Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Year : 2023 | Month : March | Volume : 17 | Issue : 3 | Page : ZE01 - ZE07 Full Version

Efficacy of Carbon Dioxide Laser in Treating Oral Lichen Planus-A Scoping Review

Published: March 1, 2023 | DOI:
Jeni Mercy Beulah, Angeline Deepthi, Gracelin, Kandasamy Murugan, John Hearty Deepak

1. Postgraduate Student, Department of Oral Medicine and Radiology, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India. 2. Professor and Head, Department of Oral Medicine and Radiology, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India. 3. Senior Lecturer, Department of Oral Medicine and Radiology, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India. 4. Reader, Department of Oral Medicine and Radiology, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India. 5. Reader, Department of Oral Medicine and Radiology, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India.

Correspondence Address :
Dr. Jeni Mercy Beulah,
Plot No. 168, 3rd Cross Street, Shanthinagar, Palayamkottai, Tirunelveli, Tamil Nadu, India.


Introduction: Oral Lichen Planus (OLP) is a chronic disorder and its aetiology is multifactorial. Factors like local and systemic inducers of cell-mediated hypersensitivity, stress, autoimmune response and viral infection play a major role. Due to the varying aetiological factors, there are varying treatment modalities. With systemic medication, remission of the lesion is the most common side-effect.

Aim: To determine the efficacy of carbon dioxide laser in treating OLP.

Materials and Methods: In this systematic review, the study was done between January 2022 to April 2022 at Rajas Dental College and Hospital, Tamil Nadu. Search categories were specifically followed to databases like PubMed, PubMed Central, Cochrane, Medline, Embase and in Google Scholar. MeSH terms like CO2 Laser, OLP, Carbondioxide Laser and Oral Premalignant Condition were used for searching the articles.

Results: A total of 942 articles had been collected. But after analysing the articles, only 16 articles based on the preformed inclusion and exclusion criteria had been selected. Out of these three were retrospective studies, five were prospective studies, one clinical trial, one observational study and one study was a Randomised Control Trial (RCT), one was a non RCT, one was a structured abstract, one was a single arm intervention study, one was a case series, and one was a case report.

Conclusion: Carbon dioxide laser was very efficient in treating larger size lesions. Recurrence rate of the lesions was very less when treated at an early stage.


Autoimmunity, Gas, Lasers, Oral

Lichen Planus (LP) was first described by Dr. Erasmus Wilson in 1869. It was originally named “Lichen Ruber Planus” and “Lichen Psoriasis”. Oral Lichen Planus (OLP) is a chronic disorder with a primary role in the immune system (1),(2),(3). Oral lesions may or may not manifest as skin lesions. OLP affects 0.5% to 2.2% of the population. The aetiology is still unknown. It has a female predilect. Middle-aged individuals are the most affected. The exact prevalence is unknown, but it has been estimated to be between 0.5% and 2.6% in various populations (4),(5). In most OLP cases, the patient is usually unaware of the oral condition. Patients may complain of roughness/burning in the lining of the mouth, red or white patches or ulceration (6),(7). Due to the unclear aetiology of OLP, the results of managing LP are also not satisfactory. Remission of the lesion is the main drawback. Carbon dioxide (CO2) laser is one of the earliest gas lasers invented by Kumar Patel of Bell Labs in 1964. Because of its cutting efficiency, it remains a desirable choice in facial cosmetic surgeries (8). Since they have less tactile sensation when compared to the other lasers, they are not preferred for hard-tissue procedures. They are mainly used for soft tissue surgical procedures (9). In the 1980s, these lasers were used for the management of oral leukoplakia. Laser surgery is considered superior when compared to conventional systemic drug therapy, cold instrumentation, and electrocautery (10). Since there was very few evidence-based information on the topic of treating OLP using CO2 laser (2), the systematic review was aimed to find the efficacy of CO2 laser in the treatment of OLP.

Material and Methods

The systematic review is registered in the PROSPERO with the registration Id CRD42022298392. The study was done between January 2022 to April 2022 at Rajas Dental College and Hospital, Tamil Nadu. A detailed systematic search of the literature was done from the databases of PubMed, PubMed Central, Cochrane Library, Medline, Embase and finally, a random search was also done in Google Scholar. The articles were searched between the timeline 1980 to 2022. The following MeSH keywords “OLP, oral premalignant condition, CO2 laser, carbon dioxide laser” were used for the search in the above databases. The Boolean logic “AND” was used between CO2 laser and OLP. It yielded more results than other keyword combinations in the database. MeSH terms like CO2 laser AND OLP yielded 262 articles in PubMed, 257 articles in PubMed Central, and 83 articles in Cochrane.

From the systematic search, a total of 942 results were obtained from the above databases and the references to the above articles were also considered, if they were relevant to the review. Out of 942, 30 articles were also obtained from Google Scholar and back references.

Inclusion criteria: It included original articles, all clinical studies including RCT, cohorts, case-control, case reports, case series, systematic reviews, and free articles. In case where free articles were not available, the articles with structured abstracts were considered, articles about CO2 laser in treating OLP, and articles that were only in English.

Exclusion criteria: Review articles about CO2 laser in treating OLP and oral leukoplakia, newsletters, letters to the editor, articles with non structured abstracts, treatment of OLP and oral leukoplakia other than CO2 lasers, and usage of CO2 laser other than oral cavity.

Based on the above inclusion and exclusion criteria, the articles obtained were filtered. A total of 61 articles were relevant. On further analysing the articles, due to the irrelevant content, 15 full articles and one structured abstract were finally selected and rest were excluded. The articles were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol in the systematic review. Three reviewers analysed every article. Blinding was not done. The conclusion was formulated after a detailed discussion with the panel of reviewers.


A total of 942 articles were identified by searching the databases like PubMed, Pubmed Central, Cochrane Library, Medline, Embase, and Google Scholar. 697 articles were excluded after screening the title and 210 were excluded after reading the abstract due to their irrelevant nature. 19 articles were excluded after full reading because the content did not meet the inclusion criteria of the study (Table/Fig 1). A total of 926 articles were excluded and therefore 16 articles (11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26) were selected for further analysis. This included one structured abstract, one clinical trial (11),(12); out of which three were retrospective studies (21),(23),(25), five were prospective studies (13),(15),(19),(20),(22), and other studies, like observational study (14), RCT (24), non RCT (18), single-arm intervention study (26), case series (16), and case report (17), which had one article each (Table/Fig 2) (11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26).

Summary of benefits of using CO2 laser: There was a significant reduction in pain and lesion size in subsequent follow-up periods (11). The healing following laser removal progressed well (12). After CO2 laser therapy in the dorsum of the tongue, instead of a denuded

tongue, the papilla started to reappear in the affected areas (13). The re-epithelialisation was complete at all wound sites in 7-14 days and healing occurred without any complication (14). The laser-treated mucosa returned to the same colour as the surrounding mucosa (15). The case series concluded that the CO2 laser was safe and more efficient to use against OLP but the cost of the CO2 laser made it less affordable (16).

Summary of advantages of CO2 laser over conventional scalpel treatment in treating OLP: The comparison of CO2 laser and conventional scalpel procedure in treating OLP was studied in an animal model. The animal model had advantages like minimal damage to the adjacent tissues, less inflammatory reaction and fewer myofibroblasts, which resulted in little wound contraction. It was more efficient when compared to a scalpel in terms of the large lesion due to the bloodless field (17),(27).

The postoperative effects on pain, bleeding and swelling were reduced when compared to the conventional scalpel. Since the lesions were subepithelial, the depth of invasion to eradicate the lesion was sufficient in the vaporisation technique. The immunologic status was altered for the better of the patient (18),(28). The case report reported that the amount of myofibroblasts was more in the case of CO2 laser treatment when compared to scalpel excision (19).

Summary of advantages of CO2 laser over systemic and topical corticosteroids: The size of the lesion and pain level showed no changes in both the groups of corticosteroids and CO2 laser. But at the end of the study, the efficiency level of laser therapy was higher than that of systemic corticosteroids. The size of the lesion and the pain level decreased in the case of CO2 laser therapy (20).

Summary of modes of CO2 lasers: The total number of articles included in this category was two. Three different modes of CO2 laser were used in the vaporisation of premalignant lesions. The modes were Continuous Wave (CW) defocussed, CW scanner, and Super Pulse (SP) scanner. Studies have proved that CW defocussed mode was found effective in treating a premalignant lesion in recurrent cases and long-term follow-up was also found successful (21),(22).

Summary of rate of recurrence of OLPOLPOLP when treated with CO2 laser: The rate of recurrence was high when treated with a CO2 laser because only the recalcitrant cases were treated with a CO2 laser. But the rate of malignant transformation was less (23). The patients who were treated with the defocussed mode in CO2 laser therapy showed a lesser recurrence rate and lower malignant transformation when compared to patients who received analgesics and steroids (24).

Summary of other lasers: The total number of articles collected under this category was 2. The other lasers like Nd: YAG and LLLT laser were also found to be effective in treating OLP.

The Nd: YAG laser shared many of the advantages of the CO2 laser, but its unique feature was that it could be utilised in both a contact excision and non contact coagulation mode. Lesions with a small surface area were most efficiently treated with Nd: YAG laser as it has a very precise contact mode of delivery. The recurrence rate of OLP when treated with Nd: YAG laser was also very less when compared to CO2 laser (25).

LLLT has a property called laser biomodulation. It can change the cell function, non thermally and non destructively. It has additional benefits when compared to CO2 laser by simultaneously applying infra-red and red light to affect the surface and depth of the lesion. It has a low recurrence rate and is easier and less time-consuming (26).


LP is a common chronic inflammatory mucocutaneous disorder that typically affects the skin and mouth (29). The major aetiological factors of OLP are local and systemic inducers of cell-mediated hypersensitivity, stress, autoimmune response, and viral infections. The foremost treatment starts with topical and systemic corticosteroids. For biopsy purposes, incisional/excisional biopsy with a scalpel is performed under local anaesthesia to make a confirmatory final diagnosis (30).

In recent years, laser treatment has come into existence to give immediate symptomatic relief in patients with a burning sensation. Various lasers have been used in recent years, like CO2 laser, Nd: YAG laser, LLLT, Argon laser, Diode laser, Ho: YAG laser, and Er: YAG laser. The choice of laser depends mainly upon the precision and depth of tissue ablation, haemostasis, effectiveness in a fluid-filled environment, and any preference for the pigmented surface (31).

The systematic review was made in such a way to prove the efficacy of the CO2 laser in treating OLP. Initially, meta-analysis was also planned since we obtained heterogeneous types of studies, but was not performed. All the RCT and non RCT, observational clinical studies, case reports, cohort studies, prospective, and retrospective study were included and the review articles were excluded.

The heterogeneous nature of studies started from the size and duration of the lesion, follow-up period, a recalcitrant or fresh case of OLP, mode of CO2 laser, the wavelength of CO2 laser, duration of CO2 laser contact with the tissue, and the brand of the laser machine. The patient’s psychological status also paves a big path (20).

The CO2 laser has two methods to remove the lesion. They are vaporisation of the surface mucosa and excision of the lesion. Vaporisation was done in inaccessible areas such as the floor of the mouth. Excision was done with the removal of soft tissue lesions with underlying tissues. This creates a slightly deeper wound. The CO2 laser has a standard wavelength of 10,600 nm and for soft tissue surgeries it has another variant of 9300 nm. The CO2 laser machine has 3 modes, defocussed mode, SP mode and scanner mode. The defocused mode shows great efficacy when compared to the other modes in treating OLP. In case of vaporisation, the beam will be in contact with the tissues for a minimum of 4 minutes. Keeping in contact with the tissues for a longer time would result in thermal injury and burrowing wounds (21),(22).

The CO2 laser has proved efficient when compared to conventional systemic and local corticosteroids and conventional scalpel excision of the lesion. The corticosteroids show remission of the lesion within a short period whereas the CO2 laser in long-term follow-up doesn’t show remission of the lesion (19). CO2 laser has few advantages over corticosteroids and conventional scalpel surgery. They can be used to excise larger lesions with the bloodless field of surgery and minimal wound contraction. Postoperatively they show less pain and a faster healing phase (19).

Studies have stated that the lesions occur in other areas which were not exposed to the laser tip (14). Some cases show recurrence even after treatment with CO2 laser because of the underlying systemic disorder.

Since the CO2 laser has a non contact mode, they cannot refine the cutting areas. They also have a larger beam and it is cost-effective (21). This is the major disadvantage of using CO2 laser. To overcome these disadvantages Nd: YAG laser and LLLT laser came into existence. Nd: YAG laser has the additional advantage of using it as a non contact and contacts laser which is used in vaporisation and excision respectively (23). LLLT has the advantage of dealing with smaller lesions particularly when the lesion is near the tooth surface area approximating gingiva since it has a smaller size beam. But still, long-term follow-up is necessary to prove the scenario (24).


Since, the articles which were included in the study were heterogeneous in nature (different varying data), the meta-analysis could not be performed. The lack of RCT clouds the result of this systematic review.


The OLP is a chronic mucocutaneous disorder and it has a multifactorial aetiology. CO2 laser is the best when large lesions are treated because of the large beam. Small lesions can also be treated but it affects the normal mucosa. The vaporisation technique proves effective in treating OLP. CO2 laser proves efficient in treating recalcitrant cases when compared to systemic and topical corticosteroids and conventional scalpel surgery. Hence, CO2 laser treatment can be given as a first line of therapy even before the use of corticosteroids. Additionally, treating the underlying systemic disorder and stress reduction may lead to the complete cure of the lesion.


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DOI and Others

DOI: 10.7860/JCDR/2023/59161.17572

Date of Submission: Jul 19, 2022
Date of Peer Review: Sep 05, 2022
Date of Acceptance: Oct 22, 2022
Date of Publishing: Mar 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

• Plagiarism X-checker: Jul 21, 2022
• Manual Googling: Oct 15, 2022
• iThenticate Software: Oct 21, 2022 (5%)

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