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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 7  |  Issue : 1  |  Page : 34-37

Clinical efficiency of a diode laser application as an adjunct to conventional surgical procedure: A boon to pediatric dentists


Department of Pedodontics and Preventive Dentistry, Army College of Dental Sciences, Secunderabad, Andhra Pradesh, India

Date of Web Publication19-Sep-2013

Correspondence Address:
Yellamma K Bai
Department of Pedodontics and Preventive dentistry, Army College of Dental Sciences, ACDS Nagar (Chennapur, CRPF road), Jai Jawaharnagar Post, Secunderabad - 500 087, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-2868.118450

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  Abstract 

Peripheral cemento-ossifying fibroma also known as peripheral ossifying fibroma (POF), peripheral cementifying fibroma, calcifying or ossifying fibroid epulis. Peripheral fibroma with calcification is a relatively common gingival growth of a reactive rather than neoplastic nature with uncertain pathogenesis and can be treated with excision under local anesthesia with Bard Parker blade, electrocautery, or Laser. Using laser in pediatric patients is been proved beneficial as laser gave us bloodless surgical site, reduced chair side time, less armamentarium and reduction or elimination of local anesthetics, suturing, postsurgical pain medication, and antibiotics due to enhanced healing. A clinical case of a 13-year-old girl child with POF with history of 45 days treated with diode laser is presented here.

Keywords: Diode laser, excision, peripheral ossifying fibroma


How to cite this article:
Bai YK, Pujita C, Venu V, Sandeep. Clinical efficiency of a diode laser application as an adjunct to conventional surgical procedure: A boon to pediatric dentists. J Dent Lasers 2013;7:34-7

How to cite this URL:
Bai YK, Pujita C, Venu V, Sandeep. Clinical efficiency of a diode laser application as an adjunct to conventional surgical procedure: A boon to pediatric dentists. J Dent Lasers [serial online] 2013 [cited 2022 Sep 26];7:34-7. Available from: https://www.jdentlasers.org/text.asp?2013/7/1/34/118450


  Introduction Top


Clinically swelling on gingiva is commonly manifested as localized traumatic, infective, or reactive lesions such as focal fibrous hyperplasia, localized gingival abscess, peripheral giant cell granuloma, pyogenic granuloma, and peripheral ossifying fibroma (POF). POF is a reactive lesion characterized by the growth of a nonneoplastic mass. [1],[2],[3] It is typically solitary, slow growing nodular mass that is either pedunculated or sessile, usually measures <1.5 cm in diameter and color may resemble that of a normal mucosa or may be slightly inflamed and its surface may be either intact or ulcerated.

The prevalence of POFs is highest around 10-19 years of age. [4] There is a gender difference with 66% of the disease occurring in females and frequently found in the area around incisors and canines. [5]

The etiopathogenesis of POF is unclear but thought to arise from cells in the periodontal ligament due to trauma or local irritation from dental plaque, calculus, poor fitting dental appliances, and poor-quality dental restorations. The recurrence rate of POF is high for a benign, reactive growth, varying from 7% to 45%. Thus, total excision and regular follow up is the preferred management of POF. [4],[5] The objective of the present article was to report a case of a 13-year-old apprehensive girl child with peripheral cemento-ossifying fibroma in the maxillary anterior region. Laser is selected as a treatment option because of its advantages of less chair side time required, less armamentarium, and bloodless surgical field, which overall decreases the child's apprehension and anxiety.


  Case Report Top


A 13-year-old girl child reported in Department of Pedodontics and Preventive Dentistry, with slow growing painless growth since 45 days present on labial gingiva in relation to maxillary central incisors. On extra oral examination there were no relevant findings. Intraoral examination revealed a 1.5 × 1.2 cm localized, nodular growth with well-defined borders, sessile, color similar to that of adjacent mucosa, painless, firm in consistency, nontender, unattached to the underlying structures on the facial surface of the maxillary gingiva between the central incisors covering most of the facial surface of right central incisor [Figure 1] and [Figure 2].
Figure 1: Picture showing the lesion (frontal view and side view)

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Figure 2: Picture showing the lesion (frontal view and side view)

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The lesion was involving the interdental papilla and the attached gingiva. There was no history of pain, ulceration, pus discharge, or bleeding. The lesion was asymptomatic and the patient's chief complaint was abnormal swelling of gums compromising aesthetics. Oral hygiene was fair to good. An Intra-oral peri-apical radiograph was taken from the maxillary anterior region, which showed no abnormal findings. A provisional diagnosis of peripheral cemento-ossifying fibroma was made while differential diagnosis included peripheral giant cell granuloma and pyogenic granuloma. The patient was referred for routine blood investigations. All findings were within normal limits.

After extra and intraoral antisepsis, infiltrative local analgesia was given. First suture was tied to the mass and incision was made involving healthy tissue with Bard Parker blade to take out biopsy specimen [Figure 3]. As after removal of biopsy specimen, it was immersed in 10% formalin and sent for histopathological examination and remaining excision of the lesion done with diode laser (3 watts, contact mode with continuous wave) that gave a blood less surgical site and complete removal of lesion along with fibrous tissue [Figure 4], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]. The surgical wound was then irrigated and ZnoE pack was applied [Figure 7]. Patient recalled after a period of one week [Figure 8] and [Figure 9].
Figure 3: A part of lesion being excised for biopsy

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Figure 4: Diode laser being used for removal of the lesion

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Figure 5: Lesion after removal with laser (hemostasis is achieved with lasers)

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Figure 6: Specimen after removal

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Figure 7: Periodontal pack applied

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Figure 8: After one week postoperative

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Figure 9: Biopsy report

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  Discussion Top


Here is a case of peripheral cement-ossifying fibroma in a 13-year-old girl child. It is a fairly common lesion that documented 3% of oral lesions. [2]. They are generally more than 2 cm in diameter, but it can vary between 0.2 and 8 cm. Cases of tooth migration and bone destruction have been reported, but these are not common. [2] Conventional treatment consists of conservative surgical excision along with scaling of adjacent teeth but according to recent advances, lasers have been used for a multitude of dental procedures, which are predominantly soft tissue procedures. [2]

The breakthrough for lasers in the field of the dentistry came in the mid 1990s, with various laser types (Nd:YAG, Er, Cr:YSGG, Er:YAG, CO2) with corresponding wavelengths (1064 2780, 2940, 10600 nm) becoming available to the dentists to address their needs for hard and soft tissue procedures. [6] Among the various lasers appearing in the mid 1990s, semiconductor diode lasers also made their debut with several advantages, including their small size, price range, and versatility regarding the possible treatment applications, which include predominantly soft tissue procedures like soft tissue surgery, periodontal therapy, periimplatitis but can also be used for hard tissue (teeth), that is, endodontics - rootcanal disinfection and laser-assisted tooth whitening. [6]

With the development and introduction of lasers, the pediatric dentist has a safe and efficient laser tool to treat hard and soft tissue of the oral cavity. It is good for treatment involving pigmented soft tissue and is absorbed by hemoglobin in blood and therefore are effective haemostatic devices giving bloodless field for surgery. The bactericidal effect that can sterilize the area, numbing or analgesic effect on the target tissue, shallow depth of tissue penetration, high affinity for water, lack of thermal damage and minimal reflective property makes it ideal for pediatric dentistry. [7] Clinical experience has shown that there are many benefits to treating children with laser over conventional methods as reduction in chair time, elimination of high speed drill with its associated vibrations, smell and fear factor; and reduction or elimination of local anesthetics, suturing, pain medications and antibiotics. Hence lasers represent a phenomenal change in dentistry and in the future the laser may be just as commonplace as the dental handpiece in the dental office. [7]

 
  References Top

1.Delbem AC, Cunha RF, Silva JZ, Soubhia AM. Peripheral Cemento ossifying Fibroma in child: A follow of four years. Report of a case. Eur J Dent 2008;2:134-7.  Back to cited text no. 1
    
2.Farquhar T, Maclellan J, Dyment H, Anderson RD. Peripheral ossifying Fibroma: A case report. J Can Dent Assoc 2008;74:809-12.  Back to cited text no. 2
[PUBMED]    
3.Bhaskar SN, Jacoway JR. Peripheral fibroma and peripheral fibroma with calcification: Report of 376 cases. J Am Dent Assoc 1996;73:1312-20.  Back to cited text no. 3
    
4.Alam T, Dawasaz AD, 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. 4
    
5.Eversole LR, Rovin S. Reactive lesions of the Gingiva. J Oral Pathol 1972;1:30-8.  Back to cited text no. 5
[PUBMED]    
6.Pirnat S. Versatility of an 810 nm Diode Laser in Dentistry: An Overview J Laser Health Acad 2007; No. 4:1-2.  Back to cited text no. 6
    
7.Kotlow LA. Lasers in Pediatric dentistry. Dent Clin North Am 2004;48:889-922.  Back to cited text no. 7
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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