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JORMAS-143; No. of Pages 5

J Stomatol Oral Maxillofac Surg xxx (2018) xxx–xxx

Available online at

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Original Article

Patient perceptions and clinical efficacy of labial frenectomies using

diode laser versus conventional techniques
A. Uraz a,*, F.D. Çetiner a, S. Cula b, B. Guler c, S. Oztoprak a
a
Gazi University, Faculty of Dentistry, Department of Periodontology, 8. cadde, 82. Sok 06510 Emek, Ankara, Turkey
b
Başkent University, Faculty of Commercial Sciences, Department of Insurance and Risk, Ankara, Turkey
c
Dumlupınar University, Faculty of Dentistry, Department of Periodontology, Kütahya, Turkey

A R T I C L E I N F O A B S T R A C T

Article history: Introduction: The aim of present study was to compare the keratinized gingival tissue measurements,
Received 31 August 2017 degree of subjective complaints and functional complications of using an 980 nm diode laser versus a
Accepted 29 January 2018 scalpel for labial frenectomies.
Material and methods: Thirty-six patients requiring labial frenectomies, between 14 and 51 years old,
Keywords: were randomly assigned to either scalpel or diode laser treatments. The soft tissue measurements,
Diode lasers including the keratinized gingiva width (KGW), attached gingiva width (AGW) and attached gingiva
Surgery
thickness (AGT), were recorded before surgery, immediately after, one week later and one, three and six
Frenectomy
Postoperative complications
months after surgery. In addition, the functional complications and the morbidity (level of pain, swelling
Oral soft tissue 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.
C 2018 Elsevier Masson SAS. All rights reserved.

1. Introduction A labial frenectomy aims to completely remove the excessive

The labial frenulum is composed of fibrous, muscular, or
fibromuscular tissue, and is covered with a mucosal membrane,
extending from the interdental surface of the upper mucosa to the
alveolar or gingival mucosa and the underlying periosteum
between the central incisors. It acts as a flexible checkrein,
limiting the movement of the cheeks and lips. In many abnormal
cases, there are restrictive problems associated with lip movement,
aesthetics, interincisal diastema and stability of the denture. Direct
tension exerted on the marginal gingiva leads to the accumulation
of biofilm, inflammation and pocket formation, as well as a
decrease in the keratinized gingival tissue. The treatment of
such mucogingival problems includes conventional and laser
surgery [1–3].
* Corresponding author.
E-mail address: ahuuraz@gazi.edu.tr (A. Uraz).
interdental tissue, including its attachment to the underlying bone
and reduce the tension of the marginal gingival tissues to
overcome these limitations. It also prevents diastema relapse
and reconstruction of the normal anatomy in the area and
improves the aesthetics, while helping to prevent periodontal
conditions [1,2,4]. The conventional technique, using scalpels and
periodontal knives, has been used for many years; however,
modern technology, like laser surgery, now offers an alternative
mode of treatment. Carbon dioxide, neodymium-doped yttrium
aluminum garnet (Nd:YAG), argon, erbium YAG (Er:YAG) and
diode lasers are commonly used in frenectomies and other soft
tissue procedures for periodontal surgery [5,6].
The use of diode lasers in soft tissue surgery has gained
popularity over the past few years. The diode wavelength
absorption depth in water, especially in 810–980 nm wavelength
diodes, is several times greater than that of the Nd:YAG (1004 nm)
laser, but not quite as rapid as with the argon laser [7,8]. The oral
tissue is composed of > 90% water; therefore, a diode laser is easy
and effective for use in intraoral soft tissue surgery, including

https://doi.org/10.1016/j.jormas.2018.01.004
2468-7855/ C 2018 Elsevier Masson SAS. All rights reserved.

Please cite this article in press as: Uraz A, et al. Patient perceptions and clinical efficacy of labial frenectomies using diode laser versus
conventional techniques. J Stomatol Oral Maxillofac Surg (2018), https://doi.org/10.1016/j.jormas.2018.01.004
G Model
JORMAS-143; No. of Pages 5
2 A. Uraz et al. / J Stomatol Oral Maxillofac Surg xxx (2018) xxx–xxx
frenectomy, because of its affinity for wet tissues. The main
advantages of the diode laser are its smaller size, portability,
minimum setup time and lowest price of all surgical lasers
currently available [8,9]. These lasers have become popular for
aesthetic soft tissue procedures and mucogingival problems (such
as in a frenectomy, gingivectomy, or recontouring), as both a
definitive treatment and with restorative dentistry, because of the
notable surgical cutting efficiency in well-vascularized tissues
[7,10,11].
The main objective of the present study was to compare labial
frenula reinsertion and keratinized tissue differences following a
frenectomy performed with a diode laser or conventional surgery.
The study also aimed to determine and compare the soft tissue
alteration and the degree of patient perception, during and after
these two different frenectomy techniques.
2. Materials and methods
2.1. Subjects and study design
The study, designed as a randomized prospective controlled
clinical trial, was conducted to compare the clinical outcomes of
labial frenectomies performed using conventional surgery or a
diode laser. Thirty-six patients (28 females and 8 males) between
14 and 51 years old were selected from those patients referred to
the Faculty of Dentistry at Gazi University and Faculty of Dentistry,
Dumlupınar University between February 2015 and May 2017. All
of the patients requiring labial frenectomies were randomly
assigned into two groups: G1 (n = 20) was treated with a diode
laser1 (2.8 W continuous wave mode, wavelength 980 nm), and G2
(n = 16) received conventional scalpel surgery.
Those subjects with maxillary anterior frenula extending to the
interdental papilla of the central incisors, those undergoing labial
frenectomies for orthodontic, prosthodontic, or periodontal
treatment, and those with no surgical contraindications were
included in this study. The patients were excluded if they exhibited
poor oral hygiene, received periodontal therapy, were being
treated with antibiotics, anti-inflammatories, or analgesics during
the previous three months, or if they had any systemic conditions
that could affect oral surgery.
Ethical approval was obtained from the Institutional Review
Board of Dumlupınar University (2015-KAEK-86/05-39) and
written informed consent was obtained from all of the patients.
The trial is registered at ClinicalTrials.gov, number NCT03156387.
2.2. Surgical technique
All of the surgeries were performed by the same surgeon,
following the principles of antisepsis, with local anesthesia,
incision, hemostasis and excision of the frenulum. The conven-
tional surgical technique was as follows:
 topical anesthesia (20% benzocaine);
 local anesthesia using the bilateral vestibular infiltration
technique, with 0.6 mL (one third of the carpule contents) of
4% articaine and 1:200,000 epinephrine;
 hemostatic clamping of the frenulum;
 excision of the whole band of tissue, together with its alveolar
attachment, with a 15 C scalpel blade;
 relaxation and unbending of any fibrous adhesions to the
underlying periosteum;
 simple suturing with 5-0 silk thread.
1 3
SIROLaser Advance, Sirona, Germany.
Please cite this article in press as: Uraz A, et al. Patient perceptions and clinical efficacy of labial frenectomies using diode laser versus
conventional techniques. J Stomatol Oral Maxillofac Surg (2018), https://doi.org/10.1016/j.jormas.2018.01.004
A 2.8 W, 980 nm diode laser in continuous wave mode with an
air-cooling handpiece was used in the alternative labial frenec-
tomy technique. The frenulum was held with a hemostat and a
repeated continuous wave mode was applied for the excision. It
was also used to remove the periosteal adhesion. The remnants of
the ablated tissue were removed with saline and no sutures were
placed after the diode laser treatment.
Both groups received the following postoperative instructions:
 abstain from mechanical trauma;
 brushing;
 chewing;
 flossing around surgical area for one week.
They were told to use analgesics as necessary and were called
for follow-ups one week, one month and 3 months after the
surgery.
2.3. Clinical parameters and scoring method
The whole mouth records of each participant served as a basis
for the clinical periodontal diagnoses. Prior to the frenectomy, the
same investigator recorded the following parameters: plaque
index (PLI), gingival index (GI), pocket probing depth (PD), clinical
attachment level (CAL) and bleeding on probing (BOP). All of the
clinical parameters were measured at six sites per tooth (mesio,
mid, and distobuccal and mesio, mid and distopalatal) using a
Williams periodontal probe2 calibrated in millimeters.
The patients were instructed to record the postoperative
degrees of pain, redness, swelling and functional complications,
including chewing and speech, on a 10 cm horizontal visual analog
scale (VAS), by placing a vertical mark between the two endpoints,
from the first through seventh days. The scale was graded from left
to right with values ranging from ‘‘0’’ (no pain, functional
complications, discomfort, swelling or redness) to ‘‘10’’ (worst
pain, extreme functional complications, extreme discomfort,
extreme swelling and extreme redness). The keratinized gingiva
width (KGW), attached gingiva width (AGW) and attached gingiva
thickness (AGT) were also recorded before the surgery. Postopera-
tive analyses were performed at four separate times:
 immediately;
 at the first week;
 at the first and third months after surgery.
The patients in each group were also asked if they required
anesthesia during the operation and analgesics after the operation.
2.4. Statistical method
The statistical analysis of the results was done using the
Statistical Package for Social Sciences3. Non-parametric tests were
chosen for the continuous variables because the data were not
distributed normally, and the comparisons between the groups
were analyzed using the Mann–Whitney U test. The time-
dependent intragroup data were analyzed using the Wilcoxon
rank sum test and the categorical variables between the groups
were analyzed using the x2 or Fisher’s exact test. Repeated
measurements were performed and the results were shown as the
mean  SD. A P value < 0.05 was considered to be statistically
significant. To achieve a power of 80%, the minimum required sample
size was determined to be 15 in the paired study groups.
2
Nordent Manufacturing Inc., Elk Grove Village, IL, USA.
SPSS v.17.0; SPSS Inc., Chicago, USA.
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A. Uraz et al. / J Stomatol Oral Maxillofac Surg xxx (2018) xxx–xxx 3

3. Results
The investigation was carried out on 40 patients, but only
36 patients (28 females and 8 males, age range from 14 to 51 years
old) completed the study; four of the patients were excluded due to
non-attendance. Twenty patients underwent labial frenectomies
with the diode laser (G1) and 16 were treated with conventional
surgery (G2). All of the patients (n = 16, 100%) treated using a
scalpel required local anesthesia; however, only eight patients
(n = 20, 40%) in the laser group required anesthesia. During
surgery, all of the patients showed sufficient coagulation in the
cutting region in the laser group and no bleeding occurred during
the procedure. A significant difference was observed in the
suturing between the procedures; none of the laser surgery sites
required suturing, while all of the conventional surgical procedure
sites required it.
The plaque accumulation was minimal and the gingival health
was excellent in all of the subjects throughout the study. Table 1
shows the data concerning the clinical parameters. The clinical
parameter scores (PLI, GI, PD and CAL) were similar in both groups,
without any statistically significant differences between G1 and G2
(P > 0.05).
The comparison of the mean VAS scores on the levels of pain,
swelling and redness for both groups, recorded on the first through
seventh postoperative days, is summarized in Table 2. The results
showed that there were no significant differences in the VAS scores
for pain (P = 0.961), swelling (P = 0.960) or redness (P = 0.943)
between the groups. However, lower VAS pain scores were
observed in the laser group when compared with the conventional
technique, except for the second day. Only the VAS swelling score
on the first day was higher in the laser group than in the scalpel
group. Moreover, the analysis showed similar VAS redness scores
between the groups. The only difference was found on the fifth day,
with the laser group displaying significantly lower swelling and
redness scores. In addition, an intragroup comparison of the pain,
swelling and redness for each group was analyzed. The VAS pain
Table 1
The mean and standard deviations of periodontal parameters.
Group 1 (diode laser) Group 2 (scalpel)
n = 20 n = 16
Mean  std. deviation Mean  std. deviation
PLI (0 to 3) 0.48  0.31 0.58  0.32
GI (0 to 3) 0.41  0.27 0.53  0.40
PD (mm) 1.38  0.43 1.41  0.46
CAL (mm) 1.38  0.43 1.41  0.46
BOP (%) 0.04  0.05 0.03  0.07
Normally distributed data are expressed as means and standard deviations.
*
P < 0.05: statistically significant.
scores were significantly higher on the first day when compared
with the third, fourth, fifth, sixth and seventh days in the laser
group (P < 0.001). Within the conventional group, the VAS pain
scores did not show any significant differences at any time point
(P > 0.05). The similar comparison results in the VAS scores for
swelling and redness were found to be significantly different
within both groups between the first and seventh days, when
compared with one another (P < 0.001).
The comparison of the mean VAS scores for discomfort
associated with speaking and chewing, for both groups (postoper-
ative first through seventh days), is summarized in Table 3. The
analysis showed that the VAS speaking discomfort scores were
higher in the conventional group than in the laser group on the
first, second and third postoperative days, but these differences
were not statistically significant (P > 0.05). In the conventional
group, the VAS chewing discomfort scores were significantly
higher than in the laser group; the differences were statistically
significant on the first and second days (P < 0.05). The analysis
showed that there were no significant differences in the VAS
speaking and chewing discomfort scores within either group
between the time points (P > 0.05).
Table 4 shows the data concerning the clinical soft tissue
measurements. We determined a statistically significant gain in
the KGW, AGW and AGT after the operation in the conventional
and laser groups; however, there was no significant difference
between the study groups (P > 0.05). These results remained stable
during first month, but a few frenulum attachment recurrences
began to occur one month after the operation in both groups.
4. Discussion
Laser treatment is often applied as an alternative to scalpel
surgery for several soft tissue procedures, including frenectomy,
gingivectomy, gingivoplasty, de-epithelization of reflected peri-
odontal flaps, removal of granulation tissue, second-stage expo-
sure of dental implants, lesion ablation, incisional and excisional
biopsies of benign and malignant lesions, irradiation of aphthous
ulcer, coagulation of free gingival graft donor sites and gingival
depigmentation [7,10,12–14].
Thirty-six patients requiring labial frenectomies were exam-
P value*
ined in this study; 20 were treated using a diode laser and 16 were
treated with conventional surgery. A conventional frenectomy
surgery can expose a large triangular-shaped wound area and
0.339 > 0.05
0.324 > 0.05
sutures must be used to close the operation area due to bleeding.
0.877 > 0.05 Previous studies have reported that the diode laser is an excellent
0.877 > 0.05 soft tissue surgical laser [6,8,11,15]. It precisely incises and
0.776 > 0.05 coagulates the gingiva and mucosa and can be used for sulcular
debridement or curettage of the soft tissue. Surgery can be safely
performed using a diode laser because the laser irradiation is

Table 2
The comparison of VAS scores of pain, swelling and redness between groups.

Group 1 (diode laser) Group 2 (scalpel) P value

n = 20 n = 16
Mean  std. deviation Mean  std. deviation

Pain Swelling Redness Pain Swelling Redness

1st day 0.34  0.59 1.11  0.56 1.03  0.60 0.55  1.26 0.85  0.77 1.03  0.82 > 0.05
2nd day 0.30  0.74 0.68  0.48 0.81  0.48 0.09  0.20 0.75  0.69 0.64  0.60 > 0.05
3rd day 0.00  0.00 0.29  0.45 0.23  0.37 0.006  0.02 0.45  0.65 0.31  0.33 > 0.05
4th day 0.00  0.00 0.13  0.30 0.13  0.41 0.00  0.00 0.14  0.27 0.13  0.13 > 0.05
5th day 0.00  0.00 0.01  0.06 0.00  0.00* 0.00  0.00 0.07  0.25 0.05  0.08* > 0.05
*
0.008
6th day 0.00  0.00 0.00  0.00 0.00  0.00 0.00  0.00 0.00  0.00 0.00  0.00 > 0.05
7th day 0.00  0.00 0.00  0.00 0.00  0.00 0.00  0.00 0.00  0.00 0.00  0.00 > 0.05

Normally distributed data are expressed as means and standard deviations; VAS: Visual Analog Scale.
*
P < 0.05: statistically significant.

Please cite this article in press as: Uraz A, et al. Patient perceptions and clinical efficacy of labial frenectomies using diode laser versus
conventional techniques. J Stomatol Oral Maxillofac Surg (2018), https://doi.org/10.1016/j.jormas.2018.01.004
G Model
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4 A. Uraz et al. / J Stomatol Oral Maxillofac Surg xxx (2018) xxx–xxx

Table 3 treated with the laser experienced less postoperative pain and
The comparison of VAS scores of discomfort associated with speaking and chewing
bleeding after the first, third and seventh days [15]. There were
between groups.
higher pain scores in days 1–3 in the scalpel-treated patients;
Group 1 (diode laser) Group 2 (scalpel) P value however, the swelling score was lower in the laser-treated group
n = 20 n = 16
than in the conventional group on days 3–5.
Mean  std. deviation Mean  std. deviation
Many investigators have also reported the absence of postop-
Speaking Chewing Speaking Chewing erative pain and edema after laser procedures including diode laser
1st day 0.06  0.18 0.02  0.11* 0.32  0.71 0.56  1.19* > 0.05 [1,2,15]. However, the pain outcomes in this study failed to
*
0.049 demonstrate statistically significant postoperative differences
2nd day 0.03  0.15 0.01  0.06* 0.06  0.15 0.20  0.35* > 0.05
*
between the groups (P > 0.05). The results showed that there
0.029
3rd day 0.00  0.00 0.00  0.00 0.02  0.06 0.05  0.13 > 0.05 were no significant differences in the VAS pain (P = 0.961), swelling
4th day 0.00  0.00 0.00  0.00 0.00  0.00 0.03  0.12 > 0.05 (P = 0.960) and redness (P = 0.943) scores between the groups,
5th day 0.00  0.00 0.00  0.00 0.00  0.00 0.02  0.07 > 0.05 but lower VAS pain scores were observed in the laser group
6th day 0.00  0.00 0.00  0.00 0.00  0.00 0.00  0.00 > 0.05 when compared with the conventional technique, except on the
7th day 0.00  0.00 0.00  0.00 0.00  0.00 0.00  0.00 > 0.05
second day.
Normally distributed data are expressed as means and standard deviations; VAS: The advantages of laser surgery include higher precision when
Visual Analog Scale.
*
compared to a scalpel, resulting in less pain, bleeding, swelling,
P < 0.05: statistically significant.
restricted function and reduced food intake due to sutures [10,14–
poorly absorbed by the tooth structure in close proximity to the 16]. Stübinger et al. showed that various soft tissue laser
enamel [6,7]. Although Nd:YAG lasers can be useful for oral soft procedures have excellent effects on the oral tissues [11]. In
tissue surgery, they produce thermal effects in the adjacent tissues. addition, other studies have demonstrated that laser surgeries on
Er:YAG lasers have a high water absorption capacity and less soft tissues culminated in less intra- and postoperative bleeding
thermal risks for mineralized surfaces. They have been used mostly and pain due to the excellent cutting and coagulation abilities of
for the removal of subgingival biofilm, treatment of melanin lasers. In addition, the laser technique prevents suture removal
pigmentation and irradiation of the root surface. Er:YAG laser pain at one week, often related to sutures buried in the mucosa.
therapy can be an adjunctive method for conventional debride- None of patients in this present study needed sutures following the
ment because of its antibactericidal potency [10,13,16]. However, frenectomies with the diode laser. The absence of sutures after
there are no studies comparing both the clinical soft tissue laser surgery contributed to less discomfort when compared to the
measurements and degree of subjective complaints and functional conventional technique, according to the results of the present
complications during and after diode laser versus scalpel assisted study. These results are similar to the findings of other studies; for
frenectomies. Therefore, the goal of this study was to compare the example, D’Arcangelo et al. demonstrated that the laser repair was
clinical soft tissue measurements and degree of subjective equivalent to the scalpel repair and that the clinical use of a low-
complaints and functional complications during and after diode level diode laser can be a good alternative to scalpel incision and
laser and scalpel-assisted frenectomy techniques. suture repair [12].
In this study, all of the conventional frenectomies were After frenectomies using the conventional technique, the
performed with infiltration anesthesia, compared to 40% of the patients often complained about functional complications, such
procedures using diode laser surgery and this was significantly as speaking and chewing and in our study, the laser group
different (P < 0.001). It was also observed that those patients exhibited a lesser degree of functional complications while
treated with the diode laser required less analgesic after the chewing and speaking on the first through third days. All the
operation in the present study. Similar to our results, Kafas et al. patients in our study tolerated the diode laser surgical complica-
and Fornaini et al. performed laser procedures without infiltration tions well. Moreover, the analysis of the present study data showed
anesthesia and sutures [17,18]. In their studies, they used only that the VAS speaking scores were higher in the conventional
topical anesthesia and reported less postsurgical pain and group than in the laser group on the first, second and third
discomfort. In frenectomies, the principal advantages of the diode postoperative days (P > 0.05). Many authors have reported that
laser are the reduced operation time and avoidance of needle- laser frenectomies led to comfortable postoperative periods,
infiltrated anesthesia. Ize-Iyamu et al. compared the soft tissue with less patient complaints, such as difficulty in speaking and
diode laser to the scalpel technique and showed that those patients chewing [1,2].

Table 4
Comparison of soft tissue measurements (KGW, AGW, AGT) after diode laser and scalpel techniques.

Group 1 (diode laser) Group 2 (scalpel) P value

n = 20 n = 16
Mean  Std. deviation Mean  std. deviation

KGW AGW AGT KGW AGW AGT

Before surgery 1.95  1.23* 0.85  0.93* 1.10  0.60 1.25  1.34* 0.50  0.81* 1.12  0.34 > 0.05#
*
0.001
After surgery 8.80  2.33* 7.55  2.13* 1.20  0.41 8.62  1.92* 7.31  1.81* 1.18  0.40 > 0.05#
*
0.001
1st week 8.70  2.36* 7.45  2.16* 1.20  0.41 8.62  1.92* 7.31  1.81* 1.18  0.40 > 0.05#
*
0.001
* * * *
1st month 8.10  1.97 6.84  1.95 1.20  0.41 7.87  1.99 6.62  1.89 1.18  0. 40 > 0.05#
*
0.001
3rd month 6.85  2.36* 5.65  2.34* 1.20  0.41 7.18  1.86* 6.12  1.85* 1.18  0.40 > 0.05#
*
0.001

Data are expressed as mean (SD). KGW: keratinized gingiva width; AGW: attached gingiva width; AGT: attached gingiva thickness.
#
Statistically significant was P < 0.05 between groups.
*
Statistically significant was P < 0.001 within group.

Please cite this article in press as: Uraz A, et al. Patient perceptions and clinical efficacy of labial frenectomies using diode laser versus
conventional techniques. J Stomatol Oral Maxillofac Surg (2018), https://doi.org/10.1016/j.jormas.2018.01.004
G Model
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A. Uraz et al. / J Stomatol Oral Maxillofac Surg xxx (2018) xxx–xxx
Based on the results of previous studies, the use of a laser for
soft tissue surgery offers less bleeding, particularly in highly
vascular oral tissues [3,11,14,19,20]. In addition, some authors
have reported that laser created wounds heal more quickly and
produce less scar tissue than those using conventional techniques
[1,2,12]. The use of a diode laser in a frenectomy provides a clearly
visible surgical site. In addition, it reduces the operation time,
postoperative infection risk and postsurgical edema. For example,
Kafas et al., Pick and Colvard and Fornaini et al. showed that the
operating time was also reduced by the use of a laser and well as
the bleeding and postoperative pain [16–18].
In the literature, there are various diode laser frenectomy
studies, but none of them evaluated the gains in the KGW, AGW or
AGT after the surgery. To the best of our knowledge, this is the first
study comparing the effects of a diode laser and conventional
technique on the KGW, AGW and AGT outcomes; therefore, a direct
comparison with other studies is not possible. In this study,
statistically significant gains in the KGW, AGW and AGT were
observed after the surgeries in both the laser and scalpel treated
groups; however, no significant differences were shown between
the two groups (P > 0.05). Small reductions in the gains of the
KGW, AGW and AGT were observed during the first month and
further in the third month. Overall, the frenulum attachment
recurrence was not statistically significant between the time
periods in either group.
For soft tissues, the diode laser surgical technique offers better
tissue manipulation, hemostasis, sterilization, reduced swelling,
minimal scaring, minimal trauma, reduced intraoperative and
postoperative pain, high patient acceptance, no need for sutures
and no or minimal requirement for anesthesia. Despite its benefits,
care must be taken when using a diode laser. However, no soft
tissue healing or operation time advantages were evaluated in the
present study. Moreover, different types of lasers should be
compared to evaluate the gains in the keratinized gingiva width
(KGW), attached gingiva width (AGW) and attached gingiva
thickness (AGT) following a frenectomy.
The use of a diode laser as an alternative and supplementary
treatment method in soft tissue surgery has gained popularity over
the past few years. Within the limits of the present study, it can be
concluded that:
 both the conventional technique and diode laser provided
statistically significant gains in the KGW, AGW and AGT after the
frenectomies;
 the use of an 810 nm diode laser causes less postsurgical patient
discomfort with regard to pain and functional complications
(chewing and speaking).
Overall, the present study results show that the use of a diode
laser offers a safe and impressive frenectomy alternative.
Please cite this article in press as: Uraz A, et al. Patient perceptions and clinical efficacy of labial frenectomies using diode laser versus
conventional techniques. J Stomatol Oral Maxillofac Surg (2018), https://doi.org/10.1016/j.jormas.2018.01.004
5
Disclosure of interest
The authors declare that they have no competing interest.
References
[1] Haytac MC, Ozcelik O. Evaluation of patient perceptions after frenectomy
operations: a comparison of carbon dioxide laser and scalpel techniques. J
Periodontol 2006;77:1815–9.
[2] Kara C. Evaluation of patient perceptions of frenectomy: a comparison of
Nd:YAG laser and conventional techniques. Photomed Laser Surg 2008;26(2):
147–52.
[3] Medeiros Júnior R, lcino Gueiros LA, enrique Silva IH, de Albuquerque Carvalho
A, arneiro Leão JC. Labial frenectomy with Nd:YAG laser and conventional
surgery: a comparative study. Lasers Med Sci 2015;30(2):851–6.
[4] Chaubey KK, Arora VK, Thakur R, Narula IS. Perio-esthetic surgery: using LPF
with frenectomy for prevention of scar. J Indian Soc Periodontol 2011;15(3):
265–9.
[5] Aras MH, Göregen M, Güngörmüş M, Akgül HM. Comparison of diode laser and
Er:YAG lasers in the treatment of ankyloglossia. Photomed Laser Surg
2010;28(2):173–7.
[6] Akbulut N, Kursun ES, Tumer MK, Kamburoglu K, Gulsen U. Is the 810-nm
diode laser the best choice in oral soft tissue therapy? Eur J Dent 2013;7(2):
207–11.
[7] Haveman L, Wilson C. Lasers in periodontics: an overview. J Oral Health
Community Dent 2010;4:29–34.
[8] Azma E, Safavi N. Diode laser application in soft tissue oral surgery. J Lasers
Med Sci 2013;4(4):206–11.
[9] Glazer H. Soft tissue diode laser. Oral Health 2010;100(7):22, http://www.
oralhealthgroup.com/features/soft-tissue-diode-laser/.
[10] Stabholz A, Zeltser R, Sela M, Peretz B, Moshonov J, Ziskind D, et al. The use of
lasers in dentistry: principles of operation and clinical applications. Compend
Contin Educ Dent 2003;24(12):935–48 [Quiz 949].
[11] Stübinger S, Saldamli B, Jürgens P, Ghazal G, Zeilhofer HF. Soft tissue surgery
with the diode laser – theoretical and clinical aspects. Schweiz Monatsschr
Zahnmed 2006;116(8):812–20.
[12] D’Arcangelo C, Di Nardo Di Maio F, Prosperi GD, Conte E, Baldi M. A preliminary
study of healing of diode laser versus scalpel incisions in rat oral tissue: a
comparison of clinical, histological and immunohistochemical results. Oral
Surgery Oral Med Oral Pathol Oral Radiol Endod 2007;103(6):764–73.
[13] Genovese MD, Olivi G. Use of laser technology in orthodontics: hard and soft
tissue laser treatments. Eur J Paediatr Dent 2010;11(1):44–8.
[14] Romanos G, Nentwig GH. Diode laser (980 nm) in oral and maxillofacial
surgical procedures: clinical observations based on clinical applications. J Clin
Laser Med Surg 1999;17(5):193–7.
[15] Ize-Iyamu IN, Saheeb BD, Edetanlen BE. Comparing the 810 nm diode laser
with conventional surgery in orthodontic soft tissue procedures. Ghana Med J
2013;47(3):107–11.
[16] Pick RM, Colvard MD. Current status of lasers in soft tissue dental surgery. J
Periodontol 1993;64(7):589–602.
[17] Fornaini C, Rocca JP, Bertrand MF, Merigo E, Nammour S, Vescovi P. Nd: YAG
and diode laser in the surgical management of soft tissues related to ortho-
dontic treatment. Photomed Laser Surg 2007;25(5):381–92.
[18] Kafas P, Stavrianos C, Jeries W, Upile T, Vourvachis M, Theodoridis M, et al.
Upper-lip laser frenectomy without infiltrated anaesthesia in a paediatric
patient: a case report. Cases J 2009;2:7138.
[19] Matthews DC. Seeing the light– the truth about soft tissue lasers and nonsur-
gical periodontal therapy. J Can Dent Assoc 2010;76(2):a30.
[20] Vescovi P, Corcione L, Meleti M, Merigo E, Fornaini C, Manfredi M, et al.
Nd:YAG laser versus traditional scalpel. A preliminary histological analysis
of specimens from the human oral mucosa. Lasers Med Sci 2010;25(5):
685–91.