Quest Journals

Journal of Medical and Dental Science Research

Volume 11~ Issue 9 (2024) pp: 103-111
ISSN(Online) : 2394-076X ISSN (Print):2394-0751
www.questjournals.org

Research Paper

Applications of Lasers in Oral and Maxillofacial Surgery –

A Review Article
Asma Yacoob1, Patel Sumaiyya2, Gurram Prashanthi3,
Lakshmi Ratan4, Jyotsna Rajan5Kaviyasri C6
1. Asma Yacoob, Undergraduate Student – Intern,Department Of Oral And Maxillofacial Surgery, SRM
Kattankulathur Dental College And Hospital, SRMIST Nagar, Kattankulathur – 603203, Chengalpet, TN, India
2. Patel Sumaiyya, Assistant Professor, Department Of Oral And Maxillofacial Surgery, SRM
Kattankulathur Dental College And Hospital, SRMIST Nagar, Kattankulathur – 603203, Chengalpet, TN, India
3. Gurram Prashanthi, Associate Professor, Department Of Oral And Maxillofacial Surgery, SRM
Kattankulathur Dental College And Hospital, SRMIST Nagar, Kattankulathur – 603203, Chengalpet, TN, India
4. Lakshmi Ratan, Assistant Professor, Department Of Oral And Maxillofacial Surgery, SRM
Kattankulathur Dental College And Hospital, SRMIST Nagar, Kattankulathur – 603203, Chengalpet, TN, India
5. Jyotsna Rajan, Assistant Professor, Department Of Oral And Maxillofacial Surgery, SRM
Kattankulathur Dental College And Hospital, SRMIST Nagar, Kattankulathur – 603203, Chengalpet, TN, India
6. Kaviyasri C, Tutor, Department Of Oral And Maxillofacial Surgery, SRM Kattankulathur Dental
College And Hospital, SRMIST Nagar, Kattankulathur – 603203, Chengalpet, TN, India
Corresponding Author: Dr. Patel Sumaiyya

ABSTRACT
LASER technology has become a cornerstone in oral and maxillofacial surgery (OMFS), transforming the field
with its precision, versatility, and minimally invasive nature. This article provides practitioners with an update
on the use of new dental instruments in daily practice to improve efficiency and reduce issues from traditional
approaches.
KEYWORDS: Laser, Application, Oral and maxillofacial surgery

Received 15 Sep., 2024; Revised 28 Sep., 2024; Accepted 30 Sep., 2024 © The author(s) 2024.
Published with open access at www.questjournas.org

I. INTRODUCTION
Maiman's successful laser demonstration in 1960 predicted its future medical applications. Today,
lasers are essential tools for Oral and Maxillofacial Surgeons (OMS), evolving from adjunctive to integral.
While the CO2 laser has been the traditional choice, advancements and new laser types have broadened their
utility. This growth has strengthened the evidence for their efficacy and safety, enhancing conventional OMS
procedures and enabling new techniques not possible with traditional tools [1].
This article's goal is to give a general review of lasers' key features, their clinical use in dentistry, particularly
oral surgery, and its benefits, drawbacks, and safety.

INITIAL USE OF LASER IN ORAL SURGERY

Strong et al. were the first oral surgeons to use CO2 lasers for various treatments, including removing
premalignant and malignant lesions. In 1974, Kaplan et al. applied lasers for oral tumor treatment. Ackermann
highlighted the use of Nd:YAG lasers for oral surgery in hemophiliacs in 1984, while in 1987, Apfelberg
utilized Argon lasers to address vascular lesions in the maxillofacial region. [3].

DEFINITION
A laser (Light Amplification by Stimulated Emission of Radiation) generates a powerful, coherent,
monochromatic beam of light through optical amplification [1]. This highly directional and in-phase light makes
lasers valuable for applications in science, medicine, industry, and communications.

*Corresponding Author: Dr. Patel Sumaiyya 103 | Page

 Applications of Lasers in Oral and Maxillofacial Surgery –A Review Article

ELECTROPHYSIOLOGY OF LASER
Lasers emit monochromatic, coherent, and collimated beams that produce various effects upon
interacting with targets. The energy can be absorbed, reflected, transmitted, or scattered, but tissue absorption is
preferred in surgery for predictable coagulation and vaporization. The "laser cavity," where the beam is
generated through stimulated emission, includes an active medium, a pumping source, and an optical
resonator[1] (Fig.1).

Figure 1 Components of laser tube

The main mechanism converts light energy into heat through photothermal effects. Energy is generated
by stimulating photons, while an optical resonator with two parallel mirrors around the active medium supports
a continuous avalanche process, producing laser light [11]. The active medium—gas, liquid, or solid—defines
the laser type and enables stimulated emission. The resulting laser beam, collimated and amplified, is delivered
to target tissues via fiber optics, hollow waveguides, or mirrored arms [1] (Fig.2a-c).

a b
c

Figure 2 (a) Fiber-optic laser (b) Hollow wave-guide laser (c) Articulated arm laser

Lenses focus the laser beam into a focal point for optimal effects. Some fiberoptic systems use quartz
or sapphire crystals for better absorption and direct contact, while others operate non-contact. Nd:YAG, CO2,
and erbium lasers emit across the spectrum and often include a visible aiming beam to help surgeons locate the
impact point, powered by standard light or a lower-power laser [1].
Surgeons control laser settings such as exposure, power, and spot size, with the smallest size at the
focal point for precision. Greater distance enlarges the spot and decreases penetration. Laser type and surgeon
speed influence thermal effects. Lasers can be used in contact mode (tip touches tissue) or non-contact mode
(beam focused from a distance)[1] (Fig 3a-b).

*Corresponding Author: Dr. Patel Sumaiyya 104 | Page

 Applications of Lasers in Oral and Maxillofacial Surgery –A Review Article

a b

Figure 3 (a) Contact mode (b) Non-contact mode

Tissue temperature varies with laser mode and surgeon speed. Lasers are either "continuous-wave" or "pulsed,"
with pulsed lasers allowing cooling intervals. Proper timing between pulses is crucial to reduce thermal effects.
Pulsed lasers can be "gated pulsed" (using an external shutter) or "true pulsed" (internally generated) [1].

INTERACTION WITH ORALTISSUES

Laser light exhibits four distinct interactions with target tissue, contingent upon the optical characteristics of the
tissue [16].

1. ABSORPTION - Laser energy is absorbed by tissue based on its wavelength, affecting the absorption
of components like water and pigments. This wavelength determines both penetration depth and absorption
extent in the tissue (Fig.4a).

2. TRANSMISSION OF LASER ENERGY- Laser energy can penetrate tissue selectively. Erbium and
CO2 lasers are rapidly absorbed at the surface, minimizing damage to surrounding areas, while Nd:YAG,
Argon, and diode lasers penetrate deeper, with effects varying by wavelength (Fig.4b).

3. REFLECTION- This property causes laser light to reflect off surfaces, reducing its effectiveness on
target tissue and posing a risk if redirected to unintended targets like the eyes (Fig.4c).

4. SCATTERING- Laser light scattering results in energy loss and reduced biological effects, potentially
causing unintentional harm by transferring heat to surrounding tissues (Fig.4d).

a b c d

Figure 4Interaction with oral tissues (a) Absorption, (b) Transmission (c) Reflection (d) Scattering

CLASSIFICATION OF LASERS [4]

1. SOFT LASERS (low energy wavelength)
● Helium-neon lasers (He-N)
● Gallium- arsenide lasers (Ga-As)

2. HARD LASERS (High energy wavelength)

● Argon lasers (Ar)
● Carbon dioxide lasers (CO2)
● Neodymium-doped yttrium aluminum garnet lasers (Nd: YAG)
● Holmium-yttrium-aluminum-garnet lasers (HO: YAG)
● Erbium (Er)

*Corresponding Author: Dr. Patel Sumaiyya 105 | Page

 Applications of Lasers in Oral and Maxillofacial Surgery –A Review Article

3. BASED ON STATE OF GAIN MEDIUM

(i) LIQUID
● Dye
(ii) MOLECULAR
● Excimers (Argon-F, Xenon-F)
(iii) GAS
● CO2
● HeN
● Ar
(iv) SOLID
● Nd:YAG
● Er: YAG
● Ruby
(v) SEMI SOLID
● Silicone

4.
● Chemical
● Dye
● Diode
● Semiconductor

SCOPE OF LASER IN OMFS

Key applications include:

1. Soft Tissue Surgery

- Lasers used for Incisions and Biopsies, Frenectomy (Fig.5), Gingivectomy and Gingivoplasty.

Figure 5Frenectomy using laser

2. Hard Tissue Surgery

- Lasers are used in Bone Surgery for cutting and contouring bone, Dental Implants.
3. Aesthetic and Cosmetic Procedures
- Scar Revision: Reducing the appearance of scars, Skin Resurfacing can be done.
4. Pain Management
- Low-Level Laser Therapy (LLLT) to reduce pain and inflammation in TMJ disorders, Nerve Regeneration:
Promoting healing in damaged nerves.
5. Oncology
- Tumor Removal: Eliminating benign and malignant lesions, Palliative Care is effective.
6. Healing and Regeneration
-Photobiomodulation: Enhancing tissue healing and regeneration post-surgery or injury.
7. Hemostasis
- Achieves immediate bleeding control during and after surgery.

APPLICATION OF LASERS IN ORAL SURGERY

Laser use in oral and maxillofacial surgery includes [1]:
1. Incisional/Excisional: Precise tissue cutting or removal.
2. Vaporization: Tissue ablation through vaporization.
3. Hemostasis: Achieving coagulation for bleeding control.

*Corresponding Author: Dr. Patel Sumaiyya 106 | Page

 Applications of Lasers in Oral and Maxillofacial Surgery –A Review Article

1. ORAL LEUKOPLAKIA- Lasers can effectively remove these lesions and promote the regeneration of
healthy epithelium. Small lesions are excised with a focused CO2 laser, maintaining a 3–4 mm margin. The
choice between excision and vaporization depends on the lesion's texture and thickness. Thick hyperkeratotic
lesions, with low water content, cannot be vaporized, while diffuse lesions are unsuitable for excision; for these,
CO2 lasers can be used in a defocused mode to create a cross-hatched pattern [4] (Fig.6).
Ishii et al. found that healing of the lesion following laser surgery is effective, with a reduced likelihood of
recurrence [10].

Figure 6Treatment of leukoplakia using laser

2. ORAL LICHEN PLANUS- Erosive oral lichen planus can be managed with laser treatment, typically
using a carbon dioxide laser in continuous, defocused mode with a cross-hatched pattern, along with local and
systemic medications. A contact Nd:YAG laser may also be effective. While not a cure, laser therapy provides
palliative care, often reducing burning sensations and improving histological appearance [4] (Fig.7).

Figure 7 Treatment of OLP using laser

3. ERYTHROPLKIA- Erythroplakia is treated by excising the lesion with a pulsed carbon diode laser,
followed by focused continuous wave mode to create a moat. To account for potential deeper dysplastic
changes, the upper lamina propria should be included, and multiple deep biopsies are advised to prevent
infiltration [4].
4. KERATOACANTHOMA- The lesion can be excised with a carbon dioxide laser, minimizing scarring.
In pulsed mode, the laser outlines the lesion, then removes a full-thickness wedge by directing the beam
perpendicularly. The tissues can then be sutured together [4].

5. RECURRENT APHTHOUS ULCERS- Low Level Laser Therapy (LLLT) offers immediate pain
relief and accelerates wound healing. De Souza et al. reported that 75% of patients had significant pain relief
during the session, with complete lesion regression in four days, while steroids took 5-7 days. Bladowski et al.
found that low-level diode laser treatment can halve healing time compared to pharmaceuticals [4] (Fig.8).

Figure 8Treatment of RAU using laser

6. VERRUCOUS CARCINOMA- Exophytic lesions can be excised using a CO2 or Nd:YAG laser. The
long-term effectiveness of lasers for leukoplakia control is still unclear. Horsch et al. noted a 78% cure rate with
the carbon dioxide laser, and microscopic control improved precision [4] .

*Corresponding Author: Dr. Patel Sumaiyya 107 | Page

 Applications of Lasers in Oral and Maxillofacial Surgery –A Review Article

7. ORAL SUBMUCOUS FIBROSIS- Shah et al. reported excellent outcomes using the Opal-5 diode
laser for excising bands of oral submucous fibrosis. Similarly, Chaudhary et al. identified the Er,Cr:YSGG laser
as an innovative and precise technique for treating OSMF [8] (Fig.9).

Figure 9Treatment of OSF using laser

8. MUCOCELE- The mucocele can be unroofed and excised with gland tissue using the Laser HF5,
which employs high-frequency technology for precise cutting and reduced necrosis risk [4]. A comparison of
oral mucocele resection showed that CO2 laser ablation resulted in more reliable outcomes and fewer
complications and recurrences than scalpel resection [2] (Fig.10).

Figure 10Treatment of mucocele using laser

9. RANULA- Lai et al. reported a case series on carbon dioxide laser treatment for ranulas, noting that
their findings and existing literature indicate it is a safe method with minimal or no recurrence [14] (Fig.11).

Figure 11Ranula treatment done by laser

10. PYOGENIC GRANULOMA- Lindenmüller et al. treated a large pyogenic granuloma of the gingiva
with a CO2 laser, noting smooth initial healing and no recurrence after 12 months, with healthy periodontal
tissues [2] (Fig.12).

Figure 12Treatment of pyogenic granuloma using laser

11. EPULIS FISSURATUM- It is adviced to undergo both surgical excision and prosthetic reconstruction.
According to a study, a patient receiving antithrombotic medicine discovered that CO2 laser removal was
succesful and did not result in any major side effects. When it came to removing these lesions, CO2 is thought
to be the best option, especially in individuals who have bleeding disorders [2].

12. GINGIVAL HYPERPLASTIC LESIONS- Asnaashari et al. used an 810 nm diode laser to remove
gingival hyperplastic lesions, achieving complete removal in one session with excellent shaping and no
recurrence after 6 months [2].

*Corresponding Author: Dr. Patel Sumaiyya 108 | Page

 Applications of Lasers in Oral and Maxillofacial Surgery –A Review Article

13. LYMPHANGIOMA- A case report on lymphangioma treatment with a CO2 laser found it to be a
viable, safe option with potentially lower recurrence rates than traditional excision, though long-term monitoring
is necessary [2].

14. HEMANGIOMA- Genovese et al. studied surgical lasers for treating hemangiomas and found that a
high-power GaAs diode laser reduced bleeding, shortened surgery time, and enabled faster postoperative
hemostasis [2].

15. CANCER OF ORAL CAVITY- A retrospective study assessed the Nd:YAG laser's effectiveness for
Stage I squamous cell carcinoma of the lip, showing it aligns with minimally invasive surgical principles.
Another study indicated that enoral laser microsurgery for oral cavity cancer yields comparable oncological and
functional outcomes with reduced morbidity and few complications [14].
An experimental study compared piezoelectric, laser, and tungsten carbide bur osteotomies. Despite high costs
and training requirements limiting their use, lasers and piezosurgery are advantageous for high-risk procedures
near vital structures. Equipment choice depends on the patient's condition, the procedure, and the operator's
experience [14].
In a clinical instance, the healing process following lesion excision was assessed using a laser diode. The use of
laser diodes significantly improved the surgical management of oral cavity cancers [2] (Fig.13).

Figure 13Treatment of tongue carcinoma using laser

16. BISPHOSPHANATE ASSOCIATED OSTEONECROSIS OF THE JAWS- A retrospective study on

laser surgery with biostimulation versus traditional surgery for bisphosphonate-induced bone necrosis showed
no significant differences in outcomes, though stage II patients fared better than stage I. The study highlighted
the need for dental health evaluations before medication to prevent BRONJ, noting laser surgery as a viable
alternative treatment [2]. Five cases of bisphosphonate-associated osteonecrosis of the jaws treated with an
Er,Cr:YSGG laser achieved stable mucosal covering, suggesting that laser surgery is an effective option for
treating BRONJ [2].

17. FRENECTOMY- A study compared Nd:YAG laser frenectomies to traditional surgery, finding that the
laser method significantly reduced surgical times and transoperative hemorrhage, eliminating the need for
sutures [2] (Fig.14). A comparison of upper lip frenectomies using CO2 and Er,Cr:YSGG lasers showed that the
CO2 laser provided a bloodless field and shorter surgical times, while the Er,Cr:YSGG laser promoted quicker
wound healing [2].

Figure 14Treatment of Frenectomy using laser

18. ORAL MELANOMA- A retrospective study found that CO2 laser treatment for oral mucosal
melanomas, combined with dental extraction and alveolar curettage, achieved complete surgical resection
without compromising quality of life [2].

19. TRIGEMINAL NEURALGIA- The authors found that low-level laser therapy (LLLT) is an effective
treatment for trigeminal neuralgia and a valuable addition to standard therapies [7].
*Corresponding Author: Dr. Patel Sumaiyya 109 | Page
 Applications of Lasers in Oral and Maxillofacial Surgery –A Review Article

20. FORDYCES GRANULES- Excision of Fordyce granules with low- and high-intensity lasers results in
better aesthetics, faster healing, and reduced postoperative pain and inflammation [13].

SAFETY PROTOCOL - LASER

1. Provide laser safety goggles for all personnel and patients, ensuring multiple pairs are available [12].
2. Plume hazard: It is Composed of vaporized water, carbon particles, and cellular debris, which emits an
unpleasant odor. This smoke can irritate and be toxic [5].
3. Each office should have a Laser Safety Officer to ensure proper laser use, coordinate staff training,
oversee protective eyewear, and understand relevant regulations [12].
4. To prevent fire hazards, limit supplemental oxygen or use room air, keeping endotracheal tubes below
30% oxygen. All personnel must understand laser operation, and a "danger" sign should restrict access during
use [1].
5. Laser use enhances tissue healing and reduces scarring by minimizing lateral damage, lessening
surgical trauma, and improving control over tissue depth [6].

ADVANTAGES OF LASERS USED IN OMFS

1. Laser procedures enhance precision and control, minimizing bleeding for a clear operating field [7].
2. Reduced Pain and Discomfort for the patient [9].
3. Faster Healing and Recovery compared to conventional method of treatment [9].
4. Reduced Risk of Infection providing enhanced aseptic condition [9]
5. Laser procedures result in less postoperative swelling and pain, eliminate the need for sutures, and
cause less mechanical trauma due to contact-free incisions [7].

DISADVANTAGES
Laser procedures require a specially trained operator and can be costly. The laser plume generated during
treatment may pose risks to personnel, and healing may take longer, potentially leading to increased pain 4 to 7
days after the procedure [7].

LIMITATIONS
The interplay of lasers effects on hard and soft tissues is underexplored. Future research should focus on the
thermal effects of lasers, wavelength accuracy, and consider the limited databases used for selecting relevant
studies [15].

II. CONCLUSION
In conclusion, laser technology in oral and maxillofacial surgery offers significant benefits, such as
increased precision, reduced bleeding, and enhanced patient comfort. This minimally invasive approach
promotes faster recovery and less postoperative pain while effectively treating various conditions. Ongoing
research is expected to further improve surgical outcomes and patient satisfaction, reinforcing the importance of
lasers in modern surgical practice.

REFERENCE
[1]. Renapurkar, Shravan & Strauss, Robert. (2021). Lasers in Oral and Maxillofacial Surgery. 10.1007/978-981-15-1346-6_39.
DOI:10.1007/978-981-15-1346-6_39
[2]. Asnaashari M, Zadsirjan S. Application of laser in oral surgery. J Lasers Med Sci. 2014 Summer;5(3):97-107. PMID: 25653807;
PMCID: PMC4281997.
[3]. Kale, LukeNandu& Garde, JanardanBhagwat& Garde, SwapnilShivdas& Gupta, Preetika. (2017). Evolution and applications of
lasers in oral and maxillofacial surgery. Journal of Dental and Allied Sciences. 6. 28. 10.4103/2277-4696.205442.
DOI:10.4103/2277-4696.205442
[4]. lal K, Parthiban J, Sargunar B, Prakash C. A, Anandh B. Usefullness of Laser in Oral and Maxillofacial Surgery. Biomed
Pharmacol J 2015;8(October SplEdition) DOI : https://dx.doi.org/10.13005/bpj/691
[5]. Shaik KV, Alanazi MIN, Albilasi RM, Albalawi BFA, Alruwaili FA. Lasers in Maxillofacial Surgery - Review of Literature. J
Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S19-S22. doi: 10.4103/jpbs.JPBS_710_20. Epub 2021 Jun 5. PMID: 34447036;
PMCID: PMC8375923. doi: 10.4103/jpbs.JPBS_710_20
[6]. [Anshuman Kumar, Aviral Verma and Apala Baduni. (2016); LASERS IN MAXILLOFACIAL SURGERY: A REVIEW Int. J. of
Adv. Res. 4 (Nov). 1344-1350] (ISSN 2320-5407) DOI: 10.21474/IJAR01/2218
[7]. Apoorva Mowar, Aditya Verma, Anshul Trivedi, Prajesh Dubey. (2019-04-29). "Use of Lasers in Oral and Maxillofacial Surgery:
An Overview." *Volume 2*, 1, 5-10 doi: 10.22259/2638-4809.0201002
[8]. Role of Laser in Oral and Maxillofacial Surgery: A Review of Literature. (1970). Journal of Orofacial Research, 5(2), 51-53.
[9]. Tachmatzidis, Theodoros &Ntamparakis, Nikolaos. (2016). Technology of Lasers and Their Applications in Oral Surgery:
Literature Review. Balkan Journal of Dental Medicine. 20. 10.1515/bjdm-2016-0021. DOI:10.1515/bjdm-2016-0021

*Corresponding Author: Dr. Patel Sumaiyya 110 | Page

 Applications of Lasers in Oral and Maxillofacial Surgery –A Review Article

[10]. Amaninder Singh, Akanksha Zutshi, et al. (2018) Application of Lasers in Treatment of Oral Premalignant Lesions . J Dent Oral
Disord Ther 6(1): 1-4. DOI: http://dx.doi.org/10.15226/jdodt.2018.00193
[11]. Singh, Manjinder & Gupta, Suvansh & Chopra, Shanta & Lubana, Anmol. (2022). LASERS IN DENTISTRY. Journal of
Pharmaceutical Negative Results. 761-764. 10.47750/pnr.2022.13.S09.087. DOI:10.47750/pnr.2022.13.S09.087
[12]. Verma, Sanjeev Kumar; Maheshwari, Sandhya; Singh, Raj Kumar; Chaudhari, Prabhat Kumar. Laser in dentistry: An innovative
tool in modern dental practice. National Journal of Maxillofacial Surgery 3(2):p 124-132, Jul–Dec 2012. | DOI: 10.4103/0975-
5950.111342
[13]. Luke AM, Mathew S, Altawash MM, Madan BM. Lasers: A Review With Their Applications in Oral Medicine. J Lasers Med Sci.
2019 Fall;10(4):324-329. doi: 10.15171/jlms.2019.52. Epub 2019 Oct 1. PMID: 31875126; PMCID: PMC6885906.
doi: 10.15171/jlms.2019.52
[14]. Oviya, M., et al. "A REVIEW ON USAGE OF LASER IN ORAL SURGERY." European Journal of Molecular and Clinical
Medicine, vol. 8, no. 1, Wntr 2021, pp. 431+. Gale Academic OneFile,
link.gale.com/apps/doc/A698747680/AONE?u=tel_oweb&sid=googleScholar&xid=6cb44ec5. Accessed 24 Sept. 2024.
[15]. Saad Liaqat, Haleema Qayyum, Zainab Rafaqat, Abdul Qadir, Sarmad Fayyaz, Aiman Khan, Humaira Jabeen, Nawshad
Muhammad, Muhammad Adnan Khan,Laser as an innovative tool, its implications and advances in dentistry: A systematic
review,Journal of Photochemistry and Photobiology,Volume 12,2022,100148,ISSN 2666-
4690,https://doi.org/10.1016/j.jpap.2022.100148.
[16]. Deshpande R N, Bhagwat H, Vadane A, Shaikh N M, Navale A S, Jagtap P P, Application of lasers in oral and maxillofacial
surgery: A literature review. J Dent Panacea 2022;4(2):57-63

*Corresponding Author: Dr. Patel Sumaiyya 111 | Page