Excision of Fibroma using Dental Soft-tissue Diode Laser

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Excision of Fibroma using Dental Soft-tissue
Diode Laser Introduction- A fibroma is a benign
scar like reaction due to persistent long
standing irritation in the mouth resulting in an
increase in connective tissue at the site of
repeated trauma. They are also known as
traumatic fibromas, focal intra-oral fibrous
hyperplasia, fibrous nodules, or oral
polyps. Clinical Features- Fibromas are often
found on the interior of the cheek, lips, or
lateral borders of the tongue and result from
tissue being trapped between the maxillary and
mandibular teeth when occluding. An oral fibroma
presents as a firm smooth lump and is usually
similar in color to the surrounding soft tissue,
although it may be paler due to less vascularity
and increased connective tissue within it. A
fibroma also may present darker if trauma has
led to bleeding inside of it and may have an
ulcerated surface related to recent trauma.
Fibromas have a dome-shaped geometry but may be
pedunculated (polyp-like with a short stalk-like
base). Treatment Biopsy and oral fibroma removal
traditionally has been performed with a scalpel
that results in excision resulting in bleeding
margins. The raw bleeding edge left by scalpel
excision frequently requires suture placement to
control bleeding. Additionally, these types of
wounds have been associated with postoperative
pain and inflammation. The use of sutures for
wound management may exacerbate site irritation
until their resorption or removal. Later
techniques advocated the use of monopolar
electrosurgery as an alternative to the scalpel
blade. Electrosurgery, if used improperly, has
the potential to cause tissue burns and increased
site inflammation that may hamper healing. With
the advent of lasers for soft-tissue surgeries,
various types of laser devices have been used
successfully for oral fibroma removal. Laser
selection is practitioner dependent. PIOON Laser
offers different wavelengths like 450nm/810nm or
980nm. The most preferred among them is 450nm
wavelength. After informed consent, the lesion
was infiltrated with local anesthesia, the
protective eye wear were worn and then the lesion
was excised using 450nm in noncontact mode with
surgical tip (400µm) making sure to remove the
stalk attaching the lesion. After the procedure,
postoperative instructions were given and
analgesic was prescribed on as and when
basis. Also, care should be taken to get rid off
the cause (sharp cusps or fractured tooth if any)
along with the excision to make the treatment
outcome more predictive. Here low level laser
therapy can also be done over the exposed wound
area using 660nm (red light) in noncontact mode
to assist in faster healing and to manage
postoperative pain. Rationale of use of lasers -
An advantage of diode laser application compared
to scalpel use is the provision of a relatively
bloodless surgical incision with minimal swelling
and scarring postoperatively. Also, compared to
an electrosurgery tip, the use of a diode laser
reduces the zone of affected cells considerably,
thus less tissue trauma and thermal burning and
better healing have been reported. Consequently,
the diode laser is suitable for excision of oral
fibromas.
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An interesting study by C. Fornaini et al
suggested decreased excision time with a blue
diode laser (wavelength 450nm). The operating
time was considerably decreased and the
superficial rise in temperature at the operated
site was markedly lower as compared to that with
810 or 1370 nm wavelength laser. Conclusion-
Dental Diode lasers can be used for fibroma
removal. A 450 nm wavelength offers
significantly better healing with comfort for the
patient themselves. References - Carlo Fornaini,
Jean-Paul Rocca, Elisabetta Merigo. 450nm blue
laser and oral surgery preliminary ex vivo
study. The Journal of Contemporary Dental
Practice, October 201617(10)795-800
Preopertaive View (Pic Courtsey Dr Sana Farista)
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Postopertaive View (Pic Courtsey Dr Sana
Farista) By Dr Saumya Bhatia BDS, MSc Oral and
Maxillofacial Surgery (University College
London, London) Divas in Laser
Tags 450nm laser ,450nm wavelength ,blue dental
laser ,dental diode laser ,dental
laser, Dental Soft-tissue Laser ,Excision Fibroma,
Excision of Fibroma, Fibroma ,oral
fibroma removal