Labial frenectomy with Nd:YAG laser and conventional surgery: a comparative study

Clinical evaluation of pain perception and surgical wound healing after lower labial frenectomy with diode laser technique: pilot study

The aim of this study was to evaluate the postoperative period of diode laser frenectomies of the lower labial frenulum (LLF) with anomalous insertions and the perceptions of postoperative pain and wound healing. This cross-sectional pilot study evaluated 3 patients who underwent mandibular labial frenectomy with a diode laser between April 2024 and July 2024. Individuals were divided into two groups according LLF insertion type and the parameters evaluated were gender, age, traumatic brushing, dentin hypersensitivity (DH), traumatic brushing, postoperative pain presence, healing, analgesic use and periodontal parameters, with follow-up occurring up to 90 days after frenectomy. Statistical analyses were performed by frequency of categorical variables, Fisher's exact test and G test were used for intra and intergroup comparisons and the Wilcoxon test was used to compare different postoperative times, with the level of significance set at 0.05 (p < 0.05). The mean age of the sample was 34.6 years and there was a predominance of female participants (n = 2/ 66.6%), we verified that 2 (66.6%) patients presented a bifurcated frenulum insertion and 100% presented mild to intense DH and gingival recession. In the postoperative period, 100% of individuals reported pain and visual dissatisfaction with the scar until the 4th day of follow-up and after 30 days of follow-up only 1 individual remained with pain and visual dissatisfaction with the scar and no evaluated parameter showed statistical significance. Diode laser frenectomy proved to be effective in controlling postoperative pain, improving healing and reducing bleeding.

Assessment and Management of Maxillary Labial Frenum-A Scoping Review

BACKGROUND

The maxillary labial frenum (MLF) is a soft tissue fold connecting the upper lip to the alveolar process. Abnormal attachment can cause periodontal, functional, and esthetic problems. Differential diagnosis is important and can prevent unnecessary interventions. This study aims to summarize the current evidence on the assessment and management of abnormal MLF.

METHODS

A thorough review of the literature was conducted. Five online databases were searched for relevant peer-reviewed human studies. Article screening and data extraction were performed independently by two reviewers using predefined inclusion/exclusion criteria. Information about article type, study design, participants' characteristics, interventions, and outcomes was extracted and synthesized.

RESULTS

52 articles met the review criteria. MLF is a dynamic structure characterized by a wide normal morphological variation. MLF assessment in infants has not been standardized. Studies in pre-adolescents reported a change in the thickness and position of the MLF observed over time, resulting in a lower prevalence of abnormal MLF morphology. Studies in adolescents and adults reported variable differential diagnosis criteria. Lasers appear as the most advantageous frenectomy modality.

CONCLUSIONS

There is a need for more objective MLF diagnostic protocols and treatment guidelines, which could prevent unnecessary surgical interventions.

The features of the reparative regeneration of an oral mucosa wound created under the exposure of a laser at a wavelength of 445 nm (a pilot study)

In clinical practice, an innovative laser technology that provides contactless preparation of soft tissues with a wavelength of 445 nm has been introduced. This study aimed to investigate the morphological changes in the oral mucosa when exposed to laser radiation at a wavelength of 445 nm in the ablation mode.An experimental study was conducted to analyze the dynamics of reparative regeneration in the wound caused by that particular type of radiation, utilizing the procedure of lower lip frenuloplasty as an illustration. 48 sexually mature male laboratory rats were chosen as the research object. The procedure of preparing the oral vestibule was executed by employing a contactless laser beam with a wavelength of 445 nm and a power of 0.7 W in continuous mode (CW) and an uninitiated fiber.Histological examination showed that 25 min after the surgery, there were large areas of coagulation necrosis in the oral mucosa in the area affected by the blue laser. In 48 h, the area of necrosis decreased both in size and depth. By the 7th day after the surgery, the necrotic masses had grown into the connective tissue, while marginal regeneration of the epithelium was noted. By the 14th day, the wound surface was completely epithelialized, represented by fibrous scar tissue. Clinically, around the mandibular incisors, there was a wide area of attached keratinized gingiva.The findings of histological examination indicate a necrosis of coagulation type in the region of tissue ablation and also show the absence of phase II of the inflammatory response (the stage of exudation), which expedites the process of epithelialization of the oral mucosa wound.

Effects of topically administered 0.6% hyaluronic acid on the healing of labial frenectomy in conventional and 940-nm indium gallium arsenide phosphide (InGaAsP) diode laser techniques in pediatric patients: a randomized, placebo-controlled clinical study

This study aimed to investigate the effects of 0.6% hyaluronic acid (HA) gel on the healing process and postoperative pain levels after diode laser-assisted labial frenectomy in pediatric patients. Ninety-six pediatric patients (females, 50 and males, 46) aged 8-14 years were randomly divided into four groups as follows: (1) conventional frenectomy with 0.6% topically administered HA (CFH, n = 24); (2) conventional frenectomy with placebo gel (CFP, n = 24); (3) frenectomy performed by diode laser with 0.6% topically administered HA (DLH, n = 24); and (4) frenectomy performed by diode laser with placebo gel (DLP, n = 24). HA application was continued for 1 week thrice daily after the frenectomy. Visual analog scale forms were collected from patients 1 week after the operation. In addition, the plaque index, gingival index, periodontal probing depth, and keratinized tissue width and thickness were recorded. This process was repeated 1 and 3 months after the first visit. The DLH group revealed significant differences in the probing depth, bleeding on probing, keratinized gingiva width, and attached gingiva width according to dual comparisons of the initial, first, and third-month values (p = 0.010, p = 0.007, p<0.001, and p = 0.001, respectively). Significant differences were observed between the CFP and CFH groups according to the initial and initial third-month values with regard to the bleeding on probing (p=0.019 and p = 0.019, respectively). The attached gingival thickness revealed significant differences between the CFP and CFH groups for the initial and initial-third-month comparisons (p = 0.005 and p = 0.007, respectively). The mean values of the initial and initial-third-month differences were significantly higher in the CFH group than those in the CFP group. HA- and laser-assisted labial frenectomies revealed better outcomes in terms of the probing depth, attached gingiva width, keratinized gingiva width, healing process, and postoperative comfort.

Labial Frenectomy using Laser: A Scoping Review

Labial frenectomy is a surgical technique, that aims to remove the frenulum with its attachment to the underlying bone. Frenectomy, is indicated if the frenulum attachment causes midline diastema, gingival recession, hindrance in maintaining oral hygiene, or if it interferes with lip movements and for prosthetic needs. A labial frenectomy can be performed either by the routine scalpel technique, electrocautery, and most recently medical lasers. The aim of this study was to evaluate, whether the laser technique is more effective than the conventional surgical technique, and whether there are differences between the different types of lasers. The scoping review was conducted and prepared on the basis of the indications of the PRISMA guidelines (PRISMA Extension for Scoping Reviews, PRISMA-ScR) of PRISMA checklist, and nine papers were considered admissible to the qualitative analysis for the following outcomes: bleeding during intervention, use of sutures, duration of the intervention, and use of analgesic drugs in the days following the intervention. This review suggests that laser-performed labial frenectomy is faster and offers better intra- and postoperative management; however, due to the limited number of available papers, the final results of the present review are not absolute.

Laser Surgical Approach of Upper Labial Frenulum: A Systematic Review

An abnormal and hypertrophied upper labial frenulum (ULF) can cause diastemas, gingival recession, eruption abnormalities, and the onset of carious and periodontal problems in the upper central incisors, as well as aesthetic and functional disorders of the upper lip. The goal of this investigation is to review the evidence on the surgical techniques that are currently available for treating ULF in order to identify the best approach. PubMed, Scopus, Cochrane Library, and Embase were searched for papers that matched our topic from 13 November 2012 up to 22 November 2022 using the following Boolean keywords: "frenulum" and "surgery*". A total of eight articles were selected for the purpose of the review. ULF can be surgically treated using either traditional scalpel surgery or laser surgery. The latter is the better option due to its intra- and post-operative benefits for both the patients and the clinicians, in terms of faster healing, fewer side effects and discomfort, and greater patient compliance. However, a higher learning curve is required for this technique, especially to calibrate the appropriate power of the laser. To date, it is not possible to identify which type of laser achieves the best clinical results for the treatment of ULF.

Diode laser chairside frenectomy in orthodontics: A case series (DIODE LASER FRENECTOMY: CASE SERIES)

Offering the whole orthodontic and surgical treatment to the patient as a single package in a one office can save them considerable time and the trouble. Diode laser enables orthodontists to do so while enjoying its benefits over the scalpel.

Perioperative outcomes of frenectomy using laser versus conventional surgery: a systematic review

Introduction: Frenectomy is an oral surgical procedure usually performed with a scalpel. Several authors recently reported the interest of laser, as a minimally invasive and efficient alternative tool to perform frenectomy. This study aimed to compare the perioperative management of patients requiring a frenectomy using scalpel versus laser. Materials and methods: A systematic review of the literature has been carried out from Pubmed and Scopus databases following PRISMA guidelines. PICO method was used to select the relevant articles. Clinical studies comparing the perioperative outcomes of patients requiring frenectomies using scalpel versus laser were included. Results: Ten articles involving 375 patients were included. Pre-operative parameter (anxiety before surgery) and per-operative data such as anesthesia, surgery duration, bleeding, suture and difficulty were assessed. The post-operative outcomes investigated were pain, analgesics use, functional discomfort, edema, healing and satisfaction of patients. Laser achieved satisfactory peri-operative outcomes such as shorter operative time, without suturing requirement, as well as less post-operative pain and functional discomfort. Discussion: The low number of eligible studies, the different type of lasers used and heterogeneity across the methodology of the selected studies were the limits of the study. Conclusion: Laser-assisted surgery became an attractive tool to perform oral soft tissue surgery.

Use of Diode Laser for Surgical Removal of Pyogenic Granuloma of the Lower Lip in a Pediatric Patient: A Case Report

BACKGROUND A pyogenic granuloma is an inflammatory exophytic lesion that can occur in the oral cavity. Numerous factors are involved in the etiology of the lesion and can lead to the tissue proliferation underlying the lesion's characteristic appearance. The main treatment is surgical excision with careful curettage of the surrounding tissues. The use of a laser has been proposed because it enables performing deep and precise incisions with better hemostasis and less invasive procedures with less discomfort to patients. The aim of this study was to evaluate the possible advantages of using a diode laser in the surgical treatment of pyogenic granuloma, particularly in the management of a pediatric patient. CASE REPORT A swelling in the lower lip of an 11-year-old female patient was analyzed. After several evaluations, a 980-nm diode laser in continuous wave mode was chosen for excision of the lesion. The lesion was excised successfully with a diode laser as a conservative method that was nonstressful for the pediatric patient. CONCLUSIONS Among the techniques for surgical excision of a lesion, the use of a diode laser has the following advantages: less invasiveness, absence of intra- and postoperative discomfort and pain, effective hemostasis with better control of bleeding, absence of scarring, better postoperative management, and greater patient compliance.

The Efficacy of Lingual Laser Frenectomy in Pediatric OSAS: A Randomized Double-Blinded and Controlled Clinical Study

This randomized, double-blind and controlled clinical trial investigates how a diode laser lingual frenectomy can improve obstructive sleep apnea syndrome (OSAS) in pediatric patients. Background: Several authors have shown that a short lingual frenulum causes a reduction in incoming air flow and the relationship between OSAS and a short lingual frenulum. Methods: Thirty-two pediatric patients were equally randomly divided into a Study Group (SG) and a Control Group (CG). On each SG patient a polysomnography 1 (PSG1) and a lingual frenectomy were performed using a diode laser via Doctor Smile Wiser technology, power 7 W. After three months, a new polysomnography (PSG2) was performed to evaluate the lingual frenectomy efficacy in pediatric patients. The pain was assessed by a numerical rating scale (NRS) before and after surgery. The CG followed the same protocol without a lingual frenectomy but myofunctional and speech therapy were conducted to qualitatively and quantitatively improve the lingual functionality. In the SG, eight subjects (50%) had severe OSAS and eight had moderate (50%) while in the CG, three subjects had severe OSAS (18.8%) and thirteen had moderate (81.2%). Results: In the SG, 93.8% were classified as mild OSAS and 6.2% as moderate. In contrast, in the CG, 18.75% were classified as mild OSAS, 62.5% as moderate and 18.75% as severe. Conclusion: The study demonstrates how a lingual laser frenectomy can improve OSAS in pediatric patients.

High-level laser therapy versus scalpel surgery in the treatment of oral lichen planus: a randomized control trial

OBJECTIVE

To compare the clinical effectiveness of various types of high-level laser therapy (HLLT) toward scalpel excision for the surgical treatment of erosive oral lichen planus (OLP).

MATERIALS AND METHODS

The total number of 128 individuals were enrolled in the study. The 35 did not meet the inclusion criteria due to malignancy signs and presence of diabetes mellitus. In total, 8 were lost to follow-up, and 10 were excluded from the analysis, due to analgesics intake. This way 75 patients with the erosive form of OLP were analyzed in three intervention groups (Er:YAG, n = 19; Nd:YAG, n = 15; Er:YAG + Nd:YAG combination, n = 20) and one control group with scalpel excision (n = 21). The therapy effectiveness has been assessed based on the comparison of salivary interleukin (IL)-1β, IL-6 and interferon (IFN)-γ preoperative levels to 14, 30 days, and 2 years postoperation, as well as pain level and time of epithelization.

RESULTS

All HLLT groups demonstrated a significantly (p > 0.05) higher IL-1β, IL-6, IFNγ and pain level reduction and quicker epithelization toward the control group on the 30th day, except Nd:YAG in case of IFNγ level. The highest IL-1β, IFNγ and pain level reduction and quicker epithelization on the 30th day was observed in Er:YAG group, followed by Er:YAG + Nd:YAG combination, Nd:YAG respectively. However no significant difference was observed between the HLLT groups with regard to IL-6 level reduction. After a 2-year follow-up, no significant difference was observed between all study groups with regard to all variables.

CONCLUSION

HLLT yields a superior clinical outcome compared to the scalpel excision for the surgical treatment of oral lichen planus, whereby the Er:YAG has been proposed as the most effective laser type at the end of the first postoperative month.

CLINICAL RELEVANCE

For the surgical treatment of erosive OLP the Er:YAG laser may be a preferable treatment option compared to Nd:YAG and scalpel surgery.

TRIAL REGISTRATION

The present trial was registered retrospectively in the German Clinical Trials Register, as a member of WHO international clinical trials registry platform, on the 18.03.2020 with the following number: DRKS00020986.

Evaluation of Pain Perception and Wound Healing After Laser-Assisted Frenectomy in Pediatric Patients: A Retrospective Comparative Study

Background: The maxillary labial frenulum is an attachment that connects the upper lip to the gingival tissue, and when it is too closely attached to gingival margin due to inadequate plaque control, it may put gingival health at risk. Objective: This study aimed to assess postoperative pain perception and wound healing after laser-assisted frenectomy in a pediatric population retrospectively. Methods: This study is based on the clinical records of the patients who received laser-assisted frenectomy treatment due to mucogingival problems at the pediatric dentistry department. Twenty-two patients were treated with either 2780 nm Er,Cr:YSGG laser (Waterlase iPlus; Biolase Technology, Irvine, CA, USA) or 940 nm diode laser (Epic10; Biolase Technology). The analyzed data included age, gender, frenulum insertion type, type of dental laser, postoperative pain perception, and wound healing. Postoperative pain evaluation was performed using Wong-Baker Faces Pain Rating Scale after 3 h, 1 day, 1 week, and 2 weeks. Wound surface healing was assessed through photography. Images were uploaded to the software, and changes in the wound surface area were measured in square millimeters on the day of frenectomy and on postoperative first day, first week, and second week. Results: Er,Cr:YSGG group had statistically significant better wound healing results after 1 and 2 weeks, respectively (p < 0.05). No significant difference was found between 2780 nm Er,Cr:YSGG laser and 940 nm diode laser groups in terms of pain perception. Conclusions: It can be concluded that both laser wavelengths are a safe and useful tool for frenectomies in pediatric patients with less pain. Er,Cr:YSGG laser achieved faster healing than 940 nm diode laser. Clinical Registration number: Clinical Trials gov ID NCT04368715.

Significance of the tethered maxillary frenulum: a questionnaire-based observational cohort study

BACKGROUND

The clinical significance of lip-tie, or a tethered maxillary frenulum, remains under debate. Clinicians and parents are often perplexed when deciding whether procedures available to relieve a seemingly tight or severe maxillary frenulum are needed.

PURPOSE

No previous studies have assessed the consequences of not subjecting a tethered maxillary frenulum in newborns to surgical intervention. This study aimed to contribute the first prospective trial on this topic with a relatively extended followup of these newborn infants.

METHODS

This prospective observational questionnaire-based cohort trial was performed in a community setting and aimed to determine whether lip-tie is associated with an increased likelihood of eventual feeding or oral disorders.

RESULTS

The convenience sample comprised of 61 consecutively arriving infants with concomitant tethered frenula who were treated at the clinic for various reasons. This cohort was compared with a random sample of 66 age-matched children for a mean follow-up period of 6.42 years. Infants undergoing oropharyngeal procedures were excluded. Awareness of a deviation in oral structures was reported by 18% of the study group versus 0% of the controls. Mothers participating in the study group (24.6%) less frequently recalled painful nipples or discomfort during breastfeeding than those in the control group (47.0%) (P<0.01). There were no intergroup differences in other types of feeding difficulty, dental hygiene, pronunciation, or speech development.

CONCLUSION

Our findings suggest that a tethered labial frenulum is not associated with an increase in breastfeeding disturbances or oral disorders. These data encourage clinicians to question the need to intervene in cases of tethered maxillary frenula.

Evaluation of upper labial frenectomy: A randomized, controlled comparative study of conventional scalpel technique and Er:YAG laser technique

Objectives

Abnormalities in the maxillary frenum may lead to esthetic or functional limitations and need to be corrected with a surgical intervention called frenectomy. The aim of the study was to compare frenectomies performed using Er:YAG laser technology with those using a conventional scalpel technique. Comparisons were of patients' experiences, treatment times, bleeding during treatment and wound healing.

Material and methods

The trial was performed as a prospective, randomized and controlled, single‐blind investigation. A total of 40 patients requiring frenectomy were randomly assigned to groups which underwent either conventional or Er:YAG laser treatment. Patients' experiences, treatment time, bleeding and wound healing were evaluated immediately after surgery and 5 days, 12 days and 3 months after surgery.

Results

Significant increase in time spent in surgery and bleeding was seen with conventional scalpel surgery. Directly after surgery the wound area was significantly larger in the laser group but at the 5‐day evaluation no difference could be observed between the groups. Finally, patients were satisfied with both methods, giving them the same assessments.

Conclusion

In the frenectomy procedure, laser surgery is faster and causes less bleeding and may be advantageous in frenectomies.

Diode versus CO2 Laser Therapy in the Treatment of High Labial Frenulum Attachment: A Pilot Randomized, Double-Blinded Clinical Trial

Background: The labial frenula are triangular plicas departing from the alveolar mucosa and attaching themselves at different heights of the gingiva. Sometimes a high attachment can determine a gingival recession. The most suitable surgical resolution is the use of laser devices. The aim of this study was to compare the labial frenulectomy through the use of Diode and CO₂ laser techniques in pediatric patients with a high labial frenulum attachment, clarifying at the same time the preventive role of the surgical treatment to avoid further recession. Methods: A pilot randomized, double-blinded clinical trial was conducted to compare both the surgical advantages and the preventive treatment of laser technology using two different wavelengths within a population of pediatric patients with a high labial frenulum attachment. Different parameters intra and post-surgery were taken into account (Bleeding, Wound Healing, Gingival Recession, Periodontal pocket and Numerical Scale Value for pain) to compare Diode versus CO₂ laser therapy. Results: Although both the laser devices provide a good performance in the post-operative period, the Diode laser shows better results (p < 0.001) in three of the five parameters evaluated. Conclusions: From the results it was found that the Diode Laser device is more suitable compared to the CO₂ device.

Evaluation of Patient's Perceptions, Healing, and Reattachment After Conventional and Diode Laser Frenectomy: A Three-Arm Randomized Clinical Trial

Objective: The aim of this study is to compare the conventional and diode laser techniques in terms of patient's perceptions, epithelization, reattachment, and periodontal clinical parameters in the treatment of abnormal papillary frenum. Materials and methods: Forty-eight patients with abnormal papillary frenum were enrolled in the study. Patients were randomly assigned into three groups; conventional frenectomy operation (C group), diode laser-assisted frenectomy (L group), and diode laser-assisted frenectomy with conventional horizontal incision on the periosteum (L + P group). Postoperative pain, discomfort in speaking, and chewing scores were assessed with visual analogue scale (VAS) at postoperative 3rd hour and on days 1, 7, 14, 21, and 45. Epithelialization process of the wound surface was evaluated by hydrogen peroxide solution applied to the wound on days 7, 14, 21, and 45 following operations. The distance between the frenum attachment point and mucogingival junction (FMGJ) was recorded at baseline, postoperative 45th day, and 6th month to assess the reattachment of the frenum. Plaque index, gingival index, bleeding on probing, and probing depth were recorded at baseline and postoperative 7th, 14th, 21^st, and 45th days. Results: On the 1st and 7th day after operation, VAS pain score in the C group was significantly higher than in the L and L + P groups (p < 0.017). Difficulty in speaking and chewing scores were significantly lower in the L and L + P groups compared to the C group at postoperative 3rd hour and 7th day (p < 0.017). The FMGJ and epithelization period demonstrated no difference among the groups at any time point (p > 0.05). Conclusions: Our results suggest that diode laser provides better postoperative patient's perceptions than the conventional technique in frenectomy operation. In addition, both conventional and laser-assisted frenectomy surgeries prevent the frenum reattachment regardless of periosteal horizontal incision.

High Power Laser and Photobiomodulation in Oral Surgery: Case Report

Introduction: The labial frenum is a fold of mucous membrane that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. In some cases, its presence can cause a midline diastema, periodontal diseases related to food impaction, or retention of biofilm, among others. In such cases, lip frenectomy is indicated as treatment, which can be performed with a scalpel (conventional method), an electric scalpel, or a surgical laser. Objective: To show a clinical case performed at Laser Extension Project in Dentistry, Federal University of Maranhão grounded in a literature review. Case Presentation: A laser frenectomy was performed on a female patient, aged 20, who had a diastema between the upper central incisors and an indication for frenum removal. The high-power diode laser is excellent for procedures in soft tissue because its wavelength is well absorbed by hemoglobin and other pigments; its use also allows a reduction in the amount of anesthetic and medicines used. The parameters used were 2 W, in a continuous mode, 808 nm infrared emission; with delivery of the beam through optical fiber 300 μM; energy of 120 J; 20 pps. Conclusion: the high power diode laser allowed a satisfactory result, the procedure was safe, the technique was a simple one and of reduced clinical time, as mentioned in the literature. It is worth noting that the technique is dependent on the skill of the professional performing it.

Therapeutic effect of laser on pediatric oral soft tissue problems: a systematic literature review

In recent years, extensive evidence has been published about usage of laser in oral lesions. The aim of the present study was to review the effectiveness of laser radiation in the treatment of pediatric oral soft tissue problems. The relevant keywords were searched in EBSCO, Medline (via Ovid), PubMed, Scopus, and Web of Science (WOS) databases. Then, eligible case series and controlled clinical trial studies, which published up to the end of 2018, were extracted and scrutinized. In this study, the age range of ≤ 21 years or the average age of ≤ 21 years was considered as the pediatric group. After limiting the search results, removing duplicate titles and eligibility evaluation, 17 papers were enrolled to the study (seven controlled clinical trials and ten case series). Er:YAG (2940 nm), CO₂ (10,600 nm), Er,Cr:YSGG (2780 nm), and diode (650, 660, and 975 nm) lasers indicated successful clinical results on mucocele excision, frenectomy, gingival incision and re-contouring, and treatment of vascular malformations. In addition, 660-nm diode laser radiation was an effective adjuvant treatment for halitosis and gingivitis induced by multi-bracket appliances. Reduction or absence of pain and bleeding, suitable homeostasis, reduction of operation time, less analgesic consumption, and antibacterial effect were among the advantages of the laser radiation in the studies. Laser as a main or adjuvant tool can have an effective role in surgical and non-surgical treatments of pediatric oral soft tissue problems. Conducting further randomized controlled trial studies on different soft tissue lesions can contribute to drawing better conclusions.

Laser Techniques or Scalpel Incision for Labial Frenectomy: A Meta-analysis

Introduction

Labial frenectomy is a common procedure in the oral surgery specialty. Nowadays, laser surgery seems to provide better post-operative results than scalpel surgery. Thus, the aim of this study was to analyze whether trans-surgical and postoperative variables of labial frenectomy are better when performed with laser than with conventional scalpel.

Materials and Methods

A systematic review has been performed based on PRISMA criteria. The search included three databases, with no limitations of time or language. After screening, seven papers were included in qualitative analysis and six in meta-analysis. Bias analysis was performed according to Cochrane Handbook. Pain during the first (MD - 3.18, 95% CI - 4.03 to - 2.32) and seventh post-surgical days (MD - 1.04, 95% CI - 1.45 to - 0.64); discomfort during speech on the first (MD - 2.15, 95% CI - 3.94 to - 0.37) and the seventh post-surgical days (MD - 1.60, 95% CI - 1.96 to - 1.24); discomfort during chewing on the first (MD - 2.90, 95% CI - 3.35 to - 2.45) and the seventh days (MD - 1.56, 95% CI - 2.21 to - 0.91); and average surgery time (MD - 1.84, 95% CI - 3.22 to - 0.46) were lower in the laser group than in the scalpel group.

Conclusion

The results of this systematic review have shown better results to laser group in the following variables: pain, discomfort during speech and chewing. However, the evidence is limited due the high risk of bias.

Clinical Efficacy and Patient Perceptions of Pyogenic Granuloma Excision Using Diode Laser Versus Conventional Surgical Techniques

The use of laser in oral surgery and periodontology is a matter of debate, mainly because of the lack of consensual therapeutic protocols. The aim of this study was to evaluate the surgical advantages of diode laser versus traditional surgery with a cold blade for the surgical excision of pyogenic granuloma (PG). Twenty-one patients (10 males, 11 females, aged 19-66 years; mean age: 46.5 years), requiring PG excision, were enrolled in the study. Through a randomized clinical trial design, all patients were randomly subjected to PG surgical excision with either diode laser or cold blade. Parameters analyzed were the speed of incision, time of intervention, intraoperative bleeding, number of stitches, and patient compliance. Histologic examination was performed before and after surgical excision of the lesions. Patients compiled a subjective evaluation questionnaire. Both treatments were successful in surgical excision of PG. However, the mean speed of incision was significantly reduced in diode laser group (0.61 ± 0.29 mm/s) compared with cold blade group (1.47 ± 1.23 mm/s) (P < 0.05). The mean lengths of time for the whole surgical intervention were significantly lower in diode laser group (221.15 ± 220.89 s) compared with cold blade group (316.10 ± 248.69 s) (P < 0.05). Moreover, diode laser induced a reduced intrasurgical bleeding, and a better gingival healing compared with cold blade surgical treatment. This study demonstrated that the use of diode laser showed additional advantages compared with cold blade in terms of less postoperative discomfort and pain for surgical removal of PG.

Patient perceptions and clinical efficacy of labial frenectomies using diode laser versus conventional techniques

INTRODUCTION

The aim of present study was to compare the keratinized gingival tissue measurements, degree of subjective complaints and functional complications of using an 980nm diode laser versus a scalpel for labial frenectomies.

MATERIAL AND METHODS

Thirty-six patients requiring labial frenectomies, between 14 and 51 years old, were randomly assigned to either scalpel or diode laser treatments. The soft tissue measurements, including the keratinized gingiva width (KGW), attached gingiva width (AGW) and attached gingiva thickness (AGT), were recorded before surgery, immediately after, one week later and one, three and six months after surgery. In addition, the functional complications and the morbidity (level of pain, swelling and redness) were evaluated during the first postoperative week using a visual analog scale (VAS).

RESULTS

We determined statistically significant gains in the KGW, AGW and AGT after surgery in both groups; however, there was no significant difference between the study groups. The VAS scores indicated that the patients treated with a diode laser had less discomfort and functional complications compare with scalpel surgery.

DISCUSSION

The results described above show that diode laser surgery offers a safe, impressive alternative for labial frenectomies that are comfortable for the patients.

Microvascular imaging and monitoring of human oral cavity lesions in vivo by swept-source OCT-based angiography

We report the development of optical coherence tomography- (OCT) based angiography (OCTA) to image blood flow within microcirculatory tissue beds in human oral cavity in vivo with a field of view at 10 mm × 10 mm. Three-dimensional (3D) structural and vascular images of labial mucosa tissue are obtained at a single 3D acquisition. Pathologic mucosal sites with mouth ulcers are examined using the OCT tomograms and angiograms, upon which to monitor the lesion healing process over a period of 2 weeks. Quantitative metrics of the capillary loop density within the lamina propria layer are evaluated, providing statistically significant difference between healthy and diseased conditions over time. Furthermore, tissue anatomy and vessel morphology of other susceptible sites to ulcer, such as tongue, alveolar mucosa, and labial frenulum, are also imaged to demonstrate the promise of the proposed method as a clinically useful tool for the diagnosis and monitoring of therapeutic treatment of oral tissue abnormalities.

Laser Surgery of Soft Tissue in Orthodontics: Review of the Clinical Trials

Introduction: Recently, a wide variety of procedures have been done by laser application in orthodontics. Apart from the mentioned range of various treatments, laser has become a tool for many soft tissue surgeries as an alternative to conventional scalpel-based technique during orthodontic treatments in the management of soft tissue. Due to scarce information in the latter subject, this study was designed in order to include clinical trials that included soft tissue ablation by laser in orthodontics. Methods: Literature was searched based on PubMed and Google Scholar databases in 5 years (2010-2015) with English language restriction and clinical trial design. Studies that performed soft tissue application of laser during orthodontic treatment were extracted by the authors. Results: Only eight studies met the inclusion criteria. No significant difference was found between laser ablation and conventional scalpel technique in the matter of treatment outcome. However, few issues remained to clarify the differences in the mentioned procedures. Conclusion: Laser performance can be recommended in case of preceding less bleeding and discomfort during surgical procedure. There are still quandaries among clinical application of scalpel-based surgery in aesthetic region with bracket-bonded teeth. Precaution and knowledge regarding the characteristics of laser beam such as wavelength, frequency, power and timing is extremely needed.

Soft tissue molding technique in cleft lip and palate patient using laser surgery in combination with orthodontic appliance: A case report

BACKGROUND

Although surgical treatment protocols for cleft lip and palate patients have been established, many patients still have some soft tissue defects after complete healing from surgical interventions. These are excess soft tissue, high attached fraena and firmed tethering scares. These soft tissue defects resulted shallowing of vestibule, restricted tooth movement, compromised periodontal health and trended to limit the maxillary growth. The aim of this case report was to present a method of correcting soft tissue defects after conventional surgery in cleft lip and palate patient by using combined laser surgery and orthodontic appliance.

CASE REPORT

A bilateral cleft lip and palate patient with a clinical problem of shallow upper anterior vestibule after alveolar bone graft received a vestibular extension by using CO₂ laser with ablation and vaporization techniques at 4 W and continuous wave. A customized orthodontic appliance, called a buccal shield, was placed immediately after surgery and retained for 1 month to 3 months until complete soft tissue healing. The procedures were performed 2 episodes. Both interventions used the same CO₂ laser procedure. The first treatment resulted in partial re-attachment of soft tissue at surgical area. The second laser operation with the proper design of buccal shield providing passive contact with more extended flange resulting in a favorable outcome from 1 year follow up. Then the corrective orthodontic treatment could be continued effectively.

CONCLUSION

The CO₂ laser surgery was a proper treatment for correcting soft tissue defects and the design of buccal shield was a key for success in molding surgical soft tissue.

Clinical Study of Laser Treatment for Frenectomy of Pediatric Patients

Aim

To suggest regarding the timing of oral surgery and laser treatment for frenulum abnormalities in the pediatric population.

Materials and methods

We investigated the sex, age, frenulum site, reason for consultation, treatment method, and prognosis of 35 patients aged 15 years or younger and who were examined at our hospital for the chief complaint of frenulum abnormality.

Results

A total of 21 (mean age, 6.0 years) of the 35 patients underwent frenectomy using a carbon dioxide (CO₂) laser. Of these, 7 patients (mean age, 2.8 years) underwent the procedure with general anesthesia and 14 patients (mean age, 7.6 years) underwent the procedure with local anesthesia. The surgical site was the lingual frenulum in 15 patients and the maxillary labial frenulum in 6 patients. No adverse events were intraoperatively reported in any of the patients, and the procedure was quickly and safely performed. The mean postoperative follow-up period was 4.6 months, and readhesion was noted in one patient (4.8%). The most common reason cited for not undergoing frenectomy in the 14 patients (mean age, 3.4 years) was the young age of the child.

Conclusion

Retrospective study of pediatric patients with frenulum abnormalities demonstrated the usefulness of the CO₂ laser in performing frenectomy and offered suggestions regarding the timing of this procedure.

Clinical significance

Frenectomy performed using a CO₂ laser for pediatric patients is a useful, simple, and safe treatment method.

How to cite this article

Komori S, Matsumoto K, Matsuo K, Suzuki H, Komori T. Clinical Study of Laser Treatment for Frenectomy of Pediatric Patients. Int J Clin Pediatr Dent 2017;10(3):272-277.

Postoperative discomfort after Nd:YAG laser and conventional frenectomy: comparison of both genders

BACKGROUND

Evidence has suggested that males and females experience and report feeling pain differently. The aim of this study was to determine the postoperative perception levels of both females and males after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser frenectomy and conventional frenectomy, and to compare the perceptions between genders.

METHODS

Eighty-nine patients requiring frenectomy were randomly assigned to have treatment with either the conventional frenectomy or with the Nd:YAG laser. Postoperative discomfort (pain, chewing, talking) was recorded using a visual analog scale (VAS) on the operation day and postoperative days 1, 3, 7 and 10.

RESULTS

According to the female VAS scores of the pain, chewing and speaking discomfort were statistically higher in the conventional group than those of the laser group on the operation day, and on the first and third postoperative days. Pain discomfort in males was statistically higher in the conventional group than those of the laser group on the operation day. Speaking discomfort in males was statistically higher in the conventional group than those of the laser group on the operation day and the first postoperative day.

CONCLUSIONS

The present study indicated that Nd:YAG laser treatment used for frenectomies provides better postoperative comfort for each gender, especially in females in terms of pain, chewing and speaking than the conventional procedure up to the seventh postoperative day. According to our results, Nd:YAG laser may provide a safe, bloodless, painless surgery and an impressive alternative for frenectomy operations.

Advantages of new technologies in oral mucosal surgery: an intraoperative comparison among Nd:YAG laser, quantic molecular resonance scalpel, and cold blade

The aim of this study is to evaluate the possible intraoperative advantages of Nd:YAG laser and quantic molecular resonance (QMR) scalpel in oral soft tissue surgery. One hundred sixty-three interventions were evaluated. Group 1 (G1) included 77 interventions performed with Nd:YAG laser, group 2 (G2) 45 with QMR scalpel, and group 3 (G3) 41 with cold blade. Parameters analyzed were as follows: speed of incision, time of intervention, intraoperative bleeding, number of stitches, patient compliance, and operator comfort. Data were analyzed using software STATA 12 (StataCorp LP, College Station, TX, USA). Mean speed of incision was 0.54 mm/s in G1, 2.83 mm/s in G2, and 1.58 mm/s in G3, Nd:YAG laser being the slowest. However, no significant differences among times of intervention were found. In particular, interventions in G1 (221.15 ± 220.89 s) have a mean duration lower than G2 (280.56 ± 248.31 s) and G3 (316.10 ± 248.69 s). Intraoperative bleeding occurred in 29.9 % (n = 23/77) of interventions in G1, 97.8 % (n = 44/45) in G2, and 97.6 % (n = 40/41) in G3 (p < 0.0001). Mean number of stitches in G1 was statistically lower (G1, 0.10; G2, 2.07; G3, 2.29; p < 0.0001). No differences with regard to patient compliance were detected. Operator comfort was higher in G1 (p < 0.0003). Nd:YAG laser and QMR scalpel give several advantages in oral mucosal surgery: Nd:YAG laser cuts tissue slowly, but it provides a good visibility and excellent hemostasis. QMR scalpel allows a very rapid cutting with no considerable temperature increase, but there is major risk of bleeding and need for sutures with lower operator comfort.