Journal of Indian Academy of Oral Medicine and Radiology

CASE REPORT
Year
: 2017  |  Volume : 29  |  Issue : 3  |  Page : 238--241

Effectiveness of soft tissue diode laser in treatment of oral mucosal lesions


Amanpreet Kaur, Neeta Misra, Deepak Umapathy, Ganiga Channaiah Shivakumar 
 Department of Oral Medicine and Radiology, Babu Banarasi Das College of Dental Sciences, Lucknow, Uttar Pradesh, India

Correspondence Address:
Amanpreet Kaur
Department of Oral Medicine and Radiology, Babu Banarasi Das College of Dental Sciences, Lucknow, Uttar Pradesh
India

Abstract

Soft tissue diode lasers are becoming popular among clinicians due to their potential value in surgical procedures providing surface sterilization, dry surgical field, and increased patient acceptance. Two patients with different soft tissue lesions were selected, and soft tissue diode laser was used for excision and wound healing was assessed by visual method with photographs. No discomfort to the patient during and after the laser procedure was observed. Inspite of using minimal local anesthesia, avoiding placement of sutures, and not prescribing any antibiotics, minimal bleeding, no edema, and good wound healing was observed. We conclude that lasers treatments can be superior to conventional approaches with regards to easy ablation, decontamination, and hemostasis, and are less painful during and after the procedure.



How to cite this article:
Kaur A, Misra N, Umapathy D, Shivakumar GC. Effectiveness of soft tissue diode laser in treatment of oral mucosal lesions.J Indian Acad Oral Med Radiol 2017;29:238-241


How to cite this URL:
Kaur A, Misra N, Umapathy D, Shivakumar GC. Effectiveness of soft tissue diode laser in treatment of oral mucosal lesions. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2020 Nov 30 ];29:238-241
Available from: https://www.jiaomr.in/text.asp?2017/29/3/238/218724


Full Text

 Introduction



Lasers have been used in medicine and dentistry since the early 1960s. Laser, an acronym used for Light Amplification by Stimulated Emission of Radiation,[1] is a device for generating a high-intensity, ostensibly parallel beam of monochromatic electromagnetic radiation. From the time laser was discovered in 1960, the desire to use this new technology in the medical field commenced.[2] As laser was yielding successful results when used as an alternative method to surgical intervention, the interest to use lasers in dentistry multiplied. The introduction of soft tissue laser was a boon for dentistry. Diode lasers were used in the soft tissue lesions because of its increased success rate, and due to the fact that they are well absorbed by chromophores such as hemoglobin and melanin, which are found abundantly in the oral mucosa.[3] The interest to use these lasers in the treatment of oral soft tissue lesions was because of the properties of these lasers.

In literature, laser has been recommended for the treatment of benign oral lesions, e.g. fibromas, hemangiomas, papillomas, idiopathic gingival hyperplasias, or gingival hyperplasia due to side effects of medications, aphthous ulcers, mucosal frenula, or tongue ties (ankyloglossia), as well as premalignant lesions such as oral leukoplakias, erythroplakia, etc., This case report describes the effectiveness of diode laser in the excision of two different oral soft tissue lesions and the objective was to assess the wound healing after 1 week. The laser procedure was performed on two patients who had visited the Department of Oral Medicine, Diagnosis and Radiology, Babu Banarasi Das College of Dental Sciences, Lucknow, with a chief complaint of a growth in the mouth. On intraoral examination, the soft tissue lesions were provisionally diagnosed as peripheral ossifying fibroma in case 1 and intraoral lipoma in case 2.

 Case Reports



Case 1

A 28-year-old female reported with a complaint of growth in the gums. The growth started 2 years back and slowly progressed to the present size. It was painless and the patient's complaint was discomfort because of cosmetic reasons. Patient's medical history was noncontributory, and there were no extraoral changes. On intraoral examination, a single sessile swelling present in the region of mandibular right back region extending from 44 to 48, measuring around 4 × 1.5 cm was observed. The growth was pinkish red, firm with a smooth surface, and was not ulcerated [Figure 1]. There was spontaneous bleeding. The teeth in the area of enlargement were vital and did not show any periodontal pockets. Intraoral periapical radiograph revealed horizontal bone loss with normal periodontal ligament space, lamina dura, and periapical tissues. Mandibular occlusal radiograph was taken, which revealed no abnormality. An orthopantomograph was taken to obtain a broader view of the jaws which did not reveal any bony lesions or pathology, relevant to the gingival enlargement directly or indirectly. Patient was systemically healthy and there were no relevant medical problems. She was not on any medication, and a hemogram and fasting blood sugar levels were within normal range. A provisional diagnosis of peripheral ossifying fibroma was made with a differential diagnosis of irritational fibroma. Under local anesthesia, surgical excision of the lesion using diode laser with 300 μm-fiber tip, 810 nm wavelength and 3 W power for 3 × 60 s was performed and the excised specimen was submitted for microscopic examination in 10% buffered formalin [Figure 2]. The patient was followed up after 1 week and good healing was observed [Figure 3]. Histopathological examination, using a light microscope revealed presence of dense fibrous connective tissue trauma with an overlying epithelium. The stroma showed collagen fibre bundles arranged closely packed together. Few odontogenic epithelial rests were also seen. The overlying epithelium was parakeratinized stratified squamous. According to the histopathology features, a definitive diagnosis of fibroma was made.{Figure 1}{Figure 2}{Figure 3}

Case 2

The second case is of a 40-year-old female who presented with a growth in the left retromolar region for the past 6 months. It was initially small and had grown to the present size. It was painless and the patient's complaint was discomfort while eating. Patient's family and medical history were noncontributory. Intraoral examination revealed single well-circumscribed, pedunculated, smooth surfaced growth in the left retromolar area. The color of the growth was pink. On palpation, it was soft, fluctuant, nontender, and mobile. The margins were slippery under the palpating finger [Figure 4]. A provisional diagnosis of intraoral lipoma was made. Under local anesthesia, surgical excision of the lesion using diode laser with 300-μm fiber tip, 810 nm wavelength, and 3 W power for 3 × 60 s was performed and submitted for microscopic examination in 10% buffered formalin [Figure 5]. The patient was followed after 1 week and good healing was observed [Figure 6]. On histopathological examination, using light microscope revealed presence of adipocytes arranged in clusters with dense fibrous capsule made up of densely packed collagen fibres. Correlating the clinical and histological features, a final diagnosis of intraoral lipoma was made.{Figure 4}{Figure 5}{Figure 6}

 Discussion



One of the applications of lasers in dentistry is soft tissue surgery and ablation of lesions. The excision of exophytic lesions is one of these applications. The advantages of laser application are relatively bloodless surgery, minimal swelling, scarring and coagulation, no need for suturing, reduction in surgical time, and less or no postsurgical pain. Furthermore, the laser instantly disinfects the surgical wound and there is no mechanical trauma to the tissue.[4],[5],[6] Laser transmits energy to the cells causing warming, welding, coagulation, protein denaturation, drying, vaporization, and carbonization.

The diode laser was introduced in dentistry and oral surgery in the mid-90s.[7] The diode laser devices have specifications such as relatively small size, being portable, and low cost that attracts the dental practitioners and oral surgeons for use in various surgical indications in comparison to other laser equipment.[8] The diode lasers have been used in three wavelengths, 810, 940, and 980 nm, in surgical treatments. Provided correct selection and application of diode lasers in soft tissue oral surgery is employed, for example, for frenectomy, epulis fissuratum, fibroma, facial pigmentation, and vascular lesions, they are safe and useful.[9] The unique specialties of diode lasers, such as sharp and definite cutting edge, hemostasis, and coagulation after surgery in addition to small size and better maneuverability during application, makes them very effective and a useful alternative device in soft tissue surgery in the oral cavity in comparison to other lasers types such as carbon dioxide laser (CO2) and erbium lasers.

In both the cases, a definitive excision of the lesion was accomplished and good healing was observed. During the procedure, the patients did not experience any discomfort or pain and no postoperative pain was observed. Minimal bleeding during the procedure was observed. Minimal local or topical anesthesia was needed during the procedure and there was no need for suturing the surgical wound. Postoperatively, there was no edema and good healing was observed after 1 month of the procedure. Laser-induced wounds because of a definite and clean wound generally heal with secondary intention and no scar formation. This is may be due to the minimal degree of wound contraction following laser irradiation, which occurs through induction and formation of smaller number of myofibroblasts and collagen.[10],[11]

 Conclusion



The application of diode lasers has been recognized as an adjunctive or alternative approach in soft tissue surgeries. Laser treatments have been shown to be superior to conventional mechanical approaches with regard to easy ablation, decontamination, and hemostasis, as well as less surgical and postoperative pain in soft tissue lesion management.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Francis C. The use of lasers in the treatment of vascular and pigmented lesions. Oral Maxillofac Surg Clin North Am 1998;10:141-54.
2Coluzzi DJ, Convissar RA. Lasers in clinical dentistry. Dent Clin North Am 2004;48:11-2.
3Taylor RT, Shklar G, Roeber F. The effect of laser radiation on teeth, dental pulp and oral mucosa of experimental animals. Oral Surg Oral Med Oral Pathol 1965;19:786-95.
4Eliades A, Stavrianos C, Kokkas A, Kafas P, Nazaroglou I. 808 nm diode laser in oral surgery: A case report of laser removal of fibroma. Res J Med Sci 2010;4:175-8.
5Pick RM, Pecaro BC. Use of the CO2 laser in soft tissue dental surgery. Lasers Surg Med 1987;7:207-13.
6Pecaro BC, Garehime WJ. The CO2 laser in oral and maxillofacial surgery. J Oral Maxillofac Surg 1983;41:725-8.
7Harris DM, Pick RM. Laser physics. In: Lasers in Dentistry. Chicago: Quintessence; 1995. p. 27-38.
8Coleton S. Lasers in surgical periodontics and oral medicine. Dent Clin North Am 2004;48:937-62.
9Desiate A, Cantore S, Tullo D, Profetta G, Grassi FR, Ballini A. 980 nm diode lasers in oral and facial practice: Current state of the science and art. Int J Med Sci 2009;6:358-64.
10Chomette G, Auriol M, Labrousse F, Vaillant JM. The effect of CO2 laser radiation on the morphological changes of mucocutaneous wound healing in oral surgery. A histoenzymologic and ultrastructural study. Rev Stomatol Chir Maxillofac 1991;92:1-7.
11Zeinoun T, Nammour S, Dourov N, Aftimos G, Luomanen M. Myofibroblasts in healing laser excision wounds. Lasers Surg Med 2001;28:74-9.