Efficacy of diode laser on healing in frenectomy compared to conventional frenectomy with scalpel

dgkh000583 10.3205/dgkh000583 urn:nbn:de:0183-dgkh0005837 Research Article Efficacy of diode laser on healing in frenectomy compared to conventional frenectomy with scalpel Wirksamkeit des Diodenlasers auf die Heilung bei der Frenektomie im Vergleich zur herkömmlichen Frenektomie mit dem Skalpell Shunmugavelu Shunmugavelu Karthik K Dr.

PSP Medical College Hospital and Research Institute Tambaram Kanchipuram, main road Oragadam Panruti Kanchipuram district Tamil Nadu, 631604, India, Phone: +91 9789885622/9840023697Department of Dentistry, PSP Medical College Hospital and Research Institute Tambaram Kanchipuram, Tamil Nadu District, India

drkarthiks1981@gmail.com author Dhinakaran Dhinakaran Evangeline Cynthia EC

Department of Pathology, Sree Balaji Medical College Hospital and Research Institute, Chrompet, Chennai, Tamil Nadu, India

author German Medical Science GMS Publishing House

Düsseldorf

610 frenectomy diode laser scalpel postoperative pain wound healing patient satisfaction Frenektomie Diodenlaser Skalpell postoperativer Schmerz Wundheilung Patientenzufriedenheit 20250923 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). 2196-5226 20 GMS Hygiene and Infection Control GMS Hyg Infect Control 54 Hintergrund: Die Frenektomie ist ein kieferchirurgischer Routineeingriff, bei dem ein abnormales Bändchen entfernt wird, um die Mundfunktion und die Ästhetik zu verbessern. Der Diodenlaser erfreut sich zunehmender Beliebtheit gegenüber der traditionellen Skalpellmethode, da er w</PlainText></TextGroup>eniger postoperative Schmerzen, weniger Blutungen und eine schnellere Heilung verspricht. </Pgraph><Pgraph><Mark1>Methode:</Mark1> In der Übersicht wird die Wirksamkeit der Diodenlaser-gestützten Frenektomie in Bezug auf Gewebeheilung, Patientenbeschwerden und klinische Ergebnisse mit der Skalpell-Frenektomie verglichen. Es wurden randomisierte kontrollierte Studien (RCTs) und Beobachtungsstudien ausgewertet.</Pgraph><Pgraph><Mark1>Ergebnis:</Mark1> Die Ergebnisse weisen darauf hin, dass die Diodenlaser-Frenektomie mit weniger intraoperativen Blutungen und Schmerzen und mit ähnlichen langfristigen Heilungsraten verbunden ist.</Pgraph></Abstract> <Abstract language="en" linked="yes"><Pgraph><Mark1>Introduction:</Mark1> Frenectomy is a routine oral surgical procedure performed to excise an abnormal frenum attachment in order to enhance oral function and esthetics. Diode laser has become more popular than conventional scalpel methods, due to promises of decreased postoperative pain, less bleeding, and quicker healing. </Pgraph><Pgraph><Mark1>Materials and methods:</Mark1> This review compares the effectiveness of diode laser-assisted frenectomy in relation to tissue healing, patient discomfort, and clinical outcomes in comparison to scalpel frenectomy. Pertinent randomized controlled trials (RCTs) and observational studies were examined. </Pgraph><Pgraph><Mark1>Results:</Mark1> The results indicate that diode laser frenectomy is associated with less intraoperative bleeding and pain, and with similar long-term healing rates.</Pgraph></Abstract> <TextBlock name="Introduction" linked="yes"> <MainHeadline>Introduction</MainHeadline><Pgraph>Frenectomy is the surgical excision of the frenum. The frenum is an area of folded connective tissue that may have unfavorable effects, e.g., midline diastema, gingival recession, or speech difficulties. Conventional scalpel frenectomy, although effective, tends to cause postoperative bleeding and pain; it requires suturing. With recent developments in laser technology, diode lasers have emerged as a minimally invasive treatment, providing enhanced precision, less trauma, and faster healing <TextLink reference="1"></TextLink>.</Pgraph><Pgraph>In comparison with other lasers, for instance, like CO<Subscript>2</Subscript>, Nd:YAG, and Er:YAG, diode lasers are cost-effective, lightweight, and easy to handle, which makes them the first line of treatment for soft tissue management, such as frenectomy <TextLink reference="2"></TextLink>.</Pgraph><Pgraph>This review compares the clinical outcomes of diode laser-assisted frenectomy with conventional scalpel methods in terms of pain perception, wound healing, intraoperative bleeding, and patient satisfaction. The review also points out potential limitations and areas for future research.</Pgraph></TextBlock> <TextBlock name="Materials and methods" linked="yes"> <MainHeadline>Materials and methods</MainHeadline><Pgraph>A systematic PubMed, Scopus, Web of Scienc<TextGroup><PlainText>e, and C</PlainText></TextGroup>ochrane Library database search was performed accordi<TextGroup><PlainText>ng t</PlainText></TextGroup>o PRISMA guidelines. Articles published between 2015 and 2025 were eligible for inclusion. Included studies were randomized controlled trials (RCTs) and observational studies comparing diode laser frenectomy with traditional scalpel frenectomy.</Pgraph><Pgraph>Inclusion criteria were:</Pgraph><Pgraph><UnorderedList><ListItem level="1">Studies published from 2015 to 2025</ListItem><ListItem level="1">RCTs and observational studies</ListItem><ListItem level="1">Patients who underwent frenectomy using diode laser or scalpel</ListItem><ListItem level="1">Studies on postoperative pain, healing, bleeding, and patient satisfaction.</ListItem></UnorderedList></Pgraph><Pgraph>Exclusion criteria were:</Pgraph><Pgraph><UnorderedList><ListItem level="1">Patients with systemic illnesses interfering with wound healing</ListItem><ListItem level="1">Studies with missing data or uncertain method</ListItem><ListItem level="1">Animal studies and case reports.</ListItem></UnorderedList></Pgraph><Pgraph>Data extraction was done for postoperative pain, wound healing, bleeding, and patient satisfaction.</Pgraph></TextBlock> <TextBlock name="Results" linked="yes"> <MainHeadline>Results</MainHeadline><Pgraph>The final analysis included six studies comparing diode laser and scalpel frenectomy. The primary outcomes assessed were postoperative pain, wound healing, bleeding, and patient comfort. The summarized data from these studies are presented in Table 1 <ImgLink imgNo="1" imgType="table" />.</Pgraph></TextBlock> <TextBlock name="Discussion" linked="yes"> <MainHeadline>Discussion</MainHeadline><Pgraph>The studies reviewed underscore that diode laser frenectomy causes much less postoperative pain than does scalpel frenectomy. Reduction in pain was noticed on the first postoperative day and continued for as long as one week after surgery <TextLink reference="3"></TextLink>, <TextLink reference="4"></TextLink>. This is based on the fact that tissue ablation using laser seals nerve endings, which reduces inflammation and excitation of nociceptors. The laser-created heat also cauterizes sensory nerve endings, adding to diminished postoperative awareness of pain <TextLink reference="5"></TextLink>.</Pgraph><Pgraph>Wound healing was accelerated in the diode laser group in the initial week of healing, as shown by Singh et al. <TextLink reference="6"></TextLink> and Fatima et al. <TextLink reference="7"></TextLink>. At the 30-day follow-up, there was no difference in healing status between the two groups, which means that diode lasers are promoters of early healing but do not necessarily differ from the scalpel method in terms of long-term healing <TextLink reference="8"></TextLink>. Comparative analysis revealed that the diode laser group experienced improved wound healing and lack of scar formation at 14 days after surgery because of the clean incision and minimal degree of wound contraction linked with the use of laser <TextLink reference="9"></TextLink>. </Pgraph><Pgraph>Laser-induced wounds heal with secondary intention and have minimal scarring in comparison to scalpel incisions. This is because of the reduced level of wound contraction after laser irradiation, which is achieved through the induction and development of fewer myofibroblasts and collagen fibers <TextLink reference="10"></TextLink>. Uraz et al. <TextLink reference="9"></TextLink>, Derikvand et al. <TextLink reference="11"></TextLink> and Azma et al. <TextLink reference="12"></TextLink> also found similar results, indicating that diode laser frenectomy causes less swelling, bleeding, pain, and formation of scar tissue.</Pgraph><Pgraph>Intraoperative bleeding was found to be minimal in the diode laser group throughout. The coagulative effect of the laser eliminates the need for sutures and minimizes intraoperative blood loss, a significant benefit in operating rooms <TextLink reference="13"></TextLink>, <TextLink reference="14"></TextLink>. Furthermore, diode laser-facilitated frenectomy takes less time during the procedure and reduces postoperative complications <TextLink reference="3"></TextLink>. The controlled bleeding that can be obtained using diode lasers provides improved surgical accuracy and visibility <TextLink reference="6"></TextLink>.</Pgraph><Pgraph>Patient satisfaction and acceptance were significantly greater in the diode laser group in several studies. Lack of suturing, less postoperative pain, and quicker healing were reasons for this preference <TextLink reference="8"></TextLink>, <TextLink reference="4"></TextLink>. Better esthetic outcomes and less scar formation also enhanced patient experience <TextLink reference="7"></TextLink>. The diode laser method was linked with lower edema, better wound healing, and greater comfort/convenience in maintaining oral hygiene in comparison with the scalpel method <TextLink reference="15"></TextLink>.</Pgraph><Pgraph>The photothermal effect of diode lasers on tissues is responsible for their effectiveness in soft tissue surgery. The heat generated during the use of the laser occludes tiny blood vessels and lymphatic vessels, minimizi<TextGroup><PlainText>ng e</PlainText></TextGroup>dema and intraoperative blood loss <TextLink reference="5"></TextLink>. The absence of sutures in the diode laser group also enable improved oral hygiene and decreased plaque accumulation <TextLink reference="15"></TextLink>.</Pgraph><Pgraph>Closure of diastema following frenectomy was also examined in some studies. Tanik et al. <TextLink reference="16"></TextLink> reported that after one-year of follow-up, diastema was reduced in both laser and scalpel groups; this indicates that the method chosen does not affect long-term closure of interdental space. Likewise, Ozener et al. <TextLink reference="15"></TextLink> found no recurrence of frenulum attachment in either group, thus again proving the success of both the techniques. </Pgraph><Pgraph>In spite of such advantages, some limitations were noted. Initial healing was quicker, but long-term results were similar in both techniques <TextLink reference="8"></TextLink>, <TextLink reference="6"></TextLink>. The high expense of laser technology and the requirement for special training could also restrict its general use <TextLink reference="13"></TextLink>. Some of the studies also mentioned that although diode lasers reduce discomfort, the quality of the outcome is operator-dependent <TextLink reference="7"></TextLink>. The other limitation mentioned was the emission of fumes during the incision using the laser, giving off a smoky smell that can cause discomfort to the patient, making the use of a high-intensity air evacuator necessary <TextLink reference="5"></TextLink>. In addition, the failure of diode lasers to fully incise muscle fibers from the periosteum promoted the likelihood of frenum reattachment in a few instances <TextLink reference="4"></TextLink>.</Pgraph><Pgraph>Lebret et al. <TextLink reference="14"></TextLink> conducted an extensive systematic review including 10 studies and a total of 375 patients, which confirmed the existing evidence that diode lasers are superior to scalpel techniques in perioperative outcomes. Their findings confirmed significantly less postoperative pain, shorter surgery time, and fewer functional discomforts with laser use.</Pgraph><Pgraph>In comparison to the RCT by Eroglu et al. <TextLink reference="3"></TextLink> and the observational study by Vincent et al. <TextLink reference="4"></TextLink>, the systematic review by Lebret et al. <TextLink reference="14"></TextLink> demontrated that laser-assisted frenectomy offers better early healing and decreases intraoperative complications such as bleeding and suturing requirements <TextLink reference="14"></TextLink>. Further studies indicate that while diode lasers accelerate short-term healing, there is no difference in long-term outcomes to those from scalpel techniques <TextLink reference="8"></TextLink>, <TextLink reference="6"></TextLink>. The research mentioned above all points to the benefit of diode lasers in lessening immediate postoperative pain, but their superiority in the long term is not conclusive. </Pgraph></TextBlock> <TextBlock name="Conclusion" linked="yes"> <MainHeadline>Conclusion</MainHeadline><Pgraph>Diode laser frenectomy is a useful substitute for traditional scalpel frenectomy with benefits of less pain, less bleeding, and improved patient comfort. Although initial healing is quicker, long-term results are equivalent for both procedures. Cost and availability continue to be barriers to widespread use, as noted in smaller-scale research <TextLink reference="13"></TextLink>. Long-term patient-reported outcomes and cost-benefit studies should be conducted in the future to determine the feasibility of diode laser frenectomy as a treatment of choice. Moreover, larger sample sizes and longer follow-up studies in the future are suggested to confirm these findings.</Pgraph></TextBlock> <TextBlock name="Notes" linked="yes"> <MainHeadline>Notes</MainHeadline><SubHeadline>Authors’ ORCIDs </SubHeadline><Pgraph><UnorderedList><ListItem level="1">Shunmugavelu K: <Hyperlink href="https://orcid.org/0000-0001-7562-8802">0000-0001-7562-8802</Hyperlink></ListItem><ListItem level="1">Dhinakaran EC: <Hyperlink href="https://orcid.org/0000-0003-2194-6455">0000-0003-2194-6455</Hyperlink></ListItem></UnorderedList></Pgraph><SubHeadline>Funding</SubHeadline><Pgraph>None. </Pgraph><SubHeadline>Competing interests</SubHeadline><Pgraph>The authors declare that they have no competing interests.</Pgraph></TextBlock> <References linked="yes"> <Reference refNo="1"> <RefAuthor>Yadav RK</RefAuthor> <RefAuthor>Verma UP</RefAuthor> <RefAuthor>Sajjanhar I</RefAuthor> <RefAuthor>Tiwari R</RefAuthor> <RefTitle>Frenectomy with conventional scalpel and Nd:YAG laser technique: A comparative evaluation</RefTitle> <RefYear>2019</RefYear> <RefJournal>J Indian Soc Periodontol</RefJournal> <RefPage>48-52</RefPage> <RefTotal>Yadav RK, Verma UP, Sajjanhar I, Tiwari R. 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