|Year : 2021 | Volume
| Issue : 1 | Page : 47-51
A case series of treatment of oral mucosal lesions using diode lasers
Akshay Katara, Mandavi Waghmare, Naisargi Kadakia, Sejal Samson, Roshni Minhas
Department of Oral Medicine and Radiology, DY Patil Deemed to be University School of Dentistry, Navi Mumbai, Maharashtra, India
|Date of Submission||25-Aug-2020|
|Date of Decision||25-Aug-2020|
|Date of Acceptance||11-Jan-2021|
|Date of Web Publication||16-Feb-2021|
Flat No: 103, Poonam Darshan C Wing, Poonam Nagar, Off Mahakali Caves Road, Andheri East, Mumbai - 400 093, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Einstein's photoelectric amplification theory provided the template for the development of lasers. With recent technological advancements, the increasing use of lasers in dentistry has had a meaningful impact on the diagnosis and management of oral mucosal lesions. This case series highlights lasers' impact. Case Reports: Five patients with diagnoses of arteriovenous malformation, homogeneous leukoplakia, mucocele, traumatic fibroma, and erosive lichen planus were treated with a diode laser (1,200 J/s; wavelength of 940 nm; 1.5 W; pulse mode). The patients were followed up to evaluate lesion healing and complete healing of the lesion was rapidly achieved with minimal discomfort. Conclusion: Soft-tissue lasers are trending in the management of various oral mucosal lesions due to their advantages of providing higher precision, a clean surgical field with minimal blood loss, accelerated wound healing, and fewer postoperative complications.
Keywords: Arteriovenous malformation, diode lasers, erosive lichen planus., homogeneous leukoplakia, mucocele, oral mucosal lesions, traumatic fibroma
|How to cite this article:|
Katara A, Waghmare M, Kadakia N, Samson S, Minhas R. A case series of treatment of oral mucosal lesions using diode lasers. Sci Dent J 2021;5:47-51
|How to cite this URL:|
Katara A, Waghmare M, Kadakia N, Samson S, Minhas R. A case series of treatment of oral mucosal lesions using diode lasers. Sci Dent J [serial online] 2021 [cited 2021 May 11];5:47-51. Available from: https://www.scidentj.com/text.asp?2021/5/1/47/309542
| Background|| |
In 1917, Albert Einstein's theory of photoelectric amplification laid the groundwork for the invention of light amplification by stimulated emission of radiation (laser). In 1960, Miaman was the first person to use lasers in dentistry, applying them to both hard and soft tissues of the oral cavity.
Lasers conduct heat by converting electromagnetic energy to thermal energy. The properties of a laser are determined by its wavelength, which influences its clinical applications. In general, a range from 193 to 10,600 nm (ultraviolet to infrared) is used in medicine and dentistry. The action of lasers is enhanced by the various chromophores present in tissues, especially heme and melanin, which are abundantly found in the oral cavity. This allows the maximization of their effectiveness in treating oral lesions. Zokaee et al. described the use of lasers as a novel prophylactic and therapeutic method with light emitted in the 600–1000-nm spectrum range (red to near-infrared). Gross et al. reported that lasers have analgesic and wound healing effects. The anti-inflammatory effect of low-level lasers is derived from their ability to limit the release of inflammatory mediators, such as bradykinin, histamine, and especially prostaglandin, during inflammatory responses.
Nonthermal laser therapy can promote cell and tissue alterations caused by different types of metabolic activation, such as the increased activity of mitochondria and the Na+/K+ pump, increased vascularization, and fibroblast formation, thereby accelerating the recovery tissue healing by noninvasive means. Lasers are recommended for the treatment of oral lesions, such as mucoceles, fibromas, papillomas, hemangiomas, gingival enlargement, aphthous ulcers, leukoplakia, lichen planus, and vesiculobullous lesions, as well as for gingival depigmentation, frenectomy procedures, and the management of pain associated with temporomandibular disorders. In this article, we report a series of cases treated with diode lasers in the Department of Oral Medicine and Maxillofacial Radiology.
| Case Reports|| |
A 30-year-old male patient referred to our department with a chief complaint of growth in the upper right side of his jaw over the previous three months. The patient reported no history of accidental cheek biting and no episodes of bleeding. The growth appeared suddenly and was painless but gradually increased in size. The swelling occasionally interfered with mastication and caused the patient discomfort. The patient's medical and family history was noncontributory to the condition.
On intra-oral examination, a solitary and roughly round sessile growth 1.5 cm × 2 cm in size was seen over the right buccal mucosa adjacent to the maxillary first molar region [Figure 1]a. The growth was bluishred, nontender, and compressible. Diascopy and fluctuation tests were positive.
|Figure 1: (a) A solitary bluish red sessile growth in the right buccal mucosa (Case 1). (b) The surgical site after laser excision (Case 1). (c) Completely healed surgical site (Case 1)|
Click here to view
Based on the patient's history, clinical presentation, and clinical examination, a provisional diagnosis of arteriovenous malformation and a differential diagnosis of capillary hemangioma was established. A surgical excision of the lesion was planned. Informed consent was obtained from the patient. Preoperative blood examinations included complete blood count (CBC), bleeding time (BT), and clotting time (CT). The lesion was excised using a BIOLASE Epic X diode laser (1,200 J/s; wavelength of 940 nm; 1.5 W; pulse mode; BIOLASE, Foothill Ranch, CA, USA) under local anesthesia [Figure 1]b. On the histopathological evaluation of the excised lesion, hematoxylin and eosin (H and E)-stained section showed a parakeratinized stratified squamous epithelium. The underlying connective tissue showed numerous vascular spaces filled with red blood cells. A deeper portion showed adipose tissue, muscle fibers, and salivary gland acini. The overall histopathological features were suggestive of lobular capillary hemangioma. Postoperative medications were not required; the patient was only instructed to maintain oral hygiene to avoid plaque accumulation on the surgical site. Mild delay in healing of the site was noted due to sharp buccal cusps of the teeth impinging on the excision site. Odontoplasty for the sharp cusps was performed and the site showed uneventful healing after 20 days, and no recurrence was noted [Figure 1]c.
A 48-year-old male patient referred to our department with a chief complaint of a white patch in the lower labial mucosa over the previous eight to nine months. The patient reported a tobacco-chewing habit four to five times a day over the previous ten years. The patch gradually increased in size.
On intraoral examination, a whitish ill-defined and slightly elevated plaque-like lesion was seen in the lower labial mucosa and the labial aspect of the gingiva extending from the mesial aspect of 34 and crossing the midline up to the right-side retromolar region [Figure 2]a. The patch was seen bilaterally, and it was non-scrapable and non-tender.
|Figure 2: (a) A whitish and slightly elevated non-scrapable patch in the right buccal mucosa (Case 2). (b) The ablation site after laser treatment (Case 2). (c) Completely healed site (Case 2)|
Click here to view
Based on the patient's history, clinical presentation, and clinical examination, a provisional diagnosis of homogeneous leukoplakia was established. An incisional biopsy of the site confirmed the presence of a hyperkeratotic lesion. On histopathological examination, the specimen revealed the presence of a stratified squamous epithelium with hyperkeratosis and hyperplasia. Ablation of the lesion with a diode laser was planned. Informed consent was obtained from the patient. The lesion was ablated in parts using a BIOLASE EPIC X diode laser under local anesthesia in multiple sittings [Figure 2]b. Complete ablation of the lesion was achieved within one month, and subsequent healing was noted [Figure 2]c. No recurrence was noted after six months.
A 43-year-old male patient referred to our department with a chief complaint of swelling on the left side of the lower lip over the previous seven months. The patient reported a history of accidental lip-biting during mastication. The swelling was initially small but gradually increased in size, interfering with mastication and causing the patient discomfort.
On intra-oral examination, a solitary, roughly round, sessile growth 3 cm × 2 cm in size was seen in the lower left labial mucosa. It had the same color as the adjacent mucosa [Figure 3]a and was non-tender on palpation. A fluctuation test was positive.
|Figure 3: (a) A solitary sessile growth in the lower left labial mucosa (Case 3). (b) Completely healed surgical site after laser excision (Case 3)|
Click here to view
Based on the patient's history, clinical presentation, and clinical examination, a provisional diagnosis of mucocele was established. A surgical excision of the lesion was planned. Informed consent was obtained from the patient. Preoperative blood examinations included CBC, BT, and CT. The lesion was excised using a BIOLASE EPIC X diode laser under local anesthesia [Figure 3]b. On the histopathological evaluation of the excised lesion, an H and E-stained section showed a hyperplastic parakeratinized stratified squamous epithelium. The underlying connective tissue showed small cystic spaces containing mucin and mucinophages surrounded by a connective tissue capsule with moderate inflammatory infiltrates, mainly lymphocytes, and plasma cells. Postoperative medications were not required; the patient was only instructed to maintain oral hygiene to avoid plaque accumulation on the surgical site. The site healed completely after ten days, and no recurrence was noted.
A 34-year-old female patient referred to our department with a chief complaint of growth in the right buccal mucosa over the previous 4–5 months. The patient reported a history of accidental cheek biting, after which the lesion developed. The growth was painless but gradually increased in size and occasionally interfered with mastication, causing the patient discomfort.
On intraoral examination, a solitary pedunculated and roughly round growth 2 cm × 2 cm in size was seen in the right buccal mucosa. Its surface was smooth and had the same color as the adjacent mucosa [Figure 4]a. The growth was firm, non-tender, and compressible.
|Figure 4: (a) A solitary pedunculated and round growth in the right buccal mucosa (Case 4). (b) Completely healed surgical site after laser excision (Case 4)|
Click here to view
Based on the patient's history, clinical presentation, and clinical examination, a provisional diagnosis of traumatic fibroma was established. A surgical excision of the lesion was planned. Informed consent was obtained from the patient. Preoperative blood investigations included CBC, BT, and CT. The lesion was excised using a BIOLASE EPIC X diode laser under local anesthesia. On the histopathological evaluation of the excised lesion, an H and E-stained section showed a parakeratinized stratified squamous epithelium with an underlying connective tissue stroma showing dense collagen bundles. Postoperative medications were not required; the patient was only instructed to maintain oral hygiene to avoid plaque accumulation on the surgical site.
The site healed completely after 10 days, and no recurrence was noted [Figure 4]b.
A 35-year-old female patient referred to our department with a chief complaint of frequent ulceration in the oral cavity with bleeding gums and a burning sensation when consuming spicy food over the previous six months. The patient's medical and family history was noncontributory.
On intraoral examination, a red erythematous patch was seen in the right buccal mucosa, which was covered with yellowish slough and surrounded by white striations. The lesion extended anterioposteriorly from the right commissure of the lip to the mesial aspect of the third molar and superioinferiorly from the buccal mucosa into the buccal vestibule [Figure 5]a. The patient reported a history of recurrent lesions, which left a blackish pigmentation after healing.
|Figure 5: (a) A red erythematous patch in the right buccal mucosa covered with yellowish slough and surrounded by white striations (Case 5). (b) Completely healed site after laser ablation (Case 5)|
Click here to view
Based on the patient's history, clinical presentation, and clinical examination, a provisional diagnosis of erosive lichen planus was established. The patient was informed about the treatment procedure and an informed consent was obtained. Microscopic evaluation of a biopsy specimen showed a hyperparakeratotic squamous epithelium with acanthosis and sawtooth patterns in the rete ridges. The underlying connective tissue was fibrocellular with a juxtaepithelial band of inflammatory cells and melanin pigment. The histopathological findings confirmed the clinical diagnosis. Ablation of the lesion was planned. The procedure was performed using a BIOLASE EPIC X diode laser under local anesthesia. The surgical site healed completely after seven days [Figure 5]b.
| Discussion|| |
Lasers are effective and conservative treatment tools in the management of oral mucosal lesions. In this case series, most patients showed lesion healing within seven to ten days, except one patient with lobular capillary hemangioma (Case 1), who showed healing after 20 days. Odontoplasty was performed for the sharp cusps, and complete healing of the lesion was rapidly achieved.
The use of soft-tissue lasers in the management of oral mucosal lesions brings several benefits to the dentist and the patient. Lasers are well tolerated by patients and provide partial decontamination of the surgical site, shorter surgical times, minimal intraoperative bleeding, less postoperative pain and inflammation, and shorter healing times. Moreover, due to the laser-hemoglobin interaction, the use of diode lasers is considered effective for the management of patients with coagulation disorders. Owing to their coagulation effects, diode lasers promote wound healing by secondary intention. Hence, the use of sutures, which may provide a nidus for plaque accumulation, can be avoided. These benefits render the use of systemic medications for the management of postoperative pain and inflammation unnecessary. Patients merely need to use mouthwashes to maintain oral hygiene and in some cases, topical anesthetic agents, such as 2% lidocaine., Romanos et al. suggested that diode lasers are effective tools for the management of oral mucosal lesions such as mucoceles, gingival fibromas, and hemangiomas, as well as for frenectomy procedures. Similarly, Ishii et al. reported that lasers are effective in treating premalignant lesions, such as those caused by leukoplakia, and are associated with lower chances of recurrence. Kharadi et al. evaluated the effectiveness of a diode laser in the management of oral leukoplakia and reported uneventful healing with no complications. Darcangelo et al. and Amaral et al. found that diode lasers are more advantageous than conventional scalpel excisions of the oral soft tissue due to less intra- and postoperative bleeding and surgical site edema, better coagulation, no scarring, no need for sutures, and less postoperative pain.,
| Conclusion|| |
Lasers contribute to excellent treatment with minimally invasive surgical procedures. They offer many advantages in the treatment of patients with various types of oral mucosal lesions and maxillofacial disorders. It is conceivable that lasers will play an increasingly important role in dentistry.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images, and other clinical information to be reported in the journal. The patients understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
David CM, Gupta P. Lasers in dentistry: A review. Int J Adv Health Sci 2015;2:7-13.
Shokrollahi K, Raymond E, Murison MS. Lasers: Principles and surgical applications. J Surg 2004;2:28-34.
Mishra M, Mishra S. Lasers and its clinical applications in dentistry. Int J Dent Clin 2011;3:358.
Zokaee H, Akbari Zahmati AH, Mojrian N, Boostani A, Vaghari M. Efficacy of low-level laser therapy on orofacial pain: A literature review. Adv Hum Biol 2018;8:70-3.
Gross AR, Dziengo S, Boers O, Goldsmith CH, Graham N, Lilge L, et al
. Low level laser therapy (LLLT) for neck pain: A systematic review and meta-regression. Open Orthop J 2013;7:396-419.
Karu TL. Molecular mechanism of therapeutic effect of low intensity laser radiation. Laser Life Sci 1988;2:53-74.
Romeo U, Russo C, Palaia G, Lo Giudice R, Del Vecchio A, Visca P, et al
. Biopsy of different oral soft tissues lesions by KTP and diode laser: Histological evaluation. ScientificWorldJournal 2014;2014:761704.
Pick RM, Colvard MD. Current status of lasers in soft tissue dental surgery. J Periodontol. 1993;64:589-602.
Goharkhay K, Moritz A, Wilder-Smith P, Schoop U, Kluger W, Jakolitsch S, et al
. Effects on oral soft tissue produced by a diode laser in vitro
. Lasers Surg Med 1999;25:401-6.
Romanos G, Nentwig GH. Diode laser (980 nm) in oral and maxillofacial surgical procedures: Clinical observations based on clinical applications. J Clin Laser Med Surg 1999;17:193-7.
Ishii J, Fujita K, Komori T. Laser surgery as a treatment for oral leukoplakia. Oral Oncol 2003;39:759-69.
Kharadi UA, Onkar S, Birangane R, Chaudhari S, Kulkarni A, Chaudhari R. Treatment of oral leukoplakia with diode laser: A pilot study on Indian subjects. Asian Pac J Cancer Prev 2015;16:8383-6.
D'Arcangelo C, Di Nardo Di Maio F, Prosperi GD, Conte E, Baldi M, Caputi S. A preliminary study of healing of diode laser versus scalpel incisions in rat oral tissue: A comparison of clinical, histological, and immunohistochemical results. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:764-73.
Amaral MB, de Ávila JM, Abreu MH, Mesquita RA. Diode laser surgery versus scalpel surgery in the treatment of fibrous hyperplasia: A randomized clinical trial. Int J Oral Maxillofac Surg 2015;44:1383-9.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]