High-power diode laser versus conventional scalpel in the surgical treatment of pediatric ankyloglossia: a randomized, parallel, triple-blind, controlled clinical trial

High-power diode laser versus conventional scalpel in the surgical treatment of pediatric ankyloglossia: a randomized, parallel, triple-blind, controlled clinical trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article High-power diode laser versus conventional scalpel in the surgical treatment of pediatric ankyloglossia: a randomized, parallel, triple-blind, controlled clinical trial Mariana Laprovitera Teixeira Carneiro, Maria Elisa Quezado Lima Verde, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6999870/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Dec, 2025 Read the published version in BMC Pediatrics → Version 1 posted 12 You are reading this latest preprint version Abstract Background Ankyloglossia can impair vital functions such as breastfeeding, swallowing, and maxillomandibular development, making effective treatment essential. Methods This randomized, parallel, triple-blind clinical trial evaluated the efficacy of high-power diode laser surgery compared to conventional scalpel frenotomy in infants aged 0–6 months (n = 40/group). Patients were assessed at D0 (pre-, trans-, and/or 30 min postoperative), D7, and D14 using specific instruments according to each outcome: tongue repositioning and frenulum release (BTAT and Tongue Test), wound healing (Landry index), perioperative pain (CRIES scale), and breastfeeding performance (body mass variation, LATCH, and IBFAT scales). Results Both the high-power laser (HPL) and scalpel (SCP) groups showed significant functional improvements and weight gain over time (p 0.05). However, on D7, the SCP group demonstrated superior breastfeeding performance (LATCH: p = 0.003; IBFAT: p = 0.024). Both groups exhibited reduced pain and progressive healing (p < 0.001). A negative correlation was observed between laser energy and healing quality on D14 (r = -0.355; p = 0.027). Conclusions Findings suggest both techniques are clinically effective, but laser parameters may influence healing. Further studies are warranted to optimize laser protocols in pediatric ankyloglossia surgery. Trial registration RBR466cykz November 13th, 2024 Laser therapy Ankyloglossia Infant Figures Figure 1 Background The lingual frenulum is a fibrous connective tissue structure that connects the ventral surface of the tongue to the floor of the mouth [ 1 ]. Along with the labial frenulum, it plays a key role in the function of the lingual and perioral muscles, being essential for speech, swallowing, sucking, and breathing. Ankyloglossia, or “tongue-tie,” is a congenital condition characterized by a short or thickened lingual frenulum that restricts tongue mobility [ 2 ]. This alteration results from insufficient apoptosis during embryonic development and may occur sporadically or be associated with craniofacial anomalies. Genetic inheritance patterns, including autosomal dominant and recessive forms, have also been described. Ankyloglossia is more prevalent in males, with a reported male-to-female ratio of approximately 2.5:1 [ 3 ]. Clinically, ankyloglossia can lead to breastfeeding difficulties, speech and feeding disorders, malocclusion, impaired oral hygiene, and psychosocial stress. Prevalence estimates vary widely (0.52–21%) due to heterogeneity in diagnostic criteria and methodologies [ 4 ]. Several diagnostic tools have been proposed, such as the Coryllos classification (which focuses on anatomical presentation) and functional assessment protocols including the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF), the Bristol Tongue Assessment Tool (BTAT), and the Lingual Frenulum Assessment Protocol for Infants (“Tongue Test”). Although the Brazilian Ministry of Health recommends the BTAT for infants, there is no global consensus on a gold-standard protocol. Recent studies have presented conflicting findings, with some reporting greater sensitivity for the “Tongue Test,” while others support the BTAT as a simple, objective, and effective tool for both diagnosis and post-intervention follow-up [ 5 ]. Despite increased awareness and diagnosis of ankyloglossia in recent years, the benefits of surgical intervention—particularly in infants—remain under debate. Professional societies, such as the Academy of Breastfeeding Medicine and the American Society of Pediatric Otolaryngology, have highlighted the lack of robust randomized clinical trials and standardization in diagnostic and treatment criteria. As a result, overdiagnosis and potentially unnecessary surgical procedures have been reported in certain populations [ 6 , 7 ]. Breastfeeding complications in the neonatal period are common, and ankyloglossia may contribute to problems such as poor latch, maternal nipple pain, breast engorgement, and reduced milk supply. Nevertheless, these symptoms may also result from other factors. Thus, multidisciplinary evaluation is crucial in distinguishing ankyloglossia from other breastfeeding issues and in supporting clinical decision-making [ 8 ]. When conservative management fails to resolve breastfeeding difficulties, frenotomy—defined as the simple incision of the lingual frenulum—is the most indicated procedure in infants due to its simplicity, low morbidity, and immediate potential benefits. In older children, frenuloplasty, which involves muscle release and suturing, may be preferred, while frenectomy is reserved for cases requiring tissue excision [ 8 , 9 ]. Surgical options include conventional cold blade or scissors, electrocautery, and high-power lasers [ 10 , 11 ]. High-power lasers (e.g., diode, CO₂, Nd:YAG) offer several advantages: enhanced hemostasis, microvascular sealing, precision cutting, better visualization of the operative field, reduced postoperative pain and inflammation, and faster tissue repair. These effects are attributed to photothermal interactions, including vaporization, coagulation, and necrosis [ 12 ]. However, cost and the need for training may limit widespread use. Among laser technologies, diode lasers have shown a particular promise in pediatric applications due to their safety and efficacy [ 13 , 14 ]. Studies comparing laser and conventional techniques report benefits such as reduced anesthesia need, improved cooperation in children, lower postoperative pain, and better maternal comfort during breastfeeding [ 15 ]. Laser use has also been associated with decreased bleeding and inflammation compared to electrocautery [ 14 ]. Despite these promising results, the literature lacks well-designed randomized clinical trials evaluating the efficacy and safety of high-power diode lasers in treating ankyloglossia in infants. Limitations include small sample sizes, heterogeneous diagnostic criteria, variable surgical protocols, and reliance on qualitative outcomes. Therefore, this study aimed to evaluate the clinical effectiveness of high-power diode laser surgery compared to the conventional scalpel technique in the treatment of pediatric ankyloglossia. Methods Ethical aspects and consent to participate The research protocol was approved by the Human Research Ethics Committee of Christus University Center under approval number 6.332.477. This study was conducted in accordance with the Declaration of Helsinki and the Brazilian National Health Council’s Resolution 466/2012, which outlines ethical principles such as autonomy, non-maleficence, beneficence, justice, and equity. Guardians of the participants were informed about the objectives, procedures, potential risks, and benefits. Written informed consent was obtained from each legal guardian prior to their participation. They were also informed of their right to withdraw at any time without any consequences. Study design A randomized, controlled, parallel, triple-blind clinical trial was conducted and registered on the Brazilian Clinical Trials Registry (ReBEC) under registration number RBR-466cykz. The trial adhered to the CONSORT 2010 guidelines. Participants Participants included infants aged 0 to 6 months with a diagnosis of severe ankyloglossia (BTAT score from 0 to 3), recruited from spontaneous demand at the School Clinic of Dentistry at Christus University Center, where all procedures were performed. Patients were evaluated and classified by eligibility criteria during scheduled visits. Participants included in this study were healthy individuals (ASA I), aged between 0 and 6 months, diagnosed with severe ankyloglossia by a pediatric dentist using the BTAT protocol, with scores ranging from 0 to 3. Exclusion criteria comprised individuals with previously diagnosed systemic conditions that contraindicated the surgical procedure; those undergoing prior pharmacological treatment; individuals with absolute or relative contraindications to the use of local anesthetics; those with congenital orofacial malformations; and cases in which the legal guardians refused to consent to participation in the study. Participants were withdrawn from the study if they failed to attend postoperative follow-up appointments, if postoperative care instructions were not followed, or if their guardians chose to discontinue participation. Interventions All surgical procedures were performed by a single experienced surgeon, while all pre- and postoperative assessments were carried out by a single experienced pediatric dentist, ensuring standardization and blinding. The diagnosis of severe ankyloglossia was established during the clinical examination using the BTAT protocol (scores from 0 to 3). Topical anesthesia with 20% benzocaine was followed by infiltrative anesthesia using 2% lidocaine with epinephrine (1:100,000), adjusted according to the infant’s weight [ 3 ]. With the aid of a tongue retractor (tentacannula), the patient’s tongue was pulled posteriorly to achieve stable tension of the lingual frenulum, allowing for a favorable incision site. In the SCL group, a no. 15 scalpel blade mounted on a no. 3 Bard Parker handle was used. In the HPL group, a high-power diode laser (Thera Lase Surgery®, DMC, São Carlos, Brazil) operating at 980 ± 20 nm (infrared region), in continuous mode with a power of 1.5 W, was used. The laser was coupled to a 400 µm optical fiber. Before the procedure, the fiber tip was cleaved using a diamond-tipped pen.[ 14 ]. In both groups, the incision extended from the anterior border of the frenulum to its posterior-inferior limit, avoiding noble anatomical structures. When necessary, hemostasis was achieved with sterile gauze, and postoperative analgesia was managed with oral paracetamol (100 mg/ml in oral suspension), when necessary. Harms and benefits of the intervention The procedure carried some risks, such as pain, edema, bleeding, paresthesia, ulcers, and infection. However, in case of complications, patients were reassessed and managed accordingly. On the other hand, benefits of ankyloglossia treatment include improvements in breastfeeding and further in speech, nutrition, and quality of life. Outcomes The primary outcome of the study was the release and repositioning of the lingual frenulum. Secondary outcomes included: perioperative pain; healing quality; variation in the patient's body weight and quality of breastfeeding. The evaluation of these outcomes was based on the following methodologies: Release and repositioning of the lingual brake Assessment was conducted using the BTAT and Tongue Test scales at baseline preoperative (D0-pre) and immediate postoperative (D0-post), day 7 (D7), and day 14 (D14) [ 3 , 16 ]. Data were presented as mean ± standard deviation (SD) for both groups. Standardized photographs were taken at each time point. Impact on the healing process Postoperative healing was evaluated quantitatively at D0-post, D7, and D14 using the Landry Healing Index [ 16 ], which scores five criteria—bleeding, granulation tissue, tissue color, wound margins, and suppuration—on a scale from 0 (poor healing) to 5 (excellent healing). Results were expressed as mean ± SD. Perioperative pain Pain was assessed using the CRIES scale, which scores five parameters (crying, oxygen requirement, vital signs, facial expression, and sleepiness) from 0 to 10 [ 16 ]. Evaluations were conducted by the same examiner at three time points on D0 (intraoperative (D0-intra); immediate postoperative (D0-post) and 30 minutes post-operative (D0-30post)), as well as on D7 and D14. A pulse oximeter was used as part of the assessment and results were expressed as mean ± SD. Rescue medication usage (paracetamol) was recorded and reported as absolute and relative frequency. Variations in the patient's body mass Patients’ body weight was measured using a digital scale on D0, D7, and D14. Data were presented as mean ± SD for each group. Quality of breastfeeding Breastfeeding quality was evaluated using two validated tools: LATCH scale (Latch, Audible swallowing, Type of nipple, Comfort, Hold), consisting of five scored items (0–2 each); and IBFAT (Infant Breastfeeding Assessment Tool), consisting of four scored items (0–3 each) and totaling up to 12 points [ 17 ]. Assessments were performed at D0-pre, D0-post, D7, and D14. Results were expressed as mean ± SD. Sample calculation Based on the study by BHAT et al. in 2015, which compared lingual frenulum removal via scalpel and high-power laser and reported a significant reduction in remnant tissue volume (-1.12 ± 0.19 vs. -1.3 ± 0.12), a sample size of 40 patients per group was calculated to ensure 80% power and 95% confidence (Student’s t-test). Participants were randomly allocated into two groups: SCP group: incision performed with a no. 15 scalpel blade; and HPL group: incision performed with high-power diode laser. Randomization Simple randomization was performed using Microsoft Excel® (version 16.73) via the “=RANDBETWEEN” function. A study assistant uninvolved in any research procedures generated the random sequence and allocated participants into groups. Group assignment was revealed to the surgeon only at the time of the procedure. Blinding To ensure tiple blinding, the patients’ guardians, the outcome assessor, and the statistician were blinded to group allocation. Surgeries were performed in a closed room, with no access granted to guardians or assessors. Only the surgeon was aware of the group allocation and were not involved in any outcome evaluations. Data analysis was initially performed with coded group labels (‘A’ and ‘B’). Group identities were revealed only after all statistical analyses were completed. Statistical analysis All data were tabulated using Microsoft Excel® (version 16.73) and exported to IBM® SPSS® Statistics for Windows® (version 20) for analysis. A confidence level of 95% (p < 0.05) was adopted for all tests. The normality of the data was assessed using the Kolmogorov-Smirnov test. Continuous variables were expressed as mean ± SD and analyzed using the Mann-Whitney and Friedman tests, followed by Dunn’s post hoc test for non-parametric data. Categorical variables were presented as absolute and relative frequencies and compared using either Fisher’s Exact Test or Pearson’s Chi-square test, as appropriate. Additionally, the correlation between the total amount of energy applied (in Joules) in the HPL group and the Landry wound healing index across different time points was evaluated using Spearman’s correlation coefficient. Results The clinical profile of the patients evaluated in this study, as well as the types of breastfeeding and use of artificial nipples, did not differ between the evaluation groups. A total of 116 patients were assessed for eligibility in this study, of whom 98 met the inclusion criteria. The SCP group included 50 patients (51.02%), with 10 subsequently withdrawn due to loss to follow-up (n = 8) or discontinuation of breastfeeding (n = 2). The HPL group consisted of 48 patients (48.98%), with 8 excluded due to missed follow-up visits. The CONSORT flow diagram summarizing the study enrollment and follow-up is presented in Fig. 1 . The clinical profile, including breastfeeding types and use of artificial nipples, did not differ significantly between groups. Regarding clinical characteristics, no statistically significant difference was observed between groups in terms of gender (p = 0.068), although the HPL group included a higher proportion of males (70%) compared to the SCP group (50%). The mean age of participants was also similar across groups (SCP: 46.73 ± 31.76 days; HPL: 42.78 ± 38.23 days; p = 0.331) (Table 1 ). Table 1 Description of clinical data (gender and age) in the different groups evaluated. SCP HPL p-Value Sex 0,068 Female 20 (50.0%) 12 (30.0%) Male 20 (50.0%) 28 (70.0%) Age (days) 46.73 ± 31.76 42.78 ± 38.23 0,331 Caption: SCP: group treated with scalpel; HPL: group treated with high-power laser; *p < 0.05, Mann-Whitney test (mean ± SD) and Pearson's chi-square (n, %). Given that the study included infants who could be exclusively breastfed or supplemented with formula and/or solid food, the majority of participants in both groups were exclusively breastfed (SCP: 70%, HPL: 62.5%), with no significant difference (p = 0.478). No significant differences were found in the combination of breastfeeding with formula (p = 0.633) or with the introduction of solid foods (p = 1.000) (Table 2 ). Table 2 Description of the types of breastfeeding and use of artificial nipples, according to the evaluation groups. SCP HPL p-Value Breastfeeding Exclusive 28 (70.0%) 25 (62.5%) 0,478 Associated with the formula 12 (30.0%) 14 (35.0%) 0,633 Associated with food introduction 1 (2.5%) 1 (2.5%) 1,000 Use of artificial nipples 26 (65.0%) 32 (80.0%) 0,133 Silicone nozzle 17 (42.5%) 13 (32.5%) 0,356 Baby bottle 17 (42.5%) 21 (52.5%) 0,370 Pacifiers 7 (17.5%) 12 (30.0%) 0,189 Caption: SCP: group treated with scalpel; HPL: group treated with high-power laser; *p < 0.05, Pearson's chi-square test (n, %). The use of artificial nipples was more frequent in the HPL group (80%) compared to the SCP group (65%), but this difference was not statistically significant (p = 0.133). Similarly, no significant differences were observed between groups in the use of specific types of artificial nipples such as silicone nipples (p = 0.356) or baby bottles (p = 0.370). Pacifier use was also more prevalent in the HPL group (30% vs. 17.5% in the SCP group), but the difference was not statistically significant (p = 0.189) (Table 2 ). Both surgical techniques demonstrated a significant impact on the degree of tongue-tie release and repositioning. Morphological and functional assessments were conducted at four time points (D0-pre, D0-post, D7, and D14) using two validated tools: the BTAT and the Tongue Test. No significant differences were observed between groups on any assessment day regardless of the assessment method used (p > 0.05) (Table 3 ). Table 3 Assessment of tongue release and repositioning (BTAT and Tongue Test) at the different assessment times, according to the treatment modality. SCP HPL p-Value BTAT D0-pre 2.45 ± 0.81 2.45 ± 0.81 1,000 D0-post 4.38 ± 1.05* 4.63 ± 0.95* 0,180 D7 4.93 ± 1.05*† 5.03 ± 1.14* 0,631 D14 5.15 ± 1.21*† 5.40 ± 1.45* 0,298 p-Value < 0,001 < 0,001 Tongue test D0-pre 13.65 ± 3.71 13.93 ± 3.38 0,828 D0-post 9.77 ± 3.21* 9.79 ± 3.16* 0,956 D7 9.25 ± 3.15* 10.23 ± 3.29* 0,260 D14 7.90 ± 3.46*† 8.58 ± 3.05*† 0,312 p-Value < 0,001 < 0,001 Legend: SCP: group treated with scalpel; HPL: group treated with high-power laser; D: day; *p < 0.05 versus D0; †p < 0.05 versus previous day; Friedaman/Dunn or Mann-Whitney test (mean ± SD) Regarding the BTAT assessment, a significant improvement in tongue morphology was observed over time in both groups. In the SCP group, significant differences emerged immediately after surgery (D0-post) compared to D0-pre, with further improvement on D7 and D14 (p < 0.001). Similarly, in the HPL group, a significant increase was seen on D0-post compared to D0-pre, with consistent values maintained on D7 and D14 (p 0.05) (Table 3 ). Similarly, the Tongue Test also revealed significant improvements in both morphological and functional tongue release. Both groups demonstrated significant gains on D0 post (vs. D0 pre), stable scores on D7, and further improvement on D14 (p < 0.001). The parameters remained similar on the 7th day of postoperative follow-up and, on the 14th day of evaluation, increased significantly in both groups (p < 0.001) (Table 3 ). Both treatment modalities showed a comparable outcome regarding perioperative pain and healing parameters. Pain was assessed using the CRIES scale and the need for rescue analgesia. No significant differences were found between groups on any evaluation day (p > 0.05), indicating a similar pain experience (Table 4 ). Likewise, healing outcomes did not differ significantly between the SCP and HPL groups (p > 0.05). Table 4 Analysis of perioperative pain parameters (CRIES), need for postoperative analgesic medication and Landry's healing index at the different evaluation times, according to the treatment modality performed. SCP HPL p-Value CRIES scale D0-transoperative 4.75 ± 1.60 4.77 ± 1.46 0,674 D0-immediate post 3.80 ± 1.95* 4.03 ± 1.79* 0,637 D0-after 30 min 1.88 ± 1.65*† 1.58 ± 1.38*† 0,442 D7 2.58 ± 1.69*† 2.43 ± 1.66*† 0,910 D14 2.50 ± 1.47*† 2.78 ± 1.83*† 0,523 p-Value < 0,001 < 0,001 Use of post-operative analgesia 20 (50.0%) 25 (62.5%) 0,260 Landry's healing index D0 3.78 ± 0.42 3.73 ± 0.51 0,750 D7 3.92 ± 0.58 3.98 ± 0.62 0,707 D14 4.80 ± 0.52*† 4.82 ± 0.45*† 1,000 p-Value < 0,001 < 0,001 Legend: SCP: group treated with scalpel; HPL: group treated with high-power laser; D: day; LATCH: Latch, audible swallowing, type of nipple, comfort, hold; IBFAT: Infant Breastfeeding Assessment Tool; *p < 0.05 versus D0; †p < 0.05 versus previous day; Friedaman/Dunn or Mann-Whitney test (mean ± SD). In both groups, the CRIES scores showed a significant reduction from the intraoperative to the immediate postoperative period (p < 0.001), with further reduction at 30 minutes post-surgery. Pain levels remained low and stable on subsequent days (Table 4 ). Healing was assessed using the Landry Healing index. A significant improvement in wound healing was observed in both groups on D14 compared to D0 and D7 (p < 0.001) (Table 4 ). The greater the energy used in the surgical procedure, the less favorable the healing process becomes in the last timepoint In the HPL group, a statistically significant negative correlation (r = − 0.355; p = 0.027) was observed between the total energy applied (in Joules) and the Landry Healing Index on D14 (Table 5 ), meaning that a higher intraoperative energy is associated with less favorable healing after 14 days. Table 5 Correlation analysis between the total amount of energy (J) and Landry's healing index at the different assessment times. HPL Landry's healing index Energy (J) D0 D7 D14 r 0.189 -0.025 -0.355* p-Value 0.243 0.877 0.027 Legend: HPL: group treated with high-power laser; D: day; *p < 0.05, Spearman's correlation. Surgical treatment of ankyloglossia had a positive effect on body mass gain over time, regardless of the surgical technique used. Body mass was assessed on D0-pre, D7, and D14. No significant differences were observed between groups at any time point (D0-pre: p = 0.064; D7: p = 0.100; D14: p = 0.131). However, within-group analysis revealed a significant increase in body mass over time. Both the SCP and HPL groups showed a statistically significant increase from D0 to D7, and again from D7 to D14 (p < 0.001) (Table 6 ). Table 6 Description of the data on body mass variations on the day of surgery and on the days of post-operative follow-up, according to the treatment modality performed. Body mass (Kg) SCP HPL p-Value D0 5.03 ± 1.27 4.54 ± 1.19 0,064 D7 5.30 ± 1.23* 4.90 ± 1.25* 0,100 D14 5.60 ± 1.25*† 5.18 ± 1.27*† 0,131 p-Value < 0,001 < 0,001 Legend: SCP: scalpel-treated group; HPL: high-power laser-treated group; D: day; *p < 0.05 versus D0; †p < 0.05 versus previous day; Friedman/Dunn or Mann-Whitney test (mean ± SD). Both treatment modalities significantly improved breastfeeding quality, with the SCP group showing superior performance on D7. Breastfeeding quality was assessed using the LATCH and IBFAT scales, in which higher scores indicate better outcomes. No significant differences were observed between groups at D0 (pre- and post-surgery) or D14 (p > 0.05). However, on D7, the SCP group showed significantly better performance compared to the HPL group in both LATCH (p = 0.003) and IBFAT (p = 0.024) assessments (Table 7 ). Table 7 Assessment of breastfeeding quality using the LATCH and IBFAT protocols at the different assessment times, according to the treatment modality used. SCP HPL p-Value LATCH D0-pre 8.40 ± 1.52 8.15 ± 1.82 0,640 D0-post 8.88 ± 1.64* 8.75 ± 2.08* 0,898 D7 9.70 ± 0.52* 8.83 ± 1.82* 0,003 D14 9.50 ± 0.88* 9.03 ± 1.56* 0,162 p-Value < 0,001 0,007 IBFAT D0-pre 10.53 ± 1.45 11.00 ± 1.15 0,131 D0-post 10.10 ± 2.84 10.45 ± 2.93 0,356 D7 11.50 ± 0.78* 10.65 ± 2.17 0,024 D14 11.08 ± 1.99* 10.48 ± 2.81 0,486 p-Value 0,001 0,888 Legend: SCP: group treated with scalpel; HPL: group treated with high-power laser; D: day; LATCH: Latch, audible swallowing, type of nipple, comfort, hold; IBFAT: Infant Breastfeeding Assessment Tool; *p < 0.05 versus D0; †p < 0.05 versus previous day; Friedaman/Dunn or Mann-Whitney test (mean ± SD). In the SCP group, LATCH scores improved significantly from D0-post and remained stable thereafter (p < 0.001). In the HPL group, the improvement was also significant, though less pronounced (p = 0.007). Regarding IBFAT, significant improvement was seen only in the SCP group beginning on D7 (p = 0.001). The HPL group did not show statistically significant changes in IBFAT scores over the assessment period (Table 7 ). Discussion This study compared two surgical techniques—cold scalpel (SCP) and high-power diode laser (HPL)—for the treatment of ankyloglossia in infants. The patient sample was clinically homogeneous, with similar distributions in gender, age, breastfeeding type, and artificial nipple use, minimizing potential confounding variables. The assessment of tongue release and repositioning using two protocols (BTAT and Tongue Test) aimed to reduce any diagnostic and postoperative assessment bias. The BTAT, used in initial enrollment, provided a simplified and objective approach and has been validated as a reliable predictor of breastfeeding difficulties in infants aged 0–6 months [ 18 ]. Results demonstrated that both SCP and HPL were effective in improving tongue morphology and function across all time points, with no statistically significant differences between groups. The BTAT scores showed significant improvement in both groups, though their progression patterns differed: SCP exhibited a continuous increase in scores, while HPL showed a plateau after initial improvement. This may be attributed to the laser’s photocoagulation effect, which, despite allowing excellent hemostasis, can provoke a unique initial inflammatory response [ 19 ]. Functional outcomes assessed by the Tongue Test mirrored these trends, with both groups showing marked improvement immediately after surgery (D0-post), stability at D7, and further gains by D14. These findings suggest that tissue healing occurring within the first two weeks post-surgery significantly contributes to enhanced tongue function, regardless of the surgical technique used [ 20 , 21 ]. Pain assessment using the CRIES scale and monitoring of analgesic use revealed no significant differences between groups, indicating both methods provided similar perioperative comfort. Both groups showed a significant reduction in pain shortly after the procedure. Interestingly, literature in adult populations suggests lasers may offer superior outcomes in terms of postoperative pain and scarring [ 22 ] [ 23 ], but this was not observed in our study—possibly due to differences in age-related healing dynamics and the challenge of accurately assessing pain in non-verbal infants. Healing quality, evaluated with the Landry healing index, improved progressively in both groups. Despite known laser-associated benefits such as photobiomodulation, disinfection, and hemostasis, no statistically significant differences were noted in healing scores. However, a negative correlation was identified between the total energy applied during laser surgery and healing quality at day 14, suggesting that excessive thermal energy may impair tissue repair [ 15 ]. This aligns with existing literature reporting thermal damage as a concern with high laser energy levels [ 14 , 19 , 22 , 23 ]. Weight gain, an indirect marker of feeding success, was also monitored. Both groups demonstrated progressive body mass increase, supporting the idea that surgical treatment of ankyloglossia can resolve sucking difficulties and enhance breast milk intake. No significant differences in weight gain were found between the SCP and HPL groups [ 2 , 16 , 24 ]. Breastfeeding performance was assessed using the LATCH and IBFAT protocols, which measure sucking efficiency and infant satisfaction [ 25 , 26 ]. On day 7, the SCP group showed significantly better results, possibly due to faster lingual functional recovery and less fibrous tissue formation compared to HPL [ 14 ]. By day 14, however, the difference resolved, indicating similar long-term outcomes. Previous research supports the idea that when tongue function is restored, the choice of surgical method may not influence long-term breastfeeding success [ 27 ]. Although no significant differences were observed between the groups for most parameters, functional breastfeeding performance showed a temporary advantage for the cold scalpel group on the 7th postoperative day. However, this difference was not sustained by day 14, indicating that both surgical methods offer comparable clinical efficacy in the medium term. A noteworthy finding was the negative correlation between the total energy applied during the high-power diode laser procedure and the healing index on the 14th day, suggesting that higher energy doses may negatively affect tissue repair. Despite this, both techniques resulted in improved tongue function, reduced pain, and progressive weight gain during the postoperative period. Conclusions This study provides meaningful insight into the clinical outcomes of two surgical techniques for the treatment of ankyloglossia in infants. By comparing the cold scalpel and high-power diode laser under standardized conditions, it offers valuable evidence to guide clinical decision-making. The results demonstrate that both methods are safe and effective, supporting their use in improving tongue mobility, feeding function, and overall well-being in infants. The temporary difference in breastfeeding function observed early in the postoperative period suggests the cold scalpel may offer a short-term advantage, while the diode laser requires further investigation, especially regarding its impact on tissue healing based on energy parameters. Importantly, this study emphasizes the relevance of individualized technique selection based on resource availability, practitioner expertise, and parental preferences. By highlighting the strengths and limitations of each modality, the findings support the development of evidence-based protocols and encourage further research to refine the application of emerging surgical technologies in pediatric care. Limitations This study has limitations that should be acknowledged: the sample size, although clinically relevant, may not be sufficient to detect subtle differences between groups or to generalize the findings to broader populations; the short follow-up period limits the evaluation of long-term outcomes related to tongue function, scarring, and breastfeeding success; the assessment of pain relied on indirect scales, which may be subject to subjectivity and variability, especially in infants who cannot self-report. Additional studies with larger sample sizes and extended follow-up are needed to validate and expand upon these findings. Abbreviations SCP Scalpel HPL High–Power Laser BTAT Bristol Tongue Assessment Tool Tongue Test Functional and morphological assessment protocol of tongue mobility CRIES Crying, Requires oxygen, Increased vital signs, Expression, Sleepless LATCH Latch, Audible swallowing, Type of nipple, Comfort, Hold IBFAT Infant Breastfeeding Assessment Tool D0 pre –Day of surgery (baseline preoperative) D0 intra –Day of surgery (intraoperative) D0 post –Day of surgery (immediate postoperative) D0 30post –Day of surgery (30 minutes post–operative) D7 7 th postoperative day D14 14 th postoperative day J Joules r Pearson’s correlation coefficient Declarations Ethics approval and consent to participate The research protocol was approved by the Human Research Ethics Committee of Christus University Center under approval number 6.332.477. This study was conducted in accordance with the Declaration of Helsinki and the Brazilian National Health Council’s Resolution 466/2012, which outlines ethical principles such as autonomy, non-maleficence, beneficence, justice, and equity. Guardians of the participants were informed about the objectives, procedures, potential risks, and benefits. Written informed consent was obtained from each legal guardian prior to their participation. They were also informed of their right to withdraw at any time without any consequences. Consent for publication Informed consent for the publication of anonymized data and images was obtained from all participants’ legal guardians. Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author contributions Mariana Laprovitera Teixeira Carneiro: Conceptualization, Methodology, Investigation, Data Curation, Formal Analysis, Writing – Original Draft. Maria Elisa Quezado Lima Verde: Conceptualization, Methodology, Investigation, Supervision, Project Administration, Writing – Original Draft; Writing – Review & Editing. Maria Fernanda da Silva Nascimento : Investigation, Data Curation, Visualization. João Emanuel Sousa de Almeida : Investigation, Data Curation, Visualization. Maria Clara Mendes Gomes : Investigation, Data Curation, Visualization. Rebeca Neneza Dias Barboza : Investigation, Data Curation, Visualization. Sheyla Cristinty Rodrigues Mendes : Investigation, Data Curation, Visualization. Laís Fernandes Pontes Mendonça: Investigation, Data Curation, Visualization. Luzia Rayane Gomes de Lima: Investigation, Data Curation, Visualization. Barbhara Girão Costa Rodrigues: Investigation, Data Curation, Visualization. Gustavo Mendes de Oliveira: Investigation, Data Curation, Visualization. Paulo Goberlânio de Barros Silva: Formal Analysis, Supervision, Writing – Review & Editing. Juliana Ximenes Damasceno: Conceptualization, Supervision, Project Administration, Writing – Review & Editing. Acknowledgements The authors extend their sincere appreciation to the families and infants who participated in this study, whose collaboration was fundamental to its execution. We are also grateful to the faculty and technical staff of the School of Dentistry at Christus University Center for their logistical and institutional support throughout the research. We acknowledge the contributions of the dental professionals and students involved in clinical data collection and follow-up, as well as the statistician for their expertise in data analysis. This work reflects the collective efforts of a multidisciplinary team. References Suellen Ferro de Brito, Marchesan IQ. Cyntia Monteiro de Bosco, Alessandra Caxeta Alves Carrilho, Rehder MI: Frênulo lingual: classificação e conduta segundo ótica fonoaudiológica, odontológica e otorrinolaringológica. Rev CEFAC. 2008;10(3):343–51. Guinot F, Carranza N, Ferres-Amat E, Carranza M, Veloso A. Tongue-tie: incidence and outcomes in breastfeeding after lingual frenotomy in 2333 newborns. J Clin Pediatr Dent. 2022;46(6):33–9. Mazzoni A, Navarro RS, Fernandes KPS, Horliana A, Mesquita-Ferrari RA, Motta PB, Silva T, Gomes AO, Martimbianco ALC, Sobral APT, et al. Evaluation of the effects of high-level laser and electrocautery in lingual frenectomy surgeries in infants: protocol for a blinded randomised controlled clinical trial. BMJ Open. 2021;11(11):e050733. Fraga M, Barreto KA, Lira TCB, Menezes VA. Diagnosis of ankyloglossia in newborns: is there any difference related to the screening method? Codas 2021, 33(1):e20190209. Ingram J, Johnson D, Copeland M, Churchill C, Taylor H, Emond A. The development of a tongue assessment tool to assist with tongue-tie identification. Arch Dis Child Fetal Neonatal Ed. 2015;100(4):F344–348. LeFort Y, Evans A, Livingstone V, Douglas P, Dahlquist N, Donnelly B, Leeper K, Harley E, Lappin S. Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads. Breastfeed Med. 2021;16(4):278–81. Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, et al. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg. 2020;162(5):597–611. Araujo M, Freitas RL, Lima MGS, Kozmhinsky V, Guerra CA, Lima GMS, Silva A, Junior PCM, Arnaud M, Albuquerque EC, et al. Evaluation of the lingual frenulum in newborns using two protocols and its association with breastfeeding. J Pediatr (Rio J). 2020;96(3):379–85. O'Shea JE, Foster JP, O'Donnell CP, Breathnach D, Jacobs SE, Todd DA, Davis PG. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev. 2017;3(3):CD011065. Ganesan K, Girgis S, Mitchell S. Lingual frenotomy in neonates: past, present, and future. Br J Oral Maxillofac Surg. 2019;57(3):207–13. Klockars T, Pitkaranta A. Pediatric tongue-tie division: indications, techniques and patient satisfaction. Int J Pediatr Otorhinolaryngol. 2009;73(10):1399–401. Akpinar A, Toker H, Lektemur Alpan A, Calisir M. Postoperative discomfort after Nd:YAG laser and conventional frenectomy: comparison of both genders. Aust Dent J. 2016;61(1):71–5. Komori S, Matsumoto K, Matsuo K, Suzuki H. Clinical Study of Laser Treatment for Frenectomy of Pediatric Patients. Int J Clin Pediatr Dent. 2017;10(3):272–7. Mazzoni A, Navarro RS, Fernandes KPS, Mesquita-Ferrari RA, Horliana A, Silva T, Santos EM, Sobral APT, Junior AB, Nammour S et al. Comparison of the Effects of High-Power Diode Laser and Electrocautery for Lingual Frenectomy in Infants: A Blinded Randomized Controlled Clinical Trial. J Clin Med 2022, 11(13). Viet DH, Ngoc VTN, Anh LQ, Son LH, Chu DT, Ha PTT, Chu-Dinh T. Reduced Need of Infiltration Anesthesia Accompanied With Other Positive Outcomes in Diode Laser Application for Frenectomy in Children. J Lasers Med Sci. 2019;10(2):92–6. Dell'Olio F, Baldassarre ME, Russo FG, Schettini F, Siciliani RA, Mezzapesa PP, Tempesta A, Laforgia N, Favia G, Limongelli L. Lingual laser frenotomy in newborns with ankyloglossia: a prospective cohort study. Ital J Pediatr. 2022;48(1):163. Conceição CMd, Coca KP, Alves, MdRdS. Almeida FdA: Validação para língua portuguesa do instrumento de avaliação do aleitamento materno LATCH. Acta Paulista de Enfermagem. 2017;30(2):210–6. Bellieni CV, Calcagna ILAG, Cartocci I, L A, Iadanza DES. E: Ankyloglossia in newborns: incidence and breastfeeding follow-up at 1 and 6 months. Minerva Pediatr (Torino) 2024. Kotlow L. Diagnosis and treatment of ankyloglossia and tied maxillary fraenum in infants using Er:YAG and 1064 diode lasers. Eur Arch Paediatr Dent. 2011;12(2):106–12. Jones H, Hintze J, Walsh M, O'Leary M, Heffernan C. Lingual frenotomy for ankyloglossia in infants with breastfeeding difficulties: a longitudinal observational study. Eur J Pediatr. 2024;183(12):5245–54. Martinelli RL, Marchesan IQ, Gusmão RJ, Honório HM, Berretin-Felix G. The effects of frenotomy on breastfeeding. J Appl Oral Sci. 2015;23(2):153–7. Tastan Eroglu Z, Babayigit O, Ucan Yarkac F, Yildiz K, Ozkan Sen D. Evaluating diode laser and conventional scalpel techniques in maxillary labial frenectomy for patient perception, tissue healing, and clinical efficacy: six-month results of a randomized controlled study. Med Oral Patol Oral Cir Bucal 2025. Haytac MC, Ozcelik O. Evaluation of patient perceptions after frenectomy operations: a comparison of carbon dioxide laser and scalpel techniques. J Periodontol. 2006;77(11):1815–9. Buryk M, Bloom D, Shope T. Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics. 2011;128(2):280–8. Riordan J, Bibb D, Miller M, Rawlins T. Predicting breastfeeding duration using the LATCH breastfeeding assessment tool. J Hum Lact. 2001;17(1):20–3. Riordan JM, Koehn M. Reliability and validity testing of three breastfeeding assessment tools. J Obstet Gynecol Neonatal Nurs. 1997;26(2):181–7. Edmunds J, Miles SC, Fulbrook P. Tongue-tie and breastfeeding: a review of the literature. Breastfeed Rev. 2011;19(1):19–26. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 04 Dec, 2025 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 04 Aug, 2025 Reviews received at journal 03 Aug, 2025 Reviews received at journal 26 Jul, 2025 Reviews received at journal 24 Jul, 2025 Reviewers agreed at journal 14 Jul, 2025 Reviewers agreed at journal 11 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviewers invited by journal 09 Jul, 2025 Editor invited by journal 08 Jul, 2025 Editor assigned by journal 08 Jul, 2025 Submission checks completed at journal 08 Jul, 2025 First submitted to journal 28 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6999870","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485284530,"identity":"fc515976-e772-4802-88e9-9e4c7e0ba0ba","order_by":0,"name":"Mariana Laprovitera Teixeira Carneiro","email":"","orcid":"","institution":"Unichristus","correspondingAuthor":false,"prefix":"","firstName":"Mariana","middleName":"Laprovitera Teixeira","lastName":"Carneiro","suffix":""},{"id":485284531,"identity":"b71ca34c-a0fb-48d3-8741-bd9d402a81c4","order_by":1,"name":"Maria Elisa Quezado Lima 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Damasceno","email":"","orcid":"","institution":"Unichristus","correspondingAuthor":false,"prefix":"","firstName":"Juliana","middleName":"Ximenes","lastName":"Damasceno","suffix":""}],"badges":[],"createdAt":"2025-06-28 22:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6999870/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6999870/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-025-06307-y","type":"published","date":"2025-12-04T15:57:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86829485,"identity":"a6c7c952-8b08-434a-b0f2-b1666015d498","added_by":"auto","created_at":"2025-07-16 05:46:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":155836,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow diagram of participant enrollment, allocation, follow-up, and analysis. Final analysis included 40 participants per group.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6999870/v1/9a9a4dbc2360cc58fa7e2a4b.png"},{"id":97723785,"identity":"b7a2a631-1e56-499c-88a5-092b46b5be90","added_by":"auto","created_at":"2025-12-08 16:06:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1526927,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6999870/v1/d2683bbe-3497-43b4-b27e-1d653248b0d5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"High-power diode laser versus conventional scalpel in the surgical treatment of pediatric ankyloglossia: a randomized, parallel, triple-blind, controlled clinical trial","fulltext":[{"header":"Background","content":"\u003cp\u003eThe lingual frenulum is a fibrous connective tissue structure that connects the ventral surface of the tongue to the floor of the mouth [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Along with the labial frenulum, it plays a key role in the function of the lingual and perioral muscles, being essential for speech, swallowing, sucking, and breathing. Ankyloglossia, or \u0026ldquo;tongue-tie,\u0026rdquo; is a congenital condition characterized by a short or thickened lingual frenulum that restricts tongue mobility [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This alteration results from insufficient apoptosis during embryonic development and may occur sporadically or be associated with craniofacial anomalies. Genetic inheritance patterns, including autosomal dominant and recessive forms, have also been described. Ankyloglossia is more prevalent in males, with a reported male-to-female ratio of approximately 2.5:1 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eClinically, ankyloglossia can lead to breastfeeding difficulties, speech and feeding disorders, malocclusion, impaired oral hygiene, and psychosocial stress. Prevalence estimates vary widely (0.52\u0026ndash;21%) due to heterogeneity in diagnostic criteria and methodologies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Several diagnostic tools have been proposed, such as the Coryllos classification (which focuses on anatomical presentation) and functional assessment protocols including the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF), the Bristol Tongue Assessment Tool (BTAT), and the Lingual Frenulum Assessment Protocol for Infants (\u0026ldquo;Tongue Test\u0026rdquo;). Although the Brazilian Ministry of Health recommends the BTAT for infants, there is no global consensus on a gold-standard protocol. Recent studies have presented conflicting findings, with some reporting greater sensitivity for the \u0026ldquo;Tongue Test,\u0026rdquo; while others support the BTAT as a simple, objective, and effective tool for both diagnosis and post-intervention follow-up [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite increased awareness and diagnosis of ankyloglossia in recent years, the benefits of surgical intervention\u0026mdash;particularly in infants\u0026mdash;remain under debate. Professional societies, such as the Academy of Breastfeeding Medicine and the American Society of Pediatric Otolaryngology, have highlighted the lack of robust randomized clinical trials and standardization in diagnostic and treatment criteria. As a result, overdiagnosis and potentially unnecessary surgical procedures have been reported in certain populations [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBreastfeeding complications in the neonatal period are common, and ankyloglossia may contribute to problems such as poor latch, maternal nipple pain, breast engorgement, and reduced milk supply. Nevertheless, these symptoms may also result from other factors. Thus, multidisciplinary evaluation is crucial in distinguishing ankyloglossia from other breastfeeding issues and in supporting clinical decision-making [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhen conservative management fails to resolve breastfeeding difficulties, frenotomy\u0026mdash;defined as the simple incision of the lingual frenulum\u0026mdash;is the most indicated procedure in infants due to its simplicity, low morbidity, and immediate potential benefits. In older children, frenuloplasty, which involves muscle release and suturing, may be preferred, while frenectomy is reserved for cases requiring tissue excision [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Surgical options include conventional cold blade or scissors, electrocautery, and high-power lasers [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHigh-power lasers (e.g., diode, CO₂, Nd:YAG) offer several advantages: enhanced hemostasis, microvascular sealing, precision cutting, better visualization of the operative field, reduced postoperative pain and inflammation, and faster tissue repair. These effects are attributed to photothermal interactions, including vaporization, coagulation, and necrosis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, cost and the need for training may limit widespread use. Among laser technologies, diode lasers have shown a particular promise in pediatric applications due to their safety and efficacy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStudies comparing laser and conventional techniques report benefits such as reduced anesthesia need, improved cooperation in children, lower postoperative pain, and better maternal comfort during breastfeeding [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Laser use has also been associated with decreased bleeding and inflammation compared to electrocautery [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite these promising results, the literature lacks well-designed randomized clinical trials evaluating the efficacy and safety of high-power diode lasers in treating ankyloglossia in infants. Limitations include small sample sizes, heterogeneous diagnostic criteria, variable surgical protocols, and reliance on qualitative outcomes. Therefore, this study aimed to evaluate the clinical effectiveness of high-power diode laser surgery compared to the conventional scalpel technique in the treatment of pediatric ankyloglossia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eEthical aspects and consent to participate\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe research protocol was approved by the Human Research Ethics Committee of Christus University Center under approval number 6.332.477. This study was conducted in accordance with the Declaration of Helsinki and the Brazilian National Health Council\u0026rsquo;s Resolution 466/2012, which outlines ethical principles such as autonomy, non-maleficence, beneficence, justice, and equity. Guardians of the participants were informed about the objectives, procedures, potential risks, and benefits. Written informed consent was obtained from each legal guardian prior to their participation. They were also informed of their right to withdraw at any time without any consequences.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA randomized, controlled, parallel, triple-blind clinical trial was conducted and registered on the Brazilian Clinical Trials Registry (ReBEC) under registration number RBR-466cykz. The trial adhered to the CONSORT 2010 guidelines.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants included infants aged 0 to 6 months with a diagnosis of severe ankyloglossia (BTAT score from 0 to 3), recruited from spontaneous demand at the School Clinic of Dentistry at Christus University Center, where all procedures were performed. Patients were evaluated and classified by eligibility criteria during scheduled visits.\u003c/p\u003e\u003cp\u003eParticipants included in this study were healthy individuals (ASA I), aged between 0 and 6 months, diagnosed with severe ankyloglossia by a pediatric dentist using the BTAT protocol, with scores ranging from 0 to 3. Exclusion criteria comprised individuals with previously diagnosed systemic conditions that contraindicated the surgical procedure; those undergoing prior pharmacological treatment; individuals with absolute or relative contraindications to the use of local anesthetics; those with congenital orofacial malformations; and cases in which the legal guardians refused to consent to participation in the study. Participants were withdrawn from the study if they failed to attend postoperative follow-up appointments, if postoperative care instructions were not followed, or if their guardians chose to discontinue participation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInterventions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll surgical procedures were performed by a single experienced surgeon, while all pre- and postoperative assessments were carried out by a single experienced pediatric dentist, ensuring standardization and blinding. The diagnosis of severe ankyloglossia was established during the clinical examination using the BTAT protocol (scores from 0 to 3). Topical anesthesia with 20% benzocaine was followed by infiltrative anesthesia using 2% lidocaine with epinephrine (1:100,000), adjusted according to the infant\u0026rsquo;s weight [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWith the aid of a tongue retractor (tentacannula), the patient\u0026rsquo;s tongue was pulled posteriorly to achieve stable tension of the lingual frenulum, allowing for a favorable incision site. In the SCL group, a no. 15 scalpel blade mounted on a no. 3 Bard Parker handle was used. In the HPL group, a high-power diode laser (Thera Lase Surgery\u0026reg;, DMC, S\u0026atilde;o Carlos, Brazil) operating at 980\u0026thinsp;\u0026plusmn;\u0026thinsp;20 nm (infrared region), in continuous mode with a power of 1.5 W, was used. The laser was coupled to a 400 \u0026micro;m optical fiber. Before the procedure, the fiber tip was cleaved using a diamond-tipped pen.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn both groups, the incision extended from the anterior border of the frenulum to its posterior-inferior limit, avoiding noble anatomical structures. When necessary, hemostasis was achieved with sterile gauze, and postoperative analgesia was managed with oral paracetamol (100 mg/ml in oral suspension), when necessary.\u003c/p\u003e\u003cp\u003e\u003cem\u003eHarms and benefits of the intervention\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe procedure carried some risks, such as pain, edema, bleeding, paresthesia, ulcers, and infection. However, in case of complications, patients were reassessed and managed accordingly. On the other hand, benefits of ankyloglossia treatment include improvements in breastfeeding and further in speech, nutrition, and quality of life.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary outcome of the study was the release and repositioning of the lingual frenulum. Secondary outcomes included: perioperative pain; healing quality; variation in the patient's body weight and quality of breastfeeding. The evaluation of these outcomes was based on the following methodologies:\u003c/p\u003e\u003cp\u003e\u003cem\u003eRelease and repositioning of the lingual brake\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAssessment was conducted using the BTAT and Tongue Test scales at baseline preoperative (D0-pre) and immediate postoperative (D0-post), day 7 (D7), and day 14 (D14) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) for both groups. Standardized photographs were taken at each time point.\u003c/p\u003e\u003cp\u003e\u003cem\u003eImpact on the healing process\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePostoperative healing was evaluated quantitatively at D0-post, D7, and D14 using the Landry Healing Index [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which scores five criteria\u0026mdash;bleeding, granulation tissue, tissue color, wound margins, and suppuration\u0026mdash;on a scale from 0 (poor healing) to 5 (excellent healing). Results were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e\u003cp\u003e\u003cem\u003ePerioperative pain\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePain was assessed using the CRIES scale, which scores five parameters (crying, oxygen requirement, vital signs, facial expression, and sleepiness) from 0 to 10 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Evaluations were conducted by the same examiner at three time points on D0 (intraoperative (D0-intra); immediate postoperative (D0-post) and 30 minutes post-operative (D0-30post)), as well as on D7 and D14. A pulse oximeter was used as part of the assessment and results were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Rescue medication usage (paracetamol) was recorded and reported as absolute and relative frequency.\u003c/p\u003e\u003cp\u003e\u003cem\u003eVariations in the patient's body mass\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePatients\u0026rsquo; body weight was measured using a digital scale on D0, D7, and D14. Data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD for each group.\u003c/p\u003e\u003cp\u003e\u003cem\u003eQuality of breastfeeding\u003c/em\u003e\u003c/p\u003e\u003cp\u003eBreastfeeding quality was evaluated using two validated tools: LATCH scale (Latch, Audible swallowing, Type of nipple, Comfort, Hold), consisting of five scored items (0\u0026ndash;2 each); and IBFAT (Infant Breastfeeding Assessment Tool), consisting of four scored items (0\u0026ndash;3 each) and totaling up to 12 points [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAssessments were performed at D0-pre, D0-post, D7, and D14. Results were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample calculation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBased on the study by BHAT et al. in 2015, which compared lingual frenulum removal via scalpel and high-power laser and reported a significant reduction in remnant tissue volume (-1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19 vs. -1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12), a sample size of 40 patients per group was calculated to ensure 80% power and 95% confidence (Student\u0026rsquo;s t-test).\u003c/p\u003e\u003cp\u003eParticipants were randomly allocated into two groups: SCP group: incision performed with a no. 15 scalpel blade; and HPL group: incision performed with high-power diode laser.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRandomization\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSimple randomization was performed using Microsoft Excel\u0026reg; (version 16.73) via the \u0026ldquo;=RANDBETWEEN\u0026rdquo; function. A study assistant uninvolved in any research procedures generated the random sequence and allocated participants into groups. Group assignment was revealed to the surgeon only at the time of the procedure.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBlinding\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo ensure tiple blinding, the patients\u0026rsquo; guardians, the outcome assessor, and the statistician were blinded to group allocation. Surgeries were performed in a closed room, with no access granted to guardians or assessors. Only the surgeon was aware of the group allocation and were not involved in any outcome evaluations.\u003c/p\u003e\u003cp\u003eData analysis was initially performed with coded group labels (\u0026lsquo;A\u0026rsquo; and \u0026lsquo;B\u0026rsquo;). Group identities were revealed only after all statistical analyses were completed.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll data were tabulated using Microsoft Excel\u0026reg; (version 16.73) and exported to IBM\u0026reg; SPSS\u0026reg; Statistics for Windows\u0026reg; (version 20) for analysis. A confidence level of 95% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was adopted for all tests. The normality of the data was assessed using the Kolmogorov-Smirnov test. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD and analyzed using the Mann-Whitney and Friedman tests, followed by Dunn\u0026rsquo;s post hoc test for non-parametric data. Categorical variables were presented as absolute and relative frequencies and compared using either Fisher\u0026rsquo;s Exact Test or Pearson\u0026rsquo;s Chi-square test, as appropriate. Additionally, the correlation between the total amount of energy applied (in Joules) in the HPL group and the Landry wound healing index across different time points was evaluated using Spearman\u0026rsquo;s correlation coefficient.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eThe clinical profile of the patients evaluated in this study, as well as the types of breastfeeding and use of artificial nipples, did not differ between the evaluation groups.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 116 patients were assessed for eligibility in this study, of whom 98 met the inclusion criteria. The SCP group included 50 patients (51.02%), with 10 subsequently withdrawn due to loss to follow-up (n\u0026thinsp;=\u0026thinsp;8) or discontinuation of breastfeeding (n\u0026thinsp;=\u0026thinsp;2). The HPL group consisted of 48 patients (48.98%), with 8 excluded due to missed follow-up visits. The CONSORT flow diagram summarizing the study enrollment and follow-up is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe clinical profile, including breastfeeding types and use of artificial nipples, did not differ significantly between groups. Regarding clinical characteristics, no statistically significant difference was observed between groups in terms of gender (p\u0026thinsp;=\u0026thinsp;0.068), although the HPL group included a higher proportion of males (70%) compared to the SCP group (50%). The mean age of participants was also similar across groups (SCP: 46.73\u0026thinsp;\u0026plusmn;\u0026thinsp;31.76 days; HPL: 42.78\u0026thinsp;\u0026plusmn;\u0026thinsp;38.23 days; p\u0026thinsp;=\u0026thinsp;0.331) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription of clinical data (gender and age) in the different groups evaluated.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSCP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHPL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,068\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20 (50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12 (30.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20 (50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28 (70.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (days)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46.73\u0026thinsp;\u0026plusmn;\u0026thinsp;31.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42.78\u0026thinsp;\u0026plusmn;\u0026thinsp;38.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,331\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eCaption: SCP: group treated with scalpel; HPL: group treated with high-power laser; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Mann-Whitney test (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) and Pearson's chi-square (n, %).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eGiven that the study included infants who could be exclusively breastfed or supplemented with formula and/or solid food, the majority of participants in both groups were exclusively breastfed (SCP: 70%, HPL: 62.5%), with no significant difference (p\u0026thinsp;=\u0026thinsp;0.478). No significant differences were found in the combination of breastfeeding with formula (p\u0026thinsp;=\u0026thinsp;0.633) or with the introduction of solid foods (p\u0026thinsp;=\u0026thinsp;1.000) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription of the types of breastfeeding and use of artificial nipples, according to the evaluation groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSCP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHPL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBreastfeeding\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExclusive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (70.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25 (62.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,478\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssociated with the formula\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (30.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (35.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,633\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssociated with food introduction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (2.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (2.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1,000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUse of artificial nipples\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26 (65.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32 (80.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,133\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSilicone nozzle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (42.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (32.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,356\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaby bottle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (42.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21 (52.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,370\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePacifiers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (17.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12 (30.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,189\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eCaption: SCP: group treated with scalpel; HPL: group treated with high-power laser; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Pearson's chi-square test (n, %).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe use of artificial nipples was more frequent in the HPL group (80%) compared to the SCP group (65%), but this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.133). Similarly, no significant differences were observed between groups in the use of specific types of artificial nipples such as silicone nipples (p\u0026thinsp;=\u0026thinsp;0.356) or baby bottles (p\u0026thinsp;=\u0026thinsp;0.370). Pacifier use was also more prevalent in the HPL group (30% vs. 17.5% in the SCP group), but the difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.189) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eBoth surgical techniques demonstrated a significant impact on the degree of tongue-tie release and repositioning.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMorphological and functional assessments were conducted at four time points (D0-pre, D0-post, D7, and D14) using two validated tools: the BTAT and the Tongue Test. No significant differences were observed between groups on any assessment day regardless of the assessment method used (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssessment of tongue release and repositioning (BTAT and Tongue Test) at the different assessment times, according to the treatment modality.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSCP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHPL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBTAT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0-pre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1,000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0-post\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,180\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,631\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,298\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ep-Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTongue test\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0-pre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.65\u0026thinsp;\u0026plusmn;\u0026thinsp;3.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,828\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0-post\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.79\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,956\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,260\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.58\u0026thinsp;\u0026plusmn;\u0026thinsp;3.05*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,312\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ep-Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eLegend: SCP: group treated with scalpel; HPL: group treated with high-power laser; D: day; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 versus D0; \u0026dagger;p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 versus previous day; Friedaman/Dunn or Mann-Whitney test (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegarding the BTAT assessment, a significant improvement in tongue morphology was observed over time in both groups. In the SCP group, significant differences emerged immediately after surgery (D0-post) compared to D0-pre, with further improvement on D7 and D14 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, in the HPL group, a significant increase was seen on D0-post compared to D0-pre, with consistent values maintained on D7 and D14 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Despite this intra-group progression, no significant inter-group differences were detected at any time point (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSimilarly, the Tongue Test also revealed significant improvements in both morphological and functional tongue release. Both groups demonstrated significant gains on D0 post (vs. D0 pre), stable scores on D7, and further improvement on D14 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The parameters remained similar on the 7th day of postoperative follow-up and, on the 14th day of evaluation, increased significantly in both groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eBoth treatment modalities showed a comparable outcome regarding perioperative pain and healing parameters.\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePain was assessed using the CRIES scale and the need for rescue analgesia. No significant differences were found between groups on any evaluation day (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating a similar pain experience (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Likewise, healing outcomes did not differ significantly between the SCP and HPL groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnalysis of perioperative pain parameters (CRIES), need for postoperative analgesic medication and Landry's healing index at the different evaluation times, according to the treatment modality performed.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSCP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHPL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRIES scale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0-transoperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,674\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0-immediate post\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,637\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0-after 30 min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,442\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,910\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,523\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ep-Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUse of post-operative analgesia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (62.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,260\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLandry's healing index\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,750\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,707\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1,000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ep-Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eLegend: SCP: group treated with scalpel; HPL: group treated with high-power laser; D: day; LATCH: Latch, audible swallowing, type of nipple, comfort, hold; IBFAT: Infant Breastfeeding Assessment Tool; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 versus D0; \u0026dagger;p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 versus previous day; Friedaman/Dunn or Mann-Whitney test (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn both groups, the CRIES scores showed a significant reduction from the intraoperative to the immediate postoperative period (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with further reduction at 30 minutes post-surgery. Pain levels remained low and stable on subsequent days (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHealing was assessed using the Landry Healing index. A significant improvement in wound healing was observed in both groups on D14 compared to D0 and D7 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe greater the energy used in the surgical procedure, the less favorable the healing process becomes in the last timepoint\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn the HPL group, a statistically significant negative correlation (r = \u0026minus;\u0026thinsp;0.355; p\u0026thinsp;=\u0026thinsp;0.027) was observed between the total energy applied (in Joules) and the Landry Healing Index on D14 (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), meaning that a higher intraoperative energy is associated with less favorable healing after 14 days.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation analysis between the total amount of energy (J) and Landry's healing index at the different assessment times.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHPL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eLandry's healing index\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEnergy (J)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eD0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eD7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eD14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e-0.355*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-Value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.243\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.877\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eLegend: HPL: group treated with high-power laser; D: day; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Spearman's correlation.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurgical treatment of ankyloglossia had a positive effect on body mass gain over time, regardless of the surgical technique used.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBody mass was assessed on D0-pre, D7, and D14. No significant differences were observed between groups at any time point (D0-pre: p\u0026thinsp;=\u0026thinsp;0.064; D7: p\u0026thinsp;=\u0026thinsp;0.100; D14: p\u0026thinsp;=\u0026thinsp;0.131). However, within-group analysis revealed a significant increase in body mass over time. Both the SCP and HPL groups showed a statistically significant increase from D0 to D7, and again from D7 to D14 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription of the data on body mass variations on the day of surgery and on the days of post-operative follow-up, according to the treatment modality performed.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody mass (Kg)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSCP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHPL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27*\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,131\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ep-Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eLegend: SCP: scalpel-treated group; HPL: high-power laser-treated group; D: day; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 versus D0; \u0026dagger;p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 versus previous day; Friedman/Dunn or Mann-Whitney test (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eBoth treatment modalities significantly improved breastfeeding quality, with the SCP group showing superior performance on D7.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBreastfeeding quality was assessed using the LATCH and IBFAT scales, in which higher scores indicate better outcomes.\u003c/p\u003e\u003cp\u003eNo significant differences were observed between groups at D0 (pre- and post-surgery) or D14 (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, on D7, the SCP group showed significantly better performance compared to the HPL group in both LATCH (p\u0026thinsp;=\u0026thinsp;0.003) and IBFAT (p\u0026thinsp;=\u0026thinsp;0.024) assessments (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssessment of breastfeeding quality using the LATCH and IBFAT protocols at the different assessment times, according to the treatment modality used.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSCP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHPL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLATCH\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0-pre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,640\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0-post\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.75\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,898\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0,003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,162\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ep-Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,007\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIBFAT\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0-pre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,131\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD0-post\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,356\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0,024\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,486\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ep-Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,888\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eLegend: SCP: group treated with scalpel; HPL: group treated with high-power laser; D: day; LATCH: Latch, audible swallowing, type of nipple, comfort, hold; IBFAT: Infant Breastfeeding Assessment Tool; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 versus D0; \u0026dagger;p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 versus previous day; Friedaman/Dunn or Mann-Whitney test (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the SCP group, LATCH scores improved significantly from D0-post and remained stable thereafter (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the HPL group, the improvement was also significant, though less pronounced (p\u0026thinsp;=\u0026thinsp;0.007).\u003c/p\u003e\u003cp\u003eRegarding IBFAT, significant improvement was seen only in the SCP group beginning on D7 (p\u0026thinsp;=\u0026thinsp;0.001). The HPL group did not show statistically significant changes in IBFAT scores over the assessment period (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study compared two surgical techniques\u0026mdash;cold scalpel (SCP) and high-power diode laser (HPL)\u0026mdash;for the treatment of ankyloglossia in infants. The patient sample was clinically homogeneous, with similar distributions in gender, age, breastfeeding type, and artificial nipple use, minimizing potential confounding variables.\u003c/p\u003e\u003cp\u003eThe assessment of tongue release and repositioning using two protocols (BTAT and Tongue Test) aimed to reduce any diagnostic and postoperative assessment bias. The BTAT, used in initial enrollment, provided a simplified and objective approach and has been validated as a reliable predictor of breastfeeding difficulties in infants aged 0\u0026ndash;6 months [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResults demonstrated that both SCP and HPL were effective in improving tongue morphology and function across all time points, with no statistically significant differences between groups. The BTAT scores showed significant improvement in both groups, though their progression patterns differed: SCP exhibited a continuous increase in scores, while HPL showed a plateau after initial improvement. This may be attributed to the laser\u0026rsquo;s photocoagulation effect, which, despite allowing excellent hemostasis, can provoke a unique initial inflammatory response [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFunctional outcomes assessed by the Tongue Test mirrored these trends, with both groups showing marked improvement immediately after surgery (D0-post), stability at D7, and further gains by D14. These findings suggest that tissue healing occurring within the first two weeks post-surgery significantly contributes to enhanced tongue function, regardless of the surgical technique used [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e Pain assessment using the CRIES scale and monitoring of analgesic use revealed no significant differences between groups, indicating both methods provided similar perioperative comfort. Both groups showed a significant reduction in pain shortly after the procedure. Interestingly, literature in adult populations suggests lasers may offer superior outcomes in terms of postoperative pain and scarring [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], but this was not observed in our study\u0026mdash;possibly due to differences in age-related healing dynamics and the challenge of accurately assessing pain in non-verbal infants.\u003c/p\u003e\u003cp\u003eHealing quality, evaluated with the Landry healing index, improved progressively in both groups. Despite known laser-associated benefits such as photobiomodulation, disinfection, and hemostasis, no statistically significant differences were noted in healing scores. However, a negative correlation was identified between the total energy applied during laser surgery and healing quality at day 14, suggesting that excessive thermal energy may impair tissue repair [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This aligns with existing literature reporting thermal damage as a concern with high laser energy levels [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWeight gain, an indirect marker of feeding success, was also monitored. Both groups demonstrated progressive body mass increase, supporting the idea that surgical treatment of ankyloglossia can resolve sucking difficulties and enhance breast milk intake. No significant differences in weight gain were found between the SCP and HPL groups [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBreastfeeding performance was assessed using the LATCH and IBFAT protocols, which measure sucking efficiency and infant satisfaction [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. On day 7, the SCP group showed significantly better results, possibly due to faster lingual functional recovery and less fibrous tissue formation compared to HPL [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. By day 14, however, the difference resolved, indicating similar long-term outcomes. Previous research supports the idea that when tongue function is restored, the choice of surgical method may not influence long-term breastfeeding success [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough no significant differences were observed between the groups for most parameters, functional breastfeeding performance showed a temporary advantage for the cold scalpel group on the 7th postoperative day. However, this difference was not sustained by day 14, indicating that both surgical methods offer comparable clinical efficacy in the medium term. A noteworthy finding was the negative correlation between the total energy applied during the high-power diode laser procedure and the healing index on the 14th day, suggesting that higher energy doses may negatively affect tissue repair. Despite this, both techniques resulted in improved tongue function, reduced pain, and progressive weight gain during the postoperative period.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides meaningful insight into the clinical outcomes of two surgical techniques for the treatment of ankyloglossia in infants. By comparing the cold scalpel and high-power diode laser under standardized conditions, it offers valuable evidence to guide clinical decision-making. The results demonstrate that both methods are safe and effective, supporting their use in improving tongue mobility, feeding function, and overall well-being in infants. The temporary difference in breastfeeding function observed early in the postoperative period suggests the cold scalpel may offer a short-term advantage, while the diode laser requires further investigation, especially regarding its impact on tissue healing based on energy parameters.\u003c/p\u003e\u003cp\u003eImportantly, this study emphasizes the relevance of individualized technique selection based on resource availability, practitioner expertise, and parental preferences. By highlighting the strengths and limitations of each modality, the findings support the development of evidence-based protocols and encourage further research to refine the application of emerging surgical technologies in pediatric care.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has limitations that should be acknowledged: the sample size, although clinically relevant, may not be sufficient to detect subtle differences between groups or to generalize the findings to broader populations; the short follow-up period limits the evaluation of long-term outcomes related to tongue function, scarring, and breastfeeding success; the assessment of pain relied on indirect scales, which may be subject to subjectivity and variability, especially in infants who cannot self-report. Additional studies with larger sample sizes and extended follow-up are needed to validate and expand upon these findings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSCP\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eScalpel\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHPL\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHigh\u0026ndash;Power Laser\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eBTAT\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBristol Tongue Assessment Tool\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eTongue Test\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFunctional and morphological assessment protocol of tongue mobility\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eCRIES\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCrying, Requires oxygen, Increased vital signs, Expression, Sleepless\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eLATCH\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLatch, Audible swallowing, Type of nipple, Comfort, Hold\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eIBFAT\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInfant Breastfeeding Assessment Tool\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eD0\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e\u003cb\u003epre\u003c/b\u003e\u0026ndash;Day of surgery (baseline preoperative)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eD0\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e\u003cb\u003eintra\u003c/b\u003e\u0026ndash;Day of surgery (intraoperative)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eD0\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e\u003cb\u003epost\u003c/b\u003e\u0026ndash;Day of surgery (immediate postoperative)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eD0\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e\u003cb\u003e30post\u003c/b\u003e\u0026ndash;Day of surgery (30 minutes post\u0026ndash;operative)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eD7\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003eth postoperative day\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eD14\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e\u003cb\u003e14\u003c/b\u003eth postoperative day\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eJ\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eJoules\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003er\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePearson\u0026rsquo;s correlation coefficient\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe research protocol was approved by the Human Research Ethics Committee of Christus University Center under approval number 6.332.477. This study was conducted in accordance with the Declaration of Helsinki and the Brazilian National Health Council\u0026rsquo;s Resolution 466/2012, which outlines ethical principles such as autonomy, non-maleficence, beneficence, justice, and equity. Guardians of the participants were informed about the objectives, procedures, potential risks, and benefits. Written informed consent was obtained from each legal guardian prior to their participation. They were also informed of their right to withdraw at any time without any consequences.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eInformed consent for the publication of anonymized data and images was obtained from all participants\u0026rsquo; legal guardians.\u003c/p\u003e\n\u003ch2\u003eData availability\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003eAuthor contributions\u003c/h2\u003e\n\u003cul\u003e\n\u003cli\u003eMariana Laprovitera Teixeira Carneiro: Conceptualization, Methodology, Investigation, Data Curation, Formal Analysis, Writing \u0026ndash; Original Draft.\u003c/li\u003e\n\u003cli\u003eMaria Elisa Quezado Lima Verde: Conceptualization, Methodology, Investigation, Supervision, Project Administration, Writing \u0026ndash; Original Draft; Writing \u0026ndash; Review \u0026amp; Editing.\u003c/li\u003e\n\u003cli\u003eMaria Fernanda da Silva Nascimento\u003csup\u003e:\u003c/sup\u003e Investigation, Data Curation, Visualization.\u003c/li\u003e\n\u003cli\u003eJo\u0026atilde;o Emanuel Sousa de Almeida\u003csup\u003e:\u003c/sup\u003e Investigation, Data Curation, Visualization.\u003c/li\u003e\n\u003cli\u003eMaria Clara Mendes Gomes\u003csup\u003e:\u003c/sup\u003e Investigation, Data Curation, Visualization.\u003c/li\u003e\n\u003cli\u003eRebeca Neneza Dias Barboza\u003csup\u003e:\u003c/sup\u003e Investigation, Data Curation, Visualization.\u003c/li\u003e\n\u003cli\u003eSheyla Cristinty Rodrigues Mendes\u003csup\u003e:\u003c/sup\u003e Investigation, Data Curation, Visualization.\u003c/li\u003e\n\u003cli\u003eLa\u0026iacute;s Fernandes Pontes Mendon\u0026ccedil;a: Investigation, Data Curation, Visualization.\u003c/li\u003e\n\u003cli\u003eLuzia Rayane Gomes de Lima: Investigation, Data Curation, Visualization.\u003c/li\u003e\n\u003cli\u003eBarbhara Gir\u0026atilde;o Costa Rodrigues: Investigation, Data Curation, Visualization.\u003c/li\u003e\n\u003cli\u003eGustavo Mendes de Oliveira: Investigation, Data Curation, Visualization.\u003c/li\u003e\n\u003cli\u003ePaulo Goberl\u0026acirc;nio de Barros Silva: Formal Analysis, Supervision, Writing \u0026ndash; Review \u0026amp; Editing.\u003c/li\u003e\n\u003cli\u003eJuliana Ximenes Damasceno: Conceptualization, Supervision, Project Administration, Writing \u0026ndash; Review \u0026amp; Editing.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThe authors extend their sincere appreciation to the families and infants who participated in this study, whose collaboration was fundamental to its execution. We are also grateful to the faculty and technical staff of the School of Dentistry at Christus University Center for their logistical and institutional support throughout the research. We acknowledge the contributions of the dental professionals and students involved in clinical data collection and follow-up, as well as the statistician for their expertise in data analysis. This work reflects the collective efforts of a multidisciplinary team.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSuellen Ferro de Brito, Marchesan IQ. Cyntia Monteiro de Bosco, Alessandra Caxeta Alves Carrilho, Rehder MI: Fr\u0026ecirc;nulo lingual: classifica\u0026ccedil;\u0026atilde;o e conduta segundo \u0026oacute;tica fonoaudiol\u0026oacute;gica, odontol\u0026oacute;gica e otorrinolaringol\u0026oacute;gica. Rev CEFAC. 2008;10(3):343\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuinot F, Carranza N, Ferres-Amat E, Carranza M, Veloso A. Tongue-tie: incidence and outcomes in breastfeeding after lingual frenotomy in 2333 newborns. J Clin Pediatr Dent. 2022;46(6):33\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMazzoni A, Navarro RS, Fernandes KPS, Horliana A, Mesquita-Ferrari RA, Motta PB, Silva T, Gomes AO, Martimbianco ALC, Sobral APT, et al. Evaluation of the effects of high-level laser and electrocautery in lingual frenectomy surgeries in infants: protocol for a blinded randomised controlled clinical trial. BMJ Open. 2021;11(11):e050733.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFraga M, Barreto KA, Lira TCB, Menezes VA. Diagnosis of ankyloglossia in newborns: is there any difference related to the screening method? \u003cem\u003eCodas\u003c/em\u003e 2021, 33(1):e20190209.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIngram J, Johnson D, Copeland M, Churchill C, Taylor H, Emond A. The development of a tongue assessment tool to assist with tongue-tie identification. Arch Dis Child Fetal Neonatal Ed. 2015;100(4):F344\u0026ndash;348.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeFort Y, Evans A, Livingstone V, Douglas P, Dahlquist N, Donnelly B, Leeper K, Harley E, Lappin S. Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads. Breastfeed Med. 2021;16(4):278\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMessner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, et al. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg. 2020;162(5):597\u0026ndash;611.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAraujo M, Freitas RL, Lima MGS, Kozmhinsky V, Guerra CA, Lima GMS, Silva A, Junior PCM, Arnaud M, Albuquerque EC, et al. Evaluation of the lingual frenulum in newborns using two protocols and its association with breastfeeding. J Pediatr (Rio J). 2020;96(3):379\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eO'Shea JE, Foster JP, O'Donnell CP, Breathnach D, Jacobs SE, Todd DA, Davis PG. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev. 2017;3(3):CD011065.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGanesan K, Girgis S, Mitchell S. Lingual frenotomy in neonates: past, present, and future. Br J Oral Maxillofac Surg. 2019;57(3):207\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKlockars T, Pitkaranta A. Pediatric tongue-tie division: indications, techniques and patient satisfaction. Int J Pediatr Otorhinolaryngol. 2009;73(10):1399\u0026ndash;401.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkpinar A, Toker H, Lektemur Alpan A, Calisir M. Postoperative discomfort after Nd:YAG laser and conventional frenectomy: comparison of both genders. Aust Dent J. 2016;61(1):71\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKomori S, Matsumoto K, Matsuo K, Suzuki H. Clinical Study of Laser Treatment for Frenectomy of Pediatric Patients. Int J Clin Pediatr Dent. 2017;10(3):272\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMazzoni A, Navarro RS, Fernandes KPS, Mesquita-Ferrari RA, Horliana A, Silva T, Santos EM, Sobral APT, Junior AB, Nammour S et al. Comparison of the Effects of High-Power Diode Laser and Electrocautery for Lingual Frenectomy in Infants: A Blinded Randomized Controlled Clinical Trial. J Clin Med 2022, 11(13).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eViet DH, Ngoc VTN, Anh LQ, Son LH, Chu DT, Ha PTT, Chu-Dinh T. Reduced Need of Infiltration Anesthesia Accompanied With Other Positive Outcomes in Diode Laser Application for Frenectomy in Children. J Lasers Med Sci. 2019;10(2):92\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDell'Olio F, Baldassarre ME, Russo FG, Schettini F, Siciliani RA, Mezzapesa PP, Tempesta A, Laforgia N, Favia G, Limongelli L. Lingual laser frenotomy in newborns with ankyloglossia: a prospective cohort study. Ital J Pediatr. 2022;48(1):163.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eConcei\u0026ccedil;\u0026atilde;o CMd, Coca KP, Alves, MdRdS. Almeida FdA: Valida\u0026ccedil;\u0026atilde;o para l\u0026iacute;ngua portuguesa do instrumento de avalia\u0026ccedil;\u0026atilde;o do aleitamento materno LATCH. Acta Paulista de Enfermagem. 2017;30(2):210\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBellieni CV, Calcagna ILAG, Cartocci I, L A, Iadanza DES. E: Ankyloglossia in newborns: incidence and breastfeeding follow-up at 1 and 6 months. Minerva Pediatr (Torino) 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKotlow L. Diagnosis and treatment of ankyloglossia and tied maxillary fraenum in infants using Er:YAG and 1064 diode lasers. Eur Arch Paediatr Dent. 2011;12(2):106\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJones H, Hintze J, Walsh M, O'Leary M, Heffernan C. Lingual frenotomy for ankyloglossia in infants with breastfeeding difficulties: a longitudinal observational study. Eur J Pediatr. 2024;183(12):5245\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartinelli RL, Marchesan IQ, Gusm\u0026atilde;o RJ, Hon\u0026oacute;rio HM, Berretin-Felix G. The effects of frenotomy on breastfeeding. J Appl Oral Sci. 2015;23(2):153\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTastan Eroglu Z, Babayigit O, Ucan Yarkac F, Yildiz K, Ozkan Sen D. Evaluating diode laser and conventional scalpel techniques in maxillary labial frenectomy for patient perception, tissue healing, and clinical efficacy: six-month results of a randomized controlled study. Med Oral Patol Oral Cir Bucal 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaytac MC, Ozcelik O. Evaluation of patient perceptions after frenectomy operations: a comparison of carbon dioxide laser and scalpel techniques. J Periodontol. 2006;77(11):1815\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuryk M, Bloom D, Shope T. Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics. 2011;128(2):280\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRiordan J, Bibb D, Miller M, Rawlins T. Predicting breastfeeding duration using the LATCH breastfeeding assessment tool. J Hum Lact. 2001;17(1):20\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRiordan JM, Koehn M. Reliability and validity testing of three breastfeeding assessment tools. J Obstet Gynecol Neonatal Nurs. 1997;26(2):181\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEdmunds J, Miles SC, Fulbrook P. Tongue-tie and breastfeeding: a review of the literature. Breastfeed Rev. 2011;19(1):19\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Laser therapy, Ankyloglossia, Infant","lastPublishedDoi":"10.21203/rs.3.rs-6999870/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6999870/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAnkyloglossia can impair vital functions such as breastfeeding, swallowing, and maxillomandibular development, making effective treatment essential.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis randomized, parallel, triple-blind clinical trial evaluated the efficacy of high-power diode laser surgery compared to conventional scalpel frenotomy in infants aged 0\u0026ndash;6 months (n\u0026thinsp;=\u0026thinsp;40/group). Patients were assessed at D0 (pre-, trans-, and/or 30 min postoperative), D7, and D14 using specific instruments according to each outcome: tongue repositioning and frenulum release (BTAT and Tongue Test), wound healing (Landry index), perioperative pain (CRIES scale), and breastfeeding performance (body mass variation, LATCH, and IBFAT scales).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBoth the high-power laser (HPL) and scalpel (SCP) groups showed significant functional improvements and weight gain over time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with no significant intergroup differences in most outcomes (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, on D7, the SCP group demonstrated superior breastfeeding performance (LATCH: p\u0026thinsp;=\u0026thinsp;0.003; IBFAT: p\u0026thinsp;=\u0026thinsp;0.024). Both groups exhibited reduced pain and progressive healing (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A negative correlation was observed between laser energy and healing quality on D14 (r = -0.355; p\u0026thinsp;=\u0026thinsp;0.027).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eFindings suggest both techniques are clinically effective, but laser parameters may influence healing. Further studies are warranted to optimize laser protocols in pediatric ankyloglossia surgery.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003eRBR466cykz November 13th, 2024\u003c/p\u003e","manuscriptTitle":"High-power diode laser versus conventional scalpel in the surgical treatment of pediatric ankyloglossia: a randomized, parallel, triple-blind, controlled clinical trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-16 05:45:56","doi":"10.21203/rs.3.rs-6999870/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-04T09:46:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-03T15:29:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-26T12:02:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-25T02:03:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336465545838419536897439287278924631252","date":"2025-07-14T16:00:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119919445028732677061099454322923507828","date":"2025-07-11T08:42:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192133429306098359920528736006976003136","date":"2025-07-10T01:15:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-09T08:41:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-08T06:16:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-08T05:09:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-08T05:08:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-06-28T21:59:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"88e3b1b6-3b93-4cd5-b845-1f3dc8666b0e","owner":[],"postedDate":"July 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T15:59:47+00:00","versionOfRecord":{"articleIdentity":"rs-6999870","link":"https://doi.org/10.1186/s12887-025-06307-y","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-12-04 15:57:14","publishedOnDateReadable":"December 4th, 2025"},"versionCreatedAt":"2025-07-16 05:45:56","video":"","vorDoi":"10.1186/s12887-025-06307-y","vorDoiUrl":"https://doi.org/10.1186/s12887-025-06307-y","workflowStages":[]},"version":"v1","identity":"rs-6999870","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6999870","identity":"rs-6999870","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}