Reduced pain and other benefits of the 10.6-micrometer CO₂ laser: As seen in clinical studies

Post-Op PAIN related Quotations from soft tissue 10,600 nm CO₂ laser oral surgery case studies (frenectomies, vestibuloplasties, tissue ablation, etc.)

Visit Laser Tissue Interaction for CO₂ laser-tissue interaction and ablation/coagulation physics discussion.

from Haytac M, Ozcelik O. Evaluation of patient perceptions after frenectomy operations: a comparison of carbon dioxide laser and scalpel techniques. J Periodontol 2006;77(11):1815-1819.

• “In our study, patients treated with the CO₂ laser had significantly less postoperative pain and functional complications compared to scalpel surgery.”
• “The results indicated patients treated with the CO₂ laser had less postoperative pain and fewer functional complications (speaking and chewing) (P <0.0001 each) and required fewer analgesics (P <0.001) compared to patients treated with the conventional technique.”
• “This clinical study indicates that CO₂ laser treatment used for frenectomy operations provides better patient perception in terms of postoperative pain and function than that obtained by the scalpel technique. Considering the above advantages, when used correctly, the CO₂ laser offers a safe, effective, acceptable, and impressive alternative for frenectomy operations.”
• “A CO₂ surgical laser unit with a flexible hollow-fiber delivery system and a non-contact, air-cooling hand-piece was used… No sutures were placed after CO₂ laser treatment. … The superpulse mode, which was used in this study, releases bursts of higher peak powers and shorter pulse durations in the microsecond range. This mode allows the surgeon to deposit pulses of higher peak power into tissue with control, to confine the exposure to pulses that are within the thermal relaxation time of the tissue (which is the time needed by the tissue to release the absorbed heat via conduction or circulation), and to use pulse repetition rates that allow cooling between individual pulses to reduce heat accumulation.”

from López-Jornet P, Camacho-Alonso A. Comparison of pain and swelling after removal of oral leukoplakia with CO₂ laser and cold knife: A randomized clinical trial. Med Oral Patol Oral Cir Bucal. 2013;18(1):e38–e44.

• “Pain and swelling reported by the patients was greater with the conventional cold knife than with the CO₂ laser, statistically significant differences for pain and swelling were observed between the two techniques during the first three days after surgery. Followed by a gradual decrease over one week. … The CO₂ laser causes only minimal pain and swelling, thus suggesting that it may be an alternative method to conventional surgery in treating patients with oral leukoplakia.”
• “The CO₂ laser is currently accepted as the technique of choice in the management of many soft tissue lesions in the oral and maxillofacial regions. Compared to the scalpel, the CO₂ laser affords a hemostatic effect particularly in highly vascularized areas. This in turn results in a clearer surgical field and therefore a reduction in operating time. Treatment with the laser has certain advantages, such as the selective removal of affected epithelium and minimal damage to surrounding healthy tissue, resulting in excellent wound healing with minimal or no scar tissue, and a good functional outcome.”

from Pogrel MA. The carbon dioxide laser in soft tissue preprosthetic surgery. J Prosthet Dent. 1989; 61:203-208.

• “Pain is difficult to evaluate, but, on the data obtained in this study, it seems likely that discomfort is less after laser surgery than by more conventional techniques and it is definitely less than discomfort after conventional surgery with a secondary epithelialization technique. Swelling and edema were virtually nonexistent after laser surgery.”
• “The surgical carbon dioxide laser has the ability to vaporize soft tissues with little bleeding, pain, swelling, or wound contraction. The laser was evaluated on 27 patients requiring soft tissue preprosthetic surgery, including frenectomies, tuberosity reduction, hyperplasia removal, and sulcus deepening. Surgery was performed on an ambulatory basis with no bleeding or infection. Swelling was minimal and pain, as measured on a linear pain scale, was moderate. One third of the patients required no analgesics. Wound contraction did occur but was less than is historically quoted for scalpel wounds.”
• “…it has been shown that with the laser an extension [vestibular extension] can be created with only mild-to-moderate discomfort, which is controlled with medium-strength analgesics.”
• “For frenectomies, the main advantages appear to be speed and a clean, bloodless field. … For palatal hyperplasia and soft tissue tuberosity reduction, the laser appears to be faster and cleaner with less discomfort than is normally associated with this form of surgery by other techniques…”

from Niccoli-Filho W, Neves ACC, Penna LAP, Seraidarian PI, Riva R. Removal of epulis fissuratum associated to vestibuloplasty with carbon dioxide laser. Lasers in Medical Science. 1999;14(3):203–206.

•  “…patients reported that minimal discomfort was felt only during the first 24 h after surgery.”
• “The use of carbon dioxide (CO₂) laser for the surgical removal of epulis lesions has resulted in many significant improvements including convenient mucosa removal, no bleeding or need for sutures, and minimal postoperative pain and oedema. This study is of 15 cases of removal of extensive epulis with vestibuloplasty in the maxilla and mandible that was carried out with CO₂ laser, with no postoperative complications, rapid healing, and excellent aesthetic and functional outcome, all of which allowed for more rapid placement of final prosthesis.”
• “It was noted that with this type of surgery the principal advantages over conventional surgeries are: excellent haemostasis, minimal trauma and oedema, sterilisation of the surgical wound, minimal postoperative pain and, in most cases, no need of suture. These advantages were fully observed by us when comparing our patients to those treated conventionally.”
• “Clinical and biological studies have shown that the surgical wound created by CO₂ laser is distinctly different from the wound produced by a scalpel. Laser vaporisation causes minimal damage to the adjoining tissue and initially, a coagulum cover is formed by denatured proteins covering the surface. Although there is minimal pain in the immediate period after surgery, episodes of pain may be noted 3–4 days after surgery and can persist for one or two weeks. These episodes are usually managed with common analgesics. However, compared to conventional surgery, CO₂ laser surgery appears to cause less severe pain though with similar duration.”
• “Excellent results can be obtained using CO₂ laser for other surgeries of the buccal cavity including actinic cheilosis, vascular tumours, multiple epithelial hyperplasias and even in premalignant lesions.”

from Gama SK, de Araujo TM, Pineiro AL. Benefits of the use of the CO₂ laser in orthodontics. Lasers Med Sci. 2008 Oct;23(4):459-65.

• “Carbon dioxide lasers are now a standard of care for many oral and maxillofacial surgical procedures, as they are efficient for a variety of procedures. … There are many advantages of the use of CO₂ lasers. The hemostatic nature of the laser is of great value, as it allows surgery to be performed more precisely and accurately because the surgeon has increased visibility of the surgical field.”
• “Decreased postoperative swelling is characteristic for CO₂ laser use and allows for increased safety when performing surgery within the airway and increases the range of surgery that can be performed safely without fear of airway compromise.”
• “Tissue healing and scarring are also improved with the use of the CO₂ laser. This improvement is due to a combination of decreased lateral tissue damage, less traumatic surgery, more precise control of the depth of tissue damage, and fewer myofibroblasts in CO₂ laser wounds compared with scalpel wounds. When CO₂ lasers are used intraorally, the wounds generally heal with minimal scar formation and soft pliable residual tissue. Because of this improved healing and hemostasis, intraoral CO₂ laser wounds often can be left unsutured except when cosmetic is an issue.”
• “Although not always predictable, decreased postoperative pain can be obtained often with the use of CO₂ lasers. The physiology of this effect is still unknown, but probably relates to decreased tissue trauma and the alteration of neural transmission. As with decreased swelling, this aspect enables surgeons to perform many procedures on an outpatient basis, with patients returning to work within 1 day or even immediately in many cases. This advantage becomes most evident in the management of extremely large lesions in which traditional surgery often requires parenteral drugs for pain control…”

from Wlodawsky RN, Strauss RA. Intraoral laser surgery. Oral Maxillofac Surg Clin North Am. 2004 May;16(2):149-63.

• “The low morbidity and minimal pain generally associated with laser ablation makes it a valuable tool in the management of premalignant mucosal lesions.”

from van der Hem PS, Egges M, van der Wal JE, Roodenburg JL. CO₂ laser evaporation of oral lichen planus. Int J Oral Maxillofac Surg. 2008 Jul;37(7):630-3. doi: 10.1016/j.ijom.2008.04.011. Epub 2008 Jun 6.

• “…the reduction in pain is an interesting result.”

from Ishii J, Fujita K, Munemoto S, Komori T. Management of oral leukoplakia by laser surgery: relation between recurrence and malignant transformation and clinicopathological features. J Clin Laser Med Surg. 2004;22(1):27-33.

• “There is minimal damage to adjacent tissue; thus reducing acute inflammatory reaction and postoperative pain, swelling, edema or infection.”