Laser-Mediated Hemostasis for Older Patients Receiving Routine Dental Treatment

Abstract

Background/Objective: Laser therapy has gained attention in dental practice to minimize bleeding and enhance blood clot formation. This study aimed to explore the utilization and to compare the clinical efficacy of laser-mediated hemostasis for older patients receiving routine dental treatment. Methods: A prospective observational study was conducted across research networks between October 2023 and August 2024, involving 60 patients aged 50 years and older (average = 63.35 years) at risk of postoperative bleeding following dental treatments. Additionally, laser therapy for hemostasis was selected and provided among calibrated operators. A single researcher performed data collection. Before statistical analysis, data verification and clinical assessment were conducted by the operators and researcher. A clinical cut-off for hemostasis was set at 5 min. Two diode laser machines were used namely, an 810 nm and dual wavelengths of 635 nm and 980 nm. Results: There were 94 extraction sockets, 28 procedures of scaling and root planing and 18 procedures of minor oral surgery. Combining laser ablating sulcular fiber and photobiomodulation initiating blood clot formation was a preferable hemostatic technique for extraction socket, while photobiomodulation alone was a preferred technique for soft tissue hemostasis (p < 0.001). All operators confirmed that 97.86 percent of bleeding events achieved more rapid hemostasis. 61.43 percent of bleeding events clinically achieved hemostasis within 5 min by using laser-mediated hemostasis alone (p = 0.092). Full recovery of the extraction socket was significantly observed during the 2- to 4-week follow-up period (p = 0.005). No clinical complications were reported. Conclusions: Laser-mediated hemostasis effectively reduced hemostatic duration, prevented postoperative bleeding and promoted wound healing in older patients undergoing routine dental treatment.

Keywords: blood coagulation; laser therapy; photobiomodulation; photocoagulation; postoperative bleeding; scaling and root planing; tooth extraction.

Figure 1

The procedures of laser-mediated hemostasis for tooth extraction in 68-year-old Thai female with hypertension and dyslipidemia, (A) HILT ablating sulcular fiber by using 810 nm diode laser at 2 W with optical fiber, (B) black arrows indicating a whitish coagulative area on gingivae, (C) PBM initiating blood clot formation by using 810 nm diode laser with a 6 mm-diameter biomodulation probe, (D) complete clot formation found within 5 min, (E) 1-day follow-up period presenting a coagulum with less swelling, minimal inflammation and no pain, (F) 4 weeks follow-up period indicating complete mucosal coverage of the edentulous ridge.

Figure 2

The procedures of laser-mediated hemostasis for tooth extraction in 64-year-old Thai male with coronary artery disease (triple vessel disease), hypertension, diabetes, history of stroke and ongoing dual antiplatelets therapy (clopidogrel 75 mg and aspirin 81 mg). (A) HILT ablating sulcular fiber by using 980 nm diode laser at 3 W with optical fiber, black arrow indicating a whitish coagulative area on gingivae, (B) PBM initiating blood clot formation by using 635 nm diode laser with 8 mm-diameter laser probe, (C) complete blood clot formation in all extraction sockets found within 5 to 15 min, (D) 7 days follow-up period indicating partial mucosal coverage and coagulum.

Figure 3

The procedures of laser-mediated hemostasis for SRP in 58-year-old Thai female with diabetes and hypertension, (A) untreated periodontal diseases with supra and subgingival calculus and inflamed gingivae, (B,C) SRP using ultrasonic scaler and hand instrumentation, (D) PBM for initiating blood clot using 810 nm diode laser with biomodulation probe over the bleeding gingival sulcus, (E) complete clot formation found within 10 min, (F) 4 weeks follow-up period indicating healthy periodontal tissue.