Effects of Er:YAG and Nd:YAG Lasers with Photobiomodulation on Alveolar Bone Preservation Post-Extraction: A Randomized Clinical Control Trial

(1) Background: This study aimed to compare alveolar bone preservation and early healing outcomes following a comprehensive laser-assisted post-extraction protocol compared to conventional extraction alone. In addition, the potential influence of serum vitamin D levels on bone regeneration was assessed. (2) Methods: Thirty tooth extractions were performed and randomized into two groups: a test group (G1, n =15) and a control group (G2, n = 15). G1 received a laser-assisted protocol using Er:YAG and Nd:YAG lasers for granulation tissue removal, socket disinfection, clot stabilization, de-epithelialization, and photobiomodulation (PBM) with the Genova handpiece (LightWalker, Fotona, Slovenia). G2 underwent standard mechanical extractions and socket debridement without laser. (3) Results: Procedures in G1 were on average 8.7 min longer, but patients in this group reported significantly lower postoperative pain during the first three days (p < 0.05). A statistically significant difference in alveolar height was observed at the distal lingual site (25.4 mm vs. 21.7 mm; p = 0.046), with other sites showing a trend toward significance. Cumulative bone preservation, measured by Bone Loss Index (BLI4), was significantly better in the laser group. Notably, a positive correlation was found between serum vitamin D levels and bone preservation: each 1 ng/mL increase in vitamin D corresponded to a 0.18 mm gain in alveolar height (p = 0.021). (4) Conclusions: The comprehensive laser-assisted post-extraction protocol reduced postoperative pain and improved alveolar bone preservation, particularly at the lingual distal site. Serum vitamin D levels positively correlated with healing outcomes, suggesting a potential synergistic role of systemic and local regenerative factors.