Evaluation of Patient Perceptions of Frenectomy: A Comparison of Nd:YAG Laser and Conventional Techniques

Surgical Correction of Ankyloglossia Using Diode Laser-Assisted Frenectomy in a Pediatric Patient: A Case Report

Tongue-tie is a continuation of the lingual frenum that is attached to the tip of the tongue. It is a congenital oral anomaly that could restrict tongue movements, caused by a lingual frenum a membrane that originates from the floor of the mouth to the bottom of the tongue that is too thick and short, which limits the natural ability of the tongue to move and function. The tongue is an auxiliary organ that facilitates speaking, mastication, and deglutition. This condition may result in several difficulties including chewing, breastfeeding, speech, and pronunciation of particular words, as well as possessing social and mechanical consequences. Ankyloglossia can be seen in young age groups. The use of lasers has increased in dentistry in recent years. However, in oral and maxillofacial surgery, the use of lasers has been largely restricted to soft tissues, and less focus is placed on the use of hard tissues. Carbon dioxide (CO2) lasers, erbium-doped yttrium aluminum garnet (Er: YAG) lasers, and Er, the erbium, chromium: yttrium: scandium gallium-garnet (Cr: YSGG) lasers are among the several types of lasers that have been utilized in dentistry for correction of soft tissues as well as for hard tissues.

Ankyloglossia as a Barrier to Breastfeeding: A Literature Review

This is a literature review of ankyloglossia and its correlation with lactation problems. Ankyloglossia, commonly referred to as tongue-tie, brings about functional difficulties and, in some cases, may lead to early weaning. It is crucial to use breastfeeding as the exclusive food source for the first six months of an infant's life, and the interference of the tongue contributes substantially to success in this regard. Even though there are many publications about ankyloglossia, there are still many controversies about its definition, diagnosis, classification, and treatment decision determined via frenotomy. Some researchers state that the identification of ankyloglossia should be based on morphological and anatomical evidence, while others claim that a short or tight frenulum should be examined in correlation with the impact on the mother-infant dyad during breastfeeding. By encouraging and supporting mothers in coping with feeding difficulties, their lactation experiences are improved, and they can continue breastfeeding.

Tissue response to different incision tools in animal model

PURPOSE

The aim of this study is to compare the repair of incisions performed with microdissection electrocautery tip, conventional electrocautery tip, high potency diode laser, and conventional scalpel blade in a in vivo model.

METHODS

Different incisions were performed in adults Holtzman rats using the four types of instruments: microdissection electrocautery tip, conventional electrocautery tip, high potency diode laser, and conventional scalpel blade, in different periods of healing process. Thirty rats were divided into 5 groups, according to the period of euthanasia-24 h, 48 h, 72 h, 7 days, and 14 days. All animals received four incisions, each by a different method. Quantitative histological and histomorphometric analyses were performed using hematoxylin and eosin (HE) and Picrosirius Red staining.

RESULTS

Inflammatory profile and tissue repair presented small statistically significance differences comparing conventional scalpel blade and microdissection tip; moreover, both presented quantitatively superior to the others.

CONCLUSION

It is believed that the microdissection tip can perform a dynamic incision just as a common scalpel blade, but more effective. Furthermore, it can promote a better hemostatic control of the surgical field that is comparable to conventional electrocautery tip without affecting tissue repair.

A Comparative Study of Mucosal Wound Healing after Excision with a Scalpel, Diode Laser, or CO2 Laser

We aimed to compare the clinical and histological secondary healing effectiveness of various types of high-level laser versus scalpel excision in mucosa frenectomy.

Methods

Forty-five Sprague Dawley rats were used in this study. These rats were divided into two laser intervention groups (CO2, n = 15; diode, n = 15) and one control group with scalpel excision (n = 15). The effectiveness of therapy has been assessed based on the comparison of intraoperative, postoperative, and histological parameters on days 7, 21, and 35, and postoperative weight changes as pain indicator.

Results

Both laser groups demonstrated significantly (P < 0.05) less bleeding than did the control group during the intraoperative stage, whereas the CO2 laser showed more precise cutting compared with the diode laser (P < 0.05). The highest healing score was reported in the CO2 and scalpel groups on the first week of healing than in the diode group (P < 0.05). However, no significant difference was observed between the groups on days 21 and 35. Weight loss was significantly (P < 0.05) demonstrated in the diode group compared to the scalpel and CO2 groups till day 7. Both laser groups demonstrated delayed healing process compared with the scalpel. Nevertheless, the CO2 group followed the scalpel trends after day 7.

Conclusion

Scalpel and CO2 laser yielded a superior clinical outcome compared with the diode excision of oral mucosa, whereby the CO2 has been proposed as the most effective laser type at the end of the first postoperative month.

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.

Dental laser training and education in postgraduate periodontics programs in North America

INTRODUCTION

The application of various lasers to treat periodontal and peri-implant diseases is gaining momentum. While laser-related dental research is ongoing, it is important to determine if current periodontal training programs are keeping pace with these new treatment modalities and actively incorporating them into their training.

MATERIALS AND METHODS

An electronic survey was created to evaluate the extent to which lasers are currently being used in North American periodontal programs. A brief explanation of the study and a link to the 15-question survey was emailed to 61 periodontal program directors requesting participation in the survey. The data regarding the prevalence of laser training in all the programs, which types of laser devices are used, and which surgical procedures are performed were collected and analyzed.

RESULTS

The response rate was 49.1% (n = 30). Among those responding to the survey, 76.7% (n = 23) of these programs reported providing clinical training in lasers, with the diode laser being the most frequently used (65.2%), followed by carbon dioxide (39.1%), neodymium-doped yttrium aluminum garnet (26.1%), and erbium:yttrium aluminum garnet lasers (26.1%). Two major reasons for not utilizing lasers as part of regular patient care were cost and lack of evidence to support laser efficacy. Three out of seven programs that do not currently use lasers plan to provide laser training in the future. Over half (56.7%) of program directors did not think that lasers would become the standard of periodontal/implant care within the next 10 years, while 20% of them believed that they would.

CONCLUSIONS

Laser training and education in postgraduate periodontal programs is still limited, and the majority of periodontal residents are not exposed to many types of laser devices.

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.

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.

Therapeutic effects of diode laser on vascular epulis in esthetic area

Vascular epulis is a rare clinical disease. In our study, a case of vascular epulis in the cosmetic area was treated by diode laser, without recurrence and obvious inflammation in the surgical site 5 years after surgery. This case report indicates that the excision of vascular epulis in the cosmetic area of the anterior teeth by diode laser could be an alternatively safe and complementary approach in lieu of conventional surgery.

Major complications after tongue-tie release: A case report and systematic review

INTRODUCTION

The diagnosis of ankyloglossia, or tongue-tie, and the number of frenotomies performed has increased over 10-fold from 1997 to 2012 in the United States. The sharpest increase has been in neonates. For parents considering frenotomy for their breastfeeding newborn, there is controversy surrounding the evaluation of tongue-tie and the benefit of a frenotomy. Complications from tongue-tie procedures are thought to be low, though it is not well reported nor studied.

OBJECTIVES

The aim of this study is to describe a case of a sublingual mucocele after laser frenotomy in a neonate with tongue-tie and to investigate major complications reported after tongue-tie release in pediatric patients through a systematic review of the literature.

CASE REPORT

We present a 6-week-old female who underwent a laser frenotomy procedure performed by a dentist who presented with a new cyst under her tongue.

MATERIAL AND METHODS

A systematic literature search of articles published from 1965 to April 2020 was conducted in Ovid MEDLINE(R), Ovid EMBASE, and Scopus. Citations were uploaded into a systematic review software program (DistillerSR, Ottawa, ON, Canada), followed by full text screening.

RESULTS

47 major complications were reported in 34 patients, including our patient. Most of the cases were located in the United States and Europe. The most frequent indications for the procedure were breastfeeding problems (n = 18) and speech impediment (n = 4). The procedure was performed by dentists (n = 6), lactation consultants (n = 5), and otolaryngologists (n = 4). The bulk of the major complications after frenotomy included poor feeding (n = 7), hypovolemic shock (n = 4), apnea (n = 4), acute airway obstruction (n = 4), and Ludwig angina (n = 2).

CONCLUSIONS

Reporting of complications after frenotomy is lacking. Risks to neonates may be different than risks to older children and adults. Practitioners across different specialties should be monitoring and studying this more rigorously to better guide patients and families on the risks and benefits of this procedure.

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.

Efficacy and safety of diode laser during circumvestibular incision for Le Fort I osteotomy in orthognathic surgery: a triple-blind randomized clinical trial

The aim of this triple-blind randomized clinical trial was to evaluate the efficacy and safety of diode laser during circumvestibular incisions for Le Fort I osteotomy in orthognathic surgeries in comparison with conventional techniques using electrocautery and scalpel. Patients were randomly allocated to one of three groups based on the technique employed to perform incisions: diode laser, electrocautery, and scalpel. The parameters used to evaluate the efficacy and safety of diode laser were incision velocity, duration of surgery, bleeding rate, alterations in postoperative functions, pain, edema, wound clinical healing, and infection. Thirty patients were enrolled in the study (10 per group). Regarding bleeding, the incisions performed with diode laser promoted a lower bleeding rate compared with scalpel and electrocautery (p = 0.00). The diode surgical laser was effective during the incision procedure, but required a longer time to perform the incisions compared with the other techniques evaluated (p < 0.05). No statistically significant difference was detected between groups regarding total surgical time or other safety parameters (p > 0.05). Thus, diode laser proved to be effective and safer during circumvestibular incisions for Le Fort I osteotomy than conventional devices.

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.

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.

Low level laser therapy induces increased viability and proliferation in isolated cancer cells

OBJECTIVES

Low level laser therapy (LLLT), which stimulates natural biological processes in the application region, is frequently used in dental treatments. The aim of our study was to evaluate the effects of LLLT which could activate precancerous cells or increase existing cancerous tissue in case of clinically undetectable situations.

MATERIALS AND METHODS

Saos-2 osteoblast-like osteosarcoma cells and A549 human lung carcinoma cells were used. Twenty-four hours after preparation of cell culture plates, laser irradiation was performed 1, 2 and 3 times according to the test groups using Nd:YAG laser with the power output 0.5, 1, 2 and 3 W. Cell proliferation analysis was performed by MTT assay at the 24th hour following the last laser applications.

RESULTS

Generally, it was observed that the proliferation rates increased as the number of applications increased, when compared to the controls, especially in those cases in which the irradiation was performed 2 or 3 times more.

CONCLUSION

The findings of this study have led to the conclusion that LLLT increases cancer cell proliferation, depending on the power output level of the laser and the number of applications. In addition to the proliferation and mitotic activity of the cancer tissue cells, we concluded that LLLT, which is frequently used in dental practice, could activate precancerous cells or increase existing cancerous tissue.

High-power diode laser in the circumvestibular incision for Le Fort I osteotomy in orthognathic surgery: a prospective case series study

The incisions during orthognathic surgery are classically performed with conventional scalpel or electrocautery. Considering that the high-power diode laser surgery may provide advantages when compared to conventional incision techniques, the current study aimed to present a prospective case series of patients submitted to circumvestibular incision for Le Fort I osteotomy. Ten patients with dentofacial deformities who underwent to rapid assisted maxillary expansion or bimaxillary orthognathic surgery were enrolled in the study. All incisions were performed by a single surgeon using an 808-nm diode laser, with an optical fiber of 600 μm, at a power of 2.5 W, in a continuous-wave mode. The performance of the incision was evaluated by incision velocity, bleeding, edema, secondary infection, clinical healing, and pain. The velocity of the incision ranged from 0.10 to 0.20 mm/s (mean 0.13 ± 0.03 mm/s). Considering bleeding during the soft tissue incision, all surgeries were classified as absent bleeding. All patients presented a clinical healing of the surgical wound in a period that range from 3 to 5 weeks and experienced swelling during the follow-up period. On average, approximately 50% of the swelling had resolved after the third postoperative week, and 28.8% of swelling remained after 2 months after the surgery. The pain decreased after 2 and 3 days, and 90.0% of the patients reported no pain after 7 postoperative days. High-power diode laser is effective and safety during circumvestibular incisions for Le Fort I osteotomy in orthognathic surgery decreasing bleeding, surgery time, pain, and edema after orthognathic surgery.

Treatment of Different Oral Soft Tissue Lesions With Surgical Neodymium: Yttrium-Aluminum-Garnet Laser: Case Series

INTRODUCTION

Oral soft tissue lesions cause discomfort and potentially serious clinical problems.

CASE SERIES

These case reports present different gingival and/or mucosal lesions (pyogenic granuloma, verruca vulgaris, giant cell granuloma, fibroma, etc.) and the surgical treatment of these lesions with a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser (320-μm optic fiber; 4 W; 100 mJ, 40 Hz; emission mode, pulsed, and contact mode). Patients were evaluated after laser surgery on degree of postoperative pain; discomfort; functional complications (eating and speech); and recurrence. Results indicated that patients had minimal postoperative pain, few functional complications, and low rates of pain. Laser surgery produced minimal bleeding, damage to the surrounding tissue, and post-surgical edema.

CONCLUSION

In these cases, the Nd:YAG laser provided a non-bleeding environment at the surgical area with an acceptable operating time, quick postoperative hemostasis, good patient acceptance, low rates of pain, and no post-treatment adverse events among patients with oral soft tissue lesions.

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.

Clinical Application of Diode Laser (980 nm) in Maxillofacial Surgical Procedures

For many procedures, lasers are now becoming the treatment of choice by both clinicians and patients, and in some cases, the standard of care. This clinical study was carried out at Department of Maxillofacial Surgery, Ramadi Teaching Hospital, Rashid Private Hospital and Razi Private Hospital, Anbar Health Directorate, Anbar Province, Iraq. A total of 32 patients including 22 (≈ 70%) male and 10 (≈ 30%) female with age range from 5 months to 34 years old. Chirolas 20 W diode laser emitting at 980 nm was used. Our preliminary clinical findings include sufficient hemostasis, coagulation properties, precise incision margin, lack of swelling, bleeding, pain, scar tissue formation and overall satisfaction were observed in the clinical application. The clinical application of the diode (980 nm) laser in maxillofacial surgery proved to be of beneficial effect for daily practice and considered practical, effective, easy to used, offers a safe, acceptable, and impressive alternative for conventional surgical techniques.

Surgical techniques for the treatment of ankyloglossia in children: a case series

This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.

The use of surgical Nd:YAG laser in an oral pyogenic granuloma: a case report

Pyogenic granuloma is a benign, non-neoplastic, mucocutaneous lesion and is especially common on the tongue, lips, and gums. This case report presents a large oral pyogenic granuloma of the gingiva and the surgical treatment of this lesion with Nd:YAG laser. A 14-year-old female patient referred with a complaint of a swelling and growth on the buccal side of her mandibular left premolar teeth. A comprehensive intraoral examination revealed a localized gingival mass between mandibular left premolar teeth on the buccal aspect. The treatment selected was surgical removal using Nd:YAG laser with the following irradiation parameters: power output 4 W, energy 100 mJ, frequency 40 Hz, and pulsed emission mode. During surgery, complications including hemorrhage were not observed, and no scarring developed after surgery. The excised area gradually improved within 1 month. The use of Nd:YAG laser in the treatment of pyogenic granuloma reduced bleeding during surgery, with a consequent reduction in operating time, promoted rapid postoperative hemostasis, and has better patient acceptance.

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

Labial frenulums are sagittal fibrous folds of oral mucosa with a periosteal insertion that extend from the lips to the alveolar or gingival mucosa. Occasionally, they assume inadequate size or location and may lead to functional and esthetic limitations. The aim of the present study was to compare pre-, trans-, and postsurgical clinical parameters of labial frenectomies performed with conventional surgery and neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Forty individuals were assessed as a convenience sample and were divided into two groups according to the treatment: group 1 (G1), conventional surgery (n = 22), and G2, Nd:YAG laser surgery (n = 18). Clinical parameters such as frenulum insertion, location, bleeding, surgical time, suturing, preoperative fear, and postoperative discomfort/functional limitations were evaluated. All surgeries were performed by the same operator, and the level of fear, pain, and discomfort related to oral functions were assessed with a visual numeric scale. Most of the frenulums (90%) were classified as papillary or transpapillary insertion. Preoperative fear was similar between groups (p = 0.593). All G2 patients did not require suture (p < 0.001), did not bleed during the procedure (p < 0.001), and had surgical time diminished (p < 0.001). No significant statistical difference regarding pain or oral function could be observed. Three individuals (7.5%) experienced postsurgical complications. Nd:YAG laser frenectomies reduces transoperative bleeding, avoiding the need of suturing, and promotes a significant reduction of surgical time in comparison with conventional surgery. Therefore, further studies are necessary to provide a complete understanding and standardization of the technique as well as the expected clinical results.

Is the 810-nm diode laser the best choice in oral soft tissue therapy?

OBJECTIVE

To evaluate the safety and efficacy of an 810-nm diode laser for treatment of benign oral soft tissue lesions.

MATERIALS AND METHODS

Treatment with the 810-nm diode laser was applied to a group of eighteen patients with pathological frenulum and epulis fissuratum; five patients with oral lichen planus, oral leukoplakia, and mucous membrane pemphigoid; and four patients with pyogenic granuloma.

RESULTS

Although the conventional surgery wound heals in a fairly short time, in the present study, the simple oral soft tissue lesions healed within two weeks, the white and vesiculobullous lesions healed completely within six weeks, and the pyogenic granuloma lesions healed within four weeks. Any complication was treated by using the 810-nm diode laser.

CONCLUSIONS

Patient acceptance and satisfaction, without compromising health and function, have been found to be of a high degree in this present study. Thus, we can say that the use of the 810-nm diode laser may indeed be the best choice in oral soft tissue surgery.

Laser physics and a review of laser applications in dentistry for children

AIM

The aim of this introduction to this special laser issue is to describe some basic laser physics and to delineate the potential of laser-assisted dentistry in children.

REVIEW

A brief review of the available laser literature was performed within the scope of paediatric dentistry. Attention was paid to soft tissue surgery, caries prevention and diagnosis, cavity preparation, comfort of the patient, effect on bacteria, long term pulpal vitality, endodontics in primary teeth, dental traumatology and low level laser therapy. Although there is a lack of sufficient evidence taking into account the highest standards for evidence-based dentistry, it is clear that laser application in a number of different aetiologies for soft tissue surgery in children has proven to be successful. Lasers provide a refined diagnosis of caries combined with the appropriate preventive adhesive dentistry after cavity preparation. This will further lead to a new wave of micro-dentistry based on 'filling without drilling'.

CONCLUSION

It has become clear from a review of the literature that specific laser applications in paediatric dentistry have gained increasing importance. It can be concluded that children should be considered as amongst the first patients for receiving laser-assisted dentistry.

Evaluation of pain levels after Nd: YAG laser and scalpel incisions: an experimental study in rats

BACKGROUND

Postoperative pain is a recognized sequel of periodontal surgery. The pain experience has been shown to peak in the first 24 hours following the procedure, and to decrease rapidly in subsequent days. The aim of the present study was to evaluate the pain levels following scalpel- and laser-incision of rat hind paws.

METHODS

The study was carried out on 10 albino Wistar male rats. Rats were randomly assigned to two groups: Group I (n = 5, laser surgery), or Group II (n = 5, conventional surgery with scalpel). For measuring mechanical hyperalgesia, the nociceptive threshold of the hind paw after mechanical stimulation was quantified using a Basile algesimeter. The measurements were done before the surgery and on the postoperative 1(st), 2(nd), 3(rd), and 7(th) days.

RESULTS

While the pain levels of the groups were similar before the surgical procedures, the laser-applied rats had significantly fewer nociceptive thresholds of the hind paw after mechanical stimulation compared with the scalpel-incised rats on the postoperative 1(st), 2(nd), 3(rd), and 7(th) days. Functional complications were not observed in the laser groups at three days after the surgery.

CONCLUSION

The results suggested that, for soft tissue surgery, Nd: YAG lasers have often led to shorter operative times, less pain, and fewer postoperative adverse events.

Comparison of diode laser and Er:YAG lasers in the treatment of ankyloglossia

OBJECTIVES

The purpose of this study was to compare the tolerance of lingual frenectomy with regard to a local anesthesia requirement and comparison of postsurgical discomfort experienced by patients operated on with both diode and erbium:yttrium-aluminium-garnet (Er:YAG) lasers.

BACKGROUND

Ankyloglossia, commonly known as tongue-tie, is a congenital oral anomaly characterized by a short lingual frenulum. A short lingual frenulum may contribute to feeding, speech, and mechanical tongue problems.

METHODS

Sixteen referred patients with tongue mobility complaints were included in this study. A GaAlAs laser device with a continuous wavelength of 808 nm was used in the diode group. Frenulums were incised by applying 2 W of laser power. The Er:YAG laser device with a continuous wavelength of 2940 nm was used in the Er:YAG group. Frenulums were incised by applying 1 W of laser power. The acceptability of the lingual frenectomy without local anesthesia and the degree of the postsurgical discomfort were evaluated.

RESULTS

Although the majority of patients (six) could be operated on without local anesthesia in the Er:YAG group, all patients could not be operated on without local anesthetic agent in the diode group. There were no differences between the two groups with regard to pain, chewing, and speaking on the first or seventh day after surgery, whereas patients had more pain in the Er:YAG group than in the diode group the first 3 h after surgery.

CONCLUSIONS

The results indicate that only the Er:YAG laser can be used for lingual frenectomy without local anesthesia, and there was no difference between the two groups regarding the degree of the postsurgical discomfort except in the first 3 h. In conclusion, these results indicate that the Er:YAG laser is more advantageous than the diode laser in minor soft-tissue surgery because it can be performed without local anesthesia and with only topical anesthesia.