Abstract
ObjectiveTo 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 methodsThe 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.ResultsAll 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.ConclusionHLLT 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 relevanceFor the surgical treatment of erosive OLP the Er:YAG laser may be a preferable treatment option compared to Nd:YAG and scalpel surgery.Trial registrationThe 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
Highlights
The oral lichen planus (OLP) is a chronic inflammatory potentially malignant mucocutaneous disease, in which immune responses play a major role
The cytological analysis was performed in order to exclude any signs of malignancy and a blood analysis to detect any sign of hepatitis-B-virus (HBV), human immunodeficiency virus (HIV), herpes simplex virus (HSV), Epstein-Barr-virus (EBV), and cytomegalovirus (CMV)
By the third follow-up, 1 control and 7 intervention subjects were lost due to the OLP exacerbation, and 10 patients were excluded from the analysis, as they have taken the analgesics in the postoperative period after scalpel excision (Fig. 1)
Summary
The oral lichen planus (OLP) is a chronic inflammatory potentially malignant mucocutaneous disease, in which immune responses play a major role. For the therapeutic treatment of OLP, the glucocorticoids are commonly used [5]. In order to avoid the systematical and local side-effects of a longterm glucocorticoid use, some other conservative treatment modalities as photodynamic therapy (PDT) and low level laser. Clin Oral Invest (2021) 25:5649–5660 therapy (LLLT) may be successfully opted [6,7,8]. The treatment efficiency of LLLT for OLP rehabilitation is disputable, and some studies reported a comparable treatment outcome over the use of glucocorticoids [9, 10]
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