ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Laser Frenectomy Post-Operatively Less Uncomfortable Than Scalpel Frenectomy
Clinical Question In a patient with a pronounced frenulum labii superioris, or lingual frenulum, does laser therapy provide a faster healing time, faster healing time and less pain when compared to a surgical frenectomy procedure?
Clinical Bottom Line Laser frenectomy results in significantly less postoperative pain and impairment of function compared to conventional surgical frenectomy. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17076605Haytac/2006Age Group: 18-26 years old, 24 females, 16 males, Carbon dioxide Laser therapy n= 20, Scalpel Techniques n= 20Randomized Controlled Clinical Trial
Key resultsThe VAS scores (visual analogue scale) of pain on days 1 and 7 were significantly lower in the laser group compared to the conventional technique (P <0.0001). In addition, postoperative functional complications assessed by the chewing and speaking VAS scores were also significantly lower in the laser group (P <0.0001). The patients treated with the CO2 laser had significantly less postoperative pain and functional complications compared to scalpel surgery. Patients often experience post-surgical bleeding and pain, and sutures can further increase bleeding and pain when they come into contact with food. The laser technique offers some advantages, such as a relatively bloodless surgical and post-surgical event; the ability to precisely coagulate, vaporize, or cut tissue; sterilization of the wound site; minimal swelling and scarring; no suturing in most cases; little mechanical trauma; reduction of surgical time; decreased post-surgical pain; and high patient acceptance.
#2) 20728254Puthusseray/2010Laser Therapy for Lingual Frenectomy, n=21Clinical Study
Key resultsMore than 50% of the patients responded to the laser frenectomy therapy with no pain, no bleeding, no swelling, improved speech, improved tongue movement, and improved oral hygiene. The article recommended the use of lasers for the release of the frenulum in young patients as their use reduces postoperative pain and swelling, and avoids unnecessary pain and postoperative complications. The risk of postoperative bleeding was also considerably low compared with the data reported with conventional methods. Moreover, healing took less time than the average reported following scalpel dissection.
#3) 17803382Kato/2007CO2 Laser Irradiation Therapy, n=76, Age: 1-15 years oldClinical Study
Key resultsIn the study there was no postoperative bleeding, no suturing, very little postoperative pain, and complete wound healing with perfect epithelialization after 3 weeks. The results clearly showed the following advantages of the CO2 laser as a vital instrument in surgical procedures: The device efficiently cut soft tissue with minimal bleeding, providing a clear operative field during the operation. The was no need for sutures, as the bleeding was well controlled during and after the procedure. The procedure was simple and less time consuming. There was no post surgical infection. Contraction and scarring of the wound was decreased or eliminated.
#4) 18341414Kara/200840 patients with mucogingival problems because of labial frenums.Randomized Controlled Trial
Key resultsPatients were included that had both maxillary and mandibular frenum treatment required. Group 1 received surgery treatment first and laser treatment one week later while Group 2 received laser treatment first and surgery second, thus patient perceptions could be assessed objectively. For both groups, the decrease in clinical index values after periodontal treatment was significantly improved compared with pretreatment values. Laser therapy significantly outperformed surgery treatment for pain, chewing, speaking and use of analgesia.
Evidence Search #12 Search frenectomy Related Citations for PubMed (Select 17803382)#8 Search (laser frenectomy) AND less tissue scarring #5 Search (#4) AND laser therapy #4 Search Frenectomy #58 Search (#57) AND lingual frenectomy #57 Search Carbon dioxide laser #56 Search lingual frenum#53 Related Citations for PubMed (Select 19127931) frenum Search (CO 2 laser irradiation) AND #1 Search Frenectomy
Comments on
The Evidence
Haytac/2006: This study was a randomized controlled clinical trial. The groups were similar at the start, with a more than 80% completion rate. The groups were not treated the same in the type of frenectomy therapy applied. There was an adequate follow-up with all of the individuals. I was not able to determine if this study was a double blind case. The compliance rate was adequate, with recall bias unlikely and no competing interests. This study would have been of even higher validity if it were a double blind case, but overall it was the best example of good evidentiary support for the clinical question. Puthussery/2010: The study design was a clinical study. A continuous CO2 laser was used to treat 76 young patients, with more than 89% completion rate. The patients were treated the same and they all had an adequate follow-up. This particular case was not a double-blind study. The compliance of the chosen individuals was adequate with no competing interests. I was not able to determine if the recall bias was unlikely. This article was of less validity than desired. Kato/2007: This study design was a clinical study. An 80% completion rate was reported. All of the groups were treated the same with adequate follow-up. The compliance was adequate. Recall bias was unlikely and there were no competing interests. This article was of less validity than desired.
Applicability Some potential harms from the CO2 laser beam are the beam possibly being reflected from shiny metal surfaces, such as retractors or mouth mirrors, causing eye injury. Protective eye wear must be worn by the operator and assistants. The patient’s eyes, throat, and delicate oral tissues outside the surgical site must be protected from accidental beam impact through use of safety glasses and wet towels or gauze packs. The patients would highly benefit by lacking the need of sutures, and less muscle damage would occur. The elimination of postoperative sutures and less pain were highly indicated.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Frenectomy, CO2 laser, Oral Surgery
ID# 769
Date of submission: 03/23/2011spacer Revised: 12/15/2011
E-mail stokess@livemail.uthscsa.edu
Author Stephanie Stokes
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Cristina Villar, DDS
Faculty mentor/Co-author e-mail Villar@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Gray, Minda; Kang, James; Ray, Ramon (San Antonio, Texas) on 01/06/2014
A PubMed search on laser compared to conventional surgical frenectomy postoperative complication was performed Jan 6, 2014. A more recent publication was found: De Santis D, 2013, PMID: 23903445 . This Controlled Case study showed similar results as those published in this CAT, stating that laser frenectomy has unquestionable advantages when compared to conventional techniques.
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