|Year : 2016 | Volume
| Issue : 1 | Page : 28-31
Surgical diode laser excision for cellular fibroma
Veena Kalburgi, Shefali Jain, Sandhya Raghuwanshi
Department of Periodontology, People's Dental Academy, Bhopal, Madhya Pradesh, India
|Date of Web Publication||23-Jun-2016|
Department of Periodontology, People's Dental Academy, Bhanpura, Bhopal - 462 038, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
Dentistry has changed tremendously over the past decade to benifit both clinician and patient.  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.  Fibroma is a result of a chronic repair process that includes granulation tissue and scar formation resulting in a fibrous submucosal mass.  Recurrences are rare and may be caused by repetitive trauma at the same site. This lesion does not have a risk for malignancy.  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. 
| Case Report: Cellular Fibroma|| |
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. 
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]. 
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.
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.
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].
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].
| Discussion|| |
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. ,,,,
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. ,,
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. ,
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. ,,
| Conclusion|| |
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. 
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]