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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 24-26

A case report on the excision of irritational fibroma using the diode laser


Department of Oral Medicine and Radiology, DY Patil University School of Dentistry, Navi Mumbai, Maharashtra, India

Date of Submission13-Sep-2020
Date of Decision31-Jan-2020
Date of Acceptance02-Apr-2020
Date of Web Publication28-Mar-2020

Correspondence Address:
Akshay Ashok Katara
Flat No: 103, Poonam Darshan “C” CHS Ltd., Poonam Nagar, Off Mahakali Caves Road, Andheri East, Mumbai - 400 093, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_46_19

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  Abstract 


Irritational fibroma is a commonly occurring oral lesion, which may mimic many other pathological conditions. In this case report, we present a case of a 15-year-old male with an ill-defined overgrowth on the gingiva which was diagnosed with an irrational fibroma due to the presence of calculus. This was then excised using biolase laser, and uneventful healing was noted postoperatively. The advantage of laser over conventional treatment is that it helps in better precision, clean surgical field, and lesser postoperative complications.

Keywords: Fibroma, gingiva, laser


How to cite this article:
Katara AA, Minhas R, Kumar A, Dasgupta S. A case report on the excision of irritational fibroma using the diode laser. J Dent Res Rev 2020;7:24-6

How to cite this URL:
Katara AA, Minhas R, Kumar A, Dasgupta S. A case report on the excision of irritational fibroma using the diode laser. J Dent Res Rev [serial online] 2020 [cited 2020 Aug 14];7:24-6. Available from: http://www.jdrr.org/text.asp?2020/7/1/24/281506




  Introduction Top


Laser was developed by Maiman in 1960.[1] The diode laser system has a wide range of practical applications and is an important tool for the efficient treatment of premalignant lesions and benign tumors of the oral mucosa.[2]

In our day-to-day clinical practice, we may come across a variety of soft-tissue benign lesions. Irritational fibroma is commonly known as traumatic fibroma. It is exophytic in nature and is regarded as one of the most common benign soft-tissue lesions occurring in the oral cavity.[3]


  Case Report Top


A 15-year-old male patient reported to the Department of Oral Medicine and Radiology, DY Patil University School of Dentistry, with the chief complaint of a painless whitish growth in the lower front region of the jaw involving the gingiva for the past 2 months with difficulty in mastication and caused discomfort [Figure 1]. The growth had gradually increased to the present size with no complaint of pain in the affected region. No previous episodes of similar overgrowth given by the patient. The patient's medical and family history was noncontributory to the present case.
Figure 1: The presence of fibroma involving the gingival margin on the labial aspect of 32

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Intraoral examination revealed a gray-white colored lesion approximately 2 cm × 1 cm solitary, pedunculated, and ovoid growth on the attached gingiva of 32. The lesion was soft in consistency, nontender, and without any discharge. Intraoral periapical radiograph showed no evidence of calcification [Figure 2]. Oral cavity examination revealed poor oral hygiene with the presence of moderate plaque and calculus deposits.
Figure 2: No evidence of calcification seen on intraoral periapical

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Based on the history given by the patient and clinical presentation, irritational fibroma was considered as a provisional diagnosis. Informed consent was obtained from the patient, and he was informed about the treatment procedure. Routine blood investigations were performed, and they were within the normal range. The lesion was excised using Biolase laser (diode laser at 1200 J/s; wavelength of 940 nm; and excision mode) under local anesthesia [Figure 3]. The patient was given postoperative instructions and was followed up after 3 days, 1 week and at the end of 1-month follow-up. The healing of the lesion was uncomplicated and no recurrence was noted [Figure 4].
Figure 3: Excised tissue

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Figure 4: Postexcision site

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  Discussion Top


Irritational fibromas are more prevalent in females with an average of 66%. Multiple fibromas may be seen in cases of fibrotic papillary hyperplasia of the palate, familial fibromatosis, and Cowden syndrome (multiple hamartoma syndromes). A generalized fibrous overgrowth of the gingival tissues is seen in cases of fibrous gingival hyperplasia.[4] The lesion typically appears as a pink nodule which is smooth surfaced and similar in color to the surrounding mucosa. Irritational fibromas are most of the time sessile, but in some cases, it may also be pedunculated. In some cases, it may be flat and have a leaf-like appearance if it grows a denture.[5]

Histopathological examination of the excised lesion is a gold standard to rule out other pathologies that may mimic an irritational fibroma.[6] Differential diagnosis is determined by the clinical location of the tumor. Granular cell tumors, schwannoma, and neurofibroma can be considered for tumors on the tongue. When the lesion is present on the lower labial mucosa, then lipoma and other salivary gland tumors should be considered.[7]

In the present case report, the diode laser is used over the conventional surgical excision, which is performed by a scalpel. Evidence shows that lasers are minimally invasive tools in dentistry and that they will continue to be a superb tool in the dental field.[8] The use of diode lasers is advantageous due to numerous factors such as the use of minimal local anesthetic agents, precision cutting, rapid hemostasis, low postoperative infections, and decreased scar formation.[9] The most important reason for the success of lasers is their ability to accurately excise and concurrently coagulate the soft tissue. Diode lasers help in the coagulation of blood vessels, and it plugs the lymphatic vessels.[10]

A laser unit is composed of a core made up of energy around which its structure is built, a lasing medium and a couple of reflecting mirrors. The emitted light from the laser reaches its target in the tissue through the medium of the fiber optic cable, a hollow waveguide, focusing lenses, and cooling system.[11] The action of laser is based on the Amdt–Schultz principle. Due to this reason, an increase or decrease in the stimulus beyond the optimal dose will cause the effect of laser to weaken. Hence, it is necessary to have an optimal dose which determines the efficacy of laser.

Laser application causes stimulation of mast cells and lymphocytes which results in anti-inflammatory action. This action results in a change in the capillary hydrostatic pressure, which results in edema absorption and elimination of intermediary metabolites. The use of lasers also causes an increase in collagen synthesis, an increase in the mitotic activity of epithelial cells, and increase in fibroblast production. Hence, lasers cause an analgesic effect and also reduce the healing time postsurgical procedures with minimal intraoperative and postoperative bleeding.[12]

In the past, scalpel excision was the most vastly used surgical technique for various surgical procedures such as incisional and excisional of benign soft-tissue lesions, oral potentially malignant disorders such as leukoplakia, lichen planus, and oral submucous fibrosis. Various complications, such as increased intraoperative and postoperative bleeding, delayed wound healing, and pain, have been routinely noted with the use of scalpel excision. Advances in laser technologies have helped to overcome these shortcomings and provide an enhanced and effective treatment to the patient.

Gabric et al. conducted a study to compare diode lasers and conventional scalpel surgery for biopsy procedures of soft lesions in the oral cavity, and they noted a significantly lower occurrence of edema, bleeding, hematoma formation, and a decreased healing time and pain in the patients treated with lasers as compared to the patients treated with scalpel surgical procedure.[13]

Ramwala et al. in their study to determine the efficacy of diode laser in the management of oral premalignant lesions, found that the patients treated with lasers had less postoperative pain and no recurrence in 1 year of follow-up period.[14]


  Conclusion Top


The diode laser is a relatively simple and safe method. They cause minimal collateral damage to the adjacent healthy tissue, have an extremely precise cutting ability, and provide the bloodless operating field of surgery. They also have minimal postoperative pain and accelerated healing time and hence, they should be considered as the treatment of choice for removal of irritation fibromas and other oral soft-tissue lesions.

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 Top

1.
Neville B, Damm DD, Allen CM, Bouquot J. Oral and Maxillofacial Pathology. 3rd ed. UK: Saunders Elsevier, Oxford; 2009. p. 50.  Back to cited text no. 1
    
2.
Kohli A, Gupta K, Pandey M, Dwivedi A. Excision of irritation fibroma using a diode laser. Rama Univ J Dent Sci 2016;3:26-9.  Back to cited text no. 2
    
3.
Jackson SD, Lauto A. Diode-pumped fiber lasers: A new clinical tool? Lasers Surg Med 2002;30:184-90.  Back to cited text no. 3
    
4.
Deppe H, Horch HH. Laser applications in oral surgery and implant dentistry. Lasers Med Sci 2007;22:217-21.  Back to cited text no. 4
    
5.
Tanuja P, Babu BK, Krishna M. Laser-assisted crown lengthening and gingival depigmentation to enhance aesthetics – A case report. Ann Essen Dent 2011;3:56-60.  Back to cited text no. 5
    
6.
Haytac MC, Ozcelik O. Evaluation of patient perceptions after frenectomy operations: A comparison of carbon dioxide laser and scalpel techniques. J Periodontol 2006;77:1815-9.  Back to cited text no. 6
    
7.
Regezi JA, Sciubba JJ, Jordan RC, Abrahams PH. Oral Pathology: Clinical Pathologic Correlations. 5th ed. St. Louis. WB Saunders; 2003. p. 165-6.  Back to cited text no. 7
    
8.
Esmeili T, Lozada-Nur F, Epstein J. Common benign oral soft tissue masses. Dent Clin North Am 2005;49:223-40, x.  Back to cited text no. 8
    
9.
Neville BW, Damm DD, Allen CM, Bouquot JE. Soft tissue tumors. In: Neville BW, Damm DD, Allen CM, Bouquot JE, editors. Oral and Maxillofacial Pathology. 3rd ed. St. Louis, MO: Saunders; 2009. p. 507-70.  Back to cited text no. 9
    
10.
Sawisch TJ. Oral surgery for the general practitioner: Ablation/vaporization techniques and procedures-clinical scenarios. In: Convissar RA, editor. Principles and Practices of Laser Dentistry. St. Louis, MO: Mosby; 2011. p. 93-113.  Back to cited text no. 10
    
11.
Verma SK, Maheshwari S, Singh RK, Chaudhari PK. Laser in dentistry: An innovative tool in modern dental practice. Natl J Maxillofac Surg 2012;3:124-32.  Back to cited text no. 11
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12.
Convissar RA. Principles and Practice of Laser DentistryE-Book. 2nd edition Elsevier Health Sciences; 2015.  Back to cited text no. 12
    
13.
Gabric D, Sušić M, Katanec D, Zore IF, Boras VV, Brailo V, et al. Comparison between Diode Laser and Conventional Technique for Soft Tissue Oral Surgery: A Pilot Study. Research Journal of Pharmaceutical Biological and Chemical Sciences 2015;6:1913.   Back to cited text no. 13
    
14.
Ramwala V. Use of diode laser in the management of oral leukoplakia – A study of 10 cases. IOSR-JDMS 2016;15:81-5.  Back to cited text no. 14
    


    Figures

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



 

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