Diode Laser‐Assisted Oral Frenectomy as a Modern Alternative: A Systematic Review and Meta‐Analysis

ABSTRACT

Background

Clinicians frequently use diode laser‐assisted oral frenectomy to correct anatomical restrictions in the oral cavity as a minimally invasive alternative. However, evidence for its effect on wound healing and on reducing common postoperative complications remains unclear. This systematic review and meta‐analysis aimed to evaluate the clinical efficacy of diode laser‐assisted frenectomy compared with the conventional scalpel technique.

Methods

This review adheres to the PRISMA statement, and the protocol is registered in PROSPERO (CRD420251050170). A comprehensive electronic and manual search identified comparative studies of diode laser vs. scalpel frenectomy from January 2015 to December 2025. The analysis pooled the primary outcomes (postoperative discomfort, intraoperative hemorrhage, and wound healing) with 95% confidence intervals (CI) using a random‐effects model. Heterogeneity assessment used the I ² statistic. Visual inspection of funnel‐plot symmetry assessed publication bias.

Results

Fourteen studies met the inclusion criteria. The meta‐analysis showed that the diode laser reduced postoperative pain on day 1 (SMD = −1.73; 95% CI: −2.70 to −0.77) and day 7 (SMD = −1.84; 95% CI: −2.78 to −0.90), compared with the scalpel. The diode laser also reduced intraoperative hemorrhage (SMD = –1.97; 95% CI: −2.89 to −1.05). Wound healing on day 7 did not differ significantly between groups.

Conclusions

This meta‐analysis indicates that diode laser‐assisted frenectomy reduces postoperative pain, significantly. In addition, the laser group experienced less intraoperative hemorrhage and better wound healing at 7 day. Future clinical trials should standardize wound‐healing indices, define uniform follow‐up intervals, and incorporate cost‐effectiveness analyses.

1. Introduction

Oral frena are connective tissue folds that stabilize lip and tongue movements [1]. Aberrant frenum attachment disrupts oral function, speech, and feeding. It can also complicate orthodontic and prosthetic treatment and compromise periodontal health by increasing sulcular tension and promoting biofilm accumulation. A short lingual frenum may result in ankyloglossia [2, 3].

Etiological factors for abnormal frena include embryological anomalies, trauma, orthodontic movement, and high muscular attachment. Some underlying genetic syndromes, such as Ehlers‐Danlos syndrome, Holoprosencephaly, and Ellis‐van Creveld syndrome, are known genetic syndromes that can predispose individuals to frenal abnormalities [4]. Diagnosis of an aberrant frenum is typically achieved visually and by applying tension to the frenum. This clinical maneuver allows the clinician to observe the movement of the papillary tip or the blanching (ischemia) produced in the adjacent soft tissue, thereby confirming the extent of the frenum's attachment and its potential for causing tissue disturbance [1].

Oral frenectomy is a common surgical procedure that removes or reshapes frenum attachments that restrict normal oral function, create diastemas, or contribute to gingival recession [5]. Conventional frenectomy techniques use a scalpel to excise the frenulum [1]. Clinicians continue to use this approach because it is straightforward, cost‐effective, and familiar to oral surgeons and periodontists [6]. Advances in surgical technology have introduced alternative methods.

Laser‐assisted frenectomy has become increasingly common with the growth of minimally invasive dentistry. Clinicians use several hard‐ and soft‐tissue lasers, including CO₂, erbium:yttrium aluminum garnet (Er:YAG), neodymium‐doped YAG (Nd:YAG), and diode lasers, with good clinical outcomes in pediatric patients. Diode lasers cost less and act only on soft tissues. Their small fiber tip permits precise incision, the fiber‐optic delivery improves access, and absorption by soft‐tissue pigments supports efficient cutting and coagulation [7].

Moreover, Aldelaimi et al. demonstrated favorable esthetic outcomes with a 940 nm diode laser for managing gummy smiles, supporting the growing evidence for laser applications in soft‐tissue surgery [8].

As a result, diode laser‐assisted frenectomy has become a popular option in clinical practice [9]. Diode systems typically operate at 810–980 nm and offer theoretical advantages such as precise cutting, hemostasis, reduced need for sutures, sealing of nerve endings, surface coagulation, and photocoagulation, which may affect postoperative pain, wound healing, intraoperative bleeding, and analgesic requirements [10, 11, 12, 13].

Despite the increasing adoption of diode lasers for frenectomy, strong comparative evidence remains limited, and published studies often report conflicting findings. Some investigations describe advantages with laser‐assisted procedures, whereas others question these benefits because of equipment costs, maintenance requirements, and a considerable learning curve. This inconsistency complicates evidence‐based clinical decisions and shows the need to synthesize all available data [14, 15].

Previous meta‐analyses reported that laser‐assisted frenectomy reduces pain and operative time compared with conventional methods, although heterogeneity and risk of bias limited the certainty of evidence [16]. Another meta‐analysis found improved breastfeeding outcomes after lingual frenectomy in young children [17]. In contrast to reviews that pooled multiple laser systems, the present study focuses specifically on diode lasers. Whereas earlier meta‐analyses mainly examined pain and operative time, this review also evaluates wound healing, for the first time among related meta‐analytical studies. It compares diode laser‐assisted surgery with scalpel techniques for postoperative pain, wound healing, bleeding, and analgesic requirements to inform treatment decisions.

2. Methods

2.1. PICO Protocol and Search Strategy

This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and Cochrane Collaboration recommendations. The investigators registered the protocol in the Prospective Register of Systematic Reviews (PROSPERO; CRD420251050170). The Population, Intervention, Comparison, Outcome (PICO) components were.

2.1.1. Population

Patients aged 16–65 years undergoing oral frenectomy (labial, lingual, or buccal).

2.1.2. Intervention

Diode laser‐assisted frenectomy at any wavelength.

2.1.3. Comparison

Conventional scalpel‐based frenectomy.

2.1.4. Outcomes

Postoperative pain, wound healing, intraoperative bleeding, and analgesic use.

2.2. Search Strategy

This review used Medical Subject Headings (MeSH) to define the keywords. The search algorithm was:

(“scalpel surgery” OR “surgical incision” OR “conventional surgery” OR “surgical procedure, operative”[MeSH])

AND

(“Lasers”[MeSH] OR “diode laser”)

AND

(“frenectomy” OR “frenulum” OR “oral frenectomy”[MeSH])

Electronic searching covered the Cochrane Library, PubMed, Web of Science, Scopus, and Google Scholar. Manual screening included Journal of Periodontology, Journal of Clinical Periodontology, Journal of Periodontal Research, Lasers in Medical Science, and Periodontology 2000.

The search covered titles and abstracts from the first available record through May 2025. Two blinded reviewers (Z.B. and P.S.) performed the search and screened records for eligibility. They also assessed inter‐reviewer reliability. The reviewers screened titles and abstracts to identify eligible studies. A third reviewer (H.A.) resolved disagreements regarding the inclusion criteria. The reviewers then assessed the full texts of eligible articles. Figure 1 presents the PRISMA flow diagram for the screening process.

Figure 1.

PRISMA flow diagram for the search and study selection.

2.3. Eligibility Criteria

Inclusion criteria:

• Patients undergoing oral frenectomy.

• Comparative studies of diode laser–assisted frenectomy and the conventional scalpel technique.

• Reporting at least one relevant clinical outcome (analgesic use, pain, wound healing, or bleeding).

• Conventional surgery used as the control group.

• Diode laser used as the intervention group.

• Reporting means and standard deviations.

• No restrictions on photosensitizer use, voltage/power, or diode laser wavelength.

• Articles in English.

Exclusion criteria:

• Patients with systemic conditions that affect wound healing (e.g., uncontrolled diabetes, immunosuppression).

• Non‐human studies.

• Case reports, case series, systematic reviews, unpublished articles, letters to the editor, and abstracts.

• Studies using other laser types (e.g., CO₂, Er:YAG).

• Studies that did not report outcomes as means and standard deviations.

• Current smokers.

2.4. Data Extraction

After full‐text review, two independent reviewers conducted the quality assessment and extracted the data. The second author (P.S.) verified the extracted entries, and the third author (H.A.) resolved any ambiguities until consensus. Extracted variables included the first author's name, country, patient demographics (age, sex, and sample size), follow‐up duration, laser parameters (output power and wavelength), and clinical outcomes (pain, discomfort, swelling, bleeding, analgesic use, and wound healing), reported as means and standard deviations.

2.5. Risk of Bias

Per the Cochrane Handbook for Systematic Reviews of Interventions, two authors (PS and ZB) independently assessed each included randomized trial using the Revised Cochrane Risk of Bias tool for randomized trials, version 2.0 (RoB 2). The assessment covered five domains [1]: randomization process [2], deviations from intended interventions [3], missing outcome data [4], measurement of the outcome, and [1] selection of the reported result. For each domain, the reviewers answered the signaling questions and reached a domain‐level judgment of low risk, some concerns, or high risk of bias. Based on these domain‐level judgments, the team assigned an overall risk of bias for each study. The reviewers also categorized each study by effect of interest as intention‐to‐treat (effect of assignment to the intervention) or per‐protocol (effect of adhering to the intervention). A third author (HA) resolved any disagreements that arose.

2.6. Data Synthesis

Two reviewers (Z.B. and P.S.) independently extracted the data. Extracted variables included patient demographics (age, sex, and sample size), type of intervention, laser parameters (wavelength, power, and duration), follow‐up period, and clinical outcomes (pain, bleeding, wound healing, use of analgesics, discomfort, and swelling). The team quantified outcomes as follows: pain was measured using the visual analogue scale (VAS, 0–10); analgesic use was recorded as the number of doses; and wound healing was measured using a 4‐point score (1 = complete epithelialization, 2 = incomplete epithelialization, 3 = ulcer, 4 = tissue defect or necrosis). The severity of intraoperative bleeding was graded from 0 (no bleeding) to 3 (severe bleeding). All quantitative outcomes appear as means with standard deviations. Data entry and statistical analysis were used with Review Manager (RevMan) version 5.0. All included studies provided complete datasets, so the reviewers did not need to contact authors for missing data.

2.7. Meta‐Analysis

The included randomized controlled trials (RCTs) assessed outcomes using standardized indices: postoperative pain measured with the Visual Analog Scale (VAS, 0–10), bleeding scores, and wound‐healing scores. These scales allowed consistent comparisons across studies of diode‐laser vs. conventional scalpel frenectomy.

Because postoperative assessment times differed, this review grouped outcomes into three time points: day 1, day 3, and day 7 after surgery. Analyses expressed effect sizes as standardized mean differences (SMD) with 95% confidence intervals (CI). The analyses used a significance threshold of p < 0.05.

We assessed statistical heterogeneity by visually inspecting forest plots to identify outlier studies. We quantified heterogeneity with the I ² statistic (0%–100%): 0% indicates no heterogeneity, 30%–60% indicates moderate heterogeneity, and 75%–100% indicates strong heterogeneity. We conducted sensitivity analyses by excluding heterogeneous studies to test the stability of the findings. We evaluated publication bias by visually inspecting funnel‐plot symmetry.

3. Results

3.1. Study Selection

Figure 1 presents the PRISMA flow diagram of study selection. Electronic searches of PubMed, Web of Science, Google Scholar, Scopus, and Cochrane CENTRAL identified 384 records. Hand‐searching of journals and citation tracking did not yield additional records. After removal of 127 duplicates, 257 unique records remained for title and abstract screening, of which 236 did not meet the inclusion criteria. The reviewers assessed 21 full‐text articles for eligibility and excluded 7 for not meeting the intervention or outcome criteria. Fourteen randomized controlled trials were included in the qualitative synthesis, and 10 studies were eligible for the quantitative meta‐analysis.

3.2. General Characteristics of the Included Studies

This review analyzed 14 randomized controlled trials (RCTs) from multiple countries (Table 1). The studies originated from Iran [18, 23], Turkey [19, 20, 27], India [21, 22, 25, 26, 28, 29, 30, 31], and Nepal [24]. Sample sizes ranged from 10 to 174 patients, and the mean age spanned 16–65 years. Reporting of sex distribution varied, and several studies did not provide these data.

Table 1.

Key characteristics of included studies.

Study ID	Study Design/Number	Age	Male/Female	Patients	Intervention groups (Test‐ Control) frenum	Laser parameters	Follow ‐up	Evaluated clinical parameters	Conclusion
Yousefimanesh et al./[18]/Iran	RCT 26	16 to 36	7/19	26 (Scalpel:13 Laser:13)	Diode laser	Wavelength: 810–980 nm	1,7 days an 1 month	Postoperative pain: VAS (0–10)/tissue repair: Landry Index (0 to 5)/Swelling (0 indicated no swelling and 3 indi‐ cated severe swelling)/Pain Reliver:NS/Surgical Difficulty: rated by the operating surgeon on a 4‐point scale/	Laser method demonstrates significant advantages over conventional frenectomy techniques, including reduced pain and bleeding, improved healing, and lower analgesic use
					Scalper	Power: 2.5 W
					Maxillary labial frenectomy
Eroglu et al. [19]	RCT/43	18 to 55	No information	46 (Laser: 23)	Diode laser	Time: continuous mode	1, 3, 7, 14, 21, and 28. Days, 4 weeks, 6 months	Postoperativpain: VAS (0–10)/wound healing: scored as 1: complete epithelialization, 2: incomplete epithelialization, 3: ulcer, and 4: tissue defect or necrosis/Plaque index (PI) and gingival index (GI) and Keratinized gingiva width (KGW): mea‐ sured using a periodontal probe from the University of North Carolina	Frenectomy with diode laser effectively reduces pain, although it may delay wound healing
Turkey					Scalpel.	Wavelength: 940 nm
					Frenectomy of maxillary labial	Power: 1.2 W
						Time: continuous mode
Sezgin et al. [20]	RCT/48	18 to 65	No information	32 (Scalpel:16	Diode laser	Wavelength: 810 nm	1st, 7th, 14th, 21st, and 45th days	Postoperativpain and discomfort during speaking and chewing: VAS (0–10)/wound healing: by applying 3% hydrogen peroxide solution onto the surface on post‐operative days/plaque index (PI), gingival index (GI), and bleeding on probing (BoP): using a periodontal probe of Uni‐ versity of North Carolina	Diode laser provides better post‐operative patient's perceptions than the conventional technique in frenectomy operation. In addition, both conventional and laser‐assisted frenectomy surgeries prevent the frenum reattachment regardless of periosteal horizontal incision.
Turkey				Laser:16	Diode laser+scalpel	Power:10 W
				(Laser+scalper:16)	scalpel.	Time: continuous mode
Ftima et al. 2020	RCT/20	16 to 40	No information	20 (Scalpel:10 Laser:10)	Diode laser scalpel.	Wavelength: 810 nm	1 day, 3 day, 7 day	Postoperativpain: VAS (0–10)/	Patients treated with the diode laser had less postoperative pain and required fewer analgesics as compared to patients treated with the conventional scalpel technique.
India						Power: 0.8–1.2 W		Analgesics use: NS
						Time: continuous mode
Gandih et al. 2017	RCT/10	16 to 40	No information	10 (Scalpel:5 Laser:5)	Diode laser scalpel.	Wavelength: noninformation	1 day	Postoperativpain: VAS (0–10)/swelling (0: No swelling, 1: Mild swelling, 2: Moderate swelling, 3: Severe swelling)/wound healing: 1‐ INADEQUATE	The results indicated patients treated with the diode laser had less postoperative pain and required fewer analgesics (p < 0.001) as compared to patients treated with the conventional scalpel & electrocautery technique. Wound healing at 7 day and after 1 month for all the groups showed statistical significant difference with better outcome in diode laser group
India					Frenectomy of maxillary labial	Power: 2.5 W	2 day	2—NEARLY ENTIRE WOUND HEALING 3— GOOD)/infection (0: No infection, 1:infection present)
						Time: continuous mode	3 day, 1 week, 1 month
Patel et al. [21]	RCT/20	16 to 40	No information	20 (Scalper: 10 Laser:10)	Diode laser	Wavelength: 980 nm	1 week	Postoperativpain: VAS (0–10)/bleeding: 0 (no bleeding) and 3 (severe bleeding)/wound healing: scored as 1: complete epithelialization, 2: incomplete epithelialization, 3: ulcer, and 4: tissue defect or necrosis/Analgesics use: NS	The results indicated patients treated with the diode laser had less postoperative pain (p < 0.0001) and required fewer analgesics (p < 0.001) as compared to patients treated with the conventional scalpel technique. Wound healing at 7th day and after 1 month for both the groups showed statistical significant difference with better outcome in laser group
India					Scalpel./	Power:	1 month
					Frenectomy of maxillary labial	10 W	3 month
						Time: continuous mode
Vincent et al., [22].	RCT/36	18 to 45	No information	36 (scalpel: 18 Laser:18)	Diode laser	Wavelength: 980 nm	1 day, 7 day, 14 day	Postoperative: Pain: vas(0–10)/wound healing: scored as 1: complete epithelialization, 2: incomplete epithelialization, 3: ulcer, and 4: tissue defect or necrosis	The diode laser group exhibited statistically significant clinical and healing outcomes. Less pain, minimal or absent ooze, increased healing, and better acceptance of the procedure with diode laser at 1, 7, and 14 days recall visit
India					Scalpel./	Power: 10 W
					Frenectomy of maxillary labial	Time: continuous mode
Sobouti et al. [23]	RCT/174	No information	57/92	174 (Scalpel:58	480 nm diode	Wavelength: 480 and 980 nm	1 week and 1 month	Postoperative: Pain and discomfort during chewing and speaking: vas (0–10)/Bleeding: Score 0: No bleeding	Diode laser frenectomy resulted in significantly lower intra and postoperative complications compared to the scalpel. Moreover, 445 nm diode laser showed significantly superior effects compared to 980 nm diode laser.
Iran				445 nm diod:58/	980 nm diode	Power: 1.5 and 1.7 W		• Score 1: Mild bleeding
				980 nm diod:58)	Scalpel	Time: continuous mode		• Score 2: Moderate bleeding
					Maxillary labial frenectomy			• Score 3: Severe bleeding/tissue healing: scored as 1: complete epithelialization, 2: incomplete epithelialization, 3: ulcer, and 4: tissue defect or necrosis
Shrestha al. [24] Nepal	RCT/28	18 to 45	9/19	28 (Scalper:14 Laser: 14)	Diode laser	Wavelength: 980 nm	Day‐1, day‐2, day‐3, and day‐7.	Postoperative: Pain and discomfort during chewing and speaking:NRS (0–10)/Analgesics use: NS	Labial frenotomies performed with diode laser offer significantly less pain and discomfort during speech and chewing compared to frenotomy with scalpel.
					Scalpel./	Power: 3.0 W
					Mandibular anterior frenum	Time: continuous mode
Indurkar et al. [25]/India	RCT/10	18 to 30	No information	10 (Sacalper: 5.laser:5)	Diode laser	Wavelength: 980 nm	1,2,3,7 day and 4 weeks	Postoperative: Pain: 10 cm VAS (0–10)/bleeding: 1—NONE	According to study, patients treated with diode laser showed less post‐operative bleeding, pain and swelling compared to the scalpel group. There was no statistical significant difference in wound healing in both the groups.
					Scalpel./frenectomy of maxillary labial	Power: 2 W		2—SLIGHT
						Time: continuous mode		3—MODERATE 4— SEVERE/swelling: 0—NO SWELLING 1—MILD
								2‐ MODERATE
								3‐ SEVERE/wound healing: 1—INADEQUATE
								2‐ NEARLY ENTIRE WOUND HEALING 3—GOOD
Singh et al. [26]/India	RCT/20	18 to 45	12/8	20 (Scalper:10 Laser:10)	Diode laser	Wavelength: 980 nm	1, 7 and 30 days.	Postoperative Pain and discomfort during speech: 100mmVAS (0–100)/bleeding: 0 (no bleeding) and 3 (severe bleeding)/wound healing: scored as 1: complete epithelialization, 2: incomplete epithelialization, 3: ulcer, and 4: tissue defect or necrosis	The use of soft tissue diode laser could be an alternative to conventional scalpel technique for maxillary labial frenectomy as it causes less pain, less bleeding and improved healing of tissues.
					Scalpel./	Power: 1.5 W
					Frenectomy of maxillary labial	Time: continuous mode
Uraz et al. [27] Turkey	RCT/36	14 to 51	8/28	36 (Scalpel:16 Laser:20)	Diode laser	Wavelength: 980 nm	Immediately after, 1 week later and 1, 3 and 6 months	Pain, redness, swelling and functional complications, including chewing and speech VAS (0–10)/keratinized gingiva width (KGW), attached gingiva width (AGW) and attached gingiva thickness (AGT): using a Williams periodontal probe calibrated in millimeters.	Study determined statistically significant gains in the KGW, AGW and AGT after surgery in both groups; however, there was no significant difference between the study groups and also indicated that the patients treated with a diode laser had less discomfort and functional complications compare with scalpel surgery.
					Scalpel.	Power: 2.8 W
					/	Time: continuous mode
					Labial frenectomies
Butchibabu et al. 2018	RCT/10	18 to 30	6/4	10	Diode laser	Wavelength: 808 nm	1st and 3rd 7th day	Postoperative Pain: 100 cm VAS (0–100)/discomfort during speaking and chewing: VAS (0–10)	Taking into consideration the clinical outcome, the diode laser is a dependable alternative as it is an efficient and satisfactory option for procedures like frenectomy.
				(Scalper:5 Laser:5)	Scalpel.	Power: 1.5–2 W
						Time: continuous mode
Bista et al. [28]	RCT/20	No infoemation	No information	20	Diode laser	Wavelength: 940 nm	Day:1 and Day:7	Postoperative: Pain: 10 cm VAS (0–10)/Analgesics use: NS	This comparative study indicates that diode laser treatment for frenectomy provides better patient perception in terms of pain compared to scalpel technique.
				(Scalper:10 Laser:10)	Scalpel.	Power: 2.00 W
						Time: continuous pulse duration, and pulse interval of 1.00 ms

Most trials evaluated maxillary labial frenectomy [18, 19, 21, 22, 23, 25, 26, 29], while a smaller number examined the mandibular anterior frenum [24]. All studies compared diode laser–assisted frenectomy with the conventional scalpel technique. One trial by Sezgin et al. also tested a combined diode laser and scalpel approach [20]. Follow‐up ranged from 1 day to 6 months, with outcomes commonly recorded on days 1, 3, 7, and 30.

The primary clinical outcomes were postoperative pain, bleeding, and wound healing. Several studies also assessed swelling and the use of analgesics.

3.3. Laser Parameters in the Included Studies

Across trials, diode laser soft‐tissue ablation used various wavelengths, with 980 nm being the most common. Power settings ranged from 0.8 W to 10 W in continuous mode [18, 21, 22, 23, 24, 25, 26, 27]. Some studies applied other wavelengths, including 810 nm [20, 30, 31], 940 nm [19, 28], or 445 nm [23], reflecting ongoing efforts to determine optimal parameters for specific tissues. Overall, diode laser groups reported lower postoperative pain, whereas healing outcomes varied with laser settings and follow‐up duration.

3.4. Quality of Clinical Studies

Two reviewers (P.S. and Z.B.) evaluated study quality using the Revised Cochrane Risk of Bias tool for randomized trials, version 2.0 (RoB 2). Figure 2 summarizes the assessments. Thirteen studies showed low risk of bias [18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 31], and one study raised some concerns [30]. The RoB 2 assessment classified ten studies as intention‐to‐treat (effect of assignment to the intervention) because they included all randomized participants and reported outcomes for all [18, 20, 21, 22, 24, 26, 28, 29, 30, 31]. It classified four studies as per‐protocol (effect of adhering to the intervention), as they analyzed only participants who followed the assigned regimen [19, 23, 25, 27].

Figure 2.

Risk of bias summary.

All included studies reported random sequence generation; however, only four trials [18, 19, 23, 29] described their randomization methods in detail. These methods comprised random‐allocation software with blocks of six [23], a coin toss method [29], computer‐generated randomization process [19], and permuted block randomization with a block size of four [18].

No study blinded participants, operators, or outcome assessors because of the nature of the interventions. This lack of blinding did not appear to introduce substantial bias in the included trials. In Fatima et al. [30], the reported results did not include all outcomes prespecified in the methods section, which raises concerns for Domain 5 (selection of the reported result) in the RoB 2 assessment.

3.5. Main Outcomes of the Studies

All trials assessed clinical outcomes and demonstrated that diode laser–assisted frenectomy resulted in reduced pain, bleeding, and postoperative discomfort compared with the scalpel technique [18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31]. Most studies [19, 20, 21, 22, 25, 26, 27, 28, 29, 31] reported lower pain scores and fewer complications in the diode laser group at multiple time points (postoperative days 1, 3, and 7; Figure 3), although the magnitude of benefit varied.

Figure 3.

Forest plots of postoperative pain at day 1, day 3, and day 7 comparing diode laser with the conventional scalpel group.

This meta‐analysis pooled parallel‐group randomized controlled trials (RCTs) comparing diode laser–assisted frenectomy with conventional scalpel procedures. On day 1, the diode laser group showed a significant reduction in pain (SMD = −1.73; 95% CI: −2.70 to −0.77) with substantial heterogeneity (I ² = 89%). On day 3, mean pain scores favored the diode laser, but the difference was not statistically significant (SMD = −1.66; 95% CI: −4.03 to 0.70) (Figure 3). By day 7, the diode laser again reduced pain significantly (SMD = −1.84; 95% CI: −2.78 to −0.90). The pooled effect across all time points showed a significant overall advantage for the diode laser technique (SMD = −1.76; 95% CI: −2.36 to −1.15).

The diode laser showed significantly lower intraoperative bleeding scores than the conventional scalpel technique (SMD = −1.97; 95% CI: −2.89 to −1.05) based on four trials (Figure 4a). Although heterogeneity was moderate, the consistent effect direction supports the hemostatic advantage of diode laser–assisted surgery.

Figure 4.

(a) Forest plot of intraoperative bleeding comparing diode laser with the conventional scalpel group; (b) forest plot of wound healing at day 7.

Three studies [21, 23, 26] evaluated wound healing on day 7, comparing diode laser‐assisted frenectomy with the conventional scalpel technique (Figure 4b). The pooled effect showed no statistically significant difference between groups (SMD = −0.61; 95% CI: −2.05 to 0.84) (Figure 4). The point estimate favored the scalpel, indicating a trend toward poorer healing in the diode laser group at this time point.

Diode laser frenectomy significantly reduces intraoperative bleeding and postoperative pain. By postoperative day 7, wound healing remains comparable to outcomes with the conventional scalpel technique.

3.6. Sensitivity Analysis

The meta‐analysis showed moderate to high heterogeneity for postoperative pain, particularly on postoperative days 1 and 7, which warranted sensitivity analyses to reduce heterogeneity and inform clinical decisions. Figures 5 and 6 present the datasets used, grouped by the three primary follow‐up intervals (days 1, 3, and 7) and the surgical outcomes.

Figure 5.

Forest plots from the sensitivity analysis showing postoperative pain at day 1, day 3, and day 7 after exclusion of outlier studies.

Figure 6.

Funnel plots for (a) postoperative pain on day 1, (b) postoperative pain on day 3, (c) postoperative pain on day 7, and (d) wound healing on day 7.

On day 1, the sensitivity analysis using a random‐effects model showed a statistically significant reduction in pain in the diode laser group (SMD = −0.84; 95% CI: −1.15 to −0.52; Z = 5.19; p < 0.00001), with reduced heterogeneity (Figure 5). This finding indicates that, despite some variability, the analgesic effect of the diode laser remains consistent.

On day 3, after excluding potential variability from smaller studies, the pooled result remained statistically non‐significant (SMD = −0.42; 95% CI: −1.01 to 0.17; Z = 1.41; p = 0.16), with no detected heterogeneity (Figure 5).

On day 7, the diode laser group again showed a statistically significant improvement (SMD = −1.86; 95% CI: −2.22 to −1.49; Z = 9.92; p < 0.00001) with low heterogeneity (Figure 5). This suggests that day 7 is a sensitive time point for detecting laser‐related reductions in postoperative pain.

The sensitivity analysis also showed a statistically significant reduction in bleeding scores for the diode laser group (SMD = −1.75; 95% CI: −2.55 to −0.94; Z = 4.25; p < 0.0001), with lower heterogeneity (Appendix S1a). These results support a hemostatic advantage for diode laser–assisted surgery.

For wound healing on day 7, the sensitivity analysis found no statistically significant difference between groups (SMD = 0.14; 95% CI: −0.20 to 0.48; Z = 0.83; p = 0.41) and no heterogeneity (Appendix S1b). Thus, diode laser and scalpel techniques yield comparable short‐term healing outcomes. Overall, the diode laser reduces pain and bleeding, while wound healing remains equivalent to the scalpel across the included randomized controlled trials.

3.7. Publication Bias

Funnel plots for pain, generated in Stata version 16 (StataCorp, College Station, TX, USA), showed asymmetry on postoperative days 1 and 7 (Figure 6). The funnel plot for wound healing on day 7 appeared symmetrical (Figure 6). After sensitivity analyses, all funnels appeared symmetrical.

Trim‐and‐fill analysis suggested three potentially missing studies for pain on day 7, but none were imputed after the sensitivity analyses. No studies were estimated as missing for pain on days 1 or 3 (Appendix S2). Accordingly, the difference between the original and adjusted effect sizes for pain was not significant. Egger's test indicated no publication bias for the wound‐healing analysis.

4. Discussion

This systematic review and meta‐analysis evaluated the clinical effectiveness of diode laser‐assisted frenectomy versus conventional scalpel techniques across 14 randomized controlled trials (RCTs) involving participants aged 16–65 years. The review assessed primary outcomes, including postoperative pain, intraoperative bleeding, wound healing, and analgesic use. The findings indicate that diode lasers reduce intraoperative bleeding and postoperative discomfort. However, the trials covered diverse settings and follow‐up intervals, and several results conflicted, which limits certainty and warrants cautious interpretation.

Because epithelial healing is normally completed within the first postoperative week, long‐term follow‐up is not necessary for assessing pain or early wound healing in frenectomy studies. Most included trials appropriately focused on the first week and, in some cases, up to 4 weeks, when symptoms are already minimal. Thus, short follow‐up periods and small sample sizes do not undermine the validity of the outcomes. For bleeding, intraoperative assessment is the most relevant, since scalpel surgery relies on sutures while diode lasers provide immediate coagulation. Overall, the available evidence remains reliable despite these study limitations.

In addition to clinical outcomes, cost considerations also influence the selection of surgical technique. Diode lasers, while more expensive than the scalpel technique, remain significantly more affordable and accessible than high‐power systems such as CO₂, Nd: YAG, and Er: YAG lasers, which require substantially greater investment, maintenance, and operator training. Given their lower cost, ease of use, and favorable patient‐centered outcomes, including reduced bleeding, shorter operative times, and decreased postoperative discomfort, diode lasers are widely regarded as a cost‐effective option for soft‐tissue procedures in general dental practice [32].

Most studies report that low‐level laser therapy (LLLT) in dentistry is a safe and effective method that significantly reduces pain, discomfort, and bleeding during and after surgical procedures [33, 34, 35]. Chromophores in target tissues absorb photon energy at specific wavelengths, producing effects such as heating, photoablation, photodisruption, coagulation, protein denaturation, vaporization, and carbonization; clinically, these mechanisms permit precise cutting and hemostasis [36]. Despite the extensive literature on LLLT benefits, Hohmann et al. [37] reported a persistent lack of standardization in laser parameters and semiconductor types used in surgery. Standardization will help determine optimal parameters for labial frenectomy and may reduce complications while improving outcomes related to pain and discomfort.

Azma et al. [38] reported that clinicians most often use diode lasers for dental soft‐tissue surgery, particularly biopsies of minor lesions and minimally invasive frenectomies, because of their lower cost and ease of use compared with other laser types. Diode lasers provide effective coagulation and hemostasis, often remove the need for suturing, and are associated with reduced edema and pain, faster epithelialization, and improved tissue repair. Movaniya et al. [39] observed that 60% of patients reported no postoperative pain on day 2 after diode‐laser biopsies. However, some studies found no significant differences between laser‐assisted and conventional frenectomy. These conflicting results may reflect small sample sizes in the included trials.

Postoperative pain was the most frequently examined outcome in comparisons of diode laser and scalpel techniques. All included trials [18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31] reported lower pain scores with diode laser–assisted surgery. Three studies [24, 28, 30] also reported a marked reduction in analgesic use. In this meta‐analysis, diode laser–assisted frenectomy produced a statistically significant reduction in pain at all follow‐up points. On day 1, heterogeneity was high, but the overall effect still favored the diode laser. Sensitivity analyses reduced heterogeneity and showed a stronger analgesic effect. The same pattern persisted on days 3 and 7, likely reflecting differences in operative technique and individual healing trajectories during mid‐recovery.

By day 7, the diode laser again showed a significant benefit. The initial heterogeneity was high (I ² = 90%), but after excluding three studies [23, 25, 31] it fell to a very low level (I ² = 5%). These findings indicate a consistent and reliable analgesic effect through the first postoperative week, supporting the clinical value of diode laser–assisted frenectomy.

Tuncer et al. corroborated these findings and proposed that pain and discomfort decrease because a protein coagulum forms on the wound surface during laser surgery. This layer acts as a biological dressing and seals the terminal endings of peripheral sensory nerves [11, 40]. The laser's thermal effect may also reduce postoperative bacteremia [41] and lower the burden of periodontitis‐associated pathogens [42], which can further relieve discomfort. A comprehensive review by L. Clément et al. also reported reduced postoperative discomfort after laser‐assisted frenectomy [11].

The thermal effects of diode laser surgery likely seal sensory nerve endings and lymphatic channels, which explains the reductions in pain and swelling. This thermal action promotes fibrin clot formation on the wound surface, creating a physical barrier that limits external irritation [27, 43, 44, 45]. Consistent with these mechanisms, this meta‐analysis showed a statistically significant reduction in pain with diode laser‐assisted frenectomy at all follow‐up points.

In general, the included trials demonstrated substantial variability in technique and the anatomic sites where frenectomies were performed. Studies used different diode laser wavelengths and parameter settings, which complicated cross‐study comparisons. Patient age ranged from 16 to 65 years. Several studies contributed limited evidence because of small sample sizes and non‐significant findings.

Several studies [19, 20, 27, 29] reported that by postoperative day 3 or 7, patients in the laser groups had no pain, whereas many in the scalpel groups still reported marked discomfort at days 14 or 21 [19, 20, 27, 29]. Another study [24] used the numeric rating scale (NRS) and found lower pain in the laser group. Reduced analgesic use in the laser arms supports a pain‐relieving effect. In this meta‐analysis, several trials recorded analgesic use; three quantified consumption over the first 7 postoperative days [24, 28, 30]. All showed lower analgesic intake in the diode laser groups. Some studies, such as Fatima et al., did not report standard deviations, which prevented inclusion in the quantitative synthesis. The available qualitative evidence indicates that diode laser–assisted frenectomy reduces the need for postoperative medication.

Other studies [46, 47] report that the analgesic effect of low‐level laser therapy (LLLT) is most evident at wavelengths between 632 and 904 nm. LLLT may lower the firing rate of peripheral nociceptors, thereby reducing the need for analgesic medication. In a cohort of 20 patients, Yadav et al. compared different laser types and found that the neodymium‐doped yttrium aluminum garnet (Nd:YAG) group required fewer analgesics [48].

This review also assessed intraoperative hemorrhage. The findings showed a significant reduction in bleeding with the use of the diode laser. However, differences in surgical technique, laser parameters, and baseline bleeding risk across studies may influence these results.

After the compared with the conventional group. Consistent results across the primary and sensitivity analyses indicate that diode laser use in frenectomy provides reliable hemorrhage control.

The marked reduction in perioperative bleeding with diode lasers likely reflects their coagulative effect, which often eliminates the need for sutures [21, 27, 49, 50]. The laser's thermal action seals small blood vessels at the time of incision, producing rapid hemostasis [51]. When sutures are unnecessary, procedures proceed more quickly and operative time decreases. Two studies reported shorter surgical durations with the laser approach [49, 50], and a recent meta‐analysis of six trials by Protásio et al. also found that laser frenectomy required less operating time than conventional techniques [16]. By contrast, the scalpel technique typically requires suturing, which can prolong surgery and increase postoperative discomfort. Notably, two comparative studies in which patients underwent both laser and scalpel procedures reported higher overall satisfaction with laser surgery, largely due to minimal bleeding, the absence of sutures, and reduced postoperative pain [52, 53]. Patients primarily preferred the laser because it minimized bleeding, eliminated the need for sutures, and reduced postoperative pain after treatment [52].

Substantial evidence supports a biological basis for these findings: diode lasers absorb hemoglobin and achieve simultaneous incision and coagulation, which stabilizes the surgical field and reduces bleeding [54, 55, 56]. This combined action improves intraoperative visibility, shortens operative time, lowers the risk of complications, and leads to better clinical outcomes.

Conversely, diode lasers, depending on wavelength and output power, can produce harmful thermal effects in soft tissues. These include carbonization of the epithelial surface, delayed healing by secondary intention, and localized necrosis, which can increase patient discomfort and pain, as reported by R. R. de Souza Fonseca et al. [57]. In that study, the keratinized epithelium showed increased thickness, which required greater pressure during incision. Using a pulsed emission mode together with immediate low‐level laser therapy (LLLT) may reduce tissue carbonization and necrosis in dense keratinized epithelium.

In this meta‐analysis, wound‐healing outcomes varied widely across trials, particularly on postoperative day 7. Clinical and methodological differences across studies may have influenced these results.

Day 7 wound‐healing results varied across studies and depended on the specific trials included. The high heterogeneity likely reflects methodological and clinical differences among the studies. Diode laser wavelengths and settings differed (e.g., 445 vs. 980 nm); surgical techniques and control protocols varied, such as V‐Y plasty [23] vs. simple excision [21, 26], and different times and criteria for assessing healing. Also, the quality of the outcome reporting and the demographics of the patients were different. Sobouti [23] used a more tightly controlled RCT design than the others.

The small number of studies and the subjective nature of many healing markers may have compromised the reliability of the findings. Research indicates that diode lasers do not impede wound healing and may, in some cases, facilitate the healing process by reducing scarring or inflammation.

The laser group demonstrated superior wound healing in the majority of studies; however, due to the variability in scoring methods and the absence of standard deviation data for some outcomes [19, 22], only three studies [21, 23, 26] were eligible for inclusion in this meta‐analysis.

Several studies [22, 23, 26] reported faster healing or superior epithelialization in the diode laser group. In one trial [23], tissue healing progressed more rapidly with a 980 nm diode laser than with the scalpel at 1 month postoperatively, while the 3‐ and 7‐day time points showed no notable differences. In another trial [19], the scalpel group showed better wound healing at 7 days; all groups achieved complete healing by day 30. Vincent et al. [22] found no differences at days 1 and 7, but the laser group showed superior healing at day 14. In Singh's study [26], laser‐assisted frenectomy produced better wound healing at all follow‐up time points, yet no significant differences remained beyond 30 days. Sezgin et al. [23] reported no statistically significant differences in epithelialization at 7 or 14 days [20].

Therefore, five studies [22, 23, 25, 26, 29] reported accelerated healing with the diode laser at 1 month compared with the scalpel, whereas three studies [19, 21, 23] found better healing in the scalpel group during the first 7 postoperative days.

In conventional scalpel techniques, frenectomy wounds typically heal by primary intention because sutures approximate the margins. In contrast, diode laser frenectomy generally heals by secondary intention, as the wound margins remain separated, which may reduce scarring because of decreased contraction and fewer myofibroblasts with reduced collagen deposition [58, 59]. Diode laser techniques tend to be more conservative and preserve more underlying connective tissue than scalpel excision.

Although the diode laser group showed slower early reduction in wound area, particularly on day 2, histological evaluation revealed a clean wound bed with minimal inflammatory infiltration, whereas the scalpel group exhibited greater connective tissue damage [60]. Laser‐treated wounds initially displayed necrotic epithelium and a disorganized extracellular matrix, accompanied by fewer inflammatory cells, followed by improved epithelialization at later time points [61].

Meenawat et al. reported that lateral thermal spread may account for delayed healing in some cases [61]. D'Arcangelo et al. found that a 6 W diode laser impeded healing because of marked collagen denaturation and inflammation, whereas a 4 W setting produced healing outcomes comparable to scalpel incisions [62]. Fisher et al. suggested that incisions created with low‐level laser therapy heal rapidly because the technique causes minimal tissue damage and forms a surface coagulum of denatured proteins; together with a less pro‐inflammatory response and reduced collagen remodeling, this can accelerate healing, although the pattern may appear more irregular [63].

The laser group largely preserved the connective tissue matrix, which may reduce scarring and support favorable long‐term remodeling [60, 61]. Uraz et al. reported significant increases in keratinized gingival width (KGW), attached gingival width, and gingival thickness in both laser and scalpel groups [27]. By contrast, Eroglu et al. found a greater increase in KGW at the maxillary central incisors with the diode laser [19]. Diode lasers may also lessen postoperative edema and inflammation by sealing lymphatic channels and sensory nerve endings [64], a finding echoed in several studies [25, 27, 29].

These findings generally align with recent meta‐analytic evidence reporting favorable laser effects across oral outcomes. In this meta‐analysis, a more detailed assessment of effect size for pain after oral frenectomy showed lower pain scores in the diode laser group at postoperative days 1 and 7, consistent with the sensitivity analyses, whereas the day 3 difference did not reach significance. The absence of a day 3 effect likely reflects trial heterogeneity and the limited number of studies reporting that time point.

Despite heterogeneity, consistent findings at early and late follow‐up, supported by the forest plot and sensitivity analysis (Figure 7a), show that diode laser–assisted frenectomy improves patient comfort and reduces early postoperative morbidity.

Figure 7.

(a) Effect size comparison for postoperative pain reduction on day 7 after frenectomy: diode laser versus conventional scalpel; (b) comparison of effect sizes for pain reduction and wound healing on day 7 after frenectomy.

Effect sizes indicate that the diode laser provides a greater reduction in pain than improvement in early wound healing at 7 days after frenectomy (Figure 7b). On postoperative day 7, the diode laser produced a marked decrease in pain, whereas differences in wound healing were smaller and varied across studies. These results suggest that the main short‐term benefit of diode laser use is pain control, while wound healing remains broadly comparable to the scalpel at this interval.

Overall, the results of this meta‐analysis demonstrating the diode laser's clear advantage in reducing postoperative pain and controlling intraoperative bleeding are strongly supported by the broader contemporary literature, despite variations in study design and methodology. The marked reduction in postoperative pain observed in our diode laser group aligns closely with the findings of Protásio et al. [16], whose pooled analysis of several laser systems (Nd:YAG, CO₂, and diode) similarly reported substantial decreases in patient discomfort during functional activities such as speaking and chewing. Likewise, our evidence of improved intraoperative hemostasis is corroborated by the systematic reviews of Lebret et al. [11] and Dioguardi et al. [33], both of which identified minimal bleeding, reduced or absent need for suturing, and shorter operative times as key advantages of laser‐assisted surgery compared to conventional techniques.

The consistency of these benefits across recent systematic reviews—particularly with respect to enhanced perioperative management and reduced postoperative analgesic requirements—reinforces the diode laser's capacity to improve patient comfort and overall clinical experience.

5. Limitations

This review has several limitations. Wound healing assessment varied substantially because studies used different scoring systems and reporting criteria. Many studies did not report standard deviations, which prevented pooling of analgesic use and healing scores. Several trials enrolled small samples and used short follow‐up periods, limiting conclusions about long‐term outcomes such as recurrence or tissue reattachment. Cost outcomes were inconsistently reported across the included trials, preventing a systematic cost or cost‐effectiveness evaluation. Based on procedural characteristics, potential differences in resource use may influence overall treatment cost, and future studies should incorporate standardized economic reporting. The nature of the interventions did not allow blinding of participants or staff, which may have introduced performance bias.

6. Conclusion

The evidence indicates that diode laser–assisted frenectomy reduces postoperative discomfort and intraoperative bleeding more than the conventional scalpel technique. Wound‐healing findings vary across trials but appear comparable by day 7, with some studies reporting advantages at later time points. Where reported, analgesic requirements were lower in the laser groups. Diode lasers therefore represent a practical option in contemporary oral surgery, particularly when parameters are selected appropriately. Future studies should standardize wound‐healing indices and pain scales, extend follow‐up, and include cost‐effectiveness analyses to support clinical decision making.

6.1. Clinical Implications

This review indicates that diode laser–assisted frenectomy offers practical advantages, particularly for children, older adults, and patients receiving anticoagulant therapy who require reliable hemostasis and minimal discomfort. The technique suits high‐volume outpatient settings because it typically requires fewer sutures and a shorter operative time. Clinicians should also weigh the higher upfront cost of laser equipment, the learning curve for correct use, and management of laser plume (fumes and odors) during treatment, which calls for effective evacuation and ventilation.

Compared with other high‐power lasers (HPLs) such as neodymium‐doped yttrium aluminum garnet (Nd:YAG) and erbium:yttrium aluminum garnet (Er:YAG), the diode laser offers greater accessibility and easier handling. However, some studies suggest that Er:YAG may permit faster healing [57].

Supporting information

Appendix S1: (a) Forest plot from the sensitivity analysis showing intraoperative bleeding between diode laser and conventional scalpel groups after excluding outlier studies; (b) forest plot from the sensitivity analysis showing wound healing at day 7 between diode laser and conventional scalpel groups after excluding outlier studies.

Appendix S2: Funnel plot using the trim‐and‐fill method for postoperative pain on day 7.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.