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Dalirsani and Seyyedi: CO2 laser on plaque‑like OLP

Surgery with CO2 laser accelerates wound healing as
compared to scalpel surgery. [18,20]
Post-surgery coagulation could accelerate with defocused
irradiation of CO2 laser, which evaporates the superficial
tissues and produces carbonized layer and reduces the
diameter of small vessels. Therefore, this type of laser
could be employed for soft tissue surgeries including
frenectomy, periodontal surgery, and excision of oral
a b lesions. [21]
Figure 4: (a) Plaque-like lesion on alveolar ridge in the patient no. 6; (b) ulcer in One study in Tehran compared the effects of CO2 laser and
the operation site after laser evaporation of the lesion
diode laser on 57 OLP lesions. The lesions of one group
interdental gingival mucosa between the canine and the received CO2 laser (3 W) and others were irradiated with
pre-molars teeth. diode laser (633 nm, 0.3-0.5 J/cm2); after 3 months,
partial (85%) and complete (100%) improvement were
After confirming the OLP diagnosis by incisional biopsy, observed in clinical signs, respectively. [13]
CO2 laser was employed for evaporation of some parts
of the plaques. As the lesion extended from alveolar Another study was performed by Van der Hem et al. [14]
mucosa to the tongue, the laser therapy was performed on 21 patients with 39 different lesions of OLP, in which
in four sessions with an interval of 3 months. the researchers used CO2 laser with output power
of 15–20 watt and energy density of 1.5-2 J/cm2 for
Follow‑up sessions removal of the lesions. They enrolled all types of OLP in
After 6 months, mild keratotic lesions were observed in the study and 62% of lesions did not have any pain or
some parts, which were evaporated with laser radiation, recurrence in the follow-up sessions. However, among six
again. The patient was under regular follow-up plaque-like lesions, recurrence happened in two cases;
examinations for 3 years. There were mild keratotic they concluded that clinical presentation of OLP is not
lesions without any pain or burning; the patient was related to the rate of recurrence.
satisfied with the treatment process.
Concurrent with similar studies, which applied CO2 laser
Discussion for OLP lesions, [13,14] in the present study, the plaque-like
Plaque-like lesion is one of the keratotic types OLP were removed with CO2 laser and after surgery
of OLP, which is susceptible for malignant topical treatments of OLP were not prescribed for them
transformation. [15] Two articles in Brazil and Croatia and just conventional analgesics were prescribed for
reported that 8% and 5.7% of OLP lesions were post-surgery pain.
plaque-like. [3,16] A review article reported that the The studies reported a range of 21.05%–44% for
rate of malignant transformation of OLP in different recurrence of pre-malignant lesions of oral mucosa,
studies is from 0 to 12.5%. [15] This type of OLP might including OLP and leukoplakia, after CO2 laser
be misdiagnosed as leukoplakia. evaporation. [22-26] This wide range of reported recurrences

Plaque-like OLP without burning may not need immediate could be related to various follow-up times and different
[6]
treatment; however, incisional biopsy for confirming types of lesions and different techniques for using CO2
the diagnosis and ruling out the dysplasia is necessary. laser, which leads to various degree of destruction of
This form might be resistant to conventional therapies the cells. [22,23] Deppe’s study revealed that treatment of
of OLP and needs regular follow-up for decreasing the pre-malignant lesions using defocused CO2 irradiation
possibility of malignancy. Patients may look for new has better results than other techniques of laser therapy.
treatments for several years. It seems that deeper penetration of laser light to oral
tissues leads to lower rates of recurrence. [23]
One of the treatments recommended recently is laser
therapy. Some benefits of evaporation of these lesions In the present study, defocused radiation was used for
with laser irradiation consist of complete elimination of evaporation of OLP lesions. No side-effects were observed
the lesion in one or few sessions, fewer complications in the follow-up sessions. In some patients, some degrees
of operation including less pain and bleeding or scar of recurrence happened; however, recurrence mostly
formation, shorter time of operation, and consequently occurred as mild keratotic lesions. For three patients,
patient satisfaction. [17-19] who had burning sensation, dexamethasone and nystatin
mouthwashes were prescribed after recurrence.
In some studies, effects of CO2 laser therapy were
evaluated. The wavelength of CO2 is 10600 nm and Since some remission and exacerbation periods during
its energy was absorbed through water of oral tissues. the autoimmune process are not uncommon, various

Indian Journal of Dermatology | Volume 66 | Issue 6 | November-December 2021 701