Laser-Assisted Pre-Prosthetic Frenulotomy in Medically Complex Anticoagulated Edentulous Patients: A Prospective Clinical Study

Introduction

Restrictive maxillary buccal frena are anatomo-functional alterations of the oral soft tissues that may reduce vestibular depth, impair denture extension, and compromise the retention and stability of complete removable prostheses. Conventional surgical correction may be associated with increased bleeding and postoperative discomfort, particularly in medically compromised patients receiving anticoagulant therapy. The aim of this prospective study was to evaluate the clinical effectiveness and safety of diode laser-assisted frenulotomy performed before complete denture rehabilitation in medically complex edentulous patients.

Materials and Methods

A prospective clinical study was conducted at the Department of Dentistry, University of Bari. Edentulous patients under chronic anticoagulant therapy with Warfarin, 5 mg/die, requiring complete denture rehabilitation and presenting with restrictive maxillary buccal frena underwent bilateral frenulotomy under local anesthesia. A diode laser with bare fiber of 300 µm, a wavelength of 810–980 nm, in a continuous-wave mode, and power of 1.5 Watt was used. Clinical outcomes, intraoperative bleeding, postoperative healing, and surgical complications were evaluated during follow-up.

Results

Five patients were prospectively enrolled and treated in this study. Laser-assisted surgery provided effective intraoperative hemostasis, reducing hemorrhagic risk and improving visualization of the operative field in all treated patients. Complete soft-tissue healing and adequate vestibular depth were observed at the one-month follow-up. No intraoperative or postoperative complications, delayed healing, or adverse events related to laser treatment were recorded, allowing successful completion of prosthetic rehabilitation.

Conclusions

Diode laser-assisted frenulotomy represents a safe and minimally invasive pre-prosthetic procedure for medically complex anticoagulated edentulous patients. The technique provides predictable hemostasis, promotes favorable soft-tissue healing, facilitates prosthetic rehabilitation, and may represent a reliable alternative to conventional scalpel surgery in high-risk clinical conditions.