ACMJ
Anatolian Current Medical Journal

Anatolian Current Medical Journal (ACMJ) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

eISSN: 2718-0115
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Submit Manuscript

Index
Original Article
The effect of 0.24% hyaluronic acid gel used after diode laser-assisted labial frenectomy on postoperative pain level and periodontal parameters: a randomized clinical research
Abstract
Aims: Diode lasers are popular dental soft tissue lasers due to their bleeding-free and sutureless surgery advantages. Although diode lasers offer benefits in surgery, their application in frenectomy procedures for pediatric patients remains limited. Hyaluronic acid gel (HA) is a commonly used natural biopolymer for treating symptoms of wound healing. No studies have examined the effect of 0.24% HA gel on postoperative pain and periodontal outcomes after laser-assisted frenectomy in children. This research aimed to evaluate the effect of 0.24% HA gel on the healing trajectory and postoperative pain management in pediatric patients undergoing diode laser-assisted labial frenectomy.
Methods: Two groups were formed for the study: a control group consisting of 20 participants aged 8 to 14 who underwent diode laser-assisted frenectomy with sterile saline and an experimental group of 20 participants, also aged 8 to 14, who received diode laser-assisted frenectomy supplemented with HA gel. A frenectomy was performed using diode laser assistance. After the surgery, the pain level was evaluated using the visual analog scale for one week. Plaque index, gingival index, pocket depth, bleeding on probing, keratinized gingival width, and attached gingival thickness values were observed and evaluated for three months.
Results: No difference in pain levels between HA gel and the control group after one week on days 1 and 2; the group that used HA gel reported lower pain levels (p>0.05). The control group reported lower pain levels during the third and fourth days (p>0.05). During days 5-7, the group treated with HA gel reported lower pain levels (p>0.05). Between days 5 and 7, the HA gel participants experienced decreased pain levels. The test group also showed no significant changes in all periodontal parameters.
Conclusion: Applying 0.24% HA gel post-laser-assisted frenectomy reduced pain, although this effect did not reach statistical significance compared to the control group. Future studies should involve larger sample sizes and extended follow-up periods to investigate further HA gel's effects, particularly formulations with higher concentrations.

Keywords : Frenectomy, hyaluronic acid, diode laser, labial frenulum, Visual Analog Scale

Download Article


1. Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(S20):S190-S198. doi:10.1111/jcpe.12948
2. Dioguardi M, Ballini A, Quarta C, et al. Labial frenectomy using laser: a scoping review.Int J Dent. 2023;2023:7321735. doi:10.1155/2023/7321735
3. Baxter RT, Zaghi S, Lashley AP. Safety and efficacy of maxillary labial frenectomy in children: a retrospective comparative cohort study. Int Orthod. 2022;20(2):100630. doi:10.1016/j.ortho.2022.100630
4. Dentistry. AA of PDP on management of the frenulum in pediatric patients. TRM of P. Policy on management of the frenulum in pediatric patient. Published online 2024.
5. Sezgin G, Öztürk Özener H, Meseli SE, Kuru L. Evaluation of Patient’s perceptions, healing, and reattachment after conventional and diode laser frenectomy: a three-arm randomized clinical trial. Photobiomodul Photomed Laser Surg. 2020;38(9):552-559. doi:10.1089/photob.2019.4783
6. Mirko P, Miroslav S, Lubor M. Significance of the labial frenum attachment in periodontal disease in man. Part 1. Classification and epidemiology of the labial frenum attachment. J Periodontol. 1974; 45(12):891-894. doi:10.1902/jop.1974.45.12.891
7. Ahn JH, Newton T, Campbell C. Labial frenectomy: current clinical practice of orthodontists in the United Kingdom. Angle Orthod. 2022; 92(6):780-786. doi:10.2319/011822-56.1
8. Amaral MBF, de Ávila JMS, Abreu MHG, Mesquita RA. Diode laser surgery versus scalpel surgery in the treatment of fibrous hyperplasia: a randomized clinical trial. Int J Oral Maxillofac Surg. 2015;44(11):1383-1389. doi:10.1016/j.ijom.2015.05.015
9. Inchingolo AM, Malcangi G, Ferrara I, et al. Laser Surgical approach of upper labial frenulum: a systematic review. Int J Environ Res Public Health. 2023;20(2):1302. doi:10.3390/ijerph20021302
10. Öztürk Özener H, Meseli SE, Sezgin G, Kuru L. Clinical efficacy of conventional and diode laser-assisted frenectomy in patients with different abnormal frenulum insertions: a retrospective study. Photobiomodul Photomed Laser Surg. 2020;38(9):565-570. doi:10.1089/photob.2020.4841
11. Uraz A, Çetiner FD, Cula S, Guler B, Oztoprak S. Patient perceptions and clinical efficacy of labial frenectomies using diode laser versus conventional techniques. J Stomatol Oral Maxillofac Surg. 2018;119(3): 182-186. doi:10.1016/j.jormas.2018.01.004
12. Ahmed A, Fida M, Javed F, Maaz M, Shoukat Ali U. Soft tissue lasers: an innovative tool enhancing treatment outcomes in orthodontics-a narrative review. J Pak Med Assoc. 2023;73(2):346-351. doi:10.47391/JPMA.6454
13. Dentistry. AA of PDP on the use of lasers for pediatric dental patients. TRM of P. Policy on the use of lasers for pediatric dental patients. Published online 2024.
14. Turgut Çankaya Z, Gürbüz S, Bakirarar B, Ünsal B, Kurtiş B. Evaluation of the effect of the application of hyaluronic acid following laser-assisted frenectomy: an examiner-blind, randomized, controlled clinical study. Quintessence Int. 2020;51(3):188-201. doi:10.3290/j.qi.a43667
15. Calcagno E, Barattini DF, Servetto R. Therapeutic approach to pediatric oral disorders. Minerva Pediatr. 2018;70(2):175-181. doi:10.23736/S0026-4946.16.04352-8
16. Casale M, Moffa A, Vella P, et al. Hyaluronic acid: perspectives in dentistry. A systematic review. Int J Immunopathol Pharmacol. 2016; 29(4):572-582. doi:10.1177/0394632016652906
17. Thomas GW, Rael LT, Bar-Or R, et al. Mechanisms of delayed wound healing by commonly used antiseptics. J Trauma Inj Infect Crit Care. 2009;66(1):82-91. doi:10.1097/TA.0b013e31818b146d
18. Wilson S. MD. &Ccedil;ocuklarda lokal anestezi ve ağız cerrahisi. In: Pediatric Dentistry: Infancy Through Adolescence. 6<sup>th</sup> ed. Mosby; 2005.
19. Digman SW, Abramowicz S. Pediatric dentoalveolar surgery. Dent Clin North Am. 2012;56(1):183-207. doi:10.1016/j.cden.2011.09.002
20. Joshi VM, Kandaswamy E, Germain JS, Schiavo JH, Fm HS. Effect of hyaluronic acid on palatal wound healing: a systematic review.Clin Oral Investig. 2024;28(10):565. doi:10.1007/s00784-024-05955-1
21. Patel M, Guni A, Nibali L, Garcia-Sanchez R. Interdental papilla reconstruction: a systematic review. Clin Oral Investig. 2024;28(1):101. doi:10.1007/s00784-023-05409-0
22. Yakout BK, Kamel FR, Khadr MAEAA, Heikal LAH, El-Kimary GI. Efficacy of hyaluronic acid gel and photobiomodulation therapy on wound healing after surgical gingivectomy: a randomized controlled clinical trial. BMC Oral Health. 2023;23(1):805. doi:10.1186/s12903-023-03519-5
23. Soriano-Lerma A, Mag&aacute;n-Fern&aacute;ndez A, Gij&oacute;n J, et al. Short-term effects of hyaluronic acid on the subgingival microbiome in peri-implantitis: a randomized controlled clinical trial. J Periodontol. 2020;91(6):734-745. doi:10.1002/JPER.19-0184
24. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-1160. doi:10.3758/BRM.41.4.1149
25. Gizani S, Seremidi K, Katsouli K, Markouli A, Kloukos D. Basic behavioral management techniques in pediatric dentistry: a systematic review and meta-analysis. J Dent. 2022;126:104303. doi:10.1016/j.jdent. 2022.104303
26. L&ouml;e H. The gingival index, the plaque index and the retention index systems. J Periodontol. 1967;38(6):610-616. doi:10.1902/jop.1967.38.6.610
27. Greenwell H; Committee on research, science and therapy. American Academy of Periodontology. Position paper guidelines for periodontal therapy. J Periodontol. 2001;72(11):1624-1628. doi:10.1902/jop.2001.72. 11.1624
28. Aftamed &ccedil;ocuk jel. https://aktident.com.tr/urun/aftamed-jel-cocuk/
29. Ginini JG, Rachmiel A, Bilder A, et al. Evaluation of parental perceptions of lingual and labial frenectomy on their child: a comparison of CO<sub>2</sub> laser and conventional scalpel. J Clin Pediatr Dent. 2023;47(6):30-37. doi: 10.22514/jocpd.2023.079
30. Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent. 2007;17(6):391-406. doi:10.1111/j.1365-263X.2007.00872.x
31. Firat D, Tunc EP, Sar V. Dental anxiety among adults in Turkey. J Contemp Dent Pract. 2006;7(3):75-82.
32. Jain A, Yeluri R, Munshi AK. Measurement and assessment of pain in children - a review. J Clin Pediatr Dent. 2012;37(2):125-136. doi:10.17796/jcpd.37.2.k84341490806t770
33. Morton N. Pain assessment in children. Pediatr Anesth. 1997;7(4):267-272. doi:10.1046/j.1460-9592.1997.d01-83.x
34. Bailey B, Trottier ED. Managing pediatric pain in the emergency department. Pediatr Drugs. 2016;18(4):287-301. doi:10.1007/s40272-016-0181-5
35. Lanka J, Gopalkrishna P, Kumar S. Management of aberrant frenal attachments in adults by scalpel method and 980 nm diode laser. Case Rep Dent. 2023;2023:1-7. doi:10.1155/2023/7258637
36. Desiate A, Cantore S, Tullo D, Profeta G, Grassi FR, Ballini A. 980 nm diode lasers in oral and facial practice: current state of the science and art. Int J Med Sci. 2009;6(6):358-364.doi:10.7150/ijms.6.358
37. Patel R, Varma S, Suragimath G, Abbayya K, Zope S, Kale V. Comparison of labial frenectomy procedure with conventional surgical technique and diode laser. J Dent Lasers. 2015;9(2):94. doi:10.4103/0976-2868.170565
38. Kang JH, Kim YY, Chang JY, Kho HS. Influences of hyaluronic acid on the anticandidal activities of lysozyme and the peroxidase system. Oral Dis. 2011;17(6):577-583. doi:10.1111/j.1601-0825.2011.01807.x
39. Dahiya P, Kamal R. Hyaluronic acid: a boon in periodontal therapy. N Am J Med Sci. 2013;5(5):309. doi:10.4103/1947-2714.112473
40. de Brito Bezerra B, Mendes Braz&atilde;o MA, de Campos MLG, Casati MZ, Sallum EA, Sallum AW. Association of hyaluronic acid with a collagen scaffold may improve bone healing in critical-size bone defects. Clin Oral Implants Res. 2012;23(8):938-942. doi:10.1111/j.1600-0501.2011.02234.x
41. Zhao N, Wang X, Qin L, et al. Effect of hyaluronic acid in bone formation and its applications in dentistry. J Biomed Mater Res A. 2016; 104(6):1560-1569. doi:10.1002/jbm.a.35681
42. Alpan AL, Cin GT. Comparison of hyaluronic acid, hypochlorous acid, and flurbiprofen on postoperative morbidity in palatal donor area: a randomized controlled clinical trial. Clin Oral Investig. 2023;27(6):2735-2746. doi:10.1007/s00784-022-04848-5
43. Pi&eacute;-S&aacute;nchez J, Espa&ntilde;a-Tost AJ, Arnabat-Dom&iacute;nguez J, Gay-Escoda C. Comparative study of upper lip frenectomy with the CO<sub>2</sub> laser versus the Er, Cr:YSGG laser. Med Oral Patol Oral Cir Bucal. 2012;17(2):e228-32. doi:10.4317/medoral.17373
Article available in :
Volume 7, Issue 2, 2025
Page : 152-158
https://doi.org/10.38053/acmj.1602419
Article Information
Received : 17 Ara 2024
Accepted : 03 Şub 2025
Published : 21 Mar 2025
Corresponding Author :

Suat Serhan Altıntepe Doğan: Department of Periodontology, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkiye

[email protected]
Citation : Altıntepe Doğan SS, Karakan C, Doğan Ö, Çelik İH. The effect of 0.24% hyaluronic acid gel used after diode laser-assisted labial frenectomy on postoperative pain level and periodontal parameters: a randomized clinical research. Anatolian Curr Med J. 2025;7(2):152-158.

Read: 13
Cited: 0
Download : 18
_Footer