Yet no universally accepted treatment protocol for oral hemangiomas and vascular malformations exists. This study determines the long-term clinical outcome after long-pulsed Nd:YAG laser treatment in 121 previously untreated patients (78 females, 43 males; mean age, 19 years) with oral hemangioma or vascular malformations. The end point was 100% vessel clearing after 1 to 3 sessions.The power of the laser was set at 6.5 W per pulse, the pulse widths ranged between 30 and 60 milliseconds. With an optical fiber diameter of 600 microm, the wavelength was constantly 1064 nm. Dynamic cooling device was set at 10 to 20 and 10 to 15 times before and after pulse, respectively. Whereas 77% of lesions were cleared totally after a single session only, 23% required an overall of 2 to 3 sessions. Tissue sloughing occurred in all patients. The mean follow-up period of 13 months (minimum, 6 months; maximum, 24 months) showed neither functional nor cosmetic shortcomings. Long-pulsed Nd:YAG laser treatment proved to be an effective and valuable method for the treatment of oral hemangiomas and vascular malformations.