CO(2) Laser Surgery and Prosthetic Management for the Treatment of Epulis Fissuratum

Multidisciplinary treatment of epulis fissuratum: A case report

BACKGROUND

Epulis fissuratum is an inflammatory fibrous hyperplasia characterized by pseudotumoral growth in the soft tissues of the oral mucosa. It is a multifactorial condition caused by factors such as poor oral hygiene, prolonged use of ill-fitting dentures, continuous use of dentures without intervals of rest, and underlying systemic conditions such as diabetes mellitus and coagulation disorders. Although initially asymptomatic if left untreated, the lesion may result in complications such as ulcerations, secondary infections, and interference with speech, masticatory function, and oral aesthetics with significant adverse impact on the patient.

CASE SUMMARY

A 56-year-old female patient with no significant medical history presented to the dental clinic with tissue overgrowth and depression of the upper lip. She reported 30 years of continuous use of a complete maxillary denture without ever removing it. The management of this condition required a multidisciplinary approach to ensure accurate diagnosis and a strategic treatment plan tailored to her systemic health and the severity of the oral condition. The diagnosis of epulis fissuratum was confirmed through histopathological analysis. Treatment was implemented in two phases: Surgical and prosthetic. The surgical phase involved excision of the excess tissue and placement of a free gingival graft in the anterior maxillary vestibular area in order to deepen the vestibule and optimize the ridge for prosthetic rehabilitation. The prosthetic phase involved fabrication and placement of a new complete denture.

CONCLUSION

The multidisciplinary management of epulis fissuratum resulted in precise clinical diagnosis, effective soft tissue management, and appropriate prosthetic adjustments, thereby ensuring favorable long-term outcomes for the patient.

Fibrocyte: A missing piece in the pathogenesis of fibrous epulis

OBJECTIVES

To explore the role of fibrocytes in the recurrence and calcification of fibrous epulides.

METHODS

Different subtypes of fibrous epulides and normal gingival tissue specimens were first collected for histological and immunofluorescence analyses to see if fibrocytes were present and whether they differentiated into myofibroblasts and osteoblasts upon stimulated by transforming growth factor-β1 (TGF-β1). Electron microscopy and elemental analysis were used to characterize the extracellular microenvironment in different subtypes of fibrous epulides. Human peripheral blood mononuclear cells (PBMCs) were subsequently isolated from in vitro models to mimic the microenvironment in fibrous epulides to identify whether TGF-β1 as well as the calcium and phosphorus ion concentration in the extracellular matrix (ECM) of a fibrous epulis trigger fibrocyte differentiation.

RESULTS

Fibrous epulides contain fibrocytes that accumulate in the local inflammatory environment and have the ability to differentiate into myofibroblasts or osteoblasts. TGF-β1 promotes fibrocytes differentiation into myofibroblasts in a concentration-dependent manner, while TGF-β1 stimulates the fibrocytes to differentiate into osteoblasts when combined with a high calcium and phosphorus environment.

CONCLUSIONS

Our study revealed fibrocytes play an important role in the fibrogenesis and osteogenesis in fibrous epulis, and might serve as a therapeutic target for the inhibition of recurrence of fibrous epulides.

Prosthetic management of an epulis fissuratum with simple conditioning tissue: A case report

INTRODUCTION AND IMPORTANCE

Epulis fissuratum is an oral hyperplasic lesion related to an overextended and ill-fitting denture. The treatment of this lesion can be conservative or surgical associated to a good prosthetic management.

CASE PRESENTATION

The aim of this article is to present a case report about treatment of an epulis fissuratum with simple conditioning tissue, using provisional removable complete dentures.

CLINICAL DISCUSSION

The early management of the epulis fissuratum with conditioning tissue, associated to a good oral hygiene and a correct prosthetic rehabilitation provides satisfactory clinical results and avoids surgical treatment.

CONCLUSION

Conditioning tissue technique is a useful conservative approach for the treatment of the epulis fissuratum at an early stage.

A review on modern prosthodontic practice using laser

Lasers are a very appealing technology in many areas of dentistry because of their minimally invasive nature, quick tissue interaction & response, and ability to heal. Numerous investigations on the possible uses of lasers in dentistry have been carried out since Maiman developed the ruby laser in 1960. Numerous applications such as quick prototyping and computer-aided design, and the study of occlusion in complete denture using three-dimensional laser scanning has been used to develop dentures. Its uses are numerous from fixed prosthodontics to dentinal hypersensitivity treatment to surface treatment of base metal alloys. These days, it even encompasses maxillofacial prosthodontics and dental implantology. Hence, it is of interest to review the use of lasers in clinical prosthodontics.

Dental implant displacement complicated by epulis fissuratum and extraoral fistula in a patient with senile dementia of Alzheimer's type

Dental treatment of patients suffering from mental illnesses should not be neglected as good condition of oral cavity is one of the factors that determine satisfactory quality of life, not only by aesthetic but also by functional considerations.

Comparison of Carbon Dioxide Laser With Surgical Blade for Removal of Epulis Fissuratum. A Randomized Clinical Trial

Introduction: Epulis fissuratum is often formed as a result of a poor fitting denture. The conventional treatment for this fibrous hyperplastic tissue is to excise it using a scalpel and to close the wound by a continuous or an interrupted suture. The increased utilization of lasers in dentistry also includes the utilization of carbon dioxide (CO2) lasers in place of surgical scalpels in soft tissue surgeries. The objective of this study is to assess the feasibility of utilizing CO2 laser in place of scalpel in surgical treatment of epulis fissuratum. Methods: In this clinical trial research (IRCT code: IRCT2016071124969N2), 19 patients were selected with nearly symmetrical epulis fissuratums in the anterior part of the jaws. The hyperplastic tissue was evenly divided into two sections in each patient. One section was randomly selected and cut by CO2 laser and the other section by a surgical scalpel. The wound created by the scalpel was closed by appropriate number of interrupted sutures. Surgery duration and bleeding as well as vestibular depth, re-epithelialization and edema in both sections were noted and recorded after 7 and 14 days postoperatively. Results: The time of surgery and the amount of bleeding during surgery in the laser section was less and the vestibular depth was more than surgical scalpel section (P < 0.05). Surgical scalpel wound at day seventh healed significantly better than the section treated by the CO2 laser (P < 0.05). Wound in both sections healed similarly on day 14 and no statistical difference was observed. Edema presence was also equal in both sides after 7th and 14th following the surgery. Conclusion: According to the results it could be concluded that the use of CO2 laser may result in less surgery time, less bleeding during surgery, more vestibular depth, better re-epithelialization of the wound and less need for suturing. CO2 laser may be a clinically preferred method for surgical treatment of epulis fissuratum.