Clinical context: the challenge of erosive forms of oral lichen planus

Oral lichen planus (OLP) is a chronic T-cell-mediated autoimmune pathology characterised by the destruction of basal keratinocytes. While the reticular form often remains asymptomatic, the erosive and atrophic variants require complex management due to severe pain, high morbidity and a documented risk of malignant transformation. Although topical corticosteroids remain the first-line treatment, the practitioner is frequently faced with refractory patients or those presenting with contraindications. In this context, the emergence of laser technologies — notably photobiomodulation (PBMT) and high-intensity lasers (HILT) — offers a targeted alternative to modulate the inflammatory response and accelerate mucosal healing.

Objectives and hypotheses of the literature review

This structured review, conducted according to PRISMA and JBI guidelines, synthesises 23 studies published between 2015 and 2025 to evaluate the efficacy and safety of laser therapies (PDT, PBMT and HILT). The objective is to define precise clinical recommendations, validated by the Polish Society of Laser Dentistry, focusing on the reduction of lesion severity and pain control. The central hypothesis (PICO) examines whether laser intervention surpasses or equals conventional pharmacological treatments or placebos in terms of mucosal healing and reduction of recurrence rates, particularly in patients intolerant to classic steroid protocols.

Review methodology

This study is a structured literature review ("umbrella review") conducted in accordance with the PRISMA and JBI (Joanna Briggs Institute) guidelines. It is registered in the PROSPERO database under the number CRD420251172714. The objective was to synthesise and critically evaluate data from systematic reviews and meta-analyses addressing laser therapies for oral lichen planus (OLP).

The selection process identified 23 relevant studies published over the 2015-2025 period. The methodology is based on a PICO question structured as follows:

• Population: Patients with oral lichen planus.
• Interventions: Photobiomodulation (PBMT), photodynamic therapy (PDT) and high-intensity laser (HILT).
• Comparisons: Conventional topical corticosteroids, placebo or sham laser.
• Evaluation criteria: Pain reduction, lesion severity, mucosal healing and recurrence rate.

Data extraction focused on the technical parameters of the lasers (wavelength, power, energy density) as well as the frequency of the sessions. The authors assessed the risk of bias and the quality of evidence, noting the heterogeneity of the therapeutic protocols used in the included studies.

Synthesis of the clinical performance of lasers in oral lichen planus (OLP)

This structured literature review, conducted according to the PRISMA guidelines, synthesised the data from 23 relevant studies published between 2015 and 2025. The analysis focuses on the efficacy of photodynamic therapy (PDT), photobiomodulation (PBMT) and high-intensity lasers (HILT) compared to conventional treatments.

The authors report that laser therapies demonstrate significant efficacy in reducing lesion size and relieving pain. The observed safety profiles are comparable, if not superior, to conventional corticosteroid treatments. Although corticosteroids remain the first-line treatment, the compiled data indicate that lasers constitute valuable adjuncts or alternatives, particularly for patients who are intolerant or refractory to conventional treatments.

Laser Modality	Main Observations	Clinical Applications
PBMT (Photobiomodulation)	Safest and most effective modality for erosive OLP.	Reduction of inflammation, analgesia, mucosal healing.
HILT (High Intensity)	Favourable outcomes, lower recurrence rates.	Targeting superficial epidermal lesions.
Diode, CO2, Nd:YAG Lasers	Targeted anti-inflammatory and analgesic effects.	Reduction in lesion size with minimal adverse effects.

The results highlight several key points regarding the clinical course of the patients:

• Reduction in pain and lesions: Lasers (notably PBMT and HILT) demonstrate a marked decrease in pain intensity and the severity of erosive/ulcerative lesions.
• Recurrence rate: PBMT and HILT are associated with lower recurrence rates compared to pharmacological approaches alone.
• Safety: Fewer side effects reported than with prolonged use of topical or systemic corticosteroids.

However, the review highlights significant heterogeneity in the treatment protocols and laser parameters used (wavelength, power, energy density), which limits strict direct comparisons between the included studies.

Analysis of efficacy and therapeutic positioning

This umbrella review, synthesising 23 studies published between 2015 and 2025, confirms that laser therapies (PBMT, PDT and HILT) constitute a robust alternative or adjunct to topical corticosteroids, particularly for the erosive and ulcerative forms of oral lichen planus (OLP). The compiled data indicate a significant reduction in lesion size and pain, with a safety profile comparable, or even superior, to conventional treatments. Photobiomodulation (PBMT) specifically stands out as the safest and most effective modality for stabilising erosive forms according to the authors.

Methodological limitations and protocol variability

The major obstacle identified in this review lies in the marked heterogeneity of the laser parameters used (wavelength, energy density, exposure time). This variability limits direct comparisons and complicates the establishment of universal standardised protocols. Although the clinical results are favourable, the authors emphasise that the lack of long-term follow-up and the need for larger-scale randomised controlled trials remain obstacles to refining definitive clinical recommendations.

Implications for daily practice

Although corticosteroids remain the first-line therapy, the integration of laser therapy offers tangible prospects for patients who are refractory or intolerant to pharmacological treatments. The study highlights immediate clinical benefits: precision application, a reduction in the use of systemic immunosuppressants and a decrease in recurrence rates under certain modalities (HILT and PBMT). For the practitioner, these technologies optimise patient management by combining a targeted analgesic effect with accelerated mucosal healing, thereby improving overall quality of life.

Summary of results

This systematic review, compiling 23 studies published between 2015 and 2025, confirms that laser therapies (PBMT, HILT) significantly reduce pain and the size of OLP lesions. With a safety profile equal or superior to conventional corticosteroids, photobiomodulation (PBMT) establishes itself as the safest and most effective modality for erosive forms.

In practical terms, for the practitioner:

• Alternative of choice: Integrate laser therapy (particularly PBMT) for your patients intolerant or refractory to corticosteroids; its safety profile is superior or comparable to conventional treatments.
• Priority target: Favour photobiomodulation for erosive forms of OLP, with data designating it as the most effective modality in the practice.
• Clinical adjustment: Remain vigilant regarding your settings; the current heterogeneity of protocols in the literature necessitates careful customisation of energy parameters based on tissue response.

The management of oral lichen planus (OLP) — an autoimmune pathology mediated by CD8+ T lymphocytes — remains a daily challenge in clinical practice, particularly for the erosive and atrophic forms. This systematic review of the literature, structured according to the PRISMA guidelines and including 23 studies published between 2015 and 2025, evaluates the laser armamentarium against conventional treatments.

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