Efficacy of diode laser versus conventional scalpel in labial frenectomy: a systematic review and meta-analysis of randomized controlled trials.

Abstract

High labial frenum attachments may cause diastema, gingival recession, and hygiene difficulties. Conventional scalpel frenectomy is effective but may cause pain and bleeding. This meta-analysis compared the use of a diode laser versus a conventional scalpel for maxillary labial frenectomy, focusing on postoperative pain, swelling, intraoperative bleeding, and operative time. PubMed, Scopus, Web of Science, Cochrane Library, and Embase were searched through September 2025 using MeSH and free-text terms related to "diode laser" and "labial frenectomy." Randomized controlled trials (RCTs) comparing the diode laser with the scalpel frenectomy were included. Data were pooled using random-effects meta-analyses, generating mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs). Six RCTs (n = 324) met the inclusion criteria. Compared with the scalpel, diode laser significantly reduced pain on day 1 (MD = -1.19, 95% CI -1.99 to -0.38; p = 0.0038) and day 7 (MD = -0.56, 95% CI -1.07 to -0.05; p = 0.031), but not day 3 (MD = -0.59, p = 0.30). Swelling showed no difference (SMD = -0.21, 95% CI -0.75 to 0.32; p = 0.43). Intraoperative bleeding was markedly reduced (MD = -1.15, 95% CI -1.50 to -0.81; p < 0.0001), and operative time was shorter (MD = -6.96 min, 95% CI -9.71 to -4.20; p < 0.0001). Evidence certainty ranged from low to very low due to the small sample size and heterogeneity of the data. Diode laser-assisted frenectomy demonstrates clinically meaningful advantages-less postoperative pain, superior intraoperative hemostasis, and reduced surgical time-without increasing swelling. However, results should be interpreted cautiously, given limited and heterogeneous evidence.