## 4 Discussion  
Through the use of this protocol, the efficacy of the diode laser technique was demonstrated for lingual frenulectomies in pediatric patients; this technique makes it possible to quantitatively increase the aforementioned parameters until physiological values are reached, bringing about the acquisition of full lingual functionality with minor anxiety and pain. Several studies have performed millimetrical evaluations to determine the best methods for the correct diagnosis of ankyloglossia [23; 24; 25], but none of them has considered the different pre- and post- operative increases, nor have they examined the use of different type of lasers. [PERSON] et al. presented a quantitative method to classify the pathological lingual frenulum with no consideration of improvement after surgical intervention [31]. [PERSON] et al. [25] employed the same millimetrical device used in our study (QTT)(r), but the aim of their study was to validate millimetrical parameters as an initial screening tool to asses for restrictions in tongue mobility. However, in our study, millimetrical evaluation was essential not only for the screening, but also to verify the efficacy of diode laser technology in the improvement of tongue mobility after surgical intervention. In this way, an unexpected result of this study was the observed continuous improvement in the first month after surgery; our analysis demonstrates how the increase from T0 to T1, T2, T3 and T4 is gradual in relation to the better functionality of the tongue. A similar correlation was noted in a study by [PERSON] et al. [32], in which enhancement after frenulectomy occurred early (1 week postoperatively), and continued to improve one month thereafter; both infants with classic anterior tongue-tie and less obvious posterior tongue-tie showed improvements, proving the superiority of the laser-technique. [PERSON] et al. [33] reported on five clinical cases of short lingual frenulum; three of them were treated with electroautery therapy, one with a diode laser and the last one with a traditional surgical technique (scalpel 15c). After follow-ups at 7 and 30 days, a better management of tissues was observed in cases treated with laser or electroautery than with traditional surgical techniques. In the latter case, the pain and swelling were also superior. This study observed how the use of laser for the treatment of frenulectomy can be considered safe and reliable; reduced pain and better function of the tongue are guaranteed after surgery. [PERSON] et al. [34] also explained several advantages of laser technology, demonstrating how it supports  
Figure 3: Quantitative evaluation t4: (**a**) (MAB), (**b**) (MIO), (**c**) (MOTTIP), (**d**) (PROTRUSIONE). healing and reduces postoperative complications. [PERSON] et al. [35] reported very positive results after a frenuelectomy with laser technology (Wavelength: 810 nm, Diameter fiber: 200 \(\upmu\)m, used in direct contact with the tissue, Power 2W, continuous modality and focused ray). Through this protocol, the authors achieved complete healing, a >16-mm increase of tongue mobility, and an improvement of speech after therapy. Laser-assisted lingual frenectomies are the simplest, safest, and least traumatic of all the treatment modalities available, with the most promising results in minimally invasive dentistry. With the use of diode lasers, it is also possible to obtain a reduction in operative times and gain easier access to the surgical site; indeed, the lack of traditional surgical instruments and the localized cauterization allow bloodless surgery. [PERSON] et al. [36] confirmed how it is possible to reach the bottom of the lingual muscle with the use of a laser; they affirmed the superiority of the technique, compared to other approaches. This technology is more acceptable for children, yielding with shorter operative times, hemostasis, and no need for local anesthesia.