Case report. Use of an argon laser to treat drug-induced gingival overgrowth

A Comparison Between the Efficacy of Scalpel and Laser Procedures for Treating Gingival Hyperpigmentation: A Case Report

Gingival hyperpigmentation is a hereditary feature in populations. Gingival pigmentation not only affects aesthetics but also has a negative psychological effect. For many people, gingival hyperpigmentation is a severe cosmetic problem. Although black gums are not a medical issue, many individuals find them unsightly. The pigmentation of gingiva contributes to the harmony of the smile in a significant way. A periodontal plastic surgery procedure called gingival depigmentation eliminates or reduces hyperpigmentation. Different treatment approaches for gingival depigmentation have been documented, such as scalpel, electrosurgery, diamond burs, chemical methods, cryosurgery, and lasers. According to studies, cryosurgery and lasers are the best procedures since they provide better aesthetic outcomes and low recurrence rates. The coordination of treatment plans and the choice technique are influenced by the patient's skin tone, the degree of gingival pigmentation, the lip line, the upper lip curvature, aesthetic concern, and treatment expectations. This case report, which involves a 23-year-old female patient, provides a comparison between the efficacy of scalpel and laser procedures for treating gingival hyperpigmentation. The patient's left side received diode laser treatment, while the right received scalpel treatment. Scalpel depigmentation caused the treated area to recover without incident. The benefits of laser depigmentation include a bloodless surgical field and recovery without complications. No postoperative pain, bleeding, infection, or scars were seen on the first and consequent visits. The recovery went smoothly. The patient was satisfied with the treatment modality, and the outcomes were outstanding, according to the patient. There was no re-pigmentation throughout the follow-up period. This split-mouth study will provide information regarding soft tissue healing using two different approaches in the same patient.

High-power diode laser on management of drug-induced gingival overgrowth: Report of two cases and long-term follow-up

BACKGROUND

Drug-induced gingival overgrowth (DIGO) is attributed mainly to the prolonged use of calcium channel blocking agents, anticonvulsants, and anti-calcineurin inhibitors . The management of DIGO depends on the severity of the disease and includes surgical intervention and plaque control. Compared to conventional surgical treatment, the recent literature data have shown that gingivectomy using a high-power laser (HPL) is a short and easy procedure, which results in minimal postoperative discomfort and greater patient accep- tance.

OBJECTIVE AND METHODS

The purpose of this study was to report two cases of recurrent DIGO treated surgically using HPL (λ 808nm, 1.5W).

RESULTS

Minimal bleeding and discomfort were observed during surgery, and patients reported no pain or bleeding after the procedure. After 1 year of follow-up, patients presented a minimal increase of gingival volume, indicating that laser technology can improve the efficiency and prognosis of DIGO.

CONCLUSIONS

The HPL was able to preventing hemorrhage and improving the patient's collaboration with the treatment and quality of life.

Drug-Induced Gingival Hyperplasia in Transplant Recipients

Gingival hyperplasia is a common occurrence in transplant recipients who are taking cyclosporine. This condition can be complicated when calcium channel blockers or phenytoin are added to the armamentarium of medications; it can be painful and may interfere with eating, speech, and appearance. Multiple mechanisms exist for gingival overgrowth. Prevention with appropriate oral hygiene appears important in controlling the inflammatory component and decreasing the severity of the overgrowth. Patients must be aware of the potential for the development of gingival hyperplasia and must follow up with regular professional cleanings. If the overgrowth persists, treatment options should be discussed between patients and their physician. Conversion from cyclosporine to tacrolimus, treatment with antibiotic therapy, and surgical excision or laser therapy are all potential therapies to consider.

Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

Drug-induced gingival overgrowth (DIGO) is a well-recognized adverse effect of certain systemic medications. Calcium channel blockers, anticonvulsants, and immunosuppressants are frequently implicated drugs in the etiology of DIGO. Drug variables, plaque-induced inflammation, and genetic factors are the three important factors in the expression of gingival changes after systemic medication use. Careful clinical examination and thorough history taking form the basis for diagnosis of DIGO. Histopathological examination is often neglected; however, it is an important aid that helps in differential diagnosis. Cessation or change of drug and meticulous plaque control often leads to regression of the lesion, which however might need surgical correction for optimal maintenance of gingival health. The purpose of the present article is to review case reports and case series published in the last two decades and to assimilate and compile the information for clinical applications such as diagnosis and therapeutic management of DIGO.

Surgical treatment of gingival overgrowth with 10 years of follow-up

Background

In some pathological conditions, gingivitis caused by plaque accumulation can be more severe, with the result of an overgrowth. Nevertheless, the overgrowth involves the gingival margin with extension to the inter-dental papilla. The lesion may involve the inter-proximal spaces, and become so extensive that the teeth are displaced and their crowns covered. Severe overgrowth may lead to impairment in aesthetic and masticatory functions, requiring surgical excision of the excessive tissue. Aim of this study is to describe an operative protocol for the surgical treatment of localized gingival overgrowth analyzing the surgical technique, times and follow-up.

Methods

A total of 20 patients were enrolled and underwent initial, non surgical, periodontal treatment and training sessions on home oral hygiene training. The treatment plan involved radical exeresis of the mass followed by positioning of an autograft of connective tissue and keratinized gingiva.

Results

During 10 years of follow-up, all the grafts appeared well vascularized, aesthetically satisfactory, and without relapse.

Conclusions

Periodontal examinations, surgical procedures, and dental hygiene with follow-up are an essential part of the treatment protocol. However, additional effort is needed from the patient. Hopefully, the final treatment result makes it all worthwhile.

Felodipine-influenced gingival enlargement in an uncontrolled type 2 diabetic patient

BACKGROUND

The potential of calcium channel blockers (CCBs) to induce gingival enlargement (GE) as well as the influence of diabetes mellitus on periodontal tissues has been well documented. This case report documents a conservative clinical approach to the management of felodipine-influenced gingival enlargement and displays a clinical and histologic case of felodipine-influenced GE in an undiagnosed type 2 diabetic patient.

METHODS

At the initial examination, a medical consultation was requested and two incisional biopsies were taken for pathological evaluation. The patient was diagnosed with uncontrolled type 2 diabetes. Felodipine was withdrawn and the diabetes was controlled before dental treatment was initiated. The patient then underwent selective extractions and full-mouth scaling and root planing as well as oral hygiene instructions. No surgical therapy was indicated.

RESULTS

The histological results demonstrated the presence of elongated rete pegs; fibrous hyperplasia; a low-grade chronic inflammatory infiltrate, predominantly consisting of lymphocytes; and collagen bundle groups randomly distributed. These features were similar to those present in other drug-influenced GE. Clinical results have demonstrated almost complete resolution of GE after the withdrawal of felodipine and the control of diabetes. Further improvements were seen after scaling and root planing and oral hygiene instructions. No recurrences were noted 12 months after initial therapy.

CONCLUSIONS

This report demonstrated that the control of systemic factors seemed to have the most influence on success for this particular case. Since the control of diabetes was managed at the same time as the felodipine withdrawal, it remains difficult to speculate how these two factors impacted both the severity of the GE and the therapeutic results. More importantly, the conservative treatment rendered demonstrated the stability of periodontal status during maintenance phase and the avoidance of surgical interventions.

Enamel caries initiation and progression after argon laser irradiation: in vitro argon laser systems comparison

OBJECTIVE

The purpose of this in vitro laboratory study was to determine the effect of low-fluence argon laser (AL) irradiation delivered from two different argon laser systems on enamel caries-like lesion initiation and progression.

BACKGROUND DATA

Previous in vitro investigations and a recent in vivo pilot study have shown that AL irradiation of enamel provided a protective effect against in vitro and in vivo cariogenic challenges.

MATERIALS AND METHODS

Twenty extracted human molars were selected, and 10 teeth were assigned to the HGM argon laser group and 10 were assigned to the LaserMed argon laser group. The exposed buccal windows of sound enamel were exposed to low-fluence irradiation, while the lingual windows of enamel were not exposed to laser irradiation and served as the no-treatment (control) group. Enamel caries-like lesions were created using an acidified gel. Two longitudinal sections were taken per sample (n = 20 lesions per group) and evaluated by polarized light microscopy for body of the lesion depths after lesion initiation (8 weeks) and progression (12 weeks) periods.

RESULTS

After lesion initiation and progression, the body of lesion depths were similar for both argon-irradiated groups (p > 0.05). With the no-treatment (control) group, there were significant increases in lesion depth with a 61-78% increase for the lesion initiation period and a 50-69% increase for the lesion progression period when compared with the argon laser-treated groups.

CONCLUSION

Argon laser irradiation provides a certain degree of protection against in vitro enamel caries initiation and progression. Resistance to a continuous caries challenge was similar with either argon laser delivery systems (HGM and LaserMed). Argon laser irradiation may prove to be beneficial in reducing the caries susceptibility of sound enamel and white spot lesions in the clinical environment.

Calcium channel blocker induced gingival overgrowth

Gingival overgrowth occurs with phenytoin, cyclosporin, and calcium antagonists. It can be disfiguring and painful. The prevalence of gingival overgrowth with the use of calcium antagonists may be as high as 38%. The prevalence with nifedipine may be greater than with other calcium blockers. Overgrowth occurs 3.3-times more commonly in men than in women. Plaque control is necessary. Some patients may require gingival surgery.

Drug-induced gingival hyperplasia in transplant recipients

Gingival hyperplasia is a common occurrence in transplant recipients who are taking cyclosporine. This condition can be complicated when calcium channel blockers or phenytoin are added to the armamentarium of medications; it can be painful and may interfere with eating, speech, and appearance. Multiple mechanisms exist for gingival overgrowth. Prevention with appropriate oral hygiene appears important in controlling the inflammatory component and decreasing the severity of the overgrowth. Patients must be aware of the potential for the development of gingival hyperplasia and must follow up with regular professional cleanings. If the overgrowth persists, treatment options should be discussed between patients and their physician. Conversion from cyclosporine to tacrolimus, treatment with antibiotic therapy, and surgical excision or laser therapy are all potential therapies to consider.