INTRODUCTION

Innovative technologies, such as diode lasers, have provided considerable benefit to dental patients and dentists.[^1,2] In addition, the role of lasers in dentistry is well-established in both the conservative and surgical management of oral diseases.[^2,3,4]

The diode laser is a semiconductor that uses solid-state elements, such as gallium, arsenide, aluminum, and indium, to change electrical energy into light energy. The light energy from the diode is greatly absorbed by the soft tissue and poorly absorbed by the teeth and bones.[⁵]

Diode lasers are useful for oral soft tissue surgical procedures because their specific wavelength (810-980 nm) is absorbed not only by water (although less so than the carbon dioxide laser wavelength), but also by other chromophores, such as melanin, and in particular, oxyhemoglobin. Moreover, the exclusive use of this laser by contact or at an extremely close distance avoids damage, due to ‘beam escape,’ in an open field, which makes it much safer than other laser sources. In addition, diode lasers have the ability to cut the tissue to perform coagulation and hemostasis, and have a higher tissue ablation capacity and enough bleeding hemostatic properties compared to most laser systems.[^1,4,6]

Clinical experience suggests some advantages of the laser over scalpel surgical procedures on oral tissues. These advantages include greater precision, a relatively bloodless surgical and postsurgical course, sterilization of the surgical area, minimal swelling and scarring, coagulation, vaporization, cutting, minimal or no suturing, and less or no postsurgical pain.[^7,8]

Studies have shown that laser surgery is widely used for oral lesions, such as, simple soft tissue surgery (frenectomy, epulis, gingival contouring plasty, etc.),[^1,2,3,5,7] vascular lesions (hemangiomas, telangiectasias, etc.),[^4,6] pigmented lesions (gingival pigmentations),[¹] white oral lesions (oral leukoplakia, oral lichen planus, etc.),[^9,10] and low-level laser therapy (LLLT) in vesiculobullous lesions (mucous membrane pemphigoid).[⁷]

The purpose of this study is to determine the efficacy and safety of the 810-nm diode laser for treatment of oral soft tissue lesions or diseases, and to answer the question of whether the 810-nm diode laser is the best choice in oral soft tissue surgery.

MATERIALS AND METHODS

A total of 27 patients who had different benign oral lesions were treated with the 810-nm diode laser at the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Ankara University, between the years 2009 and 2011. An informed written consent form was obtained from all participating adults and from parents or legal guardians for minors or incapacitated adults (19 females and eight males, 10 smokers and 17 nonsmokers, 21 to 72 years of age) in accordance with the Declaration of Helsinki. All patients had previously taken conventional medical treatment procedures (local corticosteroid, beta carotene, vitamin E, fluocinonide, triamcinolone, LLLT, etc.) except the patients having epulis fissuratum or pathological frenulum. Unfortunately, the lesions in all patients reoccurred. Therefore, the diode laser treatment was selected as an alternative treatment option for these patients.

The cases have been studied retrospectively. Patients with any systemic diseases were excluded from the study, and all operations were performed by the same surgical team.

The diagnosis of all lesions or disorders was confirmed by histopathological examination, especially in patients who suffered from white, vesiculobullous, and pyogenic granuloma lesions. All treatments were performed with the patients under local anesthesia and on an outpatient basis. Both the patients and the surgeons wore protective glasses.

Treatment was carried out using 12 different settings of the MedArt 426 Diode Laser System (Asah Medico A/S, Hvidovre, Denmark). The laser output power ranged from 0, 5-30 W, the pulse rate from 10-1000 msec in a pulsed mode, and the frequency from 0, 3-100 Hz. The laser could also be operated in a continous wave (cw) mode, as was done during the procedure. The target beam was generated by an aluminum, arsenide, and gallium laser (810 – nm). The laser beam was delivered by ultrathin optical fibers of 400-1000 μm, enabling it to be moved easily and quickly during surgical procedures.

Simple oral soft tissue surgery

Eighteen patients (10 epulis fissuratum [Figure 1a] and eight labial frenectomy) were treated with the diode laser. The treatment was carried out by moving a slightly focused 810-nm diode laser. The laser had an output power of 5-10 W, high-power continuous wavelength, and a spot size of 2 mm. The surgical operation was performed using the excision method under local anesthesia [Figure 1b].

(a) Preoperative view of the epulis fissuratum lesion of a patient, (b) immediate postoperative view of the treated area, (c) view of the treated area two weeks after diode laser intervention

Treatment of oral white and vesiculobullous lesions

Five patients with histologically proven disorders, including two with leukoplakia [Figure 2a], two with oral lichen planus [Figure 3a], and one with oral mucous membrane pemphigoid, were selected for 810-nm diode laser treatment. They had been treated with different drugs (fluocinonide, triamcinolone, LLLT) or a wait-and-see policy before the 810-nm diode laser evaporation. All patients, who had had recurring lesions or bad results with their previous treatment options, were prepared for laser surgery treatment. A defocused 810-nm diode laser was chosen for evaporation of the superficial mucosal lesions [Figure ​[Figure2b,2b, ​,3b].3b]. The laser had an output power of 10-15 W, high-power continuous wavelength and 2-mm spot size.

(a) Immediate preoperative view of the treated area of a leukoplakia patient, (b) immediate postoperative view of the treated area, (c) view of the treated area six weeks after diode laser intervention

(a) Preoperative view of a lichen planus lesion, (b) postoperative view of the treated lesion, (c) view of the healed lesion after six weeks laser treatment

Pyogenic granuloma

Four patients with pyogenic granuloma, diagnosed clinically, were treated with a diode laser, with an output power of 10-15 W, high-power continuous wavelength, and 2-mm spot size. First, the lesions were excised with a focused 810-nm diode laser under local anesthesia and then the surgical material was sent for histopathological study. Immediately, the surgical field was evaporated with a defocused 810 nm diode laser. The histopathological study confirmed the clinical diagnosis.

In all the 27 patients treated, the areas surrounding the treated tissue were cooled after the laser surgical procedure. All the patients were given suitable postoperative care such as 0.2% chlorhexidine mouthwash, and paracetamol analgesics were prescribed. All patients were seen on a regular basis for follow-up: At one, two, and six weeks, and two months after treatment.

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Articles from European Journal of Dentistry are provided here courtesy of Dental Investigations Society