Lasers in Medical Science

, Volume 32, Issue 3, pp 573–581 | Cite as

A randomized controlled clinical and histopathological trial comparing excisional biopsies of oral fibrous hyperplasias using CO2 and Er:YAG laser

  • Valerie G. A. Suter
  • Hans Jörg Altermatt
  • Michael M. Bornstein
Original Article


This study was conducted in order to compare clinical and histopathological outcomes for excisional biopsies when using pulsed CO2 laser versus Er:YAG laser. Patients (n = 32) with a fibrous hyperplasia in the buccal mucosa were randomly allocated to the CO2 (140 Hz, 400 μs, 33 mJ) or the Er:YAG laser (35 Hz, 297 μs, 200 mJ) group. The duration of excision, intraoperative bleeding and methods to stop the bleeding, postoperative pain (VAS; ranging 0–100), the use of analgesics, and the width of the thermal damage zone (μm) were recorded and compared between the two groups. The median duration of the intervention was 209 s, and there was no significant difference between the two methods. Intraoperative bleeding occurred in 100% of the excisions with Er:YAG and 56% with CO2 laser (p = 0.007). The median thermal damage zone was 74.9 μm for CO2 and 34.0 μm for Er:YAG laser (p < 0.0001). The median VAS score on the evening after surgery was 5 for the CO2 laser and 3 for the Er:YAG group. To excise oral soft tissue lesions, CO2 and Er:YAG lasers are both valuable tools with a short time of intervention and postoperative low pain. More bleeding occurs with the Er:YAG than CO2 laser, but the lower thermal effect of Er:YAG laser seems advantageous for histopathological evaluation.


Laser Oral mucosa Fibrous hyperplasia Bleeding Thermal damage zone Pain 



The authors thank Mr. Gabriel Fischer, significantis GmbH, Herzwil b. Köniz, Switzerland, for his assistance regarding the statistical analysis.

Compliance with ethical standards

The study protocol had been approved by the standing ethics committee of the State of Bern, Switzerland (Ref Nr. KEK-BE: 203/12).

Conflict of interest

The authors declare that they have no conflict of interest.


This study was supported by a grant from the Swiss Dental Association (grant number 271-13).

Informed consent

All patients included signed an informed consent to participate in the study. Examination and data collection were done according to the guidelines of the World Medical Association Declaration of Helsinki (version 2013).


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Copyright information

© Springer-Verlag London 2017

Authors and Affiliations

  • Valerie G. A. Suter
    • 1
  • Hans Jörg Altermatt
    • 2
  • Michael M. Bornstein
    • 1
    • 3
  1. 1.Department of Oral Surgery and Stomatology, School of Dental MedicineUniversity of BernBernSwitzerland
  2. 2.Pathology LänggasseBernSwitzerland
  3. 3.Applied Oral Sciences, Faculty of DentistryThe University of Hong Kong, Prince Philip Dental HospitalHong KongChina

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