Diode laser for excisional biopsy of a peripheral ossifying fibroma: A case report

Peripheral Ossifying Fibroma is one of the most common reactive lesions of connective tissue located on gingivae. It appears as a well-defi ned, benign, fi brous overgrowth and is associated with chronic trauma or irritation. It can be pedunculated or sessile, usually covered by smooth normal epithelium and it can sometimes appear ulcerated as a result of mechanical trauma. Conventional treatment of Peripheral Ossifying Fibroma includes excision of lesion down the level of periodontal ligament and periosteum. Another contemporary modality of excising oral soft-tissue lesions are dental lasers. They have been widely accepted and increasingly used in daily practice. More specifi cally, in oral soft tissue surgery, lasers minimize operative and postoperative bleeding, swelling and scarring, and are easy to handle. Moreover, lasers do not alter the microarchitecture of the biopsy specimen and are well accepted by the patients. In this case report, we present a 30-year old man diagnosed with a recurrent peripheral ossifying fi broma in the mandibular incisors’ region. The patient was fi rstly diagnosed with peripheral ossifying fi broma at the age of 18 and had a few recurrence episodes after excision of the lesion with traditional surgical treatment. This oral lesion was excised by using diode laser (980nm), and the specimen was sent for histopathological analysis. In this case report we describe advantages and superiority of diode laser application in excision of Peripheral Ossifying Fibroma. In general, diode laser may be an alternative reliable and effective treatment option for excision of oral soft-tissue lesions. Case Report Diode laser for excisional biopsy of a peripheral ossifying fi broma: A case report Vlachos Emmanouil1, Gkouzoula Despina2 and Fourmousis Ioannis3* 1Dentist (DDS), Biologist (B.Sc) Specialized in Molecular Biology-Biomedicine (M.Sc), Private Dental Clinic, University of Athens, Greece 2Dentist (DDS), Student of the National and Kapodistrian Universities of Athens, Greece 3Assistant Professor (Dr.med.dent), Department of Periodontology, Dental School, National Kapodistrian University of Athens, Greece Received: 13 November, 2020 Accepted: 24 November, 2020 Published: 25 November, 2020 *Corresponding author: Fourmousis Ioannis, Assistant Professor (Dr.med.dent), Department of Periodontology, Dental School, National Kapodistrian University of Athens, Vasilissis Sofi as Avenue 123, P.O. 11521, Athens, Greece, Tel: +3


Introduction
Peripheral Ossifying Fibroma (POF) is a common reactive gingival lesion of connective tissue [1,2]. It is slow-growing, asymptomatic, and presents a solitary, well-defi ned, nonneoplastic fi brous overgrowth, which may extend from a few mm to two centimeters at its greatest dimensions. It is assumed that it originates from cells in the periodontal ligament or periosteum that proliferate reactively to many factors such as chronic trauma, mechanical irritation from poor dental restorations, calculus, microbial biofi lm or orthodontic appliances [3]. Clinically, it can be pedunculated or sessile, covered by smooth normal epithelium (sometimes its surface may be ulcerated due to mechanical trauma) [1].
In most cases, it appears during 2nd and 3rd decade of life in incisor-cuspid region in anterior maxilla. Recent studies have also reported its high incidence during 4th decade of life in mandible [4]. Females are affected with a higher frequency than males [3,4]. Depending on its localization in oral cavity, it often interferes with normal speech, mastication, maintenance of oral hygiene and smile esthetics. Furthermore, in some cases tooth migration has been reported [5,6] pregnancy granuloma, and peripheral odontogenic tumors [1]. Due to variation of its radiographic features, diagnosis of POF is based on histopathological features. After hematoxylin and eosin staining, stratifi ed squamous epithelium (with mild hyperkeratosis) can be observed under microscope.
Traditional treatment of POF includes surgical excision of the lesion accompanied by thorough scaling and root planing of adjacent teeth [9][10][11]. Under local anesthesia, surgical A modern approach for excision (among others) of soft tissue oral lesions is application of dental lasers [9,[12][13][14].
Dental lasers have been widely accepted and increasingly used in daily practice (and among others in oral soft tissue surgery) [15]. In contrast to traditional surgical excision, lasers decrease bleeding by sealing off small vessels during procedure ensuring a clear surgical fi eld and more precise depth of excision [16]. This is very important for patients that are under medication affecting blood coagulation (e.g warfarin, clopidogrel etc.).
Furthermore, simultaneously with incision, lasers (due to their microbicidal action) protect from infection spreading to healthy tissues. In most cases, tissue welding is not performed and suturing is not essential. In contrast to surgical treatment post-operative swelling and infl ammation are signifi cantly reduced or even absent. As a consequence, no post-operative pain-relief or antibiotic medication is needed, and tissue healing appears almost similar (however longer in duration) in comparison to traditional treatment [16].
In this case report, we describe excision of a recurrent POF in mandibular incisor's region with a diode laser (980nm wavelength). The purpose of this case report is to support the superiority of dental laser application in excision of this softtissue oral lesion compared to traditional surgical treatment applied so far in the excision of this lesion and highlight its advantages.  and recommendation for use of chlorexidine mouthwash 0.12% twice daily for 2 weeks were given to the patient.

Materials and methods
Excised lesion was sent for histopathological analysis.
Histopathological analysis confi rmed initial diagnosis of a Peripheral Ossifying Fibroma. Usually, healing in sites treated by surgical excision is completed in 7 to 10 days. In sites treated with laser excision, healing is delayed and can last 2 to 3 weeks [17]. In our case report, in 1-month follow up, no scar tissue formation and complete tissue healing was observed ( Figure   4).

Discussion
In in sites with traditional surgical treatment (7 to 10 days) [17].
Additionally to advantages mentioned above, diode laser is