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Celentano A, Cirillo N. Diseases with oral malignant potential: Need for change to inform research, policy, and practice. J Oral Pathol Med 2024; 53:495-501. [PMID: 39104084 DOI: 10.1111/jop.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/09/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
This manuscript critically examines the current classification of oral potentially malignant disorders, questioning the practicality and implications of labeling such a large population as precancerous, given that the actual progression to oral cancer is significantly low for most disorders. The paper advocates for a revised classification system that accurately reflects the varying malignancy risks associated with different disorders. It suggests a reassessment of the diagnostic and management approaches to mitigate overdiagnosis and alleviate patient burdens. We propose categorizing diseases with oral malignant potential as follows: Oral Precancerous Diseases, encompassing high-risk lesions and conditions like erythroplakia, non-homogeneous leukoplakia, proliferative leukoplakia, and actinic keratosis; Oral Potentially Premalignant Diseases, covering lesions, conditions, and systemic diseases with distinct oral manifestations harboring a limited or undefined risk of transformation, such as homogeneous leukoplakia, oral submucous fibrosis, oral lichenoid diseases, chronic hyperplastic candidosis, keratosis of known aetiology (smokeless tobacco, khat), palatal lesions in reverse smokers, and dyskeratosis congenita; and Systemic Conditions with Oral Malignant Potential including Fanconi's anemia, xeroderma pigmentosum, and chronic immunosuppression (including patients post-bone marrow transplantation), which are associated with an increased risk of oral cancer without preceding precursor lesions. We provide illustrative examples to demonstrate how this framework offers practical guidance for research, policy-making, and clinical practice.
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Affiliation(s)
- Antonio Celentano
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Nicola Cirillo
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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Liu W, Shen X, Sun K. Laser evaporation and excision of oral leukoplakia: Highlighting the two techniques for treating different risk lesions. J Dent Sci 2024; 19:1874-1876. [PMID: 39035316 PMCID: PMC11259647 DOI: 10.1016/j.jds.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/01/2024] [Indexed: 07/23/2024] Open
Affiliation(s)
- Wei Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Fengcheng Hospital of Fengxian District, Shanghai Ninth People's Hospital Fengcheng Branch Hospital, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuemin Shen
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Sun
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Vilar-Villanueva M, Somoza-Martín JM, Blanco-Carrión A, García-García A, García-Carnicero T, Marichalar-Mendía X, Gallas-Torreira M, Gándara-Vila P. Importance of the vaporization margin during CO 2 laser treatment of oral leukoplakia: A survival study. Oral Dis 2023; 29:2689-2695. [PMID: 35942539 DOI: 10.1111/odi.14345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/16/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The main purpose of this study was to assess the response of oral leukoplakia to CO2 laser vaporization treatment, as well as determining possible factors that may affect recurrence of lesions. MATERIALS AND METHODS A retrospective study was conducted, in which the medical records of patients who had been clinically and histologically diagnosed with oral leukoplakia and treated with CO2 laser between 1996 and 2019 at the Oral Medicine Teaching Unit of the Faculty of Dentistry of the University of Santiago de Compostela were reviewed. RESULTS Fifty-eight patients were included: 36 female and 22 male subjects, with a mean age of 63.7 years old (SD ±13.1). The average follow-up time was 57.5 months (SD ±57.9). A relapse rate of 52.6% was determined. Of all the studied variables, the margin was the only one for which a statistically significant association with recurrence of lesions was demonstrated (p < 0.05). CONCLUSION The vaporization of lesions using CO2 laser with a safety margin of at least 3 mm from the clinical limits of OL is a key factor in preventing recurrence.
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Affiliation(s)
- Marta Vilar-Villanueva
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Manuel Somoza-Martín
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrés Blanco-Carrión
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Abel García-García
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Tamara García-Carnicero
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Xabier Marichalar-Mendía
- Department of Nursing I, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Osakidetza, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Mercedes Gallas-Torreira
- School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Pilar Gándara-Vila
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
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Ou M, Huang X. Histological evaluation of mouse tongue incisions after Er:YAG laser surgery with different pulse energies versus after conventional scalpel surgery. Lasers Med Sci 2023; 38:181. [PMID: 37568046 DOI: 10.1007/s10103-023-03852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To identify the surgical instrument that allows for optimal healing of tongue incisions. METHODS An Er:YAG laser was compared with different pulse energies to a conventional scalpel for the incision of mouse tongue tissues. Mice were sacrificed through cervical dislocation at 24, 48, and 72 h postoperatively, followed by extraction of their tongues for incision experiments. The healing of the incisions and expression of inflammation- and pain-related factors in the tongues were compared between the surgical procedure groups. RESULTS In laser-treated mice, tongue incisions healed the fastest when the laser output energy was 60 MJ per pulse. Macrophage chemotaxis toward the incisional area was triggered on the first postoperative day for the 60-MJ group, while the time for macrophage chemotaxis to the surgical area was later in the 80-MJ group. Tumor necrosis factor-alpha expression increased and then decreased in the 80-MJ group; however, it gradually decreased in the 60-MJ and conventional scalpel groups. Prostaglandin E2 expression increased and then decreased in the 80-MJ and conventional scalpel groups but gradually decreased in the 60-MJ group. The expression of transforming growth factor beta 1 gradually decreased in the 60-MJ and 80-MJ groups but gradually increased in the conventional scalpel group. CONCLUSION Compared with surgical procedures using conventional scalpels, those using an Er:YAG laser with appropriate pulse energies can inhibit inflammation in the incisional area and promote incision healing. The use of an Er:YAG laser with appropriate pulse energies can alleviate intraoperative and postoperative pain in the incisional area.
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Affiliation(s)
- Mingming Ou
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Xiaofeng Huang
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
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Tan YQ, Li ZT, Zhou G. Developmental synergism in the management of oral potentially malignant disorders. Photodiagnosis Photodyn Ther 2023; 42:103563. [PMID: 37031901 DOI: 10.1016/j.pdpdt.2023.103563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/21/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2023]
Abstract
Oral potentially malignant disorders (OPMDs) are associated with an increased risk of occurrence of cancers of the oral cavity or lips. The unifying theme of OPMDs is their potential risk for cancer development. Therefore, the primary objective of the management should be to prevent carcinogenesis. Beyond diagnosis, current strategies for the management of OPMDs predominantly include non-surgical and surgical interventions and a "watch-and-see" approach, such as disease monitoring or surveillance, and preventive strategies. Though no optimal clinical treatment has gained universal approval for reducing or preventing malignant development of OPMDs. Therefore, an urgent need exits for improved treatment properties and effective predictive markers for OPMDs treatment. This review aims to outline recent synergism regarding to the management of OPMDs. Developing new technologies and improved application parameters to promote the treatment efficacy and a novel management prescription approach to OPMDs are proposed.
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Affiliation(s)
- Ya-Qin Tan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei- MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
| | - Zheng-Tao Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei- MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Gang Zhou
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei- MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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An In Vitro Study of the Effect of CO 2 Laser Power Output on Ablative Properties in Porcine Tongue. Life (Basel) 2023; 13:life13010162. [PMID: 36676111 PMCID: PMC9861084 DOI: 10.3390/life13010162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023] Open
Abstract
CO2 lasers have been generally used in oral soft-tissue surgery. Although an increase in power enhances the depth of ablation, the specific correlation between units of power and ablative depth has not been stated. This study aimed to explore ablative depth and width affected by a power unit of 10,600-nm CO2 laser continuous wave at 3 to 10 W in tissue blocks of the swine tongue. The 112 samples were randomly allocated into eight groups according to the power settings. The depth and width of the incision were measured by using the ImageJ program. The 3 W group showed the minimal depth of ablation [0.527 mm (0.474 and 0.817)] and width of ablation [0.147 mm (0.110 to 0.184)]. The maximal depth [3.750 mm (3.362 and 4.118)] and width [0.700 mm (0.541 to 0.860)] were in the 9 W group. The correlation between the ablative depth and power unit was 0.81 (p < 0.001). Based on the regression equation (p < 0.001), the ablative depth (mm) = (the power unit of laser in W × 0.491) − 0.731. In conclusion, the ablative depth of the CO2 laser on soft tissue was strongly correlated to power units enabling the prediction equation.
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Shivhare P, Haidry N, Kumar A, Parihar A, Singh A, Subramanyam S. Diode Laser in the Management of Leukoplakia - A Retrospective Study. Ann Maxillofac Surg 2022; 12:178-184. [PMID: 36874766 PMCID: PMC9976845 DOI: 10.4103/ams.ams_117_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Leukoplakia is among the most common potentially malignant disorders encountered in clinical dental practice. The treatment of leukoplakia includes nonsurgical and surgical management. The surgical treatment includes excision, electrocauterisation, laser surgery or cryosurgery. This retrospective study aimed to analyse the efficacy of diode lasers in the management of leukoplakia. Methods The sample consists of 56 cases with 77 leukoplakia sites treated with diode laser between January 2018 and December 2020 with a minimum of six months follow-up. For each patient, personal data was collected along with site of lesions, leukoplakia phase, type of treatment performed (laser ablation or laser excision), side effects, recurrences and malignant transformation. Inferential statistical analysis was then conducted. Results After applying exclusion criteria, 56 cases with 77 leukoplakia sites were included in this study. Males aged >45 years were predominantly affected. Homogeneous leukoplakia (48.1%) was the most common phase. Recurrences were noted in 19.48% of the cases. Compared to laser excision, laser ablation had more recurrences. Gingival lesions showed a higher recurrence rate than other sites in the oral cavity. None of the cases showed malignant transformation. Discussion Laser offers many advantages over other conventional methods including lesser postoperative pain and swelling, bloodless dry operating field and increased patient comfort and requires minimal local anaesthesia. The study concluded that diode laser is an effective surgical treatment modality for treating leukoplakia. Furthermore, the laser excision technique was found to be superior to laser ablation due to lesser recurrence.
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Affiliation(s)
- Peeyush Shivhare
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Naqoosh Haidry
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ajay Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ajay Parihar
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ankur Singh
- Department of Oral Medicine and Radiology, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Shalini Subramanyam
- Department of Oral Medicine and Radiology, Narsinhbhai Patel Dental College and Hospital, Visnagar, Gujarat, India
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A histological evaluation of the mice oral mucosal tissue wounds excised with diode laser, Er:YAG laser, and cold scalpel. Lasers Med Sci 2022; 37:2707-2715. [PMID: 35298731 DOI: 10.1007/s10103-022-03544-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Laser has been considered to show many favorable characteristics, including wound healing acceleration, hemostasis, biostimulation, and microbial inhibition. Previous studies have investigated the effect of laser treatment during the process of wound healing, with conflicting results. To date, there is still no unified conclusion on the effect and application principle of clinical laser therapy. This study evaluated the incision morphology, wound healing speed, and histological changes in mice oral mucosal wounds excised with diode laser, Er:YAG laser, and cold scalpel. The results showed that compared with the cold scalpel group, laser treatments caused more tissue thermal damage and carbonization, which led to a healing delay. However, lasers also showed some advantages, including hemostasis, regular incision, and immune response mobilization, suggesting that lasers may be beneficial in some specific cases, such as reducing intraoperative accidents and wound tissue laceration and controlling bleeding and postoperative infection. This study provides a theoretical basis for clarifying the effect of laser treatments and their clinical application principle.
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Gómez-Armayones S, Chimenos-Küstner E, Arranz C, Tous S, Marquez S, Penín RM, Quirós B, Taberna M, Alemany L, Servitje O, Mena M. Risk factors for oral epithelial dysplasias to become malignant: clinical implications. Int J Oral Maxillofac Surg 2021; 51:473-480. [PMID: 34503889 DOI: 10.1016/j.ijom.2021.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 05/23/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
There is a lack of effective clinical management of oral epithelial dysplasias to reduce their risk of malignant transformation and considerable gaps in knowledge regarding the most effective means of treating such lesions. A retrospective cohort of biopsy-confirmed oral epithelial dysplasias consecutively diagnosed in the period 1995-2014 and followed-up until 2017 was identified from pathology department files. Demographic, clinical and follow-up information was collected. Multivariate Cox proportional-hazards models were performed to evaluate sociodemographic, clinical and pathological factors associated with progression to oral squamous cell carcinoma. The study included 144 oral epithelial dysplasias, of which 42% progressed to oral cancer at the end of follow-up (21 years). Clinical aspect of the lesion was described for 77 (53.5%) of the patients. Treatment, age, grade of the lesion and diagnostic period were independent prognostic factors for progression. When considering only patients with described clinical aspect, only treatment and grade of the lesion were independently associated with cancer. The results from this non-selected retrospective cohort of oral epithelial dysplasias underscore the existing limitations of the current standard-of-care of the patients and provide novel insights on the management of these lesions with and without described clinical aspect. Well-designed, robust prospective studies, a homogenized staging system and multidisciplinary treatment guidelines are warranted.
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Affiliation(s)
- S Gómez-Armayones
- Department of Dermatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Dermatology, Hospital Clínic of Barcelona, Barcelona, Spain.
| | - E Chimenos-Küstner
- Department of Odontostomatology, Odontological University Hospital of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Arranz
- Department Oral and Maxillofacial Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Tous
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - S Marquez
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - R M Penín
- Department of Pathology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - B Quirós
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - M Taberna
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain; Program of Molecular Mechanisms and Experimental Therapy in Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - L Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - O Servitje
- Department of Dermatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Pompeu DDS, de Paula BLF, Barros APO, Nunes SC, Carneiro AMP, Araújo JLN, Silva CM. Combination of strontium chloride and photobiomodulation in the control of tooth sensitivity post-bleaching: A split-mouth randomized clinical trial. PLoS One 2021; 16:e0250501. [PMID: 33909659 PMCID: PMC8081218 DOI: 10.1371/journal.pone.0250501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/06/2021] [Indexed: 01/10/2023] Open
Abstract
Objective This split-mouth randomized controlled clinical trial assessed the effect of 10% strontium chloride in combination with photobiomodulation (PBM) for the control of tooth sensitivity (TS) post-bleaching. Methods The upper/lower, right and left quadrants of fifty volunteers were randomized and allocated to four groups (n = 25): PLACEBO—placebo gel + simulation of PBM; Placebo + PBM; STRONTIUM—10% strontium chloride + simulation of PBM; and PBM + STRONTIUM—10% strontium chloride + PBM. All groups received tooth bleaching treatment with 35% hydrogen peroxide. For the PBM treatment, the laser tip was positioned in the apical and cervical regions of the teeth bleached in the respective hemi-arch. The laser system was operated in continuous mode, using 1.7 J of energy. A dose of 60 J/cm2 was applied to each point for 16 seconds under 808 nm near-infrared light (100mW of power), with a point area of 0.028 cm2. TS was assessed during a 21-day follow-up, using the modified visual analogue scale. Results In the intragroup assessment, the Friedman test indicated that PBM + STRONTIUM promoted the greatest reduction in TS after the second week of treatment (p ≤ 0.05). The Wilcoxon-Mann-Whitney test indicated that the groups Placebo + PBM, STRONTIUM, and STRONTIUM + PBM did not differ statistically (p ≥ 0.05) in the first and third weeks of treatment The group PLACEBO exhibited the greatest TS in the first three days after each bleaching session. Conclusion The combination of 10% strontium chloride with PBM was effective in reducing post-bleaching TS; however, the combination of 10% strontium chloride with PBM was effective in reducing post-bleaching TS; however, it did not differ from the individual use of Placebo + PBM or STRONTIUM groups assessed after 21 days of follow-up.
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Affiliation(s)
| | | | | | | | | | | | - Cecy Martins Silva
- Postgraduate Program in Dentistry of the Federal University of Pará, Belem, Brazil
- * E-mail:
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Palaia G, Renzi F, Pergolini D, Del Vecchio A, Visca P, Tenore G, Romeo U. Histological Ex Vivo Evaluation of the Suitability of a 976 nm Diode Laser in Oral Soft Tissue Biopsies. Int J Dent 2021; 2021:6658268. [PMID: 34007279 PMCID: PMC8100417 DOI: 10.1155/2021/6658268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/24/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Laser-induced thermal effects can preclude a safe histological evaluation of biopsy resection margins. The aim of this study was to evaluate the suitability of a 976 nm diode laser in oral soft tissue biopsies in an ex vivo study. MATERIALS AND METHODS A 976 nm diode laser (Solase®, Lazon Medical Laser, China) has been used in the contact mode, using a 400 μm fiber tip, at different parameters from 4 to 6 W in the continuous wave (CW), with a fluence between 3184 and 4777 J/cm2, and pulsed wave (PW) mode, with a fluence between 318,4 and 477,7 J/cm2, to obtain 30 samples from fresh pig cadaver tongues. All specimens were subdivided into 6 groups (from A to F), and each group consisted of 5 samples. Two sections were obtained from each sample. A histological analysis was performed using an optical microscope at magnifications of 5x and 10x. Statistical analysis was carried out using Kruskal-Wallis and Dunn's tests. RESULTS The results showed that histological readability was optimal in all the samples. The thermal damage was negligible in all groups. The average thermal damage was 208.40 ± 133.81 μm in the epithelial tissue and 330.14 ± 147.45 μm in the connective tissue. The statistical analysis showed no differences between the groups (p > 0.05). CONCLUSION A 976 nm diode laser demonstrated good surgical effectiveness that provoked little peripheral damage in the cut edges and allowed a safe histological diagnosis. Clinical Relevance. In oral pathology, many times, there is fear in using the laser to remove some lesions due to its thermal effect on the tissues close to the lesion. This effect is always present in the use of the laser, but the intent is to minimize this effect to have as little alteration as possible on the surrounding tissues.
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Affiliation(s)
- Gaspare Palaia
- “Sapienza” University of Rome, Department of Oral and Maxillofacial Sciences, Via Caserta 6, Rome 00161, Italy
| | - Federico Renzi
- “Sapienza” University of Rome, Department of Oral and Maxillofacial Sciences, Via Caserta 6, Rome 00161, Italy
| | - Daniele Pergolini
- “Sapienza” University of Rome, Department of Oral and Maxillofacial Sciences, Via Caserta 6, Rome 00161, Italy
| | - Alessandro Del Vecchio
- “Sapienza” University of Rome, Department of Oral and Maxillofacial Sciences, Via Caserta 6, Rome 00161, Italy
| | - Paolo Visca
- Department of Cytology and Cellular Diagnostics, Regina Elena Institute, Via Elio Chianesi 53, Rome 00144, Italy
| | - Gianluca Tenore
- “Sapienza” University of Rome, Department of Oral and Maxillofacial Sciences, Via Caserta 6, Rome 00161, Italy
| | - Umberto Romeo
- “Sapienza” University of Rome, Department of Oral and Maxillofacial Sciences, Via Caserta 6, Rome 00161, Italy
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Saldivia-Siracusa C, González-Arriagada WA. Difficulties in the Prognostic Study of Oral Leukoplakia: Standardisation Proposal of Follow-Up Parameters. FRONTIERS IN ORAL HEALTH 2021; 2:614045. [PMID: 35047990 PMCID: PMC8757698 DOI: 10.3389/froh.2021.614045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
Oral leukoplakia is the most prevalent potentially malignant disorder of the oral cavity. To evaluate its potential for malignancy, appropriate documentation of the biological parameters is crucial, allowing the patients' progression to be assessed. We hypothesized a lack of standardization in the parameters employed for the prognostic study of oral leukoplakia; our aims were to determine the different parameters used for follow-up according to definition, importance, and frequency of use, and to provide a standardization proposal of follow-up research. We made a scoping review to identify papers with the keywords “leukoplakia,” “oral,” and “follow-up” published until June 2019 in English, Spanish and Portuguese literature through an online search in PUBMED, SCIELO, and SCOPUS databases. In total, 514 articles were initially identified, and fifty-nine publications were selected, of which 37 were retrospective. The reports included a total of 18,660 patients between 13 and 98 years old, with a mean age of 57.6 years. Tobacco and alcohol habits were positive for 77 and 37% of the patients, respectively. Our results showed that reported leukoplakias were predominantly located on buccal mucosa (40.4%), were homogeneous (60.8%), multiple (59.9%), smaller than 2 cm (74.4%) and histopathologically non-dysplastic (71%). The mean follow-up time was 55 months, with a 13% malignant transformation rate. The categorization and definition of multiple variables were notably diverse. Age, sex, habits (tobacco and alcohol), site, size, distribution, morphology, degree of dysplasia, and evolution were the chosen parameters for our proposal. The current study reflected the lack of consensus found in the literature regarding parameters for diagnosis or follow-up, impacting negatively on clinical and research results. standardization comprises an efficient way to facilitate the prognosis assessment of oral leukoplakia, being beneficial for clinical practice, and enabling better quality information to apply in research.
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Affiliation(s)
| | - Wilfredo Alejandro González-Arriagada
- Patología y Diagnóstico Oral, Facultad de Odontología, Universidad de Valparaíso, Valparaíso, Chile
- Centro de Investigación Interoperativo en Ciencias Odontológicas y Médicas (CIICOM), Universidad de Valparaíso, Valparaíso, Chile
- *Correspondence: Wilfredo Alejandro González-Arriagada
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Nammour S, Mobadder ME, Namour A, Namour M, Romeo U, España-Tost AJ, Arnabat-Dominguez J, Grzech-Lesniak K, Zeinoun T, Vescovi P. Success Rate of Benign Oral Squamous Papilloma Treatments After Different Surgical Protocols (Conventional, Nd:YAG, CO 2 and Diode 980 nm Lasers): A 34-Year Retrospective Study. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:123-130. [PMID: 33450170 DOI: 10.1089/photob.2020.4916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: The aim of our retrospective study is to compare the long-term recurrence rate of the benign oral squamous papilloma (OSP) with different laser-assisted treatments and conventional procedures (use of scalpels) aiming to suggest the most suitable surgical protocol showing the lowest recurrence rate. Background: A retrospective multicenter DATA collection between 1985 and 2019 covering 781 OSP cases concerning different surgical protocols used for the treatment of OSP was done and included the use of different laser wavelengths [neodymium-doped yttrium-aluminum-garnet (Nd:YAG), carbon dioxide (CO2), and Diode 980 nm] and the conventional surgeries using the scalpel. The age, sex, and the oral location of the OSP were noted. Methods: Three different surgical protocols were selected in our study: protocol 1 regrouped surgical procedures performing the excision of OSP with an in-depth safety margin of 1 mm and just at the base of the tumor with reduced excision of the grossly normal marginal mucosa around the tumor (0-1 mm). Protocol 2 and 3 were similar to protocol 1, but with an additional excision of 1-2 mm and ≥3 mm of the grossly normal marginal mucosa, respectively, for group 2 and 3. All laser-treated OSP wounds were left without sutures. In the conventionally treated OSP, sutures were regularly performed. Follow-up was done after 15 days and at 1, 6, and 18 months. The three included wavelengths were Nd:YAG (1064 nm), CO2 laser (10,600 nm), and diode laser (980 nm). Results: After 18 months of follow-up, the highest success rate was obtained with protocol 3 (100% with Nd:YAG, 99% with CO2, 98.4% with diode, and 99% with the scalpel), which was significantly higher than the values of protocol 2 (96.6% with Nd:YAG, 91% with CO2, 96% with diode, and 95% with the scalpel) and the protocol 1 (38% with Nd:YAG, 29% with CO2, 33% with diode, and 30% with the scalpel). The oral locations of OSP were 30% on palates, 30% on the tongue, 16% on cheek, 14% on lips, and 10% on other locations. Conclusions: The lowest recurrence rate was observed when a minimum of three millimeters (≥3 mm) of grossly normal aspect mucosa around the OSP was included in the excisions. The laser wavelengths and the use of scalpel did not show any significant difference in terms of recurrence.
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Affiliation(s)
- Samir Nammour
- Department of Dental Sciences, Faculty of Medicine, University of Liege, Liege, Belgium
| | - Marwan El Mobadder
- Department of Dental Sciences, Faculty of Medicine, University of Liege, Liege, Belgium
| | - Amaury Namour
- Department of Dental Sciences, Faculty of Medicine, University of Liege, Liege, Belgium
| | - Melanie Namour
- Department of Dental Sciences, Faculty of Medicine, University of Liege, Liege, Belgium
| | - Umberto Romeo
- Department of Oral and Maxillofacial Sciences, University of Rome "Sapienza", Rome, Italy
| | - Antonio-Jesús España-Tost
- Investigator of the IDIBELL Institute, School of Dentistry, University of Barcelona, Barcelona, Spain
| | - Josep Arnabat-Dominguez
- Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
| | | | - Toni Zeinoun
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Lebanese University, Beirut, Lebanon
| | - Paolo Vescovi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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C. de Silva C, de M. Alencar C, de Paula BLF, de A. Jassé FF, Araújo JLN, Silva CM. Photobiomodulation vs. Placebo on Post-Bleaching Sensitivity and Color Change: A Split-Mouth Clinical Study. Open Dent J 2020. [DOI: 10.2174/1874210602014010267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective:
This study aimed to investigate the efficiency of Photobiomodulation (PBM) with low-level LASER therapy compared to placebo in post-bleaching sensitivity and color change during a three-week office bleaching treatment.
Methods:
A split-mouth model was used to evaluate 21 subjects. The right and left hemi-archs were randomized to one of two groups: GP (placebo): simulated LASER application followed by tooth bleaching with 35% hydrogen peroxide; and GL: treated with PBM followed by tooth bleaching with 35% hydrogen peroxide. A four-degree modified Visual Analog Scale (VAS) was used to assess tooth sensitivity after the application of an evaporative stimulus (stimulated pain). In addition, a daily questionnaire was used to measure unstimulated pain. The color change was measured using a spectrophotometer. The Friedman and Wilcoxon tests were used to analyze data sensitivity. Color results were statistically analyzed using Analysis Of Variance (ANOVA) followed by the Tukey post-hoc test.
Results:
There was no significant difference between GP and GL for stimulated pain evaluation (p> 0.05). However, there was a significant difference between the groups for unstimulated pain evaluation (p≤ 0.05). In addition, ΔE data did not reveal any significant difference in tooth color between groups at any time (p> 0.05).
Conclusion:
PBM prevented post-bleaching sensitivity compared to placebo, based on the daily pain assessment questionnaires. PBM did not compromise the quality of bleaching treatments.
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15
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de Pauli Paglioni M, Migliorati CA, Schausltz Pereira Faustino I, Linhares Almeida Mariz BA, Oliveira Corrêa Roza AL, Agustin Vargas P, Franco Paes Leme A, Bianca Brandão T, Prado Ribeiro AC, Ajudarte Lopes M, Santos-Silva AR. Laser excision of oral leukoplakia: Does it affect recurrence and malignant transformation? A systematic review and meta-analysis. Oral Oncol 2020; 109:104850. [PMID: 32540612 DOI: 10.1016/j.oraloncology.2020.104850] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022]
Abstract
Oral leukoplakia (OL) is a white lesion with high potential of recurrence and malignant transformation. The variable clinical and histopathological features of OL may potentially impact both treatment and prognosis. Current literature shows that post treatment rates of recurrence and malignant transformation vary widely. The use of surgical lasers have been proposed with the objective of improving outcomes. We performed a systematic review and a comprehensive meta-analysis dedicated to pooling the rates of recurrence and malignant transformation of OL lesions treated using the main types of surgical lasers available. Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 36 articles met the inclusion criteria. Selected studies included OL lesions that were treated by evaporation or excision using Nd:YAG laser, Er:YAG laser, CO2 laser, KTP laser, or diode laser. The results of this systematic review and meta-analysis suggest that surgical laser excision of OL may decrease recurrence rates but have no effect on the malignant transformation of OL when compared with conventional treatments.
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Affiliation(s)
- Mariana de Pauli Paglioni
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | | | | | | | | | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | | | | | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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Saibene AM, Rosso C, Castellarin P, Vultaggio F, Pipolo C, Maccari A, Ferrari D, Abati S, Felisati G. Managing Benign and Malignant Oral Lesions with Carbon Dioxide Laser: Indications, Techniques, and Outcomes for Outpatient Surgery. Surg J (N Y) 2019; 5:e69-e75. [PMID: 31392277 PMCID: PMC6682487 DOI: 10.1055/s-0039-1694735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose
Because of its affinity for water-based tissues, carbon dioxide (CO
2
) laser has become an instrument of choice for treating oral mucosa conditions, ranging from inflammatory to malignant lesions. The aim of this work is to systematically evaluate the outcomes of laser surgery over a wide range of lesions, while providing a solid and reproducible protocol for CO
2
laser surgery in the outpatient management of oral lesion.
Methods
Seventy-eight patients underwent 92 laser outpatient procedures for treatment of a wide range of benign and malignant lesions. We performed 60 removals, 11 exeretic biopsies, 15 vaporizations, and 3 vaporization/removal combined. We analyzed laser parameters applied for each technique and provided a systematic evaluation of surgical results.
Results
No problems occurred intraoperatively in any of the patients. Five patients complained marginal pain, while 3 patients had postsurgery bleeding. All treatments were successful, with the notable exception of 3 relapsing verrucous proliferative leukoplakias and an infiltrating squamous cell carcinoma of the tongue requiring radicalization. We did not record any adverse reactions to drugs or lesions due to laser action. Concordance between clinical diagnosis and pathology results was at 94.8%.
Conclusions
Our data indicate that CO
2
laser is a solid choice for outpatient treatment of oral lesions. This technique grants painless and almost bloodless treatment, with negligible recurrence rates. Providing a solid reference for laser settings and operative techniques could provide a foundation for further exploring this tool while offering the basis for a positive comparison between different surgical techniques and options.
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Affiliation(s)
| | - Cecilia Rosso
- Department of Otolaryngology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Paolo Castellarin
- Department of Biomedical, Surgical and Dental Sciences, Odontostomatology Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Federica Vultaggio
- Department of Otolaryngology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Carlotta Pipolo
- Department of Otolaryngology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alberto Maccari
- Department of Otolaryngology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Daris Ferrari
- Department of Oncology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Silvio Abati
- Department of Dentistry, Unit of Oral Pathology, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Felisati
- Department of Otolaryngology, San Paolo Hospital, University of Milan, Milan, Italy
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Matulić N, Bago I, Sušić M, Gjorgievska E, Kotarac Knežević A, Gabrić D. Comparison of Er:YAG and Er,Cr:YSGG Laser in the Treatment of Oral Leukoplakia Lesions Refractory to the Local Retinoid Therapy. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:362-368. [PMID: 31081716 DOI: 10.1089/photob.2018.4560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: The aim of this study was to compare the efficacy of Er:YAG and Er,Cr:YSGG laser in the treatment of oral leukoplakia refractory to conventional retinoid therapy. Materials and methods: The study sample consisted of 54 patients (16 men and 38 women) who were histopathologically diagnosed with oral leukoplakia that was refractory to conventional retinoid therapy. Patients were randomly allocated into two groups according to the type of the laser used for treatment of oral leukoplakia: Group 1. Er:YAG laser; Group 2. Er,Cr:YSGG laser. Patients were recalled at 6 months and 1 year after treatment to evaluate possible recurrence and assess the patients' postoperative quality of life. Results: After initial ablation, the degree of residual lesion was significantly greater in the Er:YAG laser group (74.1%), compared with the Er,Cr:YSGG group (18.5%) (p = 0.0001). Six months and 1 year after the second ablation, there was no lesion recurrence in either laser group. Fourteen days after the initial ablation, the visual analog scale (VAS) pain rating and the total oral health impact profile score fell significantly in both groups (p < 0.0001). However, in the Er,Cr:YSGG laser group, the average value of the VAS rating was significantly lower than in the Er:YAG laser group (p = 0.039). Conclusions: The Er:YAG and Er,Cr:YSGG lasers showed similar efficacy in the treatment of oral leukoplakia and resulted in full postoperative recovery without recurrence after 1 year of follow-up.
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Affiliation(s)
- Nena Matulić
- 1 School of Dental Medicine, Department of Oral Surgery, University of Zagreb, Zagreb, Croatia
| | - Ivona Bago
- 2 Department of Endodontics and Restorative Dentistry and School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Mato Sušić
- 3 Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Elizabeta Gjorgievska
- 4 Department of Pediatric and Preventive Dentistry, School of Dental Medicine, St Cyril and Methodius University in Skopje, Skopje, Macedonia
| | - Ana Kotarac Knežević
- 3 Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Dragana Gabrić
- 3 Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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Monteiro L, Delgado ML, Garcês F, Machado M, Ferreira F, Martins M, Salazar F, Pacheco JJ. A histological evaluation of the surgical margins from human oral fibrous-epithelial lesions excised with CO2 laser, Diode laser, Er:YAG laser, Nd:YAG laser, electrosurgical scalpel and cold scalpel. Med Oral Patol Oral Cir Bucal 2019; 24:e271-e280. [PMID: 30818322 PMCID: PMC6441595 DOI: 10.4317/medoral.22819] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/15/2019] [Indexed: 11/17/2022] Open
Abstract
Background We aim to evaluate the presence of histological artefacts in the surgical margins of human oral fibro-epithelial hyperplasias excised with lasers of different wavelengths, and also electrosurgical scalpel and cold scalpel. Moreover, we aim to determine if some of these instruments could impair the normal histological diagnosis of these lesions. Material and Methods We included 130 consecutive surgical samples of 80 females and 50 males (mean age of 53.82±16.55) with a histological diagnosis of an oral benign fibrous-epithelial hyperplasias. The samples were categorized into 6 groups according to the type of instrument used: CO2 laser group, diode laser group, Er:YAG laser group, Nd:YAG laser group, electrosurgical scalpel group and cold scalpel group. Histological instrument-induced changes were microscopic evaluated and related with clinical and pathological variables. Results The instrument with highest tissue damage extension (TDE) was the electrosurgical scalpel (1002.2µm±434.92), followed by diode laser (913.73 µm±322.45), Nd:YAG (899.83µm±327.75), CO2 laser (538.37µm±170.50), Er:YAG laser (166.47µm±123.85), and at last with fewer alterations the cold scalpel group (2.36µm±7.27) (P< 0.001). The most regular incision was observed in CO2 laser group, followed by Er:YAG laser, Nd:YAG laser, electrosurgical scalpel and diode laser group with the less regular incision using cold scalpel as comparison (P< 0.001). A correlation was found between the incision score and TDE (P< 0.001). Regarding histological diagnosis, no case showed any limitation of diagnosis related with the use of any instrument evaluated. Conclusions Our results suggest that lasers can be used for the excision of oral benign fibrous-epithelial hyperplasias, without hispathological diagnosis limitations, as long as the physical properties of each laser are known and respected. Er:YAG laser have shown to be a laser with few tissue damage extension and with good incision regularity, been a possible instrument of choice for the surgical removal of these lesions. Key words:CO2 laser, diode laser, Er:YAG laser, Nd:YAG laser, oral mucosa.
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Affiliation(s)
- L Monteiro
- Instituto Universitário de Ciências da Saúde, Rua Central de Gandra, 1317, 4585-116 Gandra PRD, Portugal,
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Farah CS, Pollaers K, Frydrych A. Management of Premalignant Disease of the Oral Mucosa. HEAD AND NECK CANCER CLINICS 2019. [DOI: 10.1007/978-981-13-2931-9_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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20
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Malignant transformation of oral leukoplakia treated with carbon dioxide laser: a meta-analysis. Lasers Med Sci 2018; 34:209-221. [DOI: 10.1007/s10103-018-2674-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/25/2018] [Indexed: 01/11/2023]
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