IADS Lecture of the Month- December

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Removal of Epulis Fissuratum with Carbon Dioxide Laser : a case report

Bassir S.H1, DrKamali A2, Dr Chiniforush3 1Student, School of Dentistry, Tehran University of Medical Sciences 2Periodontist, Laser Research Center of Dentistry (LRCD), School of Dentistry, Tehran University of Medical Sciences. 3Dentist , Laser Research Center of Dentistry (LRCD), School of Dentistry, Tehran University of Medical Sciences.

Introduction: The Epulis fissuratum is caused by chronic irritation from badly adapted prostheses and presents itself as a connective tissue tumor. Trauma and irritation are important etiological factors for Epulisfissuratum .Elimination of trauma/irritation and inflammation can lead to modest decreases in lesion’s size and conservative excisional surgery is the definitive treatment. There have been numerous surgical techniques developed for removing the Epulis fissuratum lesions .Most of these techniques can cause postoperative complications such as edema, pain, difficulty in swallowing and jaw movements, hemorrhage, infections and slow placement of final prostheses. More recently laser irritation has been used for removing hyper plastic mucosal lesions.

Materials and Methods: An edentulous 55-year-old female patient who was referred to the Oral Medicine department in the dentistry school of Tehran University of Medical Sciences,with exophitic mass on anterior segment of alveolar ridge and labial vestibule. The size of mass was 4 * 1.5 cm and color of mass was same as normal tissue. There was not seen any wound or erosion on the lesion Figure 1). Moreover, there was no history of systemic diseases.

After clinical examination and due to her very badly adapted denture, this lesion was diagnosed as Epulis Fissuratum. Then, patient was referred to laser department and the lesion was removed by applying the Carbon Dioxide Laser(10600nm,20HZ,6.4w) under local anesthesia(Figure2 to 4). The patients, as well as the surgeon and the team, were protected with laser safety glasses and masks. The Patient was followed up after a month (Figure 5) Figure1-Epulis fissuratum on anterior segment of alveolarRidge and labial vestibule Figure2-The lesion was being removed with co2 laser Figure3-The half of lesion was removed. Bleeding was minimum. Figure4-Complet lesion after removing Figure5-Complet healing after 1 month.

Results and discussion: In this patient, the use of CO2 laser for the surgical removal of Epulis lesions has resulted in several improvements including convenient mucosa removal, no bleeding or need for sutures, and minimal postoperative pain and edema and ideal healing after a month. Several researchers have reported on the use of CO2 laser for removing hyperplastic mucosal lesions. It was noted that with this type of surgery the main advantages over conventional surgeries are: excellent homeostasis, minimal trauma and edema, sterilization of the surgical wound, minimal postoperative pain and, in most cases, no need of suture. These advantages were fully observed by us when comparing our patients to those treated conventionally.

Conclusion: CO2 Laser has less post-operative complication compare to other methods and could be treatment of choice in treatment of Epulis fissuratum