Efficacy of Er:YAG laser in removal of impacted mandibular third molars (a randomized controlled clinical trial).

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).