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| case report 18 laser 4 2016 tral side of the tongue, measuring approximately 2 mmindiameter(Fig.1);and3)amoderatethickening whitish patch at the buccal mucosa of the left cheek, measuring approximately 7 mm in diameter (Fig. 2). The surgical procedure involved local anaesthesia (2 % lidocaine with epinephrine 1:100,000) and exci- sional biopsy of the lesions at the buccal mucosa by using 10,600 nm CO2 laser at 5 W and continuous wave. Then tissue coagulation for haemostasis was undertaken using a defocused CO2 laser at 3 W and continuouswave.Theablationwithhaemostasiswas easily achieved (Fig. 3). At the left lateral border of the tongue, the pho- toablationwasundertakenusinga10,600 nmCO2 la- ser at 5 W and continuous wave (Fig. 4). After exci- sional biopsy, there was an active bleeding over the lesion because of a highly vascularised tissue (Fig. 5-A). A blue light-emitting diode (LED) for dental practice (WOODPECKERTM LED light unit; a single bluelightsourcenon-heatproducing,energydensity 1,000-1,200mW/cm2 )wasirradiatedfor5secondsto the oozing area. This was repeated for four episodes togainaninitiatingbloodclot(Fig.6).Forthesmaller lesion at the ventral side of the tongue, the vapouri- sation technique was applied using 10,600 nm CO2 laserat3 Wandcontinuouswave.Therewasnoactive bleeding at the surgical site (Fig. 5). Clinical results Theoutcomeafterusinglaserforsurgicalremoval of the soft tissue lesion showed ablation with hae- mostasis except the lesion at lateral border of the tongue, a site with high vascularity. In this case, the irradiation of LED at the active bleeding area pro- moted blood clot formation without producing any clinical soft tissue destruction. Furthermore, soft tissue biopsy using laser had many advantages, for example,providingadrycleansurgicalfieldenhanc- ingvisibilityfortheoperatorandreducingoperation time. At the two-week follow-up, there was soft tis- sue healing with some coagulum coverage and no clinical signs of inflammation or infection (Figs. 7a & b). The histopathology investigation was obtain- able. In this case, epithelial keratosis was diagnosed. The five-month follow-up after excisional biopsy showed complete healing of the mucosal coverage with some thin whitish areas and without tethering of the scar (Figs. 8a & b). Based on the histopatho- logicalfinding,theseshouldbeinaconditionforob- servation. Patient satisfaction Withoutanyeffortstostopbleedingsuchasbiting on gauze pads, he felt more confident with regard to the operation being necessary and agreed with rou- tine follow-up. There was still no pain and bleeding interfering routine activities after laser surgery. Case 2: Photocoagulation for hard tissue haemostasis after routine tooth extraction by LED light curing unit The second case study was a 66 year-old woman who had a history of diabetes mellitus and hyperten- sion.Theupperleftcanineandsecondpremolarwere diagnosed “chronic periodontitis”. The tooth ex- tractionwasrequestedasatreatment.Routinetooth extraction was performed under local anaesthesia; 2 % mepivacaine with 1:100,000 epinephrine. The LEDatanenergydensityof1,000-1,200 mW/cm2 was irradiated at the extraction socket for 5 sec per cycle for a total of four episodes. Clinical results There was an oozing of bleeding after extraction (Fig.9).Aninitialclotoccurredinthebonysocketim- mediately after LED photocoagulation procedure (Fig. 10). Patient satisfaction Thepatientseemedtobeanxiousabouttheopera- tion at the beginning. After using LED light photoco- agulation to accelerate blood clot formation into the sockets, she seemed more comfortable and satisfied with the procedure with no need to be worried about pressure compression by biting a gauze. Fig. 7a Fig. 9 Fig. 8a Fig. 10 Figs. 7a & b: Two-week post photoablation biopsy and the healing with coagulum coverage. Figs. 8a & b: Five-week follow-up after photoablation biopsy, complete coverage with mild whitish mucosa. Fig. 9: Oozing at the sockets of bleeding after tooth extraction. Fig. 10: Immediate post-photocoag- ulation using LED showed an initial blood clot formation. Fig. 7b Fig. 8b 42016