Laser-Assisted Strategies for Alveolar Bone Preservation After Tooth Extraction: A Systematic Review and Meta-Analysis

Abstract

Background: Post-extraction alveolar bone resorption complicates implant planning and compromises functional and aesthetic outcomes. High-power lasers, including surgically applied Er:YAG and Nd:YAG lasers, as well as Nd:YAG-based photobiomodulation (PBM), have been proposed as adjunctive approaches to decontaminate extraction sockets, modulate inflammation, and stimulate osteogenesis, potentially limiting post-extraction ridge collapse. Methods: This systematic review and meta-analysis included prospective and retrospective clinical studies evaluating changes in alveolar ridge height, width, volume, or density following tooth extraction treated with Er:YAG, surgically applied Nd:YAG, or Nd:YAG-based PBM. Outcomes were assessed using cone-beam computed tomography (CBCT) or calibrated mechanical or optical measurement methods. Study selection followed PRISMA guidelines. Quantitative synthesis was performed using random-effects meta-analysis, and certainty of evidence was assessed using the GRADE approach. Results: All laser modalities demonstrated statistically and clinically significant preservation of alveolar bone compared with standard care. Er:YAG laser therapy resulted in a mean ridge preservation of 1.12 mm (95% CI: 0.9-1.4), while surgically applied Nd:YAG achieved a comparable effect of 1.15 mm (95% CI: 0.88-1.4). Nd:YAG-based PBM showed the most consistent effect, with a mean difference of 1.20 mm (95% CI: 1.0-1.4) and the lowest heterogeneity (I² = 22%). The largest effects were observed within the first month after extraction (mean difference 1.26 mm) and diminished with longer follow-up. CBCT-based assessments demonstrated the highest measurement precision, with an average effect of 1.32 mm. Overall certainty of evidence was rated as moderate due to risk of bias, incomplete methodological reporting, and possible publication bias. Conclusions: Er:YAG, Nd:YAG, and Nd:YAG-based PBM represent effective adjunctive approaches for alveolar ridge preservation following tooth extraction, particularly during the early healing phase. Their effects appear enhanced when combined with barrier membranes or osteoconductive grafting materials. CBCT should be preferred for outcome assessment in both clinical practice and research. These findings support the evidence-based integration of laser technologies into ridge preservation protocols in implant dentistry and oral surgery.

Keywords: Er:YAG laser; Nd:YAG laser; alveolar ridge preservation; cone-beam computed tomography; dental implants; photobiomodulation; tooth extraction.

Figure 1

PRISMA 2020 Flowchart.

Figure 2

Forest plot for assessing the mean difference in alveolar bone preservation after tooth extraction using the Er:YAG laser. Source: [12,19,21,25,26,27,28].

Figure 3

Forest plot for assessing the mean difference in alveolar bone preservation after tooth extraction using the Nd:YAG laser. Source: [14,31,33,34,35,36,37].

Figure 4

Effect of Nd:YAG laser-based photobiomodulation on the morphometric parameters of post-extraction healing. Source: [16,30,38,39,40,41].

Figure 5

Funnel plot for assessing publication bias in studies on the effect of laser technologies on the preservation of alveolar bone. Source: [12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48].