Use of Diode Laser for Surgical Removal of Pyogenic Granuloma of the Lower Lip in a Pediatric Patient: A Case Report

The features of the reparative regeneration of an oral mucosa wound created under the exposure of a laser at a wavelength of 445 nm (a pilot study)

In clinical practice, an innovative laser technology that provides contactless preparation of soft tissues with a wavelength of 445 nm has been introduced. This study aimed to investigate the morphological changes in the oral mucosa when exposed to laser radiation at a wavelength of 445 nm in the ablation mode.An experimental study was conducted to analyze the dynamics of reparative regeneration in the wound caused by that particular type of radiation, utilizing the procedure of lower lip frenuloplasty as an illustration. 48 sexually mature male laboratory rats were chosen as the research object. The procedure of preparing the oral vestibule was executed by employing a contactless laser beam with a wavelength of 445 nm and a power of 0.7 W in continuous mode (CW) and an uninitiated fiber.Histological examination showed that 25 min after the surgery, there were large areas of coagulation necrosis in the oral mucosa in the area affected by the blue laser. In 48 h, the area of necrosis decreased both in size and depth. By the 7th day after the surgery, the necrotic masses had grown into the connective tissue, while marginal regeneration of the epithelium was noted. By the 14th day, the wound surface was completely epithelialized, represented by fibrous scar tissue. Clinically, around the mandibular incisors, there was a wide area of attached keratinized gingiva.The findings of histological examination indicate a necrosis of coagulation type in the region of tissue ablation and also show the absence of phase II of the inflammatory response (the stage of exudation), which expedites the process of epithelialization of the oral mucosa wound.

A Novel Air-Cooled Nd:YAG Laser for the Treatment of the Venous Lakes of the Lips

Objective: To evaluate the therapeutic effect of a novel air-cooled Nd:YAG laser in the venous lakes of the lips (VLL). Background: The thermal injury is one of the most important issues during laser therapy for venous lakes. Methods: Six pieces of fresh pork livers were used to provide 30 regions with a diameter of 6 mm for experiment in vitro, among which 15 regions were treated by Nd:YAG laser with air cooling until the tissue turned gray-white, whereas the rest were treated without air cooling as control. The operation time of laser irradiation, the degree of temperature increase, and the depth of coagulation tissue were compared between two groups. Then, 60 VLL patients were selected for Nd:YAG laser treatment with or without air cooling. The operation time of laser irradiation, the degree of temperature increase, the postoperative pain visual analog scale (VAS) score, and the percentage of lesions removed within 1 month were compared. Results: In tissue studies, the treated group showed a longer operation time of laser irradiation (p < 0.01), a lower degree of temperature increase (p < 0.01), and there was no significant statistical difference in the depth of coagulation tissue (p = 0.624). In clinical studies, the treated group showed a longer operation time of laser irradiation (p < 0.01), a lower degree of temperature increase (p < 0.01), and a lower VAS score on the 1st and 2nd day, compared with the control group (p < 0.01). Conclusions: Air cooling during Nd:YAG laser for the treatment of VLL can prolong the surgical time, but lowered tissue temperature and reduced patient pain within 2 days under the premise of ensuring the treatment effect.

Laser Excisional Biopsy of Bleeding Tumor near Newly Erupted Tooth in an 11-Month-Old Patient under General Anesthesia

Pyogenic granuloma (PG) is a well-known tumor-like growth that commonly appears in the gingiva of the oral cavity. This reactive lesion can develop in response to local irritation, chronic low-grade trauma, long-term low-grade infection, or hormonal imbalances. PG is more frequently observed in individuals during their second and third decades of life, although it can occur at any age. It is more prevalent in young females than males, but on rare occasions, it can be found in children, even infants. Several treatment options exist for PG lesions, which apply after a final diagnosis specified by biopsy and histopathological investigations. Surgical excision is the most common treatment choice for PG lesions. However, comparisons between laser therapy and surgical excision have shown numerous advantages for laser treatment, making it a preferred option for soft tissue lesions. Laser excision offers benefits such as precise and deep incisions, preservation of sterile conditions, improved hemostasis, avoidance of sutures, and less invasive procedures resulting in reduced intra- and postoperative discomfort, pain, and bleeding. This report is aimed at presenting a case of an 11-month-old infant with a gradually growing pyogenic granuloma (PG) lesion that appeared in the palate behind the upper left first deciduous tooth, with a duration of approximately 2 months. The parents reported a history of bleeding associated with the lesion, which emerged after the eruption of the mandibular tooth. An excisional biopsy was done by the application of an 810 nm diode laser under general anesthesia, and the specimen was evaluated by a pathologist. No posttreatment complications or relapses were observed in this case.

Oral Pyogenic Granuloma: A Narrative Review

Pyogenic granuloma (PG) is a benign vascular lesion found predominantly in the oral cavity. Characterized by rapid growth and propensity to bleed, PG presents diagnostic challenges due to its similarity and alarming proliferation. This narrative review synthesizes current knowledge on the epidemiology, etiopathogenesis, clinical manifestations, and management of oral PG, with emphasis on recent advances in diagnostic and therapeutic approaches. The epidemiology of the injury is meticulously analyzed, revealing a higher incidence in women and a wide range of ages of onset. It delves into the etiopathogenesis, highlighting the uncertainty surrounding the exact causal factors, although historical attributions suggest an infectious origin. It exhaustively analyzes the clinical and histopathological aspects of oral PG, offering information on its various presentations and the importance of an accurate diagnosis to guide effective treatment. It details treatment strategies, emphasizing the personalized approach based on individual patient characteristics. This comprehensive review consolidates current knowledge on oral PG, highlighting the need for further research to clarify its pathogenesis and optimize treatment protocols.

The Use of Diode Laser for the Surgical Removal of Pyogenic Granuloma of the Dorsum of the Tongue: A Case Report

Pyogenic granuloma (PG) is a common reactive oral lesion predominantly involving the gingiva and rarely occurring on the dorsum of the tongue. It can develop at any age but more commonly in the second decade with a female predilection. Numerous factors are associated with its development, and surgical removal is the standard treatment. Various surgical modalities have been used to excise it. Herein, we report a case of a female patient in her late 60s who presented with an exophytic lesion involving the dorsum of the tongue, which was excised using a 940 nm diode laser. In addition, it discusses the advantages of diode laser as a surgical modality and describes this lesion's clinical features and pathogenesis.

Excision of Pyogenic Granuloma (PG) With Diode Laser on the Lower Lip in an Unusual Location: A Case Report

Pyogenic granuloma (PG) is a tumor with regular growth expressed usually in the oral cavity, expressing characteristics of a non-neoplastic lesion. The first treatment option is surgical excision, which can be proceeded with surgical diode lasers (940 nm). This case report focuses on the surgical excision of a PG located in the lower lip using diode lasers. Post-operative follow-up of 6 months demonstrated adequate healing without esthetical compromise and no lesion recurrence, showing that diode lasers can be a safe and effective alternative for PG removal.

Is Ozone a Valid Adjuvant Therapy for Periodontitis and Peri-Implantitis? A Systematic Review

INTRODUCTION

Ozone is a naturally occurring unstable compound with three oxygen atoms that generally transforms into an oxygen molecule, releasing one oxygen atom. This feature has been exploited in dentistry for numerous applications, including for periodontal diseases and peri-implantitis.

METHODS

This review was performed in relation to the PRISMA flow chart and was annotated in the PROSPERO register. PICO questions were used as research questions. The risk of bias in the non-randomized clinical trials was appraised using the ROBINS-I tool.

RESULTS

An electronic search found a total of 1073 records, in particular, 842 from MEDLINE/PubMed, 13 from Bio Med Central, 160 from Scopus, 1 from the Cochrane library databases, and 57 from the PROSPERO register. A total of 17 studies were included in the present systematic review. Information regarding the characteristics of the periodontal clinical and radiographic parameters for gaseous ozone, ozonate water, ozonate oil, and ozone gel, including clinical attachment loss (CAL) probing depth (PPD), bleeding on probing (BoP), plaque index (PI), gingival index (GI), and marginal bone levels (MBL), were obtained.

CONCLUSIONS

The studies included in this systematic review show different results regarding the ozone in periodontal treatment in association with or without SRP.

Diode laser versus sclerotherapy: bloodless approaches in the treatment of oral pyogenic granuloma (randomised controlled clinical trial)

Oral pyogenic granuloma (PG) is traditionally treated by surgical excision which is associated with bleeding, pain and a high rate of recurrence. Our research aimed to clinically assess the effectiveness of diode laser versus sclerotherapy, as bloodless approach, in the treatment of oral PG. We randomly divided 20 patients with oral PG into two groups, with those in the test group being managed via diode laser application and those in the control group via injections of ethanolamine oleate as a sclerosing agent. All patients were evaluated intraoperatively for bleeding severity and postoperatively for pain. The quality of healing was also assessed using Landry healing index after the 1st, 2nd and 4th weeks. Additionally, the patients were recalled after 3, 6 and 9 months from the end of treatment for recurrence evaluation. Our results revealed that intraoperative bleeding did not differ significantly between both groups while postoperative pain decreased significantly in the sclerotherapy group compared to the laser group. For different intervals, the sclerotherapy group had a higher healing quality index than the laser group, although the difference was not statistically significant. However, recurrence occurred in the laser group, there were no cases of recurrence in the sclerotherapy group in all intervals. In conclusion, diode laser treatment of PG is a reliable, less invasive, and sensitive procedure that requires an experienced operator and specialised equipment. However, ethanolamine oleate sclerotherapy is an inexpensive, simple technique besides being less prone to recurrence problems, especially when treatment duration is not a concern.

Diode Laser as an Adjunctive Treatment for Peri-implant Mucositis: A Systematic Review and Meta-analysis

The early detection and management of peri-implant mucositis may help in reducing inflammatory parameters and arrest disease progression to peri-implantitis. The potential therapeutic benefits of different adjunctive therapies, such as the diode laser, are still not completely understood. The objective of this systematic review and meta-analyses was to assess the outcomes of using diode laser on the management of peri-implant mucositis in terms of changes in periodontal parameters. Electronic databases were searched to identify randomised controlled trials (RCTs) that compared the combined use of mechanical debridement and diode laser with mechanical debridement alone. A specific risk-of-bias tool was used to assess the risk of bias. Data were analysed using a statistical software programme. In total, 149 studies were found. A meta-analysis of 3 RCTs showed no statistically significant differences in probing pocket depths (mean difference [MD], -0.36; 95% confidence interval [CI], -0.88 to 0.16; P = .18) or bleeding on probing (MD, -0.71; 95% CI, 1.58-0.16; P = .11) between the 2 groups at 3 months. In the management of peri-implant mucositis, the combined use of diode laser and mechanical debridement did not provide any additional clinical advantage over mechanical debridement alone. Long-term, well-designed RCTs are still needed.

Comparative Evaluation of Efficacy and Safety of the Diode Laser (980 nm) and Sclerotherapy for the Treatment of Oral Pyogenic Granuloma

Background

Pyogenic granuloma (PG) is a tumor-like, non-neoplastic lesion of the soft tissue that commonly appears in the oral cavity. Various treatment modalities have been discussed, including surgical excision, cryosurgery, curettage, electrodessication, corticosteroid injection, sclerotherapy, and lasers. This observational retrospective study compared effectiveness between diode lasers and sclerotherapy for PG treatment.

Materials and Methods

From July 2016 to January 2021, data of oral PG cases treated with sclerotherapy and diode lasers were gathered. Patients were evaluated and categorized according to their gender, sex, site of lesions, size of lesions, number of sessions, details of side effects, details of the VAS (Visual Analogue Scale) on third postoperative day, response of treatment to individual groups, time required for complete resolution, and details of recurrence. Inferential statistical analysis was performed.

Results

We included 73 patients, of whom 43 and 30 received laser and sclerotherapy treatment, respectively. Compared with the sclerotherapy group, the laser group had less side effects including pain, edema, ulceration, ecchymosis, infections, and scarring. The difference in postoperative pain (VAS scale) between the groups was statistically significant (p-value 0.004). Complete remission was seen in the laser group, while 3 cases of the sclerotherapy group had no response (p-value −0.034). The laser group experienced greater recurrence than did the sclerotherapy group.

Conclusions

Both sclerotherapy with laser and 3% sodium tetradecyl sulfate are effective for treating oral PG. Sclerotherapy is more effective in preventing recurrence. In terms of side effects, diode lasers are superior to sclerotherapy.