versus Traditional Bur in the Extraction of Impacted Mandibular Third Molars: Analysis of Intra- and Postoperative Differences

Introduction: Different osteotomy techniques have been proposed in order to improve post-operative course of impacted third molar extraction. The aim is to evaluate the possible advantages achieved with Er:YAG laser osteotomy compared to traditional burs. Materials and methods: Seventy-six extractions were randomly classified into 2 groups according to osteotomy instrument: group 1 (G1) - Er:YAG laser: 35 cases; group 2 (G2) - traditional bur: 41 cases. Intra-operative parameters: total time, stitches number, patient compliance. Post-operative: pain, Health-Related Quality of Life (HR-QoL), need for analgesics, oedema, trismus, intra- and extra-oral haematoma and postoperative complications. Results: Mean time for G1 resulted 1069.4s; for G2 1913.5s (p<0.0001). Mean number of stitches (p=0.773) and patient compliance (p=0.063) were not statistically different. Regarding pain, mean VAS and NRS scores were lower in G1 than G2. Statistically significant differences were highlighted at days 0, 1 and 3 with VAS scale and at days 0, 1, 3 and 7 with NRS scale. HR-QoL scores resulted lower in G1 than G2 (p<0.0001). Mean facial swelling and trismus resulted statistically lower in G1 than G2 at day 2 (p<0.0001). Trismus resulted statistically lower in G1 than G2 at day 2 (p<0.0001) and 7 (p=0.004). Two cases (5.71%) of subcutaneous emphysema was recorded in G1 and 2 cases (4.88%) of lip paraesthesia in G2. Conclusion: Data confirm that the use of Er:YAG laser for osteotomy may achieve several advantages both technical and biological.