CO₂ Laser Surgery for Oral Leukoplakia and Erythroplakia:

Hello everyone, this is Raymond Lee from Raymond’s Dental Solutions.

Today, I’d like to walk you through a high-impact 2024 systematic review and meta-analysis that every clinician using—or considering—CO₂ lasers should know:

“CO₂ Laser Surgery for Oral Leukoplakia and Erythroplakia”,published by Almeida et al. 

Why This Topic Matters

Oral leukoplakia and erythroplakia are among the most clinically significant oral potentially malignant disorders (OPMDs).Both carry a real risk of progression to oral squamous cell carcinoma, making treatment choice and long-term management critically important.

Because of its precision, hemostasis, and affinity for soft tissue, the CO₂ laser has become an increasingly preferred surgical modality.This review evaluates whether the clinical data truly support that trend.

Purpose of the Review

The authors aimed to assess how effective and safe CO₂ laser excision or ablation is for managing oral leukoplakia and erythroplakia, focusing on:

• Recurrence rates

• Malignant transformation

• Healing outcomes

• Postoperative complications

• Quality of tissue specimens for histopathology

Study Design & Methodology

The authors conducted a comprehensive literature search including:

• Prospective clinical studies

• Retrospective cohort studies

• Clinical case series

All included studies involved CO₂ laser treatment of leukoplakia or erythroplakia.When possible, meta-analytic techniques were applied to strengthen the conclusions across studies.

Key Findings

1. Recurrence and Treatment Success

Across the literature, CO₂ laser surgery demonstrated low to moderate recurrence rates.

In studies that allowed direct comparison, CO₂ laser treatment generally showed equal or better outcomes than conventional scalpel excision.

Recurrence was most strongly associated with:

• High-grade epithelial dysplasia

• Larger lesion size

• Patient risk factors such as tobacco use

  
  

2. Malignant Transformation

The meta-analysis showed low malignant transformation rates following CO₂ laser treatment.

Evidence suggests that complete laser excision with clear margins may reduce progression to oral cancer, particularly in dysplastic lesions.논문 26 CO₂ Laser Surgery for Ora…

3. Healing and Patient Comfort

Consistent benefits were reported across multiple studies:

• Minimal intraoperative bleeding

• Reduced postoperative pain

• Faster re-epithelialization

• Less scarring

• Improved functional outcomes

These results are attributed to the precise photothermal interaction of the CO₂ laser with water-rich soft tissue.

4. Safety and Complications

Complications were rare and generally mild, with no significant long-term morbidity reported.

Importantly, histopathological evaluation of excised tissue remained reliable, with minimal thermal artifacts—addressing a common concern regarding laser surgery.논문 26 CO₂ Laser Surgery for Ora…

Strengths and Limitations

While overall outcomes strongly support CO₂ laser use, the authors note limitations in the existing literature, including:

• Variability in laser parameters

• Differences in surgical protocols

• Inconsistent follow-up periods

• Variable study quality

As a result, they emphasize the need for more standardized, randomized clinical trials in the future.

Conclusion

This systematic review and meta-analysis supports CO₂ laser surgery as a safe, effective, and minimally invasive treatment option for oral leukoplakia and erythroplakia.

Key advantages include:

• Low recurrence rates

• Low malignant transformation rates

• Excellent healing and patient comfort

However, long-term follow-up remains essential, given the inherent malignant potential of these lesions.논문 26 CO₂ Laser Surgery for Ora…

Clinical Takeaway

From a practical standpoint, this review reinforces the CO₂ laser as a preferred modality for early intervention in potentially malignant oral lesions.

It offers:

• Superior patient comfort

• Predictable healing

• A valuable role in reducing cancer risk

For clinicians focused on modern, minimally invasive, and patient-centered care, the evidence continues to move clearly in favor of CO₂ laser surgery.