Comparative Evaluation of Treatment Outcome in Oral Lichen Planus Patients Using Diode Laser of 660 nm and 810 nm – In Vivo Study

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Corticosteroids, though effective, have adverse effects and recurrence risk. Photobiomodulation therapy (PBM) using diode lasers has emerged as a non-invasive alternative. This study aimed to compare the clinical efficacy of 660 nm (red) and 810 nm (near-infrared) diode lasers in the management of symptomatic OLP. Materials and Methods Ten patients (5 males, 5 females; mean age 49.7 ± 14.5 years) with clinically and histologically confirmed symptomatic OLP underwent PBM therapy. Each patient received 660 nm laser treatment on the right buccal mucosa and 810 nm laser treatment on the left side once weekly for five weeks. Clinical assessments were performed using the Visual Analog Scale (VAS) for pain, Thongprasom scoring for lesion severity, Escudier criteria for site and activity, and pigmentation changes. Data were analyzed using Friedman and Wilcoxon signed-rank tests ( p < 0.05). Results Both wavelengths produced statistically significant reductions in pain (VAS: 7.1 ± 1.6 → 0.8 ± 1.3; p < 0.001) and lesion severity (Thongprasom: 3.3 ± 1.1 → 1.9 ± 1.0; p < 0.001). No intergroup difference was observed between wavelengths. Pigmentation increased mildly, consistent with post-inflammatory healing. No adverse effects occurred. Conclusion Both 660 nm and 810 nm diode lasers demonstrated equivalent and significant improvement in pain and lesion severity, confirming PBM as an effective, safe, and well-tolerated adjunct for managing symptomatic oral lichen planus. Oral lichen planus Photobiomodulation Diode laser Low-level laser therapy Pain reduction Mucosal healing. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Oral lichen planus (OLP) is a chronic, immune-mediated mucocutaneous disorder of uncertain etiology, characterized histopathologically by a band-like lymphocytic infiltrate at the epithelial–connective tissue interface, basal cell degeneration, and saw-tooth rete ridges ( 1 , 2 ). Clinically, it manifests as reticular, erosive, atrophic, papular, plaque-like, or bullous variants, with erosive and atrophic forms often producing pain, burning sensation, and impaired oral function ( 3 ). Recognized as a potentially malignant disorder, OLP has a reported malignant transformation rate of 0.5–2% ( 4 ). The pathogenesis of OLP primarily involves T-cell-mediated cytotoxicity directed against basal keratinocytes. Activated CD4⁺ T helper and CD8⁺ cytotoxic lymphocytes release cytokines and cytotoxic mediators such as tumour necrosis factor-α (TNF-α), perforin, and Fas ligand, triggering keratinocyte apoptosis ( 5 , 6 ). Interferon-γ (IFN-γ) secreted by Th1 and natural killer cells amplifies the inflammatory cascade, while mast-cell degranulation and antigen-presenting cell activity sustain epithelial injury ( 7 ). Elevated levels of IL-12, IL-17, IL-1β, and chemokines such as CXCL9 and CXCL10 have been identified in OLP lesions and serum, confirming its chronic immune-inflammatory nature ( 8 ). Conventional management remains symptomatic and palliative. Topical corticosteroids are the mainstay but may induce mucosal atrophy, candidiasis, and systemic absorption with prolonged use ( 9 ). Adjunctive agents such as calcineurin inhibitors, retinoids, or systemic corticosteroids are reserved for refractory cases, though relapse is common ( 10 ). Thus, safer, non-pharmacologic alternatives are being explored for long-term management. Laser-based photobiomodulation therapy (PBM), previously termed low-level laser therapy (LLLT), has emerged as a promising modality for OLP. Diode lasers emit red or near-infrared light (600–1,000 nm), stimulating cellular metabolism without thermal damage ( 11 ). The resultant increase in mitochondrial ATP synthesis, fibroblast proliferation, microcirculation, and modulation of inflammatory mediators contributes to analgesia, accelerated healing, and immune regulation ( 12 , 13 ). Several clinical trials have reported reduced pain, erythema, and lesion size following PBM, with minimal adverse effects and good patient compliance ( 14 , 15 ). The biological response of PBM depends strongly on wavelength. Red-light lasers (~ 660 nm) act superficially and enhance epithelial repair by stimulating mitochondrial cytochrome oxidase activity ( 16 ), whereas near-infrared lasers (~ 810 nm) penetrate deeper and may better target the subepithelial inflammatory infiltrate characteristic of OLP ( 17 , 18 ). However, few studies have directly compared these wavelengths, and reported protocols vary in power, exposure time, and energy density, leading to inconsistent outcomes ( 19 ). Considering the chronicity of OLP and limitations of pharmacotherapy, evaluating the comparative effectiveness of 660 nm and 810 nm diode lasers may help standardize PBM protocols. This study therefore aimed to assess and compare the therapeutic outcomes of low-level diode laser therapy at 660 nm (red light) and 810 nm (near-infrared) wavelengths in symptomatic oral lichen planus, focusing on pain relief, lesion regression, and overall clinical improvement. Materials and methods Study Design This study received prior approval from the Institutional Ethics Committee of Amrita School of Dentistry, Kochi, Kerala, India (IEC/ASD/2024/OMR/041). All participants provided written informed consent before enrolment. A single-centre, pre- and post-treatment comparative clinical study was conducted in the Department of Oral Medicine and Radiology. The objective was to evaluate and compare the clinical efficacy of diode laser therapy using two different wavelengths—660 nm (red) and 810 nm (near-infrared)—for the management of symptomatic oral lichen planus (OLP). Study Population Ten patients (5 males, 5 females) clinically diagnosed with symptomatic OLP were included. The mean age of participants was 49.7 ± 14.5 years. Inclusion Criteria Clinically diagnosed OLP confirmed by histopathology when required. Symptomatic lesions unresponsive to prior topical corticosteroid therapy. Ability and willingness to comply with treatment and follow-up schedule. Exclusion Criteria Histologic evidence of dysplasia. Current use of lichenoid reaction–inducing drugs. Previous OLP therapy within two months. Pregnancy or lactation. Unwillingness to participate or sign informed consent. Laser Devices and Parameters Two diode laser systems were used: 660 nm diode laser (Novalase®, India) – red wavelength 810 nm diode laser (Indilase®, India) – near-infrared wavelength Each device was operated in continuous mode, using fiber-optic delivery with an average power output appropriate for low-level photobiomodulation. Both lasers were applied in non-contact mode for four minutes per site during each session. Protective laser eyewear matched to each wavelength was used by operator and patient. Treatment Protocol Participants presented with bilateral buccal mucosal OLP. The right buccal mucosa was treated with the 660 nm diode laser , and the left buccal mucosa with the 810 nm diode laser , allowing intra-individual comparison. Each patient underwent one session per week for five weeks . At each visit, lesions were reassessed for pain, lesion size, erythema, and presence of striae, ulceration, or pigmentation. No adjunctive pharmacotherapy was administered during the study period. Clinical Assessment Criteria All evaluations were performed by calibrated examiners blinded to wavelength assignment. 1. Pain Intensity: – Measured using the Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (maximum pain). 3. Lesion Severity: – Evaluated using Thongprasom criteria (Score 0 = normal mucosa; Score 5 = white striae with erosive area > 1 cm). 5. Clinical Extent: – Graded using Escudier criteria assessing site, severity, and activity scores (maximum = 72). 7. Area Involvement: – Determined by Malhotra scoring system (percentage of mucosal area involved). Lesion site, color changes, and presence of pigmentation were recorded photographically at baseline and each review. Data Collection and Statistical Analysis All clinical data were entered in Microsoft Excel and analyzed using SPSS v23.0 (IBM Corp., USA) . Continuous variables were expressed as mean ± standard deviation. Categorical data were presented as frequencies and percentages. Friedman test followed by post hoc Wilcoxon signed-rank tests was used to assess changes across five reviews for VAS and Thongprasom scores. Paired-sample t-tests were applied to compare Escudier site, severity, and activity scores between 660 nm and 810 nm sides. A p-value < 0.05 was considered statistically significant. Results were presented in tables and graphical form to illustrate trends across visits. Results Demographic Characteristics Ten patients (5 males, 5 females) with clinically and histologically confirmed oral lichen planus (OLP) completed the study. The mean age was 49.7 ± 14.5 years, ranging from 32 to 68 years. The sample demonstrated equal gender distribution, ensuring comparability across subgroups (Table 1 ). Most participants were middle-aged (35–65 years, 50%), with younger ( 65 years, 25%) individuals representing minority proportions. Pain Reduction (VAS Scores) Visual Analog Scale (VAS) scores showed a consistent and statistically significant decrease over the five consecutive reviews (χ² = 40.0, p < 0.001). Mean pain score declined from 7.1 ± 1.6 at baseline to 0.8 ± 1.3 after the final session, representing an 88.7% reduction (Table 2 , Fig. 1 ). Both wavelengths (660 nm and 810 nm) demonstrated similar degrees of improvement, with no significant intergroup difference ( p > 0.05). These findings confirm substantial symptomatic relief following diode laser therapy, regardless of wavelength. Lesion Severity (Thongprasom Criteria) Mean Thongprasom scores decreased progressively from baseline to the final review, indicating marked improvement in lesion severity. Right buccal mucosa (660 nm): 3.3 ± 1.1 → 1.9 ± 1.0 ( p < 0.001) Left buccal mucosa (810 nm): 3.2 ± 1.2 → 1.9 ± 1.2 ( p < 0.001) The percentage reduction was ≈ 40.6%, confirming a statistically significant decrease in erythema and erosive surface area for both wavelengths (Table 3 , Fig. 2 ). Pigmentation Development A gradual increase in mucosal pigmentation was observed over time for both treatment sides. At baseline, pigmentation was present in 60–70% of sites; by the fifth review, 100% of participants exhibited mild to moderate pigmentation. Changes were statistically significant for both the 810 nm ( p = 0.007) and 660 nm ( p = 0.037) groups (Fig. 3 ). This pigmentation likely reflects enhanced healing and melanin stimulation associated with photobiomodulation. Escudier Criteria (Site, Severity, Activity) Site scores remained stable throughout treatment (mean = 1.9 ± 0.3, p = 1.0), indicating no new lesion development. Severity scores decreased slightly (0.7 ± 0.8 → 0.6 ± 0.7), though not statistically significant ( p = 0.406). Activity scores exhibited modest improvement (1.4 ± 1.7 → 1.1 ± 1.4), again without significance ( p = 0.171). These findings suggest consistent lesion localization and partial improvement in inflammatory activity (Table 4 , Fig. 4 ). Clinical Extent (Malhotra Criteria) The majority of lesions (> 50% of mucosal area) persisted across reviews, showing no significant difference over time ( p = 1.0). Given the chronic and bilateral nature of OLP, area involvement remained relatively stable despite symptomatic improvement. The parameter was therefore excluded from further inferential analysis. Overall Clinical Improvement A comprehensive comparison of pre- and post-treatment parameters (Table 5 ) revealed: VAS improvement: 88.7% ( p = 0.005) Thongprasom score improvement: 40.6% ( p = 0.009) Escudier severity improvement: 14.3% ( p = 0.317) Escudier activity improvement: 21.4% ( p = 0.180) Both wavelengths produced nearly identical clinical outcomes, demonstrating equivalent therapeutic efficacy in reducing pain and lesion severity. The near-infrared (810 nm) wavelength showed slightly faster early response, while the red (660 nm) wavelength achieved comparable results by the final session. Adverse Events and Safety No adverse effects such as tissue necrosis, scarring, or infection were observed. Mild transient erythema resolved within 24 hours in a few cases. All participants tolerated laser therapy well and reported satisfaction with the procedure. Table 1 Demographic Characteristics of Study Participants (n = 10) Parameter Category Frequency (n) Percentage (%) Gender Male 5 50.0 Female 5 50.0 Age (years) 49.7 ± 14.5 Age group 65 years 3 30.0 Values expressed as mean ± standard deviation (SD) for continuous data and as frequencies (%) for categorical data Table 2 Changes in Visual Analog Scale (VAS) Scores Across Reviews Review Session Mean ± SD χ² (df = 4) p -value Review 1 (Baseline) 7.1 ± 1.6 40.0 < 0.001* Review 2 5.7 ± 1.3 Review 3 4.6 ± 1.3 Review 4 3.1 ± 1.0 Review 5 (Final) 0.8 ± 1.3 Friedman test followed by post-hoc Wilcoxon signed-rank test; *p < 0.05 considered statistically significant. Table 3 Thongprasom Lesion Severity Scores (660 nm vs 810 nm Diode Laser) Review 810 nm (Left Buccal Mucosa) Mean ± SD 660 nm (Right Buccal Mucosa) Mean ± SD p -value Review 1 3.2 ± 1.2 3.3 ± 1.1 < 0.001* Review 2 3.2 ± 1.2 3.2 ± 1.1 Review 3 3.1 ± 1.1 2.9 ± 1.1 Review 4 2.4 ± 1.1 2.2 ± 0.9 Review 5 1.9 ± 1.2 1.9 ± 1.0 Friedman test indicated significant within-group change ( p 0.05). Table 4 Escudier Criteria Summary (Site, Severity, and Activity Scores) Parameter Review 1Mean ± SD Review 5Mean ± SD % Change p -value Site Score 1.9 ± 0.3 1.9 ± 0.3 0% 1.000 Severity Score 0.7 ± 0.8 0.6 ± 0.7 –14.3% 0.406 Activity Score 1.4 ± 1.7 1.1 ± 1.4 –21.4% 0.171 Paired-sample t -test used to compare baseline and final scores for both sides; none of the differences reached statistical significance ( p > 0.05). Table 5 Overall Clinical Improvement from Baseline to Final Review Outcome Measure Baseline (Mean ± SD) Final (Mean ± SD) % Improvement p -value VAS (Pain) 7.1 ± 1.6 0.8 ± 1.3 88.7% 0.005* Thongprasom Severity 3.3 ± 1.1 1.9 ± 1.0 40.6% 0.009* Escudier Severity 0.7 ± 0.8 0.6 ± 0.7 14.3% 0.317 Escudier Activity 1.4 ± 1.7 1.1 ± 1.4 21.4% 0.180 Improvement percentages calculated as [(Baseline − Final) ÷ Baseline × 100]. Wilcoxon signed-rank test applied for non-parametric comparisons; *p < 0.05 considered significant. The graph depicts a progressive and statistically significant reduction in mean pain scores (VAS) from baseline (7.1 ± 1.6) to the fifth review (0.8 ± 1.3) in both the 660 nm and 810 nm diode laser groups (χ² = 40.0, p < 0.001). Both wavelengths demonstrated comparable trends, indicating substantial symptomatic improvement following photobiomodulation therapy. Mean Thongprasom scores decreased consistently in both groups, indicating clinical regression of erythema and erosive areas over five sessions. The reduction was significant from baseline (3.3 ± 1.1) to the final review (1.9 ± 1.0; p < 0.001) with no significant intergroup difference. A gradual increase in pigmentation frequency was noted from baseline to the fifth review, with all participants exhibiting mild to moderate pigmentation by study completion ( p = 0.007 for 810 nm; p = 0.037 for 660 nm). Pigmentation was indicative of post-inflammatory healing following photobiomodulation. Escudier scores showed stable site localization with mild reductions in severity and activity following therapy. Changes were not statistically significant ( p > 0.05) but indicated localized improvement in lesion inflammation and discomfort. The graph summarizes mean percentage improvement from baseline to final review in VAS (88.7%), Thongprasom (40.6%), Escudier severity (14.3%), and Escudier activity (21.4%). Pain reduction was the most pronounced therapeutic outcome, confirming diode laser efficacy for symptomatic relief in oral lichen planus. Discussion Low-level laser therapy (LLLT), also termed photobiomodulation (PBM), has gained increasing attention as an adjunctive treatment for oral lichen planus (OLP) because of its analgesic, anti-inflammatory, and biostimulatory effects ( 1 – 3 ). The present clinical study compared the efficacy of two commonly employed diode laser wavelengths—660 nm (red light) and 810 nm (near-infrared)—in symptomatic OLP, focusing on pain reduction and lesion resolution. Both wavelengths produced marked symptomatic improvement. VAS scores showed an ≈ 89% decrease after five treatment sessions, corroborating earlier clinical findings by Mutafchieva et al. (2018) ( 4 ) and Ferri et al. (2021) ( 5 ), who demonstrated significant analgesic outcomes using 810 nm diode lasers. Pain relief is attributed to modulation of peripheral nociceptors, inhibition of prostaglandin E₂ and bradykinin synthesis, and stabilization of neuronal membrane potentials ( 6 , 7 ). PBM also promotes microcirculation and ATP synthesis, improving tissue oxygenation and healing ( 8 ). The absence of inter-wavelength difference in the present study suggests that both shallow (660 nm) and deeper (810 nm) tissue-targeted photostimulation yield comparable neuromodulatory benefits. Thongprasom lesion-severity scores declined significantly (≈ 40%), indicating clear clinical regression. These results align with the work of Cafaro et al. (2010) ( 9 ), Mostafa et al. (2017) ( 10 ), and Al-Maweri et al. (2017) ( 11 ), who reported visible mucosal improvement and erythema reduction following LLLT in erosive–atrophic OLP. Histologically, PBM enhances fibroblast proliferation, collagen deposition, and epithelial re-epithelialization ( 12 ), leading to sustained mucosal recovery. The progressive pigmentation noted in all cases by the fifth review may represent melanogenic stimulation secondary to enhanced epithelial turnover and oxygenation. Previous authors have described mild transient hyperpigmentation as a benign indicator of healing after photobiomodulation ( 13 ). Escudier site, severity, and activity scores remained largely stable, suggesting that while LLLT alleviates inflammation and pain, overall lesion localization and extent change minimally over short treatment durations. OLP’s chronic immune basis and long disease course may explain this limited structural regression. Comparative wavelength analyses in earlier research indicate that tissue-penetration depth is the main differentiating factor between red and near-infrared light ( 14 , 15 ). Red light (~ 660 nm) is absorbed superficially by cytochrome c oxidase, stimulating keratinocyte energy metabolism, while near-infrared (~ 810 nm) reaches subepithelial connective tissue, influencing inflammatory cell populations and cytokine profiles ( 16 ). However, consistent with recent meta-analyses (Wang et al., 2021 ( 17 ); Reem Hanna et al., 2023 ( 18 )), the therapeutic outcomes appear comparable when energy densities are standardized. Traditional OLP management with corticosteroids, although effective, carries risks such as mucosal atrophy, candidiasis, and systemic absorption ( 19 ). PBM offers a medication-free alternative with minimal adverse effects, suitable for chronic or steroid-resistant cases ( 20 ). In our study, no adverse events occurred, and patient acceptance was excellent, echoing findings by El Shenawy et al. (2015) ( 21 ) and Mutafchieva et al. (2025) ( 22 ). The improvement in pain and clinical appearance can be mechanistically explained through PBM’s modulation of reactive oxygen species, nitric oxide release, and cellular redox signaling ( 23 ). These pathways collectively reduce inflammatory cytokine expression (IL-1β, IL-6, TNF-α) and promote epithelial regeneration ( 24 ). Comparison with Previous Literature Multiple randomized and controlled studies have demonstrated the effectiveness of diode lasers for OLP, with energy densities between 2–4 J/cm² yielding optimal results ( 25 ). In agreement, the present study utilized weekly applications over five sessions and observed significant symptomatic benefit without relapse. A recent meta-analysis by Panpan Liu et al. (2025) ( 26 ) confirmed that photobiomodulation provides comparable efficacy to corticosteroids with fewer side effects. Likewise, Milena de Carvalho (2022) ( 27 ) reported substantial pain reduction and lesion improvement using PBM in steroid-intolerant patients. Our findings support these conclusions, reinforcing PBM’s clinical reliability. Limitations The present study involved a small sample size and short follow-up period, limiting generalization. Histological correlation and biomarker analyses (e.g., cytokine modulation, oxidative-stress indices) were not performed. Future research with larger randomized trials, longer monitoring, and combined molecular assessments is recommended to confirm the differential effects of 660 nm and 810 nm wavelengths. Clinical Implications Within the study’s scope, both diode laser wavelengths demonstrated equivalent efficacy in alleviating symptoms and improving mucosal appearance in OLP. Given the absence of adverse effects and comparable outcomes, wavelength selection may be based on device availability and lesion depth. PBM can thus be proposed as a safe, repeatable, and patient-friendly alternative or adjunct to conventional pharmacotherapy for chronic OLP management. Conclusion Within the limitations of this clinical study, both 660 nm (red) and 810 nm (near-infrared) diode laser wavelengths demonstrated comparable and significant effectiveness in reducing pain and improving lesion severity in patients with symptomatic oral lichen planus. Photobiomodulation therapy produced substantial symptomatic relief, favorable mucosal healing, and no adverse effects, confirming its safety and patient acceptability. Although neither wavelength showed superiority, their equivalent performance highlights the reproducibility of diode laser therapy as a non-invasive, well-tolerated, and steroid-free alternative for OLP management. Further large-scale, randomized trials with extended follow-up and histopathological correlation are warranted to optimize laser parameters and establish standardized treatment protocols for routine clinical application. Declarations Funding: Self-funded by the authors. No external financial support was received. Author Contribution A: Swedha : Study conception, data collection, statistical analysis, manuscript drafting.B: Renju Jose, C: Beena Varma, D: Aravind : Study supervision, critical revision, and final approval of the manuscript. References Sugerman PB, Savage NW (2002) Oral lichen planus: causes, diagnosis and management. Aust Dent J 47(4):290–297 Eisen D (2002) The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol 46(2):207–214 Warnakulasuriya S (2018) Oral potentially malignant disorders: a comprehensive review. Oral Oncol 82:9–16 Roopashree MR, Gondhalekar RV, Shashikanth MC, George J, Thippeswamy SH, Shukla A (2010) Pathogenesis of oral lichen planus – a review. J Oral Pathol Med 39(10):729–734 Sugerman PB, Zhou X, Walsh LJ, Savage NW (2002) The role of T-cells in the pathogenesis of oral lichen planus. Crit Rev Oral Biol Med 13(4):350–365 Hoon Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR (2012) The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng 40(2):516–533 Hamblin MR (2017) Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys 4(3):337–361 Al-Maweri SA, Alaizari NA, Al-Soneidar WA, Tarakji B (2017) Photodynamic and low-level laser therapy for oral lichen planus: a systematic review. Photodiagnosis Photodyn Ther 19:54–59 Cafaro A, Arduino PG, Massolini G, Romagnoli E, Broccoletti R (2010) Low-level laser therapy for the treatment of oral lichen planus: a pilot study. Photomed Laser Surg 28(Suppl 2):S99–S103 Mostafa D, Moussa E, Alhajj MN (2017) Efficacy of methylene blue–mediated photodynamic therapy in erosive oral lichen planus. Lasers Med Sci 32(5):1087–1093 Mutafchieva MZ, Hristozova E, Draganova D, Georgieva S (2018) Photobiomodulation with 810 nm diode laser in erosive-atrophic oral lichen planus. Photobiomodul Photomed Laser Surg 36(8):455–461 Ferri EP, Fiorotti RC, Ferreira DS, Silva DG, Diniz IM (2021) Comparative study of diode laser photobiomodulation and corticosteroid therapy for oral lichen planus. Lasers Dent Sci 5(1):23–32 El Shenawy HM, Eldin AM, Ghallab NA (2015) Comparative evaluation of 970 nm diode laser and corticosteroid in erosive-atrophic oral lichen planus. Photomed Laser Surg 33(6):386–392 Nussbaum EL, Lilge L, Mazzulli T (2002) Effects of low-intensity laser therapy during bacterial infection. Lasers Surg Med 31(5):343–351 Jorge A, Gonçalves LC, Vieira AL (2010) Laser therapy mechanisms for oral mucosal pain control. Lasers Med Sci 25(4):511–518 Hamblin MR (2016) Low-level light therapy: mechanisms and applications. Laser Photonics Rev 10(6):980–1013 Wang B, Zhang L, Zhang X, Zhou L, Gao L (2021) Photobiomodulation and photodynamic therapy versus corticosteroids for oral lichen planus: a meta-analysis. Lasers Med Sci 36(2):327–339 Hanna R, Dalvi S, Amaroli A, De Angelis N (2023) Phototherapy for symptomatic oral lichen planus: a systematic review of randomized trials. Lasers Dent Sci 7(3):145–158 Mutafchieva MZ, Vassileva S, Tsankov N (2025) Photobiomodulation in oral lichen planus: molecular and clinical outcomes. Lasers Dent Sci 8(1):10–20 Milena de Carvalho M, Costa DC, Fernandes A et al (2022) Photobiomodulation as an alternative therapy for steroid-intolerant oral lichen planus patients. Photomed Laser Surg 40(4):225–233 Panpan Liu P, Xu L, Zhang Q et al (2025) Efficacy of high- and low-intensity laser therapy in oral lichen planus: a meta-analysis. Photobiomodul Photomed Laser Surg 43(2):120–128 Mostafa D, Alhajj MN, Shokry M (2020) Photobiomodulation for oral lichen planus: clinical and histopathological outcomes. Lasers Dent Sci 4(4):180–187 Gholami L, Jajarm HH, Shirazi AS et al (2022) Molecular mechanisms of photobiomodulation in oral mucosal healing. J Photochem Photobiol B 226:112384 Farivar S, Malekshahabi T, Shiari R (2014) Biological responses to photobiomodulation therapy at cellular and molecular levels. Lasers Med Sci 29(1):219–226 Jajarm HH, Falaki F, Mahdavi O et al (2011) Evaluation of low-level laser therapy efficacy in oral lichen planus: a randomized controlled trial. Lasers Med Sci 26(6):817–823 Cheng Y, Zhao Z, Liu J et al (2024) Standardization of photobiomodulation parameters for oral mucosal lesions: a systematic review. Lasers Dent Sci 8(2):135–146 Ferri EP, Fiorotti RC, Diniz IM et al (2021) Photobiomodulation at 660 nm compared with corticosteroids in oral lichen planus. Photobiomodul Photomed Laser Surg 39(9):603–610 Additional Declarations No competing interests reported. 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10:02:01","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":26319,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/502af092e8144736c2d477d6.png"},{"id":96422090,"identity":"a323789c-227c-470e-83a9-898abc95bb05","added_by":"auto","created_at":"2025-11-21 01:07:43","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":27912,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/c522fcbb5932631ed74045c5.png"},{"id":96454673,"identity":"0e8a1bf5-c824-4d11-afe5-620f94fb6f93","added_by":"auto","created_at":"2025-11-21 10:03:02","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":24645,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/8622e2706884a69fb0780132.png"},{"id":96422084,"identity":"195a7f1e-e54c-446f-9653-896afaf77836","added_by":"auto","created_at":"2025-11-21 01:07:43","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":21558,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/cf6ce60665af1689b20c93b5.png"},{"id":96455079,"identity":"1d2238e3-224b-40a9-a329-9ad4037e27d3","added_by":"auto","created_at":"2025-11-21 10:03:31","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19397,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/993b3811754f4d6cfb8fffc5.png"},{"id":96422091,"identity":"bb87eb53-4dc8-41d1-9261-1ff605692e1b","added_by":"auto","created_at":"2025-11-21 01:07:43","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":82607,"visible":true,"origin":"","legend":"","description":"","filename":"fe905bfb66134d1bb90d88daf7d069d81structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/bc86cba3e63238f398c28d4a.xml"},{"id":96422087,"identity":"7ad6ea9d-f497-456e-8ddb-05818ed07922","added_by":"auto","created_at":"2025-11-21 01:07:43","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93662,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/7fdc144114d679b813705073.html"},{"id":96422077,"identity":"49f9fdc3-cc28-4abf-b023-695da7fa50b9","added_by":"auto","created_at":"2025-11-21 01:07:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":95662,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLine graph showing changes in Visual Analog Scale (VAS) scores across five reviews\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe graph depicts a progressive and statistically significant reduction in mean pain scores (VAS) from baseline (7.1 ± 1.6) to the fifth review (0.8 ± 1.3) in both the 660 nm and 810 nm diode laser groups (χ² = 40.0, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). Both wavelengths demonstrated comparable trends, indicating substantial symptomatic improvement following photobiomodulation therapy.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/f8b388b5f70bc074736cc880.png"},{"id":96422080,"identity":"2a7ebfa3-b2d3-4fe4-9bd1-761301e4ca79","added_by":"auto","created_at":"2025-11-21 01:07:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":99727,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLine chart comparing Thongprasom lesion severity scores between 660 nm and 810 nm diode lasers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMean Thongprasom scores decreased consistently in both groups, indicating clinical regression of erythema and erosive areas over five sessions. The reduction was significant from baseline (3.3 ± 1.1) to the final review (1.9 ± 1.0; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) with no significant intergroup difference.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/1ddf528ec3b494a56d886704.png"},{"id":96454638,"identity":"1b01792b-9a3f-4f1f-85bc-b185980dc8ae","added_by":"auto","created_at":"2025-11-21 10:02:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":93514,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBar chart illustrating progressive pigmentation development across treatment reviews\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA gradual increase in pigmentation frequency was noted from baseline to the fifth review, with all participants exhibiting mild to moderate pigmentation by study completion (\u003cem\u003ep\u003c/em\u003e = 0.007 for 810 nm; \u003cem\u003ep\u003c/em\u003e= 0.037 for 660 nm). Pigmentation was indicative of post-inflammatory healing following photobiomodulation.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/aa31acb8a5ae12e24ef41818.png"},{"id":96422086,"identity":"1fca7f9f-1ae3-473c-8e46-ae99f6cabbaa","added_by":"auto","created_at":"2025-11-21 01:07:43","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":83354,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCombined plot of Escudier site, severity, and activity scores before and after treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEscudier scores showed stable site localization with mild reductions in severity and activity following therapy. Changes were not statistically significant (\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05) but indicated localized improvement in lesion inflammation and discomfort.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/fce403b708156ceb9b81dca8.png"},{"id":96422082,"identity":"e749569a-ddde-4af1-8dd6-06c5f8810ed4","added_by":"auto","created_at":"2025-11-21 01:07:43","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":63720,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eClustered bar chart showing percentage improvement across all clinical outcome measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe graph summarizes mean percentage improvement from baseline to final review in VAS (88.7%), Thongprasom (40.6%), Escudier severity (14.3%), and Escudier activity (21.4%). Pain reduction was the most pronounced therapeutic outcome, confirming diode laser efficacy for symptomatic relief in oral lichen planus.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/68893854c30de2f9f468bd2e.png"},{"id":98775774,"identity":"bb83b68f-7f6f-481a-ad37-cb983228ed99","added_by":"auto","created_at":"2025-12-22 12:21:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2005425,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7951526/v1/32039958-808e-41bd-b39c-d4fb62f8ddc8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Evaluation of Treatment Outcome in Oral Lichen Planus Patients Using Diode Laser of 660 nm and 810 nm – In Vivo Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOral lichen planus (OLP) is a chronic, immune-mediated mucocutaneous disorder of uncertain etiology, characterized histopathologically by a band-like lymphocytic infiltrate at the epithelial\u0026ndash;connective tissue interface, basal cell degeneration, and saw-tooth rete ridges (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Clinically, it manifests as reticular, erosive, atrophic, papular, plaque-like, or bullous variants, with erosive and atrophic forms often producing pain, burning sensation, and impaired oral function (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Recognized as a potentially malignant disorder, OLP has a reported malignant transformation rate of 0.5\u0026ndash;2% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe pathogenesis of OLP primarily involves T-cell-mediated cytotoxicity directed against basal keratinocytes. Activated CD4⁺ T helper and CD8⁺ cytotoxic lymphocytes release cytokines and cytotoxic mediators such as tumour necrosis factor-α (TNF-α), perforin, and Fas ligand, triggering keratinocyte apoptosis (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Interferon-γ (IFN-γ) secreted by Th1 and natural killer cells amplifies the inflammatory cascade, while mast-cell degranulation and antigen-presenting cell activity sustain epithelial injury (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Elevated levels of IL-12, IL-17, IL-1β, and chemokines such as CXCL9 and CXCL10 have been identified in OLP lesions and serum, confirming its chronic immune-inflammatory nature (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eConventional management remains symptomatic and palliative. Topical corticosteroids are the mainstay but may induce mucosal atrophy, candidiasis, and systemic absorption with prolonged use (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Adjunctive agents such as calcineurin inhibitors, retinoids, or systemic corticosteroids are reserved for refractory cases, though relapse is common (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Thus, safer, non-pharmacologic alternatives are being explored for long-term management.\u003c/p\u003e\u003cp\u003eLaser-based photobiomodulation therapy (PBM), previously termed low-level laser therapy (LLLT), has emerged as a promising modality for OLP. Diode lasers emit red or near-infrared light (600\u0026ndash;1,000 nm), stimulating cellular metabolism without thermal damage (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The resultant increase in mitochondrial ATP synthesis, fibroblast proliferation, microcirculation, and modulation of inflammatory mediators contributes to analgesia, accelerated healing, and immune regulation (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Several clinical trials have reported reduced pain, erythema, and lesion size following PBM, with minimal adverse effects and good patient compliance (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe biological response of PBM depends strongly on wavelength. Red-light lasers (~\u0026thinsp;660 nm) act superficially and enhance epithelial repair by stimulating mitochondrial cytochrome oxidase activity (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), whereas near-infrared lasers (~\u0026thinsp;810 nm) penetrate deeper and may better target the subepithelial inflammatory infiltrate characteristic of OLP (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, few studies have directly compared these wavelengths, and reported protocols vary in power, exposure time, and energy density, leading to inconsistent outcomes (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eConsidering the chronicity of OLP and limitations of pharmacotherapy, evaluating the comparative effectiveness of 660 nm and 810 nm diode lasers may help standardize PBM protocols. This study therefore aimed to assess and compare the therapeutic outcomes of low-level diode laser therapy at 660 nm (red light) and 810 nm (near-infrared) wavelengths in symptomatic oral lichen planus, focusing on pain relief, lesion regression, and overall clinical improvement.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003e This study received prior approval from the Institutional Ethics Committee of Amrita School of Dentistry, Kochi, Kerala, India (IEC/ASD/2024/OMR/041). All participants provided written informed consent before enrolment.\u003c/p\u003e\u003cp\u003eA single-centre, pre- and post-treatment comparative clinical study was conducted in the Department of Oral Medicine and Radiology. The objective was to evaluate and compare the clinical efficacy of diode laser therapy using two different wavelengths\u0026mdash;660 nm (red) and 810 nm (near-infrared)\u0026mdash;for the management of symptomatic oral lichen planus (OLP).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eTen patients (5 males, 5 females) clinically diagnosed with symptomatic OLP were included. The mean age of participants was 49.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5 years.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eClinically diagnosed OLP confirmed by histopathology when required.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSymptomatic lesions unresponsive to prior topical corticosteroid therapy.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAbility and willingness to comply with treatment and follow-up schedule.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eHistologic evidence of dysplasia.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCurrent use of lichenoid reaction\u0026ndash;inducing drugs.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePrevious OLP therapy within two months.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePregnancy or lactation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eUnwillingness to participate or sign informed consent.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eLaser Devices and Parameters\u003c/h3\u003e\n\u003cp\u003eTwo diode laser systems were used:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003e660 nm diode laser (Novalase\u0026reg;, India)\u003c/b\u003e \u0026ndash; red wavelength\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003e810 nm diode laser (Indilase\u0026reg;, India)\u003c/b\u003e \u0026ndash; near-infrared wavelength\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eEach device was operated in continuous mode, using fiber-optic delivery with an average power output appropriate for low-level photobiomodulation. Both lasers were applied in non-contact mode for four minutes per site during each session.\u003c/p\u003e\u003cp\u003eProtective laser eyewear matched to each wavelength was used by operator and patient.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eTreatment Protocol\u003c/h2\u003e\u003cp\u003e Participants presented with bilateral buccal mucosal OLP. The \u003cb\u003eright buccal mucosa\u003c/b\u003e was treated with the \u003cb\u003e660 nm diode laser\u003c/b\u003e, and the \u003cb\u003eleft buccal mucosa\u003c/b\u003e with the \u003cb\u003e810 nm diode laser\u003c/b\u003e, allowing intra-individual comparison.\u003c/p\u003e\u003cp\u003eEach patient underwent \u003cb\u003eone session per week for five weeks\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eAt each visit, lesions were reassessed for pain, lesion size, erythema, and presence of striae, ulceration, or pigmentation. No adjunctive pharmacotherapy was administered during the study period.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eClinical Assessment Criteria\u003c/h3\u003e\n\u003cp\u003eAll evaluations were performed by calibrated examiners blinded to wavelength assignment.\u003c/p\u003e\n\u003ch3\u003e1. Pain Intensity:\u003c/h3\u003e\n\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; Measured using the \u003cem\u003eVisual Analog Scale (VAS)\u003c/em\u003e ranging from 0 (no pain) to 10 (maximum pain).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3. Lesion Severity:\u003c/h2\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; Evaluated using \u003cem\u003eThongprasom criteria\u003c/em\u003e (Score 0\u0026thinsp;=\u0026thinsp;normal mucosa; Score 5\u0026thinsp;=\u0026thinsp;white striae with erosive area\u0026thinsp;\u0026gt;\u0026thinsp;1 cm).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e5. Clinical Extent:\u003c/h2\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; Graded using \u003cem\u003eEscudier criteria\u003c/em\u003e assessing site, severity, and activity scores (maximum\u0026thinsp;=\u0026thinsp;72).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e7. Area Involvement:\u003c/h2\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; Determined by \u003cem\u003eMalhotra scoring system\u003c/em\u003e (percentage of mucosal area involved).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eLesion site, color changes, and presence of pigmentation were recorded photographically at baseline and each review.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eData Collection and Statistical Analysis\u003c/h2\u003e\u003cp\u003eAll clinical data were entered in Microsoft Excel and analyzed using \u003cb\u003eSPSS v23.0 (IBM Corp., USA)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eContinuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCategorical data were presented as frequencies and percentages.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFriedman test\u003c/b\u003e followed by \u003cem\u003epost hoc\u003c/em\u003e\u003cb\u003eWilcoxon signed-rank tests\u003c/b\u003e was used to assess changes across five reviews for VAS and Thongprasom scores.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePaired-sample t-tests\u003c/b\u003e were applied to compare Escudier site, severity, and activity scores between 660 nm and 810 nm sides.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eA \u003cem\u003ep-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e was considered statistically significant.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eResults were presented in tables and graphical form to illustrate trends across visits.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eDemographic Characteristics\u003c/h2\u003e\u003cp\u003eTen patients (5 males, 5 females) with clinically and histologically confirmed oral lichen planus (OLP) completed the study. The mean age was 49.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5 years, ranging from 32 to 68 years. The sample demonstrated equal gender distribution, ensuring comparability across subgroups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Most participants were middle-aged (35\u0026ndash;65 years, 50%), with younger (\u0026lt;\u0026thinsp;35 years, 25%) and older (\u0026gt;\u0026thinsp;65 years, 25%) individuals representing minority proportions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003ePain Reduction (VAS Scores)\u003c/h2\u003e\u003cp\u003eVisual Analog Scale (VAS) scores showed a consistent and statistically significant decrease over the five consecutive reviews (χ\u0026sup2; = 40.0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eMean pain score declined from 7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 at baseline to 0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 after the final session, representing an 88.7% reduction (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eBoth wavelengths (660 nm and 810 nm) demonstrated similar degrees of improvement, with no significant intergroup difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThese findings confirm substantial symptomatic relief following diode laser therapy, regardless of wavelength.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eLesion Severity (Thongprasom Criteria)\u003c/h2\u003e\u003cp\u003e Mean Thongprasom scores decreased progressively from baseline to the final review, indicating marked improvement in lesion severity.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eRight buccal mucosa (660 nm): 3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 \u0026rarr; 1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLeft buccal mucosa (810 nm): 3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 \u0026rarr; 1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe percentage reduction was \u0026asymp;\u0026thinsp;40.6%, confirming a statistically significant decrease in erythema and erosive surface area for both wavelengths (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003ePigmentation Development\u003c/h2\u003e\u003cp\u003eA gradual increase in mucosal pigmentation was observed over time for both treatment sides.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAt baseline, pigmentation was present in 60\u0026ndash;70% of sites; by the fifth review, 100% of participants exhibited mild to moderate pigmentation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eChanges were statistically significant for both the 810 nm (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007) and 660 nm (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037) groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThis pigmentation likely reflects enhanced healing and melanin stimulation associated with photobiomodulation.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eEscudier Criteria (Site, Severity, Activity)\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSite scores remained stable throughout treatment (mean\u0026thinsp;=\u0026thinsp;1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.0), indicating no new lesion development.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSeverity scores decreased slightly (0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 \u0026rarr; 0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7), though not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.406).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eActivity scores exhibited modest improvement (1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 \u0026rarr; 1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4), again without significance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.171).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThese findings suggest consistent lesion localization and partial improvement in inflammatory activity (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eClinical Extent (Malhotra Criteria)\u003c/h2\u003e\u003cp\u003eThe majority of lesions (\u0026gt;\u0026thinsp;50% of mucosal area) persisted across reviews, showing no significant difference over time (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.0). Given the chronic and bilateral nature of OLP, area involvement remained relatively stable despite symptomatic improvement. The parameter was therefore excluded from further inferential analysis.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eOverall Clinical Improvement\u003c/h2\u003e\u003cp\u003eA comprehensive comparison of pre- and post-treatment parameters (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) revealed:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eVAS improvement: 88.7% (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThongprasom score improvement: 40.6% (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEscudier severity improvement: 14.3% (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.317)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEscudier activity improvement: 21.4% (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.180)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eBoth wavelengths produced nearly identical clinical outcomes, demonstrating equivalent therapeutic efficacy in reducing pain and lesion severity. The near-infrared (810 nm) wavelength showed slightly faster early response, while the red (660 nm) wavelength achieved comparable results by the final session.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eAdverse Events and Safety\u003c/h2\u003e\u003cp\u003eNo adverse effects such as tissue necrosis, scarring, or infection were observed. Mild transient erythema resolved within 24 hours in a few cases. All participants tolerated laser therapy well and reported satisfaction with the procedure.\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\u003eDemographic Characteristics of Study Participants (n\u0026thinsp;=\u0026thinsp;10)\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\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\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.0\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\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e49.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;35 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.0\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\u003e35\u0026ndash;65 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.0\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\u003e\u0026gt;\u0026thinsp;65 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eValues expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) for continuous data and as frequencies (%) for categorical data\u003c/b\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\u003eChanges in Visual Analog Scale (VAS) Scores Across Reviews\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=\"\u0026plusmn;\" 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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReview Session\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eχ\u0026sup2; (df\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-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\u003eReview 1 (Baseline)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e40.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReview 2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e5.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReview 3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReview 4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReview 5 (Final)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFriedman test followed by post-hoc Wilcoxon signed-rank test; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant.\u003c/b\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\u003eThongprasom Lesion Severity Scores (660 nm vs 810 nm Diode Laser)\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=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReview\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e810 nm (Left Buccal Mucosa)\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e660 nm (Right Buccal Mucosa)\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-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\u003eReview 1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReview 2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReview 3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReview 4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReview 5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFriedman test indicated significant within-group change (\u003c/b\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;0.001). No significant inter-group difference observed (paired-sample\u003c/b\u003e \u003cb\u003et\u003c/b\u003e\u003cb\u003e-test\u003c/b\u003e, \u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e\u0026gt;\u0026thinsp;0.05).\u003c/b\u003e\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\u003eEscudier Criteria Summary (Site, Severity, and Activity Scores)\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=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReview 1Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReview 5Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e% Change\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-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\u003eSite Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSeverity Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;14.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.406\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eActivity Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;21.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePaired-sample\u003c/b\u003e \u003cb\u003et\u003c/b\u003e\u003cb\u003e-test used to compare baseline and final scores for both sides; none of the differences reached statistical significance (\u003c/b\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e\u0026gt;\u0026thinsp;0.05).\u003c/b\u003e\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\u003eOverall Clinical Improvement from Baseline to Final Review\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=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome Measure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFinal (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e% Improvement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-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\u003eVAS (Pain)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e88.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.005*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThongprasom Severity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.009*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEscudier Severity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.317\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEscudier Activity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eImprovement percentages calculated as [(Baseline\u0026thinsp;\u0026minus;\u0026thinsp;Final)\u0026thinsp;\u0026divide;\u0026thinsp;Baseline \u0026times; 100]. Wilcoxon signed-rank test applied for non-parametric comparisons; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered significant.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe graph depicts a progressive and statistically significant reduction in mean pain scores (VAS) from baseline (7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6) to the fifth review (0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3) in both the 660 nm and 810 nm diode laser groups (χ\u0026sup2; = 40.0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Both wavelengths demonstrated comparable trends, indicating substantial symptomatic improvement following photobiomodulation therapy.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMean Thongprasom scores decreased consistently in both groups, indicating clinical regression of erythema and erosive areas over five sessions. The reduction was significant from baseline (3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1) to the final review (1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with no significant intergroup difference.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA gradual increase in pigmentation frequency was noted from baseline to the fifth review, with all participants exhibiting mild to moderate pigmentation by study completion (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007 for 810 nm; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037 for 660 nm). Pigmentation was indicative of post-inflammatory healing following photobiomodulation.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eEscudier scores showed stable site localization with mild reductions in severity and activity following therapy. Changes were not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) but indicated localized improvement in lesion inflammation and discomfort.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe graph summarizes mean percentage improvement from baseline to final review in VAS (88.7%), Thongprasom (40.6%), Escudier severity (14.3%), and Escudier activity (21.4%). Pain reduction was the most pronounced therapeutic outcome, confirming diode laser efficacy for symptomatic relief in oral lichen planus.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eLow-level laser therapy (LLLT), also termed photobiomodulation (PBM), has gained increasing attention as an adjunctive treatment for oral lichen planus (OLP) because of its analgesic, anti-inflammatory, and biostimulatory effects (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The present clinical study compared the efficacy of two commonly employed diode laser wavelengths\u0026mdash;660 nm (red light) and 810 nm (near-infrared)\u0026mdash;in symptomatic OLP, focusing on pain reduction and lesion resolution.\u003c/p\u003e\u003cp\u003eBoth wavelengths produced marked symptomatic improvement. VAS scores showed an \u0026asymp;\u0026thinsp;89% decrease after five treatment sessions, corroborating earlier clinical findings by Mutafchieva et al. (2018) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and Ferri et al. (2021) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), who demonstrated significant analgesic outcomes using 810 nm diode lasers. Pain relief is attributed to modulation of peripheral nociceptors, inhibition of prostaglandin E₂ and bradykinin synthesis, and stabilization of neuronal membrane potentials (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). PBM also promotes microcirculation and ATP synthesis, improving tissue oxygenation and healing (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The absence of inter-wavelength difference in the present study suggests that both shallow (660 nm) and deeper (810 nm) tissue-targeted photostimulation yield comparable neuromodulatory benefits.\u003c/p\u003e\u003cp\u003eThongprasom lesion-severity scores declined significantly (\u0026asymp;\u0026thinsp;40%), indicating clear clinical regression. These results align with the work of Cafaro et al. (2010) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), Mostafa et al. (2017) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and Al-Maweri et al. (2017) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), who reported visible mucosal improvement and erythema reduction following LLLT in erosive\u0026ndash;atrophic OLP. Histologically, PBM enhances fibroblast proliferation, collagen deposition, and epithelial re-epithelialization (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), leading to sustained mucosal recovery.\u003c/p\u003e\u003cp\u003eThe progressive pigmentation noted in all cases by the fifth review may represent melanogenic stimulation secondary to enhanced epithelial turnover and oxygenation. Previous authors have described mild transient hyperpigmentation as a benign indicator of healing after photobiomodulation (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEscudier site, severity, and activity scores remained largely stable, suggesting that while LLLT alleviates inflammation and pain, overall lesion localization and extent change minimally over short treatment durations. OLP\u0026rsquo;s chronic immune basis and long disease course may explain this limited structural regression.\u003c/p\u003e\u003cp\u003eComparative wavelength analyses in earlier research indicate that tissue-penetration depth is the main differentiating factor between red and near-infrared light (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Red light (~\u0026thinsp;660 nm) is absorbed superficially by cytochrome c oxidase, stimulating keratinocyte energy metabolism, while near-infrared (~\u0026thinsp;810 nm) reaches subepithelial connective tissue, influencing inflammatory cell populations and cytokine profiles (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, consistent with recent meta-analyses (Wang et al., 2021 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e); Reem Hanna et al., 2023 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)), the therapeutic outcomes appear comparable when energy densities are standardized.\u003c/p\u003e\u003cp\u003eTraditional OLP management with corticosteroids, although effective, carries risks such as mucosal atrophy, candidiasis, and systemic absorption (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). PBM offers a medication-free alternative with minimal adverse effects, suitable for chronic or steroid-resistant cases (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In our study, no adverse events occurred, and patient acceptance was excellent, echoing findings by El Shenawy et al. (2015) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and Mutafchieva et al. (2025) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe improvement in pain and clinical appearance can be mechanistically explained through PBM\u0026rsquo;s modulation of reactive oxygen species, nitric oxide release, and cellular redox signaling (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). These pathways collectively reduce inflammatory cytokine expression (IL-1β, IL-6, TNF-α) and promote epithelial regeneration (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003eComparison with Previous Literature\u003c/h2\u003e\u003cp\u003eMultiple randomized and controlled studies have demonstrated the effectiveness of diode lasers for OLP, with energy densities between 2\u0026ndash;4 J/cm\u0026sup2; yielding optimal results (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In agreement, the present study utilized weekly applications over five sessions and observed significant symptomatic benefit without relapse.\u003c/p\u003e\u003cp\u003eA recent meta-analysis by Panpan Liu et al. (2025) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) confirmed that photobiomodulation provides comparable efficacy to corticosteroids with fewer side effects. Likewise, Milena de Carvalho (2022) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) reported substantial pain reduction and lesion improvement using PBM in steroid-intolerant patients. Our findings support these conclusions, reinforcing PBM\u0026rsquo;s clinical reliability.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe present study involved a small sample size and short follow-up period, limiting generalization. Histological correlation and biomarker analyses (e.g., cytokine modulation, oxidative-stress indices) were not performed. Future research with larger randomized trials, longer monitoring, and combined molecular assessments is recommended to confirm the differential effects of 660 nm and 810 nm wavelengths.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003eClinical Implications\u003c/h2\u003e\u003cp\u003eWithin the study\u0026rsquo;s scope, both diode laser wavelengths demonstrated equivalent efficacy in alleviating symptoms and improving mucosal appearance in OLP. Given the absence of adverse effects and comparable outcomes, wavelength selection may be based on device availability and lesion depth. PBM can thus be proposed as a safe, repeatable, and patient-friendly alternative or adjunct to conventional pharmacotherapy for chronic OLP management.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWithin the limitations of this clinical study, both 660 nm (red) and 810 nm (near-infrared) diode laser wavelengths demonstrated comparable and significant effectiveness in reducing pain and improving lesion severity in patients with symptomatic oral lichen planus. Photobiomodulation therapy produced substantial symptomatic relief, favorable mucosal healing, and no adverse effects, confirming its safety and patient acceptability. Although neither wavelength showed superiority, their equivalent performance highlights the reproducibility of diode laser therapy as a non-invasive, well-tolerated, and steroid-free alternative for OLP management. Further large-scale, randomized trials with extended follow-up and histopathological correlation are warranted to optimize laser parameters and establish standardized treatment protocols for routine clinical application.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eSelf-funded by the authors. No external financial support was received.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA: Swedha : Study conception, data collection, statistical analysis, manuscript drafting.B: Renju Jose, C: Beena Varma, D: Aravind : Study supervision, critical revision, and final approval of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSugerman PB, Savage NW (2002) Oral lichen planus: causes, diagnosis and management. Aust Dent J 47(4):290\u0026ndash;297\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEisen D (2002) The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol 46(2):207\u0026ndash;214\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWarnakulasuriya S (2018) Oral potentially malignant disorders: a comprehensive review. Oral Oncol 82:9\u0026ndash;16\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoopashree MR, Gondhalekar RV, Shashikanth MC, George J, Thippeswamy SH, Shukla A (2010) Pathogenesis of oral lichen planus \u0026ndash; a review. J Oral Pathol Med 39(10):729\u0026ndash;734\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSugerman PB, Zhou X, Walsh LJ, Savage NW (2002) The role of T-cells in the pathogenesis of oral lichen planus. Crit Rev Oral Biol Med 13(4):350\u0026ndash;365\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoon Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR (2012) The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng 40(2):516\u0026ndash;533\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHamblin MR (2017) Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys 4(3):337\u0026ndash;361\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Maweri SA, Alaizari NA, Al-Soneidar WA, Tarakji B (2017) Photodynamic and low-level laser therapy for oral lichen planus: a systematic review. Photodiagnosis Photodyn Ther 19:54\u0026ndash;59\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCafaro A, Arduino PG, Massolini G, Romagnoli E, Broccoletti R (2010) Low-level laser therapy for the treatment of oral lichen planus: a pilot study. Photomed Laser Surg 28(Suppl 2):S99\u0026ndash;S103\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMostafa D, Moussa E, Alhajj MN (2017) Efficacy of methylene blue\u0026ndash;mediated photodynamic therapy in erosive oral lichen planus. Lasers Med Sci 32(5):1087\u0026ndash;1093\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMutafchieva MZ, Hristozova E, Draganova D, Georgieva S (2018) Photobiomodulation with 810 nm diode laser in erosive-atrophic oral lichen planus. Photobiomodul Photomed Laser Surg 36(8):455\u0026ndash;461\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFerri EP, Fiorotti RC, Ferreira DS, Silva DG, Diniz IM (2021) Comparative study of diode laser photobiomodulation and corticosteroid therapy for oral lichen planus. Lasers Dent Sci 5(1):23\u0026ndash;32\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl Shenawy HM, Eldin AM, Ghallab NA (2015) Comparative evaluation of 970 nm diode laser and corticosteroid in erosive-atrophic oral lichen planus. Photomed Laser Surg 33(6):386\u0026ndash;392\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNussbaum EL, Lilge L, Mazzulli T (2002) Effects of low-intensity laser therapy during bacterial infection. Lasers Surg Med 31(5):343\u0026ndash;351\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJorge A, Gon\u0026ccedil;alves LC, Vieira AL (2010) Laser therapy mechanisms for oral mucosal pain control. Lasers Med Sci 25(4):511\u0026ndash;518\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHamblin MR (2016) Low-level light therapy: mechanisms and applications. Laser Photonics Rev 10(6):980\u0026ndash;1013\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang B, Zhang L, Zhang X, Zhou L, Gao L (2021) Photobiomodulation and photodynamic therapy versus corticosteroids for oral lichen planus: a meta-analysis. Lasers Med Sci 36(2):327\u0026ndash;339\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHanna R, Dalvi S, Amaroli A, De Angelis N (2023) Phototherapy for symptomatic oral lichen planus: a systematic review of randomized trials. Lasers Dent Sci 7(3):145\u0026ndash;158\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMutafchieva MZ, Vassileva S, Tsankov N (2025) Photobiomodulation in oral lichen planus: molecular and clinical outcomes. Lasers Dent Sci 8(1):10\u0026ndash;20\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMilena de Carvalho M, Costa DC, Fernandes A et al (2022) Photobiomodulation as an alternative therapy for steroid-intolerant oral lichen planus patients. Photomed Laser Surg 40(4):225\u0026ndash;233\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePanpan Liu P, Xu L, Zhang Q et al (2025) Efficacy of high- and low-intensity laser therapy in oral lichen planus: a meta-analysis. Photobiomodul Photomed Laser Surg 43(2):120\u0026ndash;128\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMostafa D, Alhajj MN, Shokry M (2020) Photobiomodulation for oral lichen planus: clinical and histopathological outcomes. Lasers Dent Sci 4(4):180\u0026ndash;187\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGholami L, Jajarm HH, Shirazi AS et al (2022) Molecular mechanisms of photobiomodulation in oral mucosal healing. J Photochem Photobiol B 226:112384\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFarivar S, Malekshahabi T, Shiari R (2014) Biological responses to photobiomodulation therapy at cellular and molecular levels. Lasers Med Sci 29(1):219\u0026ndash;226\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJajarm HH, Falaki F, Mahdavi O et al (2011) Evaluation of low-level laser therapy efficacy in oral lichen planus: a randomized controlled trial. Lasers Med Sci 26(6):817\u0026ndash;823\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCheng Y, Zhao Z, Liu J et al (2024) Standardization of photobiomodulation parameters for oral mucosal lesions: a systematic review. Lasers Dent Sci 8(2):135\u0026ndash;146\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFerri EP, Fiorotti RC, Diniz IM et al (2021) Photobiomodulation at 660 nm compared with corticosteroids in oral lichen planus. Photobiomodul Photomed Laser Surg 39(9):603\u0026ndash;610\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Oral lichen planus, Photobiomodulation, Diode laser, Low-level laser therapy, Pain reduction, Mucosal healing.","lastPublishedDoi":"10.21203/rs.3.rs-7951526/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7951526/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eOral lichen planus (OLP) is a chronic immune-mediated mucosal disorder with recurrent pain and erythema. Corticosteroids, though effective, have adverse effects and recurrence risk. Photobiomodulation therapy (PBM) using diode lasers has emerged as a non-invasive alternative. This study aimed to compare the clinical efficacy of 660 nm (red) and 810 nm (near-infrared) diode lasers in the management of symptomatic OLP.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e\u003cp\u003eTen patients (5 males, 5 females; mean age 49.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5 years) with clinically and histologically confirmed symptomatic OLP underwent PBM therapy. Each patient received 660 nm laser treatment on the right buccal mucosa and 810 nm laser treatment on the left side once weekly for five weeks. Clinical assessments were performed using the Visual Analog Scale (VAS) for pain, Thongprasom scoring for lesion severity, Escudier criteria for site and activity, and pigmentation changes. Data were analyzed using Friedman and Wilcoxon signed-rank tests (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBoth wavelengths produced statistically significant reductions in pain (VAS: 7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 \u0026rarr; 0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and lesion severity (Thongprasom: 3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 \u0026rarr; 1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No intergroup difference was observed between wavelengths. Pigmentation increased mildly, consistent with post-inflammatory healing. No adverse effects occurred.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eBoth 660 nm and 810 nm diode lasers demonstrated equivalent and significant improvement in pain and lesion severity, confirming PBM as an effective, safe, and well-tolerated adjunct for managing symptomatic oral lichen planus.\u003c/p\u003e","manuscriptTitle":"Comparative Evaluation of Treatment Outcome in Oral Lichen Planus Patients Using Diode Laser of 660 nm and 810 nm – In Vivo Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-21 01:07:38","doi":"10.21203/rs.3.rs-7951526/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"85435162-b249-40ad-9a14-b33f22908640","owner":[],"postedDate":"November 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-20T17:23:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-21 01:07:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7951526","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7951526","identity":"rs-7951526","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}