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

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.

The use of low level laser therapy in conjunction with diode laser-assisted and conventional vestibuloplasty: Comparison of wound healing and vestibular depth gain

BACKGROUND

The aim of this study is to compare wound healing and vestibular depth gain in individuals undergoing vestibule deepening surgery using diode laser and conventional technique and to further investigate the possible wound healing effect of low-level laser therapy (LLLT).

MATERIAL AND METHODS

52 systemically healthy individuals with insufficient vestibular depth in the region of teeth 33-43 in the lower jaw were included. Following nonsurgical periodontal treatment, patients were divided into four groups as follows: a) diode laser (L); b) diode laser + LLLT; c) conventional surgery and d) conventional surgery + LLLT. Vestibular depth and horizontal wound size measurements of the individuals were recorded using digital calipers. Reepithelization was evaluated via an image analysis program.

RESULTS

Vestibular depth measurements were found to be higher in the conventional surgery groups compared to that of diode laser groups after the operation, while the results were not statistically different between groups (p >0.05). Reepithelization area did not differ between groups in the evaluated time periods (p >0,05). On the other hand, horizontal wound shrinkage was significantly higher in the conventional surgery group than that of diode laser.

CONCLUSIONS

Within the limits of this study, both methods yielded in vestibule depth gain. On the other hand, LLLT did not have an additional positive effect on mucosal wound healing. As a clinical relevance, the results are valuable for clinicians in terms of showing that suturing of the mucosal flap formed following vestibule deepening should not be necessary in laser assisted surgery for attaining more vestibule depth.

Recent development of photoacoustic imaging in dentistry: A review on studies over the last decade

Background

This work performs a literature review of photoacoustic imaging (PAI) in dentistry and discusses the development of PAI in relation to oral health.

Methods

A search method was used to locate papers published between 2011 and 2023 in Google Scholar and PubMed databases, and 25 studies were selected. Reports on PAI in dentistry were included. Articles not written in English or whose full text could not be accessed were excluded. The remaining publications were checked and evaluated to determine whether they contain supportive materials for PAI in dentistry.

Results

The majority of articles about PAI in dentistry are associated with caries studies. Photoacoustic microscopy is the most commonly utilized PAI system. PAI studies generally focus on ex-vivo investigations using extracted human teeth. The acoustic signal obtained from carious teeth is greater than that obtained from normal teeth. In addition to imaging oral soft tissues from animal models and the periodontal pocket depth in human volunteers, PAI is applied to evaluate dental implants and oral biofilms.

Conclusion

There have been numerous investigation on PAI in dentistry, but it is not yet applicable in dental practice. In the future, PAI studies are expected to contribute to the invention of an alternative non-ionizing imaging technology that is comfortable for patients, user friendly, and capable of providing reliable information at a reasonable cost.

Management of Aberrant Frenal Attachments in Adults by Scalpel Method and 980 nm Diode Laser

Treatment modalities like electrosurgery and lasers have emerged as effective painless alternatives to scalpel methods for a frenectomy. The present case series involves ten patients, diagnosed with abnormal frenal attachments. Frenectomy was performed by 980 nm diode laser and scalpel methods. Scalpel frenectomy was performed as described by Archer and Kruger. Laser-assisted frenectomy was performed by a hemostat-guided incision using a 980 nm diode laser tip in a paintbrush motion. It was observed that Visual Analogue Scale (VAS) pain scores in patients who underwent scalpel frenectomy were comparatively higher than the laser-treated patients. In contrast, wound healing scores were higher in the scalpel group, suggesting early wound healing in the scalpel-treated patients.

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.

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.

Systematic Review of Post-Surgical Laser-Assisted Oral Soft Tissue Outcomes Using Surgical Wavelengths Outside the 650-1350 nm Optical Window

Objective: To explore via systematic review the validation of uneventful post-surgical healing, associated with shorter and longer laser wavelength applications in minor oral surgery procedures. Methods: From April 28 to May 11, 2020, PubMed, Cochrane Database of Systemic Reviews, and Google Scholar search engines were applied to identify human clinical trials of photobiomodulation (PBM) therapy in clinical dentistry. The searches were carried out with reference to (1) dental laser wavelengths shorter than 650 nm; (2) wavelengths localized within the 2780-2940 nm; and (3) the 9300-10,600 nm range. Selected articles were further assessed by three independent reviewers for strict compliance with PRISMA guidelines and modified Cochrane Risk of Bias to determine eligibility. Results: Using selection filters of randomized clinical trials, moderate/low risk of bias, and the applied period, and following PRISMA guidelines, 25 articles were selected and examined. A risk of bias was completed, where 11 out of 25 publications were classified as low risk of bias, and 14 out of 25 were classified as medium risk status. In total, 6 out of 13 (46% of) studies comparing the examined laser wavelengths with scalpel-based treatment showed positive results, whereas 6 out of 13 (46%) showed no difference, and only 1 out of 13 (7.7%) presented a negative outcome. In addition, 5 out of 6 (83% of) studies comparing the examined laser wavelengths with other diodes (808-980 nm) showed positive results, whereas 1 out of 6 (17%) had negative outcomes. Conclusions: A detailed and blinded examination of published studies has been undertaken, applying strict criteria to demonstrate research outcome data, which suggests positive or at worst neutral comparatives when a given laser wavelength system is used against an alternative control therapy. As such, substantiated evidence for laser surgery in delivering uneventful healing and analgesic effects, as an expression of a PBM-like (quasi-PBM) influence, has been shown.

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.