In modern societies, there is an increasing number of older patients, especially who take anticoagulant drugs. Over the past years, lasers haemostatic properties have been established.
Due to deeper penetration in soft tissues, Nd:YAG and diode laser have been very effective.To reduce the thermal effect, pulsed lasers are used. Optical characteristics of blood result in scaterring and dispersion of laser light, thereby reducing the adverse effects on bony tissue.
There are basically three photothermal techniques for laser use within the oral cavity
and on the face: incisional and excisional procedures, ablation and vaporization procedures,and hemostasis. Incisional and excisional procedures are common in cases of soft tissue laser surgery using the laser device essentially as a light scalpel to make relatively deep, thin cuts such as one would do with a scalpel blade. This technique allows the surgeon to perform almost any intraoral procedure that would normally be done with conventional technique,such as incisional and excisional biopsy, lesion removal, or incision for flap access.The main advantages are bloodless surgical field and the reduced need for suturing. Tissue ablation or vaporization is used for removal of the superficial part of the tissue but generally over a fair‐ly large area, as well as for the bone removal. The most common examples are leukoplakias,dysplasias, papillary hyperplasia, and osteotomies. In contrast to incisional procedures in which is spot size is kept small by locating the laser at its focal length; vaporization is accomplished by using larger spot sizes. This technique allows removal of a surface lesion in layers of a few hundred microns to 1-2mm at a time. Visualization of tissue anatomy is excellent, owing to the hemostasis, and the layers are identified easiliy. By removing only the epithelium less damage is done to the underlying tissues, and the risk of inadvertent damage to an underlying nerve, duct, or blood vessel is minimal. Any superficial tissue removal without the need for histologic examination can be treated using this technique.
Finally,even in cases in which other modalities of treatment have been used, the laser can be used as a hemostatic tool to stop bleeding in the field and to allow for similar postoperative wound management. The cause of this effect is not coagulation of blood, but rather the contraction of the vascular wall collagen. The contraction results in constriction of the vessels and hemostasis. The technique is very useful for removal of vascular lesions in the oral and maxillofacial region. Once these three techniques are understood, the surgeon has to decide which technique would be best for treatment of the lesion most appropriately, taking into account the laser parameters, such as power, time, and spot size to best affect the target with the least collateral damage.