These cases highlight the potential benefits of incorporating LLLT as an adjunctive treatment following dental extractions in patients with type 2 diabetes mellitus. The use of LLLT was associated with accelerated soft tissue healing, reduced post-extraction bleeding, and decreased discomfort, underscoring its value in improving clinical outcomes in this high-risk patient population.

This study was conducted as a prospective split-mouth case series and included six patients with controlled type 2 diabetes mellitus who presented to the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Damascus University, for dental extraction. Ethical approval was obtained from the Scientific Committee of the Faculty of Dentistry, Damascus University (Approval No: DN-261124-351, dated 26-11-2024). All participants provided written informed consent for participation and publication of anonymized clinical data and images. For each patient, one extraction site was randomly allocated to receive diode laser therapy, while the contralateral site served as the control and received a placebo (sham) laser application. This split-mouth design was chosen to minimize interpatient variability. Due to the nature of the intervention, operator blinding was not feasible; however, outcome assessment was conducted by an independent examiner who was not involved in the treatment procedures. Patient confidentiality was strictly maintained in accordance with the Declaration of Helsinki ⁹ and institutional ethical guidelines. This clinical report follows the SCARE 2020 criteria ⁷ for case series reporting. Given the small sample size, this study is intended to provide preliminary clinical observations rather than statistical generalization.

Patients were eligible if they had a confirmed diagnosis of type 2 diabetes mellitus with adequate glycemic control (HbA1c ≤ 8%) and required one or more tooth extractions. Exclusion criteria included uncontrolled diabetes (HbA1c > 8%), systemic conditions contraindicating tooth extraction, presence of acute oral infection at the extraction site, recent use of corticosteroids or immunosuppressive drugs, and history of radiotherapy to the head and neck region.

A thorough medical history was taken for each patient, and panoramic radiographs were obtained to rule out periapical pathology. Dental extractions were performed under local anesthesia (2% lidocaine with 1:100,000 epinephrine) using a minimally traumatic surgical technique. Standard postoperative instructions were provided to all patients.

Low-level laser therapy (LLLT) was performed using an 808-nm diode laser device (Klas DX-61, Konftec, Taiwan) in continuous wave mode. The laser was applied at an output power of 300 mW using a 400 μm fiber tip with a spot size of 0.04 cm ², resulting in a power density of 7.5 W/cm ². Each irradiation point received 18 J over 60 seconds, corresponding to an energy density (fluence) of 450 J/cm ² per point. Laser irradiation was performed at three sites around the extraction socket—vestibular, lingual/palatal, and occlusal surfaces. ¹⁰ The procedure was repeated on postoperative days 2 and 7. In each patient, the contralateral extraction site served as the control and received a placebo (sham) laser application without energy emission.

Healing was clinically evaluated on days 2 and 7 post-extraction. ¹¹ Outcomes assessed included: •

Presence and stability of the blood clot

To enhance objectivity and standardization: •

Soft tissue healing was assessed using the Landry, Turnbull, and Howley Wound Healing Index (WHI), which scores healing on a scale from 1 (very poor) to 5 (excellent).

All evaluations were performed by an independent examiner who was not involved in the surgical procedure or laser application to minimize assessment bias.

Case 1

A 49-year-old male, a non-smoker, presented with partial edentulism and requested a complete removable denture. His medical history included type 2 diabetes mellitus and angina pectoris, diagnosed five years earlier. Current medications were aspirin 81 mg and metformin 850 mg daily. HbA1c was 6.6%, confirming adequate glycemic control. Teeth numbers 13, 23, and 24 were indicated for extraction. Tooth no. 13 was extracted first and received a placebo (sham) laser application. Follow-up evaluations were conducted on days 2 and 7 to assess healing. Subsequently, tooth no. 23 was extracted, followed by low-level laser therapy using an 808-nm diode laser at 300 μW, delivering 18 J per point. Laser irradiation was applied for 60 seconds to the vestibular, lingual/palatal, and occlusal surfaces. The same protocol was repeated on days 2 and 7 post-extraction to promote tissue repair and hemostasis ( Figure 1).

Case 2

A 67-year-old female, a non-smoker, presented with partial edentulism and requested a removable denture. Her medical history included type 2 diabetes mellitus and controlled hypertension. She was taking aspirin 81 mg and metformin 1000 mg daily. HbA1c was 6.0%, confirming adequate glycemic control. Teeth numbers 13 and 23 were indicated for extraction. Tooth no. 23 was extracted first with a placebo laser application. Follow-up assessments were performed on days 2 and 7. Tooth no. 13 was subsequently extracted, followed by diode laser therapy using an 808-nm laser at 300 μW, delivering 18 J per point for 60 seconds to vestibular, lingual/palatal, and occlusal surfaces. The same laser protocol was repeated on days 2 and 7 post-extraction ( Figure 2).

Case 3

A 67-year-old female, a non-smoker, presented with partial edentulism for removable denture placement. Her medical history included type 2 diabetes mellitus, controlled hypertension, and hypothyroidism. Current medications included thyroxine 100 μg, lorazepam, magnesium, metformin 1000 mg, and vitamin D. HbA1c was 6.0%. Teeth numbers 32 and 42 were indicated for extraction. Tooth no. 42 was extracted with a placebo laser application. Tooth no. 32 was subsequently extracted and treated with diode laser therapy (808 nm, 300 μW, 18 J per point, 60 seconds per site applied to vestibular, lingual, and occlusal surfaces). Follow-up assessments were conducted on days 2 and 7 post-extraction ( Figure 3).

Case 4

A 56-year-old male, a non-smoker, presented with fractured anterior teeth. His medical history included type 2 diabetes mellitus, treated with metformin 1000 mg daily. HbA1c was 8.0%, indicating moderately controlled diabetes. Teeth numbers 12 and 22 were indicated for extraction. Tooth no. 22 was extracted with a placebo laser application. Tooth no. 12 was subsequently extracted and treated with diode laser therapy using the same protocol described previously. Follow-up evaluations occurred on days 2 and 7 post-extraction ( Figure 4).

Case 5

A 63-year-old male, a non-smoker, presented with partial edentulism. His medical history included type 2 diabetes mellitus, treated with metformin 1000 mg daily. HbA1c was 8.0%. Teeth numbers 12 and 22 were indicated for extraction. Tooth no. 12 was extracted with a placebo laser application, followed by the extraction of tooth no. 22 with diode laser therapy (808 nm, 300 μW, 18 J per point, 60 seconds per site applied to vestibular, lingual, and occlusal surfaces). Follow-up assessments were conducted on days 2 and 7 post-extraction ( Figure 5).

Case 6

A 67-year-old female, a non-smoker, presented with partial edentulism. Her medical history included type 2 diabetes mellitus, treated with gliclazide 60 mg and enalapril 10 mg daily. HbA1c was 8.0%. Teeth numbers 32 and 34 were indicated for extraction. Tooth no. 34 was extracted with a placebo laser application. Tooth no. 32 was subsequently extracted and treated with diode laser therapy (808 nm, 300 μW, 18 J per point, 60 seconds per site applied to vestibular, lingual, and occlusal surfaces). Follow-up evaluations were performed on days 2 and 7 post-extraction ( Figure 6).

This study has several limitations that should be acknowledged. The most significant is the small sample size (n = 6), which limits statistical analysis and prevents generalization of the results to the broader diabetic population. While a split-mouth design was used to minimize interpatient variability, the findings remain descriptive and observational in nature. To improve objectivity, we incorporated semi-quantitative measures, including the Landry Wound Healing Index (WHI), a modified bleeding score, and pain assessment using VAS. However, histological evaluation and statistical testing were beyond the scope of this case series. Additionally, four of the six patients were taking low-dose aspirin (81 mg/day), which is known to inhibit platelet aggregation and may affect clot formation and postoperative bleeding. Interestingly, despite aspirin use, laser-treated sites demonstrated faster clot stabilization and reduced bleeding compared with placebo sites. This suggests that diode laser therapy may help counteract aspirin-induced delays in hemostasis by promoting local vasoconstriction and improving clot organization. Nevertheless, due to the small sample size, no subgroup statistical analysis could be performed to compare aspirin versus non-aspirin patients. Therefore, while these preliminary observations are promising, larger randomized controlled trials with stratification for systemic medications such as aspirin and anticoagulants are required to validate these findings.