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215]

Case Report

Effect of Low‑Level Laser Therapy on Wound Healing After

Gingivectomy
Vikrant Sharma, D.S. Kalsi, Arushi Goyal, Swantika Chaudhry, Naveen Oberoi, Parvinder Singh Baweja1
Departments of Periodontology and Oral Implantology and 1Conservative Dentistry and Endodontics, B.J.S. Dental College, Hospital and Research Institute, Ludhiana,
Punjab, India

Abstract
Low‑level laser therapy (LLLT) is based on the principle of biostimulation or biomodulation effect. LLLT after gingivectomy has resulted
in better wound healing because of its action on collagen synthesis, angiogenesis, and growth factor release. The authors here present a case
report on the effect of LLLT, using a diode laser (InGaAsP), on wound healing and patient’s response after scalpel gingivectomy.

Keywords: Gingivectomy, low‑level laser therapy, wound healing

Submitted: 24‑Nov‑2020; Accepted: 11-Jan-2021; Published: 22-Mar-2021

Introduction Various light sources, including helium–neon, ruby, diode,

and gallium arsenide, have been used to deliver LLLT under
Research and clinical practice using lasers is at its zenith since
different conditions like treatment of mucositis, paresthesia,
the past decade. The first prototype of the laser was developed
and TMJ disorders.[14‑16] In addition, LLLT has also been
by Maiman in 1960. Today, a wide range of lasers such as
used for promoting wound healing and reducing pain after
diode, CO2, Nd:Yag, and Er:Yag are used in periodontology
gingivectomy, endodontic surgery, orthodontic treatment,
for hard‑  and soft‑tissue ablation, detoxification of root
and as an adjunct to improve wound healing after nonsurgical
surfaces, pocket debridement, microbial control, and various
periodontal treatment.[17‑21]
surgical approaches.[1] Despite the common use of high‑power
lasers energy for surgery, there is another lesser‑known We hereby present a case where LLLT was used to improve
application of lasers called low‑level lasers. Low‑level laser wound healing after a gingivectomy procedure.
therapy (LLLT) was first introduced by Mester et al. in 1967
at Semmelweis Medical University in Budapest, Hungary. In Case Report
these lasers, a light source generates light of single wavelength,
A 35‑year‑old  male patient was referred to the department of
in milliwatt range with wavelengths in the near‑infrared
periodontology with a chief complaint of gingival overgrowth.
spectrum  (400–900 nm).[2] LLLT does not cut or ablate the
[Figure 1] Intraoral examination revealed generalized gingival
tissues.
overgrowth involving both maxillary and mandibular anterior teeth.
The effectivity of LLLT is based on biostimulation or The patient was not taking any antiepileptic, antihypertensive, or
biomodulation effect[3,4] which states that irradiation of tissues at immunosuppressive medications that could cause gingival
a specific wavelength can alter cellular behavior.[5,6] This effect enlargement. His weight and height were considered to be within
is achieved by action on cellular mitochondrial respiratory chain
or on membrane calcium channels and promotes an increase
Address for correspondence: Dr. Vikrant Sharma,
in cell metabolism and proliferation.[7‑9] In vitro and in  vivo
Department of Periodontology and Oral Implantology, B.J.S. Dental College,
studies suggest that LLLT improves/increases fibroblast and Hospital and Research Institute, Ludhiana, Punjab, India.
keratinocyte cell motility collagen synthesis, angiogenesis, and E‑mail: vikrant.toh@gmail.com
growth factor release leading to increased wound healing.[10‑13]
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DOI: How to cite this article: Sharma V, Kalsi DS, Goyal A, Chaudhry S,
10.4103/IJDS.IJDS_203_20 Oberoi N, Baweja PS. Effect of low-level laser therapy on wound healing
after gingivectomy. Indian J Dent Sci 2021;13:128-33.

128 © 2021 Indian Journal of Dental Sciences | Published by Wolters Kluwer - Medknow
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Sharma, et al.: Effect of LLLt on gingival wound healing

Figure 2: Picture showing surgically treated sites on the 3rd day

Figure 1: Preoperative picture showing maxillary and mandibular sites
postoperative day after periodontal pack removal
to be treated surgically

Figure 4: Picture showing application of plaque disclosing agent to assess

healing on 3rd post operative day
Figure 3: Picture showing application of low‑level laser therapy on the
mandibular surgical site on the 3rd postoperative day

Figure 6: Picture showing application of low‑level laser therapy on the

mandibular surgical site on the 7th postoperative day

Figure 5: Picture showing surgically treated sites on the 7th postoperative
day after periodontal pack removal
normal limits and peripheral blood counts were normal which
were correlated with an absence of any history of systemic disease.
The enlargement was diagnosed as due to periodontitis.
The case was assessed and full‑mouth SCRP was done.
Assessment of need of treatment and extent was done after
3  weeks. It was decided that gingivectomy would be the
indicated procedure. After gingivectomy, LLLT was done
on buccal gingival of mandibular anteriors and placebo laser
aiming light application of the laser unit on maxillary anteriors.
Surgical protocol and low‑level laser therapy application
The patient underwent presurgical preparation consisting
of full‑mouth scaling and root planing with oral hygiene
instructions. After 3 weeks, physiologic gingival contours

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Sharma, et al.: Effect of LLLt on gingival wound healing
Figure 7: Picture showing application of plaque disclosing agent to assess
healing on the 7th postoperative day
Figure 9: Picture showing application of low‑level laser therapy on the
mandibular surgical site on the 14th postoperative day
were re‑examined for continued need of gingivectomy.
It was found that surgical intervention was needed.
Gingivectomy was carried out in both the maxillary and
mandibular anterior teeth. Excess gingival tissue was
excised and gingival was contoured using Kirkland, Orban’s
knives # 15 Bard‑Parker blades, tissue nipper, and scissors.
Thereafter, excised tissue was removed using curettes, and
gingivoplasty was refined to re‑establish suitable gingival
contours. After attaining hemostasis, gingival on the buccal
surface of mandibular anteriors was irradiated with a diode
laser (940 nm), at a power setting of 0.5W applied in a pulse,
noncontact mode for 30 s in relation to each tooth. Sham
laser application was imitated with aiming light of the laser
unit for the control site.
Periodontal dressing (Coe–Pak) was given. This dressing was
replaced at 3rd and 7th postoperative visits [Figures 2,5] when
the laser was reapplied on the mandibular sites, while the
maxillary site again underwent laser imitation. On the 14th day,
the dressing was removed and the final application of laser was
performed. [Figure 8] The pain was assessed on 3rd, 7th, and
14th postoperative visit using a visual analog scale (VAS) score.
130 Indian Journal of Dental Sciences  ¦  Volume 13  ¦  Issue 2  ¦  April-June 2021
Figure 8: Picture showing surgically treated sites on the 14th postoperative
day after periodontal pack removal
Figure 10: Picture showing application of plaque disclosing agent to
assess healing on 14th postoperative day
Maxillary and mandibular wound healing was assessed on
3rd‑ 7th‑, and 14th‑day application using a healing index (HI)  by
Landry et al.[22] which grades the wound healing on a scale
of 1–5, where 1 indicates very poor healing and 5 indicates
excellent healing. Healing index scoring was given by a
different examiner (different from the one who performed the
gingivectomy) who did not know which of the two, maxillary
or mandibular sites, was actually irradiated by LLLT.
Wound healing was scored after application of LLLT and
imitation laser application on each postoperative visit.
[Figures 3,6,9] For this, surgical sites were stained with
plaque‑disclosing agent (2‑tone disclosing agent) to identify
the regions of gingiva in which epithelization was incomplete
or lacked complete keratinization. [Figures 4,7,10]
The gross surface area was estimated from digital clinical
photographs of surgical sites. Darkly stained bluish areas were
considered as sites still undergoing active wound healing and
having incomplete epithelization. The surface areas of the
stained sites in both the test and control sites were compared
on 3rd, 7th, and 14th postoperative days.
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Sharma, et al.: Effect of LLLt on gingival wound healing
Table 1: Showing wound healing and pain scores after 3, 7 and 14 days
Parameters After 3 days
Wound healing (Landry index) 1-upper (very poor)
2-lower (poor)
Pain response 7-upper
0-lower
Results
Healing took place uneventfully in both maxillary and
mandibular surgical sites with no complaints of any adverse
postoperative complications. On the evaluation of surface
keratinization, it was observed that the stained areas of
both sites on the 3rd and 7th day were similar. [Figure 4,7]
However, on the 14th postoperative day, LLLT treated sites,
i.e., mandibular sites, showed significantly less surface area
that was darkly stained when compared to the maxillary sites
demonstrating better surface epithelialization. [Figure 10]
Comparison of healing index scores also showed results
similar to that of the surface keratinization. Here also, there
was no difference in healing scores on 3rd and 7th days. On
the 14th postoperative day, a difference in healing was clearly
apparent between maxillary and mandibular sites with the
LLLT treated site (mandibular sites) having much better look
and healing status.
Visual analog scale score
 
The patient experienced no pain in the mandibular site as
compared to the maxillary site where the patient experienced
pain after performing gingivectomy procedure.
Discussion
LLLT is a noninvasive, painless process that provides biological
therapeutic advantages, including analgesic effects.[23] The use
of LLLT for oral and periodontal purposes has been the subject
of numerous in vitro and in vivo studies. Increasing interest in
the field of LLLT is based on the perceptions of patients who
desire minimally invasive and painless treatments.
Numerous studies have been conducted over the years to
evaluate healing after periodontal surgical procedures. In this
case, the effect of LLLT on wound healing after gingivectomy
was evaluated and postoperative pain to check whether LLLT
provides any added benefit in improving healing and patient’s
comfort postsurgically.
The results showed that the pain score in the test site was
comparatively less on the 3rd day, 7th day, and 14th days, than
on the control site. [Table 1] These results explain the positive
effect of LLLT on patient’s pain response after gingivectomy.
Patients in the test site experienced lower postoperative
pain as compared to the control site. Our results are in
Indian Journal of Dental Sciences  ¦  Volume 13  ¦  Issue 2  ¦  April-June 2021
After 7 days After 14 days
2-upper (poor) 2-upper (poor)
3-lower (good) 4-lower (very good)
5-upper 5-upper
0-lower 0-lower
accordance with a study conducted by Sanz‑Moliner et  al.,
who concluded that less pain was reported by patients at the
sites where LLLT was performed after modified Widman flap
surgery and Tomasi et al. where they concluded that low‑level
lasers showed analgesic effect when used during periodontal
maintenance.[24,25] However, these results are in contradiction
to a study conducted by Masse et  al., who did not find a
significant analgesic effect of low‑level lasers when used after
the placement of free gingival grafts.[26] This may due to the
heterogeneity of studies, differences in laser parameters used.
LLLT apart from pain reduction is also known to help
in repair process and thus subsequently accelerating the
wound‑healing process. Low‑level laser accelerates the
healing process by stimulating mitochondria to increase ATP
production to increase reactive oxygen species, which in turn
influences redox signaling, affecting intercellular homeostasis
of the proliferation of cells.[27] LLLT also has an effect on
microcirculation, which reduces edema by changing the
capillary hydrostatic pressure.[28] Studies have also suggested
that LLLT application may accelerate wound healing by
increasing the motility of human keratinocytes and promoting
early epithelialization, by increasing fibroblast proliferation
and matrix synthesis, and by enhancing neovascularization. It
has also been shown that the expression of fibroblast growth
factors by macrophages and fibroblasts is increased after LLLT
application.
In this case, healing was assessed clinically using Landry et al.
HI at all postoperative visits.[22] Healing scores in control as
well as test groups increased from day 3 to day 14. [Table 1]
Comparison of the mean healing scores within the same group
revealed statistically significant differences in both the test
and control groups on postoperative day 3, day 7, and day 14.
The test group showed visibly better healing as compared to
the control group by day 14. [Figure 8,10] Our results are in
agreement with the study conducted by Amorim et al.[18] and
Martu et al. Both the studies reported that the use of LLLT
showed better repair and improved healing of the damaged
tissues.[18,29]
In this case, LLLT was applied to the test sites immediately
after surgery followed by day 3 and day 7. Diode laser with a
wavelength of 940 nm for 30s in the noncontact mode for LLLT
and three‑time application proved to be sufficient as better
wound healing was observed in the test sites. Day 3 and day
7 were selected for LLLT application as there are formation
and proliferation of newer blood vessels and fibroblasts in the
initial stages of wound healing. This was done in accordance
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Sharma, et al.: Effect of LLLt on gingival wound healing
with other studies by Ozcelik et al. and Ahmed who also used
LLLT application during the first 7 days of wound healing.[30,31]
Methylene blue was used to evaluate the wound epithelialization
as compared to conventionally used hydrogen peroxide. This
was because of the cytotoxic effects of hydrogen peroxide
on human gingival fibroblast which could have potentially
impaired the wound healing.[32] The results showed that
LLLT‑applied sites displayed better healing as compared to
the control sites. There was less amount of stained surgical
area (surface lacking epithelium) in the test sites. These results
are in accordance with the study conducted by Ozcelik et al.[30]
where they found that the surgical area was less stained in sites
treated with LLLT.
Conclusion
Based on the result of this case report, it can be said that LLLT
when used as an adjunct to surgical gingivectomy can be used
to reduce postoperative pain and discomfort and aid in better
wound healing.
Further studies must be conducted to evaluate the effect of
adjunctive use of LLLT on wound healing and patients’ response.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and other
clinical information to be reported in the journal. The patients
understand that their names and initials will not be published
and due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.
Ethical clearance
Ethical clearance was obtained from the ethical committee of
the institute.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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