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)-1 beta, IL-6 and interferon (IFN)-gamma 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-1 beta, IL-6, IFN gamma and pain level reduction and quicker epithelization toward the control group on the 30th day, except Nd:YAG in case of IFN gamma level. The highest IL-1 beta, IFN gamma 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.