The Impact of Laser Thermal Effect on Histological Evaluation of Oral Soft Tissue Biopsy: Systematic Review

Abstract

The aim of the study is to review the literature to observe studies that evaluate the extent of the thermal effect of different laser wavelengths on the histological evaluation of oral soft tissue biopsies. An electronic search for published studies was performed on the PubMed and Scopus databases between July 2020 and November 2022. After the selection process, all the included studies were subjected to quality assessment and data extraction processes. A total of 28 studies met the eligibility criteria. The most studied laser was the carbon dioxide (CO2) laser, followed by the diode laser 940 nm–980 nm. Six studies were focused on each of the Erbium-doped Yttrium Aluminium Garnet (Er:YAG), Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) lasers, and diode lasers of 808 nm and 445 nm. Three studies were for the Potassium Titanyl Phosphate (KTP) laser, and four studies were for the Erbium, Chromium-doped Yttrium, Scandium, Gallium, and Garnet (Er,Cr:YSGG) laser. The quality and bias assessment revealed that almost all the animal studies were at a low risk of bias (RoB) in the considered domains of the used assessment tool except the allocation concealment domain in the selection bias and the blinding domain in the performance bias, where these domains were awarded an unclear or high score in almost all the included animal studies. For clinical studies, the range of the total RoB score in the comparative studies was 14 to 23, while in the non-comparative studies, it was 11 to 15. Almost all the studies concluded that the thermal effect of different laser wavelengths did not hinder the histological diagnosis. This literature review showed some observations. The thermal effect occurred with different wavelengths and parameters and what should be done is to minimize it by better adjusting the laser parameters. The extension of margins during the collection of laser oral biopsies and the use of laser only in non-suspicious lesions are recommended because of the difficulty of the histopathologist to assess the extension and grade of dysplasia at the surgical margins. The comparison of the thermal effect between different studies was impossible due to the presence of methodological heterogeneity.

Diagnóstico e tratamento do fibroma traumático em Mucosa Jugal: relato de caso clínico

“…De acordo com a revisão sistemática de literatura de Tenore et al, 2023, a maioria dos trabalhos estudados concluíram que o efeito térmico de diferentes comprimentos de onda do laser não prejudicava o diagnóstico histológico das amostras teciduais. 19 Seu prognóstico se mostra favorável após a remoção da lesão, desde que a causa e a lesão tenham sido removidos por completo, apresentando então baixa frequência de recidivas. 14…”

Analysis of the Temperature Elevation of the Dual-Wavelength Diode Laser and the Er, Cr: YSGG Laser in Oral Soft Tissue Incisions

“…Thus, the power density increased and more thermal changes came from the same optical fiber in the same area of tissue as Tenore et al reported in their diode laser review of thermal damage. 12,13,[15][16][17][18] Pigments (melanin, hemoglobin, and protein) are the main chromophores in the range of diode lasers (808-1064 nm). However, water, which makes up more than 70% of most tissues, is not a chromophore and creates almost minimal interaction at diode wavelengths.…”

Diode Laser Surgery of Peripheral Ossifying Fibroma in Children: A Case Report with Narrative Review of the Literature

“…Diode laser use in dentistry and oral surgery is widely supported by literature, mainly for soft tissue surgery (both for benign and malignant lesions) [41][42][43], providing a fast and not-bleeding lesion removal with (usually) second intention healing of the covering mucosa, as well as the transmucosal or intralesional photocoagulation of vascular malformations (thus avoiding invasive and unpredictable surgical procedures as in the past years) or lesions with high risk of intraoperative bleeding before the surgical removal [44]. It is relevant to underline that the use of diode laser was debated due to the risk of thermal alterations at the histologic examination, but it is fully demonstrated that the thermal effect is usually very low and doesn't affect the histological diagnosis [45]. Therefore, diode laser excision is highly suggestable for patients with reduced compliance, including children, and with similar lesions reported herein [27,31].…”