{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T10:53:49Z","timestamp":1781607229117,"version":"3.54.5"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009827","name":"Alexandria University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009827","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Twenty-four patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924) were randomized equally (laser\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200912; rotary\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200912). 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\u2009&gt;\u20090.90). Postoperative pain, edema, and trismus were clinically assessed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Immediate postoperative bone density showed no significant difference between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.319). At 3 months, bone density was significantly higher in the laser group compared with the rotary group (median: 310.7 vs. 270.0;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017), with a moderate effect size (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.477). Bone density significantly increased over time in both groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), with a significantly greater increase observed in the laser group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017). Pain scores on day 2 were significantly lower in the laser group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov (Identifier: NCT07297043). Registered 09 December 2025 (retrospective).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-08790-w","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T01:33:16Z","timestamp":1780623196000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of Er:YAG laser in removal of impacted mandibular third molars (a randomized controlled clinical trial)"],"prefix":"10.1186","volume":"26","author":[{"given":"Karim A.","family":"Elhaw","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed A.","family":"Abdelhakim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnabat.","family":"Dominguez J","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riham M.","family":"Eldibany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Espa\u00f1a.","family":"Tost A","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"8790_CR1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.4103\/2141-9248.160177","volume":"5","author":"P Santosh","year":"2015","unstructured":"Santosh P. Impacted mandibular third molars: Review of literature and a proposal of a combined clinical and radiological classification. Ann Med Health Sci Res. 2015;5:229\u201334.","journal-title":"Ann Med Health Sci Res"},{"key":"8790_CR2","doi-asserted-by":"publisher","first-page":"S1393","DOI":"10.4103\/jpbs.jpbs_1838_24","volume":"17","author":"KP Noufal","year":"2025","unstructured":"Noufal KP, Shanoj RP, Assaggaf M, Sunil R, Pai DR, Amin R. Evaluation of Laser-Assisted Bone-Cutting Techniques Compared to Traditional Methods. J Pharm Bioallied Sci. 2025;17:S1393\u20135.","journal-title":"J Pharm Bioallied Sci"},{"key":"8790_CR3","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1111\/prd.12080","volume":"68","author":"A Aoki","year":"2015","unstructured":"Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki AA, et al. Periodontal and peri-implant wound healing following laser therapy. Periodontol 2000. 2015;68:217\u201369.","journal-title":"Periodontol 2000"},{"key":"8790_CR4","doi-asserted-by":"publisher","first-page":"7101","DOI":"10.1038\/s41598-026-37117-6","volume":"16","author":"M Liu","year":"2026","unstructured":"Liu M, Hamidi A, Blaser D, Wilson D, Garcia K, Friederich NF, et al. Influence of laser beam intensity profile on deep bone ablation in laser osteotomy. Sci Rep. 2026;16:7101.","journal-title":"Sci Rep"},{"key":"8790_CR5","doi-asserted-by":"publisher","first-page":"2515","DOI":"10.1016\/j.joms.2012.06.192","volume":"70","author":"D Gabri\u0107 Panduri\u0107","year":"2012","unstructured":"Gabri\u0107 Panduri\u0107 D, Bago I, Katanec D, Zabkar J, Mileti\u0107 I, Ani\u0107 I. Comparison of Er:YAG laser and surgical drill for osteotomy in oral surgery: an experimental study. J Oral Maxillofac Surg. 2012;70:2515\u201321.","journal-title":"J Oral Maxillofac Surg"},{"key":"8790_CR6","first-page":"1","volume":"7","author":"AB Mustafa","year":"2015","unstructured":"Mustafa AB. Prevalence of Impacted Pre-Molar Teeth in College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia. J Int Oral Health. 2015;7:1\u20133.","journal-title":"J Int Oral Health"},{"key":"8790_CR7","first-page":"1302","volume":"2014","author":"TB Dodson","year":"2014","unstructured":"Dodson TB, Susarla SM. Impacted wisdom teeth. BMJ Clin Evid. 2014;2014:1302.","journal-title":"BMJ Clin Evid"},{"key":"8790_CR8","doi-asserted-by":"crossref","unstructured":"Kasapo\u011flu \u00c7, Brki\u0107 A, G\u00fcrkan-K\u00f6seo\u011flu B, Ko\u00e7ak-Berbero\u011flu H. Complications following surgery of impacted teeth and their management. In: A Textbook of Advanced oral and Maxillofacial surgery. IntechOpen. 2013. p. 3\u201325.","DOI":"10.5772\/53400"},{"key":"8790_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta24300","volume":"24","author":"J Hounsome","year":"2020","unstructured":"Hounsome J, Pilkington G, Mahon J, Boland A, Beale S, Kotas E, et al. Prophylactic removal of impacted mandibular third molars: a systematic review and economic evaluation. Health Technol Assess. 2020;24:1\u2013116.","journal-title":"Health Technol Assess"},{"key":"8790_CR10","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/j.jcms.2020.03.011","volume":"48","author":"M Zimmermann","year":"2020","unstructured":"Zimmermann M, Nkenke E. Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic. J Craniomaxillofac Surg. 2020;48:521\u20136.","journal-title":"J Craniomaxillofac Surg"},{"key":"8790_CR11","doi-asserted-by":"publisher","first-page":"7712829","DOI":"10.1155\/2024\/7712829","volume":"2024","author":"P Dignam","year":"2024","unstructured":"Dignam P, Elshafey M, Jeganathan A, Foo M, Park JS, Ratnaweera M. Prevalence and factors influencing post-operative complications following tooth extraction: A narrative review. Int J Dent. 2024;2024:7712829.","journal-title":"Int J Dent"},{"key":"8790_CR12","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1038\/s41591-023-02237-3","volume":"29","author":"A Domenghino","year":"2023","unstructured":"Domenghino A, Walbert C, Birrer DL, Puhan MA. Consensus recommendations on how to assess the quality of surgical interventions. Nat Med. 2023;29:811\u201322.","journal-title":"Nat Med"},{"key":"8790_CR13","first-page":"745","volume":"49","author":"G Juodzbalys","year":"2018","unstructured":"Juodzbalys G. A classification for assessing surgical difficulty in the extraction of mandibular impacted third molars: Description and clinical validation. Quintessence Int. 2018;49:745\u201353.","journal-title":"Quintessence Int"},{"key":"8790_CR14","doi-asserted-by":"crossref","unstructured":"Gabri\u0107 D, Baraba A, Batinjan G, Bla\u0161kovi\u0107 M, Boras VV, Zore IF et al. Advanced applications of the Er: YAG laser in oral and maxillofacial surgery. In: A Textbook of Advanced Oral and Maxillofacial Surgery. IntechOpen. 2015;2. p. 800\u201336.","DOI":"10.5772\/59273"},{"key":"8790_CR15","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1007\/978-3-030-29604-9_9","volume-title":"Lasers in Oral and Maxillofacial Surgery","author":"LM Beltr\u00e1n Bernal","year":"2020","unstructured":"Beltr\u00e1n Bernal LM, Abbasi H, Zam A. Laser in bone surgery. Lasers in Oral and Maxillofacial Surgery. Cham: Springer International Publishing; 2020. pp. 99\u2013109."},{"key":"8790_CR16","doi-asserted-by":"crossref","unstructured":"Peavy GM, Wilder-Smith PE. Laser surgery. Oral and Maxillofacial Surgery in Dogs and Cats-E-Book: Oral and Maxillofacial Surgery in Dogs and Cats-E-Book. 2019. p 99.","DOI":"10.1016\/B978-0-7020-7675-6.00019-X"},{"key":"8790_CR17","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3390\/jfb16060209","volume":"16","author":"J Fiegler-Rudol","year":"2025","unstructured":"Fiegler-Rudol J, Skaba D, Kawczyk-Krupka A, Wiench R. Antibacterial and Bactericidal Effects of the Er: YAG Laser on Oral Bacteria: A Systematic Review of Microbiological Evidence. J Funct Biomater. 2025;16:209.","journal-title":"J Funct Biomater"},{"key":"8790_CR18","doi-asserted-by":"publisher","first-page":"28","DOI":"10.22543\/7674.91.P2837","volume":"9","author":"AM Babtan","year":"2022","unstructured":"Babtan AM, Ilea A, Feurdean CN, Ceci S, Pula B, Candrea S, et al. Biostimulation with low-level laser therapy and its effects on soft and hard tissue regeneration. Literature review. J Mind Med Sci. 2022;9:28\u201337.","journal-title":"J Mind Med Sci"},{"key":"8790_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jdsr.2023.11.002","volume":"60","author":"A Aoki","year":"2024","unstructured":"Aoki A, Mizutani K, Taniguchi Y, Lin T, Ohsugi Y, Mikami R, et al. Current status of Er:YAG laser in periodontal surgery. Jpn Dent Sci Rev. 2024;60:1\u201314.","journal-title":"Jpn Dent Sci Rev"},{"key":"8790_CR20","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.4103\/jpbs.jpbs_266_21","volume":"13","author":"N Maiti","year":"2021","unstructured":"Maiti N, Sharma P, Jadon SS, Qadri F, Pamidi VRCB, Ganvir SR, et al. Efficiency of laser versus bur in impacted mandibular third molar surgery: An original research. J Pharm Bioallied Sci. 2021;13:1501\u20135.","journal-title":"J Pharm Bioallied Sci"},{"key":"8790_CR21","unstructured":"Rosner B. Fundamentals of biostatistics. Nelson Education. 2015."},{"key":"8790_CR22","unstructured":"Universit\u00e4t D\u00fcsseldorf. G*Power. 2019. Retrieved from: http:\/\/www.gpower.hhu.de\/."},{"key":"8790_CR23","first-page":"e088","volume":"2","author":"DA Delgado","year":"2018","unstructured":"Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2:e088.","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"8790_CR24","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1590\/0103-6440202305413","volume":"34","author":"CEN Nunes","year":"2023","unstructured":"Nunes CEN, Andrade KDS, Martins CA, Chaves FN, Oliveira DHIP, Sampieri MBDS. Effectiveness of low power laser in reducing postoperative signs and symptoms after third molar surgery: a triple-blind clinical trial. Braz Dent J. 2023;34:158\u201368.","journal-title":"Braz Dent J"},{"key":"8790_CR25","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.joms.2021.10.006","volume":"80","author":"PHDH Sales","year":"2022","unstructured":"Sales PHDH, Barros AWP, Silva PGB, Vescovi P, Le\u00e3o JC. Is the Er: YAG Laser Effective in Reducing Pain, Edema, and Trismus After Removal of Impacted Mandibular Third Molars? A Meta-Analysis. J Oral Maxillofac Surg. 2022;80:501\u201316.","journal-title":"J Oral Maxillofac Surg"},{"key":"8790_CR26","doi-asserted-by":"publisher","first-page":"e44061","DOI":"10.1097\/MD.0000000000044061","volume":"104","author":"X Dai","year":"2025","unstructured":"Dai X, Liu C, Li Y, Liu J, Fan Y, Guo Q. Evaluation of the therapeutic effects of Er:YAG laser with different parameters on peri-implantitis. Med (Baltim). 2025;104:e44061.","journal-title":"Med (Baltim)"},{"key":"8790_CR27","doi-asserted-by":"publisher","first-page":"817","DOI":"10.3390\/photonics12080817","volume":"12","author":"M Gryka-Deszczy\u0144ska","year":"2025","unstructured":"Gryka-Deszczy\u0144ska M, Grzech-Le\u015bniak Z, Dembicka-M\u0105czka D, Wiench R, Dominiak M, Matys J, et al. Effects of Er: YAG and Nd: YAG lasers with photobiomodulation on alveolar bone preservation post-extraction: a randomized clinical control trial. InPhotonics. 2025;12:817.","journal-title":"InPhotonics"},{"key":"8790_CR28","doi-asserted-by":"publisher","first-page":"4371","DOI":"10.3390\/jcm14124371","volume":"14","author":"D Dembicka-M\u0105czka","year":"2025","unstructured":"Dembicka-M\u0105czka D, Gryka-Deszczy\u0144ska M, Sitkiewicz J, Makara A, Fiegler-Rudol J, Wiench R. Effectiveness of the Er: YAG Laser in Snoring Treatment Based on Systematic Review and Meta-Analysis Results. J Clin Med. 2025;14:4371.","journal-title":"J Clin Med"},{"key":"8790_CR29","doi-asserted-by":"publisher","first-page":"418","DOI":"10.3390\/dj12120418","volume":"12","author":"H Elafifi Ebeid","year":"2024","unstructured":"Elafifi Ebeid H, Altayeb W, Parada Avenda\u00f1o I, Abad-Sanchez D, Arnabat-Dom\u00ednguez J. Outcomes of flapless Er: YAG and Er, Cr: YSGG laser-assisted crown lengthening: a systematic review. Dent J. 2024;12:418.","journal-title":"Dent J"},{"key":"8790_CR30","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1186\/s12903-024-04954-8","volume":"24","author":"LY Qi","year":"2024","unstructured":"Qi LY, Zhang R, Zhang J, Wang JS, Wang J, Liu RX, et al. The comparative study of temperature rise, time consuming and cut quality among piezosurgery, conventional rotary instruments and er: YAG laser in apicectomy. BMC Oral Health. 2024;24:1295.","journal-title":"BMC Oral Health"},{"key":"8790_CR31","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1007\/s10103-025-04624-3","volume":"40","author":"S Safaee","year":"2025","unstructured":"Safaee S, Moghanian A, Mehrdar M, Asadi P, Akbari M, Nesabi M, et al. A comprehensive review on advancements in laser-assisted dental treatments: focus on minimally invasive techniques and clinical outcomes. Lasers Med Sci. 2025;40:382.","journal-title":"Lasers Med Sci"},{"key":"8790_CR32","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.joms.2014.08.013","volume":"73","author":"U Romeo","year":"2015","unstructured":"Romeo U, Libotte F, Palaia G, Tenore G, Galanakis A, Annibali S. Is erbium:yttrium-aluminum-garnet laser versus conventional rotary osteotomy better in the postoperative period for lower third molar surgery? Randomized split-mouth clinical study. J Oral Maxillofac Surg. 2015;73:211\u20138.","journal-title":"J Oral Maxillofac Surg"},{"key":"8790_CR33","doi-asserted-by":"publisher","first-page":"420","DOI":"10.3390\/dj12120420","volume":"12","author":"L Sachelarie","year":"2024","unstructured":"Sachelarie L, Cristea R, Burlui E, Hurjui LL. Laser Technology in Dentistry: From Clinical Applications to Future Innovations. Dent J (Basel). 2024;12:420.","journal-title":"Dent J (Basel)"}],"container-title":["BMC Oral Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12903-026-08790-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-08790-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-08790-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T10:10:55Z","timestamp":1781604655000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12903-026-08790-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["8790"],"URL":"https:\/\/doi.org\/10.1186\/s12903-026-08790-w","relation":{},"ISSN":["1472-6831"],"issn-type":[{"value":"1472-6831","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]},"assertion":[{"value":"18 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Institutional Review Board (0969-09\/2024-IORG 0008839) at Alexandria University. Informed consent was obtained from all participants before they participated in the study. Participants were provided with detailed information about the study, including the objectives, procedures, potential risks, and benefits, and were given the opportunity to ask questions before providing written consent. This study was conducted in full accordance with the ethical standards of the Declaration of Helsinki and its later amendments.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication of clinical images and study-related data was obtained prospectively from all participants prior to enrollment. A signed patient consent for publication form and an English translated informed consent form were provided as supplementary files.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1060"}}