Ablation and sulcular debridement utilizing the CO2 aser for denture-induced gingival hyperplasia

The term gingival hyperplasia refers to excess gingival tissue growth. It can be caused by numerous factors, most common being periodontal disease, poor oral hygiene, medications, smoking, and ill-fitting denture prostheses.1,2 The treatment of hyperplasia includes elimination of the causing factors and surgical removal of the lesion.1 If the cause persists, the tissue becomes more fibrous over time and can ulcerate and cause further pathology. This article presents a case report of the surgical removal of gingival hyperplasia along with the sulcular debridement for peri-implantitis using the flexible fiber CO2 laser with a variety of dental and surgical laser handpieces. Hyperplasia can be treated conservatively (by improving oral hygiene) or surgically (by scalpel, electrosurgery, carbon dioxide [CO2], Er:YAG, Nd:YAG, and diode lasers).1-3 The greatest disadvantage of the conventional scalpel is intraoperative hemorrhage and the need to suture the wound (patient discomfort).4 The CO2 laser in the case described in this article did not require sutures and allowed the surgeon to perform vestibuloplasty with a palatal mucosal graft during the same visit. Electrosurgery was not an option in the case described in this article because of the close proximity to the titanium implants.5 The CO2 laser is an excellent tool for removal of gingival hyperplasia because of its ability to induce hemostasis, speed, lack of the need for sutures, and excellent healing with reduced wound contraction without scar tissue resulting in healthy pliable tissue.6-8 In comparison with scalpel wounds, healing in the CO2 laser-treated wounds is characterized by a higher fibroblastic proliferation with young fibroblasts actively producing collagen. Only a small number of myofibroblasts (the cells responsible for wound contraction) are found in the CO2 laser-treated wounds compared with scalpel wounds.9,10 Thus, diminished wound contraction and reduced possibility of scar tissue formation are attributed to the insignificant amount of myofibroblasts. In addition, the CO2 laser can be effectively used for sulcular debridement due to its bactericidal properties along with the safety of the 10,600 nm wavelength around titanium implants.11-13