High-level laser therapy versus scalpel surgery in the treatment of oral lichen planus: a randomized control trial

Abstract

Objective To compare the clinical effectiveness of various types of high-level laser therapy (HLLT) toward scalpel excision for the surgical treatment of erosive oral lichen planus (OLP). Materials and methods The total number of 128 individuals were enrolled in the study. The 35 did not meet the inclusion criteria due to malignancy signs and presence of diabetes mellitus. In total, 8 were lost to follow-up, and 10 were excluded from the analysis, due to analgesics intake. This way 75 patients with the erosive form of OLP were analyzed in three intervention groups (Er:YAG, n = 19; Nd:YAG, n = 15; Er:YAG + Nd:YAG combination, n = 20) and one control group with scalpel excision (n = 21). The therapy effectiveness has been assessed based on the comparison of salivary interleukin (IL)-1β, IL-6 and interferon (IFN)-γ preoperative levels to 14, 30 days, and 2 years postoperation, as well as pain level and time of epithelization. Results All HLLT groups demonstrated a significantly (p > 0.05) higher IL-1β, IL-6, IFNγ and pain level reduction and quicker epithelization toward the control group on the 30th day, except Nd:YAG in case of IFNγ level. The highest IL-1β, IFNγ and pain level reduction and quicker epithelization on the 30th day was observed in Er:YAG group, followed by Er:YAG + Nd:YAG combination, Nd:YAG respectively. However no significant difference was observed between the HLLT groups with regard to IL-6 level reduction. After a 2-year follow-up, no significant difference was observed between all study groups with regard to all variables. Conclusion HLLT yields a superior clinical outcome compared to the scalpel excision for the surgical treatment of oral lichen planus, whereby the Er:YAG has been proposed as the most effective laser type at the end of the first postoperative month. Clinical relevance For the surgical treatment of erosive OLP the Er:YAG laser may be a preferable treatment option compared to Nd:YAG and scalpel surgery. Trial registration The present trial was registered retrospectively in the German Clinical Trials Register, as a member of WHO international clinical trials registry platform, on the 18.03.2020 with the following number: DRKS00020986

Effect of Photobiomodulation on Atrophic–Erosive Clinical Forms of Oral Lichen Planus: A Systematic Review

“…All results were summarized and are synthesized in Table 3 and Table 4 . The chosen articles were Gambino et al (2018) [ 28 ], Mirza et al 143 (2018) [ 29 ], Mutafchieva et al (2018) [ 30 ], Lavaee et al (2019) [ 31 ], Khater et al (2020) [ 32 ], Nammour et al (2021) [ 26 ] and Tarasenko et al (2021) [ 33 ] as they met all the inclusion criteria proposed in this systematic review.…”

“…When analyzing the type of source used in PBM, as well as the parameters established in each study, we observed that in four cases the diode laser was used (Gambino et al [ 28 ], Mirza et al [ 29 ], Mutafchieva et al [ 30 ] and Lavaee et al [ 31 ]), while Khater et al [ 32 ] and Tarasenko et al [ 33 ] used the Nd–YAG laser at the same wavelength of 1064 nm, and Nammour et al [ 26 ] used the He–Ne laser. The power used ranged between 25 mW in Lavaee et al [ 31 ] and 3 W in Tarasenko et al [ 33 ], while the minimum wavelength used was 630 nm, and the maximum one was 1064 nm.…”

“…Most studies analyzed lesions treated with topical corticosteroids as a control group, although some studies compared PBM with another type of a laser, e.g., (high-power laser) plus corticosteroids, as in Lavaee et al [ 31 ], or with cold knife surgery, as in Tarasenko et al [ 33 ]. The follow-up times of the studies were highly variable; therefore, it was not possible to establish any treatment pattern or extrapolate the best follow-up schedule to achieve the best results.…”

“…Studies such as Mutafchieva et al [ 30 ] concluded with a clinical improvement in 59.3% of the lesions, as did Khater et al [ 32 ], with even a complete remission in 37.3% of the cases. Some authors such as Taresenko et al [ 33 ] proposed using this therapy in combination with other treatments. They combined PBM or Low-Light Laser Therapy (LLLT) with High-Light Laser Therapy (HLLT), obtaining better 181 results for the remission of symptoms with HLLT.…”

“…The studies included in this systematic review showed that the biological effects of PBM treatment are beneficial compared to those of other conventional therapies such as corticosteroids [ 26 , 30 , 32 ] as shown by the reduction of symptoms such as pain and signs associated with LPO lesions, highlighted by de Carvalho et al [ 24 ]. Other authors clarified that, in addition to PBM, there is another type of therapy, i.e., high-power laser (HLLT) [ 33 ] which, they claim, allow achieving significantly better results than PBM in the aforementioned parameters.…”