Diode Laser Assisted Excision and Low Level Laser Therapy in the Management of Mucus Extravasation Cysts: A Case Series

Diode laser approach for excision of solitary mucocele

Oral mucoceles or mucoceles are communal minor salivary gland lesions, and they are clinically categorized by the presence of single or multiple, spherical-shaped fluctuant nodules which are asymptomatic and pain free. Application of diode laser for removal of mucosal lesions in the oral cavity is relatively new and viably better alternative to its precedent methods. The added advantage of using a laser includes lesser bleeding, improved or reduced healing time, and its affinity to melatonin that prevents further or recurrent pigmentation.

Management of Mucocele of the Glands of Blandin-Nuhn With a High-Intensity Laser: A Case Report

Introduction: The glands of Blandin-Nuhn are mucous and serous salivary glands situated on both sides of the midline of the ventral surface of the tongue. In this area, a mucocele generally results from trauma. The diagnosis of mucoceles is based on clinical and histopathological examinations and the recommended treatment is surgical excision. Case Report: This report describes a case of mucocele of the glands of Blandin-Nuhn (MGBN) affecting a 20-year-old male. Oval-shaped swelling with a smooth and bright surface of soft consistency was observed on the ventral surface of the individual's tongue. The diagnostic hypothesis was mucocele. Surgical excision was performed in a single session with a diode laser. A histopathological examination revealed mucus extravasating into connective tissue, with foamy macrophages and granulation tissue. Conclusion: The high-intensity laser was a safe and effective tool for treating MGBN. No need for a suture, minimal or no intraoperative bleeding, and a minimal report of pain and edema by the patient were observed. A diode laser may be a helpful tool because it is less invasive and it is safe and effective.

Overview of the Clinical Benefits Using the Different Diode Laser Wavelengths in Treatment of the Mucocele: Clinical Cases Report Review

Objective: Diode laser has a wide range of wavelengths that may render the absorption effect and interaction with the tissue is different. Based on available evidences, the aim of this review is to critically evaluate the use of different diode laser wavelengths in the treatment of mucocele. Materials and methods: The literature of clinical case studies for the past 8 years has been considered. Literature search and selection, data extraction and methodological quality assessment, data analysis and interpretation, and drafting and revision have been performed. Both authors have read and approved the final article. Results: This review has aimed at detecting the experience on the background and at giving a critical summary of the clinical cases literature. Previous results of controlled clinical case reviews in this field as well as in basic research pointed to a potential of the diode laser in the surgical removal of mucocele. Initial clinical results showed that diode laser surgical therapy positively influences the post-surgical wound healing. All diode laser wavelengths do not show much difference in the acceleration in epithelial regeneration, and the healing of the wound takes some time by all wavelengths. They can reduce the need for anesthesia or wound care and therefore reduce the fear of the patient. Conclusions: The procedure in the most reviewed clinical cases took place within a few minutes and thus required no more time than a conventional surgical intervention with conventional surgical instruments. Since all surgical steps are carried out with the same instrument, there is no need for sutures and only one handpiece is sterilized. Due to the contactless preparation and the lack of vibrations as well as the elimination of the anesthesia, the entire process is much more pleasant for the patient and thus indirectly for the practitioner, because a relaxed patient can simply be better treated.

A Review of Evidence-Based Recommendations for Pericoronitis Management and a Systematic Review of Antibiotic Prescribing for Pericoronitis among Dentists: Inappropriate Pericoronitis Treatment Is a Critical Factor of Antibiotic Overuse in Dentistry

This work provides a narrative review covering evidence-based recommendations for pericoronitis management (Part A) and a systematic review of antibiotic prescribing for pericoronitis from January 2000 to May 2021 (Part B). Part A presents the most recent, clinically significant, and evidence-based guidance for pericoronitis diagnosis and proper treatment recommending the local therapy over antibiotic prescribing, which should be reserved for severe conditions. The systematic review includes publications analyzing sets of patients treated for pericoronitis and questionnaires that identified dentists’ therapeutic approaches to pericoronitis. Questionnaires among dentists revealed that almost 75% of them prescribed antibiotics for pericoronitis, and pericoronitis was among the top 4 in the frequency of antibiotic use within the surveyed diagnoses and situations. Studies involving patients showed that antibiotics were prescribed to more than half of the patients with pericoronitis, and pericoronitis was among the top 2 in the frequency of antibiotic use within the monitored diagnoses and situations. The most prescribed antibiotics for pericoronitis were amoxicillin and metronidazole. The systematic review results show abundant and unnecessary use of antibiotics for pericoronitis and are in strong contrast to evidence-based recommendations summarized in the narrative review. Adherence of dental professionals to the recommendations presented in this work can help rapidly reduce the duration of pericoronitis, prevent its complications, and reduce the use of antibiotics and thus reduce its impact on patients’ quality of life, healthcare costs, and antimicrobial resistance development.

Recurrent Oral Mucocele Management with Diode Laser

Background

Mucocele is the most common minor salivary glands disease. Its management may present a challenge for dental professionals. The aim of the present clinical case was to describe mucocele treatment with diode laser and its benefits. Case Report. A case of lower lip mucocele in a 10-year-old female patient is reported. A conventional excision surgery was performed. Two months later, the patient reported discomfort and swelling at the same operative site. The lesion had recurred. Thus, mucocele was removed using a diode laser with wavelength of 980 nm, an initiated fiberoptic tip of 300 μm, in continuous mode, and a power setting of 2 Watts. The procedure was rapidly completed with no bleeding. The patient was followed-up after 2 weeks and 6 months. The wound healed without complications: no postoperative discomfort or pain and no infection. There was no recurrence.

Conclusion

Diode laser is an effective, easy, bloodless, and well-accepted procedure to treat mucocele in pediatric patients.

The Clinical Evaluation of the Effects of Low-Level Laser Therapy on the Donor and Recipient Sites of the Free Gingival Graft: A Case Series

Introduction: Free gingival grafting is among the most foreseeing procedures for increasing the zone of keratinized attached gingiva and enhancing soft tissue around the teeth and dental implants. Nowadays low-level laser therapy (LLLT) is a promising approach in providing patients with more pleasing results in terms of esthetics and comfort. This study aims to investigate the effects of LLLT on gingival recessions treated with free gingival graft (FGG). Methods: This case series was conducted on 12 individuals requiring a bilateral gingival graft in the mandibular region. There was a 30-day interval between the two operations. The test side was selected randomly and irradiated by a low-level laser (LLL) just before surgery. The patients did not know which side was irradiated. LLLT was applied to the donors' as well as recipients' site immediately after the operation and 48 hours later. The patients were instructed to record their post-operative pain in a visual analogue scale (VAS) 3 and 24 hours and 7 days after the surgical procedure. The clinical photographs were taken immediately and 30 days after surgical treatment were graded by three experienced periodontists for color matching to adjacent tissues. Results: Ten individuals could finish the study. The test group presented significantly better shade matching and wound healing at the palatal donor site on days 7, 14 and 21. There was a significant reduction in post-operative pain after 24 hours (P = 0.007). No statistically significant difference was found between both groups in terms of clinical periodontal indices. Conclusion: LLLT could reduce post-operative pain 24 hours after surgical treatment. Furthermore, the application of LLLT could improve the donors' site healing and the recipients' site color matching.

Reduced Need of Infiltration Anesthesia Accompanied With Other Positive Outcomes in Diode Laser Application for Frenectomy in Children

Introduction: The abnormal maxillary labial frenum is common in children during the primary or mixed dentition stage. A conventional surgery for this abnormality usually requires infiltration anesthesia which leads to fear in children and consequent noncooperation during the surgery. The aim of present study was to evaluate the reduction in the need of infiltration anesthesia, intraoperative bleeding control and postoperative pain and wound healing in children when using the diode laser for abnormal labial frenum in the maxilla. Methods: The present study was carried out among 30 children attending the Hanoi Medical University, Vietnam. A Diode Laser with 810 nm wavelength and power of 0.8 W was used for frenectomy. Results: The proportion of procedures without any need of infiltration anesthesia was 70%, while 93.34% of children demonstrated positive and very positive behavior. Proportion of indolence on the first day after surgery was 83.3%. While 83.3% of children did not take any analgesics, not a single child complained of any pain 3 days after surgery. Conclusion: Our results indicated that the use of diode laser showed several benefits in maxillary labial frenectomy in children. These included reducing the need of infiltration anesthesia, increasing the children's cooperation as well as decreasing the postoperative pain.

Diode Laser-Assisted Surgical Therapy for Early Treatment of Oral Mucocele in a Newborn Patient: Case Report and Procedures Checklist

Mucocele (also known as ranula or salivary gland mucous cyst) of the newborn is a lesion present on the intraoral cavity, with the potential to interfere with respiration and feeding. In the present report, a case of mucocele in a 4-month female patient has been described. As conventional surgery can be followed by several complications such as intraoperative bleeding, difficulties in wound healing, and maintenance of sterility during surgery, in the present case, the use of diode laser has been planned. A topic anesthesia with lidocaine gel was performed. A diode laser (810 nm wavelength, continuous wave mode, power output of 3 watt, and 0.4 mm diameter fiber optic) was set for excising the lesion. The tip was directed at an angle of 10 to 15°, moving around the base of the lesion with a circular motion. The procedure was completed in 3 minutes. The patient was visited with a follow-up of 2 weeks and 4 months after excision. The intraoral wound healed without complications, and no signs of infection or mass recurrence were noted. The histopathological examination confirmed the diagnosis of mucocele. On the basis of the results of the present case report, the use of diode laser can be easily performed also in a noncompliant newborn patient for successful excision of mucocele lesions, and checklist of clinical procedures has been described.

Healing of self-inflicted thermal injury of palatal mucosa by low-level laser therapy

Self-inflicted injury to oral mucosa is a rare entity. These injuries can be premeditated, accidental, or can result from an abnormal habit. These uncommon gingival injuries can sometimes test the clinician's diagnostic abilities as well as treatment planning skills. In conventional treatment, removal of etiology and application of topical drugs is usually sufficient for healing. However, some cases require alternative or adjunctive wound healing methods. Low-level laser therapy (LLLT) has been reported to be effective in pain management and improvement in wound healing through promotion, fortification, and commissioning of cellular cycle to generate productive and substitute cells. This report presents a case of 25-year-old female with complaints of a painful, nonhealing wound on the palate for last 6 months. She had an unusual habit of keeping burning matchsticks in her mouth. Although she had quit the habit 2 months ago after psychiatric counseling, the wound on her palate did not show any improvement in symptoms. Based on the history and clinical findings, diagnosis of chronic wound by self-inflicted thermal injury was made. LLLT was administered on the wound every 48 hours for next 10 days. The burn wound healed completely after five applications of LLLT.