Erbium-Doped Yttrium Aluminium Garnet Laser–Assisted Access Osteotomy for Maxillary Sinus Elevation: A Human and Animal Cadaver Study

Abstract

To evaluate the usability of a variable square pulse (VSP) erbium-doped yttrium aluminium garnet (Er:YAG) laser for a lateral access osteotomy to the maxillary sinus in the course of a sinus elevation procedure. In six formalin-fixed human heads and six fresh sheep heads, a VSP Er:YAG laser was used to perform a bilateral maxillary access osteotomy. For the osteotomies, the Er:YAG laser was applied with a pulse energy of 1000 mJ, a pulse duration of 300 mus, and a frequency of 12 Hz. The spot size was 0.9 mm, and the handpiece was kept approximately 10 mm from the bone surface. In all 24 sites investigated, the Er:YAG laser osteotomy was possible without any visible carbonization or thermal damage. The average time required for laser osteotomy for 12 standardized rectangular lateral windows in human cadavers was 39 s. No anatomical structures limited laser osteotomy, yet a critical evaluation of any membrane perforations was not possible because the postmortem fixation method caused partial detachment and fractional destruction. Laser-access osteotomy in six fresh sheep heads (12 sites) revealed major disruptions and perforations (<8 mm) of the sinus membrane (100%). Even though VSP Er:YAG laser osteotomy showed convincing results for efficient bone cutting without thermal damage, applied laser parameters do not seem to be practicable for any clinical sinus elevation procedure. Missing depth control resulted in uncontrollable severe damage of the underlying membrane.