BMC Oral Health. 2026 Jun 5. doi: 10.1186/s12903-026-08790-w. Online ahead of print.
ABSTRACT
BACKGROUND: Removal of impacted mandibular third molars is associated with postoperative discomfort and delayed bone healing. Er:YAG laser osteotomy has been proposed as a minimally invasive alternative to conventional rotary instrumentation.
AIM: To compare Er:YAG laser osteotomy and conventional rotary osteotomy regarding postoperative radiographic bone density and clinical healing outcomes following impacted mandibular third molar removal (pain, edema, and trismus).
METHODS: Twenty-four patients (n = 24) were randomized equally (laser n = 12; rotary n = 12). CBCT scans were obtained preoperatively and at 3 months for voxel-based grayscale bone density assessment. Standardized 3D ellipsoid VOIs were used. A single trained examiner performed all CBCT measurements twice, two weeks apart (ICC > 0.90). Postoperative pain, edema, and trismus were clinically assessed.
RESULTS: Immediate postoperative bone density showed no significant difference between groups (p = 0.319). At 3 months, bone density was significantly higher in the laser group compared with the rotary group (median: 310.7 vs. 270.0; p = 0.017), with a moderate effect size (r = 0.477). Bone density significantly increased over time in both groups (p = 0.002), with a significantly greater increase observed in the laser group (p = 0.017). Pain scores on day 2 were significantly lower in the laser group (p = 0.020). Edema and trismus showed significant improvement over time within both groups, with no statistically significant differences between groups. Operation time was significantly longer in the laser group.
CONCLUSION: Er:YAG laser osteotomy was associated with lower postoperative pain and higher radiographic grayscale values at 3 months compared with rotary osteotomy. Edema and trismus improved over time in both groups, with no significant differences between the two techniques.
CLINICAL RELEVANCE: Er:YAG laser may improve patient comfort by reducing postoperative pain and may be associated with improved radiographic bone healing. However, further studies are needed to confirm its long-term effects on bone density.
TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT07297043). Registered 09 December 2025 (retrospective).
PMID:42243813 | DOI:10.1186/s12903-026-08790-w
