Year : 2007 | Volume
: 18 | Issue : 3 | Page : 135--137
Denture-induced fibrous hyperplasia. Treatment with carbon dioxide laser and a two year follow-up
J Naveen Kumar1, M Bhaskaran2,
1 Oral and Maxillofacial Surgeon, Meenakshi Ammal Dental College, Chennai, India
2 Oral and Maxillofacial Surgeon, GEM Head & Neck Hospital, Thirunelveli, India
J Naveen Kumar
Oral and Maxillofacial Surgeon, Meenakshi Ammal Dental College, Chennai
Denture-induced fibrous hyperplasia (DIFH) is a persistent lesion caused mostly by the prolonged wear of an ill-fitting, over-extended denture. Although the condition frequently coexists with denture stomatitis, it is a distinct entity with a different protocol for management. The article describes successful treatment for a case of DIFH using carbon dioxide laser and a two year follow-up. The inherent advantages of using carbon dioxide laser over conventional surgical techniques are discussed.
|How to cite this article:|
Naveen Kumar J, Bhaskaran M. Denture-induced fibrous hyperplasia. Treatment with carbon dioxide laser and a two year follow-up.Indian J Dent Res 2007;18:135-137
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Naveen Kumar J, Bhaskaran M. Denture-induced fibrous hyperplasia. Treatment with carbon dioxide laser and a two year follow-up. Indian J Dent Res [serial online] 2007 [cited 2021 Oct 16 ];18:135-137
Available from: https://www.ijdr.in/text.asp?2007/18/3/135/33791
One of the most common tissue reactions to a chronically ill-fitting denture is inflammatory fibrous hyperplasia (DIFH). , Although benign, the condition is relatively troublesome since it interferes with denture placement. Surgical excision is the treatment of choice for DIFH. , With conventional techniques, high levels of skill with accurate planning of incisions and repositioning of tissues is mandatory to prevent loss of sulcus depth. A reliable alternative to conventional surgery is the use of lasers.  Intraoral use of lasers has evolved over the last four decades with improvements in clinical experience and scientific investigations. Although the first laser was introduced in 1960 by Theodore Maiman, it became a viable intraoral surgical tool only after Patel developed the first continuous-wave carbon-dioxide (CO 2 ) device in 1964. , In 1970, Polanyi premiered the incision of living tissue with a CO 2 laser.  Laser surgery is well-documented in otolaryngologic, plastic and reconstructive and general surgical literature. Using such newly developed equipments has taken patient care to great heights through improvised surgical techniques and an expanded array of novel procedures.
A 70 -year-old woman presented with elongated rolls of tissue in the maxillary muco-labial fold area [Figure 1]. She had no teeth in the maxilla since she was 50 years old and wore a complete set of ill-fitting acrylic dentures all the time. The growth appeared to be split apparently by the over-extended labial flange of the denture and was firm on palpation. Systemic examination revealed no significant abnormality but for mild, controlled diabetes. A provisional diagnosis of epulis fissuratum was made and an excision biopsy was planned using carbon dioxide (CO 2 ) laser under local anaesthesia as a day care procedure. The patient's physician was consulted to verify the fitness of the patient to undergo the surgery as planned. Bilateral infraorbital nerve blocks and naso-palatine block were administered to anaesthetize the involved areas. The prescribed protocol for handling surgical laser was strictly adhered to and the lesion excised using CO 2 laser in a continuous mode setting with a power output of 9.5 watts (W). Haemostasis was achieved using defocused mode with 3.5 W power setting [Figure 2]. The wound was allowed to heal without a stent or sutures [Figure 3]. A prescription of 500 mg paracetamol was given for postoperative pain control.  A histopathological diagnosis of inflammatory fibrous hyperplasia was established based on typical findings. A new set of well-formed acrylic dentures were fabricated after a month. The site was recurrence-free, the dentures immaculate and the patient comfortable during the follow-up period of two years [Figure 4].
Oral mucosa demonstrates a significantly low tolerance level to injury and irritation compared to human skin.  It does not appear to be suited to a complete denture load-bearing role. Approximately one third of denture wearers with a clinically normal mucosa show histologic evidence of severe injury.  The extent of injury is also related to the duration of the denture-wearing experience. A logical observation regarding the tolerance of oral mucosa is as follows: If the tolerance is exceeded (as by an over-extended denture border), injury and inflammation will result and the denture cannot be worn. If on the other hand, initial tolerance is high and the trauma is tolerable, a fibrous response is elicited and the residual ridge is replaced with a flabby hyperplastic tissue. The patients in the latter case usually present late, making surgical excision technically challenging.
While planning for surgical excision, great care must be taken to avoid excising attached mucosa to prevent loss of sulcus depth. In the absence of mucosal over-ridge, a skin graft must be placed and a splint inserted to maintain the patency of the sulcus following surgery.  Postoperative scar contracture is a very important factor for success as in many other preprosthetic surgeries.
With conventional surgical techniques, stringent asepsis, adequate antibiotic cover and analgesia are essential considering the vastness of the surgical site. Our patient required only a dose of paracetamol (500 mg SOS) for postoperative pain control. Neither antibiotic prophylaxis nor therapy was advocated in our protocol  because the delivered laser energy appears to be bactericidal and viricidal creating a sterile surgical field. , The neuron sealing effect of lasers aids in adequate pain control reducing or even abolishing the need for nonsteroidal antiinflammatory drugs (NSAIDs). ,, Needless to say, laser surgeries almost always present a bloodless field, making visibility better even when incising through inflamed and richly vascular areas. ,,, Inhibition of myofibroblasts, although a temporary phenomenon, may help to some extent in minimizing scar contracture following laser surgery. ,,, Suture closure of areas excised with carbon dioxide laser is not mandatory.  Given the excellent haemostasis and low propensity for postoperative scarring, it is often acceptable to allow laser wounds to heal secondarily. , A stent is unnecessary since healing is usually uneventful (10). Although laser wounds are slow to epithelialize and in many cases, a fibrinous coagulum is still present after two weeks, it may act as a biological dressing and is helpful.  Postoperative pain occurring after four days in some individuals is a normal phenomenon and can easily be managed with oral analgesics.
CO 2 lasers are a superb alternative to conventional modalities.  When used with optimal safety precautions, the cost of laser equipments may only be of secondary concern, considering the advantages lasers present with regards to standards of healthcare.
The authors would like to acknowledge Dr. P. Jayakumar, B.D.S. for clinical support.
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