Diode laser assisted excision of a gingival pyogenic granuloma: A case report

Abstract

Pyogenic granuloma is a non-neoplastic, exuberant, reactive lesion seen in response to local irritation or trauma caused by dental calculus, bacterial plaque, caries and restorations, with a strong predilection for the gingiva. It is among the frequently encountered oral lesions, occurring at a challenging oral site, the gingiva. Herein, we report a 71-year-old medically compromised Caucasian female who presented with a relatively large lobulated pyogenic granuloma on the buccal gingiva of the maxillary molar-premolar region. Total surgical excision was performed with an 840nm diode laser followed by the placement of hyaluronate gel and relevant periodontal dressing. Two weeks after surgical excision, complete healing was observed, but patient denied replacement of dental restoration. After 4 months of follow-up, an overall reduction of associated teeth mobility was also observed, with a minor recurrence in gingival inflammation. The objective of this report is to briefly review clinical, radiographic and histological findings of pyogenic granuloma along with a detailed discussion on its management through a diode laser.

Keywords: Diode laser; Gingiva; Laser surgery; Pyogenic granuloma.

Figure 1.

A solid and lobulated pinkish mass with a diameter more than 2 cm is associated with local ulceration on marginal, buccal gingiva of maxillary right molar. The relevant teeth (#14 and #16) are covered by metal-ceramic crowns for partial denture with irregular margins. Circumferential dental calculus is visible around the metal crown of the premolar

Figure 2.

Periapical radiograph shows no osseous involvement.

Figure 3.

After total excision of the lesion with diode laser.

Figure 4.

Hyaluronate gel and overlying periodontal dressing was placed and left in situ after excision.

Figure 5.

Histological examination with hematoxylin and eosin staining revealed high vascular proliferation (A) and inflammatory granulomatous tissue (B) with infiltration of lymphocytes, plasma cells and neutrophils and areas of fibrous connective tissue. The lesion was covered by ulcerated stratified squamous epithelium without atypia. These features confirmed the diagnosis of pyogenic granuloma.

Figure 6.

4-month follow-up: reduction of the involved teeth mobility and a minor recurrence in gingival inflammation.