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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 10  |  Issue : 2  |  Page : 77-80

Fibroepithelial hyperplasia excision by diode laser: A novel treatment approach in periodontal therapy


Department of Periodontology, People's Dental Academy, Bhopal, Madhya Pradesh, India

Date of Web Publication29-Dec-2016

Correspondence Address:
Veena Kalburgi
Department of Periodontology, People's Dental Academy, Bhanpura, Bhopal - 462 038, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-1385.196995

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  Abstract 

Laser first came into light in 1960 and has been used extensively in various fields of dentistry. Lasers are widely used for a numerous procedures such as de-epithelization, pocket disinfection, frenectomy, scaling and root planing, and surgical procedures such as excision of soft-tissue growths. Improved healing, hemostasis, and sutureless excisions are some of the many advantages of laser over conventional treatment modalities. It is because of these advantages that laser is becoming more and more popular as a treatment option in various aspects of dentistry. We hereby present a case report, where we have used soft-tissue diode laser for surgical management of a fibroepithelial hyperplasia with reactive bone formation, because of its many advantages over conventional methods. Fibroepithelial hyperplasia is most commonly seen at the site of trauma in mouth or in other areas of the body. This polyp is usually not harmful and does not grow in size. However, at times, these tags may need to be surgically excised for esthetic and functional purposes or for the fear of malignancy.

Keywords: Diode laser, fibroepithelial hyperplasia, surgical excision


How to cite this article:
Kalburgi V, Jain S, Varma N. Fibroepithelial hyperplasia excision by diode laser: A novel treatment approach in periodontal therapy. J Dent Lasers 2016;10:77-80

How to cite this URL:
Kalburgi V, Jain S, Varma N. Fibroepithelial hyperplasia excision by diode laser: A novel treatment approach in periodontal therapy. J Dent Lasers [serial online] 2016 [cited 2017 May 26];10:77-80. Available from: http://www.jdentlasers.org/text.asp?2016/10/2/77/196995


  Introduction Top


Chronic and recurrent tissue irritation causes excessive tissue response resulting in reactive lesions that are clinically and histopathologically categorized as nonneoplastic swellings. Some of the common examples are pyogenic granuloma, fibrous epulis, peripheral giant cell granuloma, fibroepithelial polyp, peripheral ossifying fibroma, giant cell fibroma, pregnancy epulis, and commonly manifest in the gingival. [1],[2] Almost all lesions in the oral cavity that are called fibromas are not true neoplasms, but merely fibrous overgrowths caused by chronic irritation. Many authors, therefore, prefer the term fibroepithelial polyp or fibrous hyperplasia for these type of lesions. [3] The lesion presents as painless, sessile, round or ovoid, broad-based swelling, lighter in color than surrounding tissue due to a reduced vascularity. [4] The surface may be ulcerated, and diameter varies from 1 mm to several centimeters. Treatment is surgical excision, and a low recurrence rate is expected. [5],[6]

There are many treatment modalities that can be used for these hyperplastic tissues such as the conventional scalpel excision, electrical surgery, and the recently recognized laser surgery. Soft-tissue diode lasers are commonly used in a variety of surgical procedures and have many advantages such as reduced scar formation, less pain and bleeding, and reduced chances of infection. [7]

We are thus presenting a case report evaluating the efficacy of diode laser in the surgical management of fibroepithelial polyp with excellent and satisfactory result without any report of recurrence.


  Case Report Top


A 45-year-old female patient reported to the Department of Periodontology, People's Dental Academy, with the chief complaint of swelling in the upper front teeth region for 3 years. The swelling was peanut size initially but gradually increased in size. Through intraoral examination, it was investigated that it was a well-defined solitary round swelling present on labial gingiva measuring approximately <1 cm involving marginal gingival, interdental, and attached gingiva. On palpation, it was sessile, firm in consistency, bleeds on slight provocation and was nonfluctuant as well as noncompressible [Figure 1].
Figure 1: Preoperative picture

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A radiograph was taken from the upper anterior labial region. A provisional diagnosis of fibroepithelial polyp was made while the differential diagnosis included traumatic fibroma, peripheral ossifying fibroma. The patient was referred for routine blood investigation.

All the findings were within normal limits with the hemoglobin level of 11 mg%. After sufficient local anesthesia was administered, the outline of the lesion was made around 0.5-1mm beyond its clinical extent.

Excision technique

Because of its size, location, and possible excessive bleeding, we decided to removal lesion under local anesthesia with diode laser at 810 nm wavelength with an average of power 4 W and a 0.4 mm diameter fiber tip in 5 min. The irradiation mode was continuous wave. Precautionary measures included wearing of protective goggles, using gauze in the operative field, and high vacuum suction. The polyp was surgically excised using laser [Figure 2]. A slight char tissue at the base of the wound was seen; this char acts a bioprotective plug that has prevented bleeding and also helps to prevent infection in such wounds. The absence of bleeding was the most evident feature of this wound. The borders were rolled out, and these borders flattened out later [Figure 3]. The biopsy confirmed the case to be that of fibroepithelial hyperplasia. The patient was recalled for follow-up after 7 days. On the 7 th day follow-up, granulation tissue was seen which was sign of secondary healing [Figure 4]. After 1 month, complete resolution of the lesion was seen.
Figure 2: Laser excision

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Figure 3: Excised tissue

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Figure 4: Postoperative picture

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Histopathological report

The specimen was sent to Oral and Maxillofacial Pathology Department in formalin buffer solution 10%. Hematoxylin- and eosin-stained section showed overlying keratinized, hyperplastic stratified squamous epithelium. Underlying stroma is fibrocellular with diffuse chronic inflammatory cell infiltration. Furthermore, focal reactive bone formation along the basophilic, calcified globular masses noted in some areas. Moderately, vascularity noted, and few vessels were engorged with red blood cells [Figure 5].
Figure 5: Histologic picture

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  Discussion Top


Fibrous growths of the oral soft tissues are fairly common and include a diverse group of reactive and neoplastic conditions. Tissue enlargement of the oral cavity often presents a diagnostic challenge because a diverse group of pathologic processes can produce such lesions. Within these lesions, a group of hyperplasias which develop in response to a chronic, recurring tissue injury stimulates an exuberant or excessive tissue repair response. [8] The etiologies include long-term irritation, occlusal trauma, ill-fitting prosthetic appliances, and habitual cheek biting. They are usually asymptomatic, and in most of the cases, they remain unchanged for many years. Clinically, these reactive lesions often present diagnostic challenges to the diagnostician because they imitate various groups of pathological process. Although they are clinically similar, they differ in their histopathological features. They are often termed as "epulides" if they remain confined only to the gingiva. Almost all the fibromas of the oral cavity are not true neoplasms, but mere fibrous overgrowths caused by chronic irritation. [3] Many authors, therefore, prefer the term fibroepithelial polyp or fibrous hyperplasia for these type of lesions. As a result of improved healing and hemostasis, intraoral laser wounds can often be left without sutures, healing by secondary intention which is the most effective healing method when the wound involves multiple layers of mucosa.

In the present case, we evaluated the advantages of diode laser for the treatment of fibroepithelial polyp, where the results that we obtained were excellent. The patient did not report recurrence of the tissue growth, thereby eliminating the need for another histopathological examination.


  Conclusion Top


Diagnosis of such reactive hyperplastic gingival lesion is based on the formulation of a correct differential diagnosis to allow accurate evaluation and management of these lesions. These lesions must be clinically and histologically differentiated from precancerous, developmental, and neoplastic lesions. Laser is often used as a successful treatment modality for obtaining biopsy specimens. The application of lasers as a substitute of soft-tissue surgeries is also gaining more and more recognition. Laser treatments have been shown to be superior over conventional mechanical approaches because of its ability to easy ablate, decontaminate, and better hemostasis as well as less surgical and postoperative pain in soft-tissue management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shafer WG, Hine MK, Levy BM. Benign and malignant tumors of oral cavity. In: Rajendran R, Shivapathasundaram B, editors. Shafer's Textbook of Oral Pathology. 5 th ed. New Delhi: Elsevier; 2007. p. 178-80.  Back to cited text no. 1
    
2.
Regezi JA, Sciubba JJ. Connective tissue lesions. Oral Pathology: Clinical Pathologic Correlations. 5 th ed. St. Louis: Saunders, Elsevier; 2008. p. 155-78.  Back to cited text no. 2
    
3.
Tyldesley WR. Oral medicine for the dental practitioner 7. Inflammatory overgrowths and neoplasms. Br Dent J 1974;136:111-6.  Back to cited text no. 3
    
4.
Cortan R, Kumar V, Collins T. Robbins Pathologic Basis of Disease. 6 th ed. Philadelphia: W.B. Saunders; 1999.  Back to cited text no. 4
    
5.
Greenberg MS, Glick M. Burket's Oral Medicine, Diagnosis and Treatment. 10 th ed. Hamilton: BC Decker; 2003. p. 141-2.  Back to cited text no. 5
    
6.
Czerninski R, Nadler C, Kaplan I, Regev E, Maly A. Comparison of clinical and histopathologic diagnosis in lesions of oral mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:e20.  Back to cited text no. 6
    
7.
Asnaashari M, Azari-Marhabi S, Alirezaei S, Asnaashari N. Clinical application of 810nm diode laser to remove gingival hyperplasic lesion. J Lasers Med Sci 2013;4:96-8.  Back to cited text no. 7
    
8.
Alam MN, Chandrasekaran SC, Valiathan M. Fibroma of the gingiva: A case report of a 20 year old lesion. Int J Contemp Dent 2010;1:107-9.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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