# A Review of CO\({}_{2}\) Laser-Mediated Therapy for Oral Mucosal Lesions
## 3 Results
### CO\({}_{2}\) Laser Treatment in the Case of Oral Leukoplakia
In the study group, 53 patients were treated with CO\({}_{2}\) laser, while the remaining 20 patients received classic surgery and were considered to be the control group. Comparing the outcomes, the study revealed that the operating times were shorter and bleeding was less in the laser group than in the control group. Another two prospective studies ([PERSON] et al. [38] and [PERSON] et al. [39]) also compared and evaluated CO\({}_{2}\) laser interventions with conventional surgery. [PERSON] et al. conducted a randomized clinical trial from January 2005 to December 2010 and included 48 patients with a mean age of 53.7 years (ranging from 28 to 74 years), all suffering from oral leukoplakia. A total of 39 were smokers, while 9 were non-smokers. The study's main conclusion was that postoperative pain and edema were dependent on the size of the lesion. [PERSON] et al. 's study [39] consisted of 30 patients with bilateral oral leukoplakia lesions, thus resulting in 60 oral leukoplakia cases. Their main results included less postoperative swelling, less hemorrhaging, less postoperative scarring (after 1 month), less pain, and a shorter excision time when the CO\({}_{2}\) laser was used. Currently, in the case of oral leukoplakia lesions, several therapies can be used in order to prevent malignant transformation, such as surgical treatment (cold knife surgery, cryotherapy, or laser treatment) or drug therapy (vitamin A and retinoid, non-steroidal anti-inflammatory drugs, or even herbal extracts). However, there is no therapy able to prevent the recurrence or significantly reduce malignant development in long-term follow-up studies [40]. [PERSON] et al. 's study [41] involved 35 oral leukoplakia patients that were treated using the CO\({}_{2}\) laser. Follow-ups occurred between 12 and 179 months. A total of 35 patients presented recurrences in the first 43 postoperative months. Later on, after a 54-month period, malignant transformations had developed in five cases. [PERSON] et al. [42] conducted a retrospective study of 65 patients suffering from oral leukoplakia. The patients were treated using CO\({}_{2}\) laser and subsequently followed up for 15 months. A total of 22 patients were identified as recurrent cases during this time, while 10 patients presented with malignant transformations. [PERSON] et al. [43] published a meta-analysis investigating the malignant transformation of oral leukoplakia lesions treated with CO\({}_{2}\) laser. Based on the 24 studies included in the research, the authors concluded that non-invasive treatment options should be first considered in the case of oral leukoplakia patients. In addition, the results of this meta-analysis revealed that the overall rate of malignant transformations of the oral lesions is 4.5%. Another meta-analysis published by [PERSON] et al. investigated the malignant transformation of oral leukoplakia lesions treated either by classic surgical techniques or by different laser surgery (Nd: YAG, Er: YAG, CO\({}_{2}\), or diode laser). The authors concluded that the overall rates of recurrence and malignant transformation for oral leukoplakia lesions treated by surgical laser were 16.5% and 5.2%, respectively. In comparison to classic surgery excision, laser ablation seems to have a lower recurrence rate, but it does not seem to affect the rate of malignant transformation in oral leukoplakia patients [44]. [PERSON] et al. 's comparative study [45] focused on 30 patients divided into three study groups; the first group was treated with a diode laser, the second group received CO\({}_{2}\) laser treatment, and the third group was treated using cryosurgery. The results displayed important differences in parameters, such as swelling, pain, and scar formation, but less significant differences for postoperative infection, lesion recurrence, and bleeding. The Visual Analogue Scale (VAS) was used for pain analysis, and the greatest pain was found in the CO\({}_{2}\) laser group when compared to the diode laser group in the days following surgery.