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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 10  |  Issue : 1  |  Page : 28-31

Surgical diode laser excision for cellular fibroma


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

Date of Web Publication23-Jun-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: 10.4103/0976-2868.184605

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  Abstract 

The use of lasers in periodontal treatment has been well documented over the past 10 years. Lasers can be used for initial periodontal therapy and surgical procedures. When used in deep periodontal pockets with associated bony defects, the laser not only removes the diseased granulation tissue and associated bacteria but also it promotes osteoclast and osteoblast activity, often resulting in bone regrowth. Laser is effectively used to perform gingivectomies, gingivoplasties, free gingival graft procedures, crown lengthening, operculectomy, pocket disinfection, and many more. Gingival depigmentation using laser ablation has been recognized as an effective, pleasant, and reliable technique. In terms of esthetic dentistry, the use of the Erbium laser in crown lengthening in the anterior has created an entirely new dimension in smile design.

Keywords: Diode laser, fibroma, hemostatic agent


How to cite this article:
Kalburgi V, Jain S, Raghuwanshi S. Surgical diode laser excision for cellular fibroma. J Dent Lasers 2016;10:28-31

How to cite this URL:
Kalburgi V, Jain S, Raghuwanshi S. Surgical diode laser excision for cellular fibroma. J Dent Lasers [serial online] 2016 [cited 2021 May 10];10:28-31. Available from: https://www.jdentlasers.org/text.asp?2016/10/1/28/184605


  Introduction Top


Dentistry has changed tremendously over the past decade to benifit both clinician and patient. [1] Gingival growths are one of the most frequently encountered lesions in the oral cavity. Most of these lesions such as irritational fibroma, pyogenic granuloma, peripheral ossifying fibroma, and peripheral giant cell granuloma are innocuous and rarely present with aggressive features. In the majority of cases, these lesions are the result of trauma or chronic irritation. [2] Fibroma is a result of a chronic repair process that includes granulation tissue and scar formation resulting in a fibrous submucosal mass. [3] Recurrences are rare and may be caused by repetitive trauma at the same site. This lesion does not have a risk for malignancy. [4] This case report describes the use of diode laser on the excision of fibromas. The excision of fibroma using the diode laser was a quick clinical procedure without bleeding. During the days following surgery, the patient reported no pain or discomfort. The wound healing of the soft tissue was satisfactory, and no scarring could be seen in the region of the surgery. The excision of the fibroma with the diode laser is a safe, quick procedure, with minimum postoperative discomfort and complications. [2]


  Case Report: Cellular Fibroma Top


A 35-year-old female patient reported to the Department of Periodontology of People's Dental Academy, Bhopal, with the chief complaint of swelling in the right lower posterior alveolar ridge in edentulous molar region for the past 5-6 months. The patient also provided with the history of extraction of the first molar in the same region 2 years back. No other relevant history could be recorded. [5]

On examination, there was gingival growth in the mandibular posterior alveolar ridge of the patient oral cavity. The patient stated that the lesion (growth) had been present for approximately 5-6 months. Initially, the lesion was only a pinpoint but slowly increased in size. The lesion measured 1 cm mesiodistally as well as occluso-gingivally. The growth was pedunculated with ill-defined borders and firm in consistency with a history of pain and bleeding on slight probing with no pus discharge. The patient concern was interference with mastication and oral hygiene was poor [Figure 1]. [5]
Figure 1: Preoperative picture

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A radiograph was taken from the mandibular posterior region. A provisional diagnosis of peripheral ossifying fibroma was made, whereas the differential diagnosis included traumatic fibroma and fibroepithelial polyp.

The patient was referred for routine blood investigation. All the findings were within normal limits with the hemoglobin level of 10.4 mg%. The clinician's safety lesion was covered with wet gauze. After sufficient local anesthesia was administered, the outline of the lesion was made around 0.5-1 mm beyond its clinical extent.

Treatment

Teeth in the area of involvement were thoroughly root planed and debrided. Patients were put on a regimen of 0.2% chlorhexidine mouthwash and necessary oral hygiene instructions were given. The enlargement did not show perceptible improvement except for very slight reduction in inflammation, and the option of surgical excision was considered at this stage. Patients were explained about the necessity for surgical excision under local anesthesia and were also given the choice of undergoing the excision either with traditional surgery or laser approach. After patient's consent for the laser procedure, necessary presurgical screening was performed.

Excision technique

Diode laser irradiation was delivered through an optical fiber with 300 μm fiber at 4 W, 50 Hz, long pulsed as recommended by the manufacturer in contact mode to control the depth of penetration. The lesion was excised 0.5-1 mm beyond its clinical extent, and the underlying surface was thoroughly curetted, and root planing was carried out on the adjacent teeth using the periodontal curettes [Figure 2]. There was no bleeding, and tissues were well coagulated during the entire procedure. Patients were discharged with necessary postoperative instructions. Analgesics (ibuprofen 200-400 mg) were prescribed to be taken as and when required and 0.2% chlorhexidine mouth rinse was advised twice daily for 4 weeks. After 1 week postoperative picture was taken [Figure 3].
Figure 2: Laser excision

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Figure 3: Postoperative picture after 1 week

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The excised specimens after due processing were evaluated, and a final diagnosis of cellular fibroma with secondary inflammation was arrived at by the oral pathologist [Figure 4]. The light microscopic examination section showed cellular fibrous connective tissue. The fibrovascular tissue comprised a large number of plump proliferating fibroblasts intermingling throughout in a delicate fibrillar stroma. The overlying squamous epithelium was intact. Cells were showing characteristic swirling pattern of growth. Focal areas of inflammatory infiltrate of mixed type. Variable collagen fibers are seen as delicate fibrils and few in bundles [Figure 5].
Figure 4: Excised tissue

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Figure 5: Histopathological picture

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  Discussion Top


Cellular fibroma is a fibrous tumor with distinctive clinicopathological features. The literature review confirmed the gingiva as the most commonly affected location (362/773, 46.8%) among cases with specified site, with a predilection for the mandible (2:1 mandible to maxilla ratio). The lesions localization in the case presented here was the mandibular gingiva which is in accordance to the gingiva predilection reported in the literature. The giant cell fibroma is typically an asymptomatic sessile or pedunculated nodule, usually <1 cm in size. The surface of the mass often appears papillary; therefore, the lesion may be clinically mistaken for the papilloma. Compared with the common irritation fibroma, the lesion is diagnosed during the first three decades of life with a slight female predilection. [6],[7],[8],[9],[10]

The origin of the giant cells is also controversial. The most accepted theory supports a fibroblastic origin of giant cells. However, these giant cells contain more microfibrils, a distinctive appearance that may reflect a functional response to the requirement for higher protein and collagen formation. Some researchers argue that the giant cells might be multipotential mesenchymal cells with myofibroblastic differentiation, but myofibroblastic origin is unlikely due to the negative alpha-smooth muscle actin reaction. [11],[12],[13]

The differential diagnosis of a firm, soft tissue nodule in the gingiva may include irritation fibroma, papilloma, peripheral ossifying fibroma, focal fibrous hyperplasia, peripheral odontogenic fibroma, and odontogenic hamartoma. Irritation fibroma usually occurs at an older age, the buccal mucosa being the most common location. It is one of the most common oral lesions representing approximately 25% of total biopsies; irritation fibroma has a distinct female predilection and usually is larger than 1 cm. In addition, the frequent pebbly or papillary surface and the potential pedunculated appearance of cellular fibroma are not features of irritation fibroma. Peripheral ossifying fibroma is characterized by calcified regions, which may be apparent radiographically. It is found exclusively in the gingiva, possibly causing superficial resorption of the alveolar ridge, whereas GCF can also occur in different areas of the oral mucosa. Focal fibrous hyperplasia (fibrous epulis) has similar clinical appearance; however, the absence of giant cells which are typical histopathological finding in cellular fibroma can set the diagnosis. [7],[8]

Recurrences have been reported only in solitary cases. However, recall visits are necessary to ensure the absence of recurrence. If the lesion is left untreated, it may continue to proliferate but its benign nature certifies limited growth potential. Moreover, cellular fibroma in contrast to other gingival lesions, such as the peripheral ossifying fibroma, has never been reported to cause migration of teeth or interdental resorption of the alveolar ridge. [14],[15],[16]


  Conclusion Top


The diode laser treatment was highly effective for the excision of cellular fibroma. Diode laser is used according to the protocol and it is a relatively simple and safe method. Easy handling of the fiber-optic tip combined with the properties of diode laser helped in obtaining a clean, thin, and fast cut; often without bleeding or scarring. Because of the sterilizing and tissue growth stimulating properties of the laser, we were able to obtain excellent healing in a few days, even without surgical suturing. [2]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Dang AB, Rallan NS. Role of lasers in periodontology: A review. Ann Dent Spec 2013;1:8-12.  Back to cited text no. 1
    
2.
Pai JB, Padma R, Divya, Malagi S, Kamath V, Shridhar A, et al. Excision of fibroma with diode laser: A case series. J Dent Lasers 2014;8:34-8.  Back to cited text no. 2
  Medknow Journal  
3.
Pedrona IG, Ramalhob KM, Moreirac LA, Freitasd PM. Association of two lasers in the treatment of traumatic fibroma: Excision with Nd: YAP laser and photobiomodulation using InGaAlP: A case report. Oral Laser Appl 2009;9:49-53.  Back to cited text no. 3
    
4.
Esmeili T, Lozada-Nur F, Epstein J. Common benign oral soft tissue masses. Dent Clin North Am 2005;49:223-40.  Back to cited text no. 4
    
5.
Alam T, Dawasaz AA, Thukral N, Jangam D. Surgical diode laser excision for peripheral cemento-ossifying fibroma. A case report and literature review. J Oral Laser Appl 2008;8:43-9.  Back to cited text no. 5
    
6.
Nikitakis NG, Emmanouil D, Maroulakos MP, Angelopoulou MV. Giant cell fibroma in children: Report of two cases and literature review. J Oral Maxillofac Res 2013;4:1.  Back to cited text no. 6
    
7.
Weathers DR, Callihan MD. Giant-cell fibroma. Oral Surg Oral Med Oral Pathol 1974;37:374-84.  Back to cited text no. 7
    
8.
Magnusson BC, Rasmusson LG. The giant cell fibroma. A review of 103 cases with immunohistochemical findings. Acta Odontol Scand 1995;53:293-6.  Back to cited text no. 8
    
9.
Houston GD. The giant cell fibroma. A review of 464 cases. Oral Surg Oral Med Oral Pathol 1982;53:582-7.  Back to cited text no. 9
    
10.
Savage NW, Monsour PA. Oral fibrous hyperplasias and the giant cell fibroma. Aust Dent J 1985;30:405-9.  Back to cited text no. 10
    
11.
Neville BW, Damm DD, Allen CM, Bouquot JE. Soft tissue tumors. In: Dollan J, editor. Oral and Maxillofacial Pathology. 3 rd ed. St. Louis: Saunders Elsevier; 2009. p. 509-10.  Back to cited text no. 11
    
12.
Bakos LH. The giant cell fibroma: A review of 116 cases. Ann Dent 1992;51:32-5.  Back to cited text no. 12
    
13.
Lukes SM, Kuhnert J, Mangels MA. Identification of a giant cell fibroma. J Dent Hyg 2005;79:9.  Back to cited text no. 13
    
14.
Weathers DR, Campbell WG. Ultrastructure of the giant-cell fibroma of the oral mucosa. Oral Surg Oral Med Oral Pathol 1974;38:550-61.  Back to cited text no. 14
    
15.
Odell EW, Lock C, Lombardi TL. Phenotypic characterisation of stellate and giant cells in giant cell fibroma by immunocytochemistry. J Oral Pathol Med 1994;23:284-7.  Back to cited text no. 15
    
16.
Kuo RC, Wang YP, Chen HM, Sun A, Liu BY, Kuo YS. Clinicopathological study of oral giant cell fibromas. J Formos Med Assoc 2009;108:725-9.  Back to cited text no. 16
    


    Figures

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



 

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Introduction
Case Report: Cel...
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