A punch technique for gingival incisional biopsy.

INTRODUCTION Gingiva is a common site for reactive, non-neoplastic, and neoplastic lesions with unspecific clinical features (Fig. 1): desquamative gingivitis as expression of mucocutaneous diseases (lichen planus, pemphigus, pemphigoid, plasma-cell gingivitis, lupus erythematosus), preneoplastic lesions (gingival verrucous proliferative leukoplakia), and gingival enlargements (gingival fibromatosis, Wegener’s granulomatosis, leukemic infiltrate), and gingival carcinomas frequently require one or more incisional biopsies to establish a definitive diagnosis. Occasionally, gingival biopsies may be also useful in the diagnosis of amyloidosis and syndromic entities such as tuberous sclerosis or Cowden syndrome (multiple hamartomas). An oral biopsy specimen can be affected by a number of artifacts that may be critical for histologic diagnosis, thus the selection of the technique and surgical instruments are crucial to avoid potential pitfalls in the histological interpretation. Different studies have proved better results for incisional biopsies when using a punch instead of a scalpel in terms of pathological artifacts related to handling of the specimen. However, the gingiva is part of the lining tissue of the oral cavity and is firmly attached to alveolar processes by connective fibers that make it a relatively unmovable tissue with difficult surgical handling. Moreover, gingival sites do not allow adequate biopsies, as access to some sites may not be possible. To avoid this inconvenience, the use of a small-diameter punch is suggested. MATERIALS AND METHODS Materials used were intraoral mirror or separator, syringe for intraoral local anesthesia, local anesthesia, molt-type periosteotome, 3-mm biopsy punch (Stiefel Laboratories, Madrid, Spain) or 3-mm powered punch (Mozo-Grau, Valladolid, Spain), contra-angle and surgical motor, and periodontal-type surgical cement.