Abstract / Summary
Traumatic dental injuries (TDIs) in older adults present complex clinical and public health challenges because of frailty, multimorbidity, and antithrombotic therapy. Invasive surgery in anticoagulated patients increases the risk of hemorrhage and delayed healing. Multiwavelength laser systems provide a minimally invasive alternative, combining precise ablation, hemostasis, and disinfection. A 92-year-old woman receiving anticoagulant therapy for atrial fibrillation presented with multiple anterior maxillary fractures following a fall. The right maxillary central incisor (Tooth 11) showed a complete coronal fracture with pulp exposure (Ellis Class 3) and a palatal fracture line extending below the bone crest. Owing to systemic risk, a tooth-preserving laser-assisted approach was adopted instead of extraction. Gingivectomy was performed using an Nd:YAG laser (1064 nm; 3.5 W, 60 Hz, fluence: 72.5 J/cm2, power density: 4.36 kW/cm2) to achieve hemostasis and soft-tissue decontamination. Bone vaporization was completed with an Er:YAG laser (2940 nm; QSP mode, H14 handpiece; 250 mJ, 15 Hz) to expose the fracture margin. Root-canal decontamination used the Er:YAG SWEEPS technique for photoacoustic activation of irrigants (NaOCl: 5%, EDTA: 17%), enhancing biofilm removal and smear-layer disruption. The tooth was reconstructed with fiber-post and composite resin buildup, followed by monolithic zirconia crowns on both central incisors. Soft-tissue healing was complete at 15 days, and functional rehabilitation was achieved without complications. Two-year clinical and radiographic follow-up confirmed stable periapical conditions, preserved gingival contours, and satisfactory aesthetics. The coordinated use of Nd:YAG, Er:YAG, and Er:YAG SWEEPS lasers enabled selective tissue management-hemostasis, bone remodeling, and endodontic disinfection-under continuous anticoagulation, avoiding extraction and minimizing operative trauma. Rapid soft-tissue healing was observed clinically during follow-up. Within the limitations of a single case report, multiwavelength laser-assisted therapy may represent a conservative treatment option for managing dental trauma in anticoagulated geriatric patients, supporting tooth preservation and functional rehabilitation.