|Year : 2014 | Volume
| Issue : 2 | Page : 64-67
810NM diode laser for management of a peripheral giant cell granuloma
Department of Periodontology and Implantology, Military Dental Centre BEG, East Kirkee, Pune, Maharashtra, India
|Date of Web Publication||21-Nov-2014|
Military Dental Centre BEG, East Kirkee, Pune 411 003, Maharashtra
Source of Support: None, Conflict of Interest: None
Peripheral giant cell Granuloma is a slow growing, solitary, common gingival overgrowth of unknown etiology. A combination of clinical presentation, radiographic and histopathology study is essential to diagnose such case. We report a case of a 62-year-old female having gingival overgrowth was managed by diode lasers with success has been described.
Keywords: Diode laser, gingival overgrowth, peripheral giant cell granuloma
|How to cite this article:|
Dhir V. 810NM diode laser for management of a peripheral giant cell granuloma. J Dent Lasers 2014;8:64-7
| Introduction|| |
Peripheral giant cell granuloma is a slow growing, solitary, common gingival overgrowth of unknown etiology. A combination of clinical presentation, radiographic and histopathology study is essential to diagnose such case. A case of 62-year-old female having gingival overgrowth was managed by diode lasers with success has been described.
| Case Report|| |
A 62-year-old female patient came to Department of Periodontology with a referral due to enlarged gingiva. The enlargement was first noticed by the patient 2-3 years back and had progressed steadily since then. Medical history was nil relevant. She had no history of any deleterious habits. General examination revealed no abnormality detected. Intraoral examination revealed there was poor oral hygiene with presence of calculus especially between 31 and 42 region, pathological migration of 31, 42 and these were grade-II mobile. A firm, resilient, non-tender, smooth enlargement localized to 31, 41 region that did not bleed spontaneously was seen. Growth was 2.5 × 2.0 cm in size, oval in shape, non-tender, sessile located between 31 and 42, originating from interdental and marginal gingiva. It was smooth in texture except indentation due to maxillary anterior teeth while in occlusion [Figure 1] and [Figure 2].
Based on clinical presentation and examination, a provisional diagnosis of fibrous localized gingival overgrowth was made.
Routine blood investigations were done. NAD was detected. Orthopantogram [Figure 3] was advised which revealed no gross osseous pathology in relation to mandibular anterior region or otherwise. Various carious and root stumps were present. IOPA radiograph confirmed pathological migration of 31,42.
Phase-I therapy consists of non-surgical therapy. Oral prophylaxis and restorations. Phase-II therapy-review after 1, 2 weeks. There was no change in appearance in 2 weeks. Phase-III -excisional biopsy of gingival overgrowth.
Patient was explained about the procedure. Informed consent was taken. Laser safety protocol was established and monitored. Safety goggles were put for everyone in the room. Laser was used as per instructions provided by manufacturer. Test fire was conducted. Excisional biopsy of gingival overgrowth was performed under local infiltration anesthesia by a gingivectomy using 810 nm Diode Laser (Smile Doctor, Italy) in continuous wave, contact mode at 5 W using 300 μm fiber (parameters). Initially, 1 W then 2 W, then gradually increased to 5 W [Figure 4] and [Figure 5]. There were no complications during the surgery. Patient was comfortable under local anesthesia. There were minimal areas of carbonization and bleeding were controlled. Surgical prognosis was good. Excised tissue was sent for histopathological examination. Periodontal dressing was given to protect the site.
Post-operative care and follow up
Patient was given post-operative instructions and medications included Ibuprofen 400 mg thrice a day for 3 days and 0.2% Chlorhexidiene Mouthwash for first operative week. Patient was followed up every week and month. Post-operative healing was uneventful at 48 h, 1 week. Clinically healthy gingival tissue without any inflammation was seen at 2 week, 1 m and 3 months during followup [Figure 6]a and b. There is no recurrence reported by the patient even after 3 years.
Histopathological report confirmed the diagnosis as Peripheral Giant cell granuloma. There were numerous foci of multinucleated giant cells, hemosiderin particles in connective tissue stroma. There were areas of chronic inflammatory cell infiltrate. Overlying epithelium was hyperplastic and ulcerated.
| Discussion|| |
Peripheral giant cell granuloma is a benign reactive lesion of gingiva. It is arising mainly from the connective tissue of the gingiva, periodontal membrane, periosteum of the alveolar ridge, or in response to local irritation. It is seen in the young as well as in the elderly population with the highest incidence in the 4 th -6 th decades of life.  However, 20-30% of cases manifest in the 1 st and the 2 nd decades of life. The preferential location of the lesion according to Pindborg is the premolar and molar zone, though Shafer and Giansanti suggest that it generally occurs in the incisor and canine region. 
Although etiology is unknown but it arises in response to local irritating factors such as tooth extractions, ill-fitting prostheses, poor restorations, collections of food remnants, and calculus. 
Clinically, lesions arise interdentally from gingival margins, occurs most frequently on the labial surface especially in mandible. These may be sessile or pedunculated. However, there are no pathognomic clinical features, which can differentiate these from other form of gingival enlargements. Since, they are benign reactive lesions usually treated with surgical resection with extensive clearing of the base of the lesion and elimination of the local etiologic factor. Malignant transformation of these lesions has never been reported. The recurrence rate after local excision is around 10%. 
Radiographic features are generally nonspecific. However, sometimes they reveal superficial destruction of the alveolar margin or crest of the interdental bone when the granuloma is seen associated with the teeth.
Microscopic histopathological findings are essential to provide a definitive diagnosis and differentiate them from pyogenic granuloma, fibroma, papilloma, peripheral giant cell granuloma, or any other malignant tumor. 
Various approaches have been used. Electrosurgery has been used, but it does not have a defined target tissue as lasers. The primary mode of tissue interaction with electrosurgery is heat ablation and zone of necrosis can be 500-1500 um. Diode laser can generate heat up to 500 um. 
Clinical observation demonstrates that resecting gingiva with a laser enhances access due to increased visualization resulting from sealing of capillaries and lymphatics during laser irradiation. This causes minimal inflammatory response and thereby patient experiences less postoperative swelling and pain. ,,] In early stages of wound healing with blades, inflammation is noted with collagen production and epithelization and a high tensile strength is associated with the wound. ,
The advantages of lasers over scalpel surgery are it's relatively better hemostatic effect and pronounced bactericidal effect. Furthermore, lasers provide good conditions for an accelerated healing process. However, the practitioners must have excellent knowledge of their specific characteristics and interactions with the tissues to be properly applied in certain manipulations. ,
| Conclusion|| |
Early and definite diagnosis of peripheral giant cell granuloma on the basis of clinical, radiographic, and histopathological examination allows conservative management with minimal risk. Diode laser has been found to be useful and successful for its management by reducing tissue trauma, early postoperative healing and increased comfort to the patient.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]