A histological evaluation of the surgical margins from human oral fibrous-epithelial lesions excised with CO2 laser, Diode laser, Er:YAG laser, Nd:YAG laser, electrosurgical scalpel and cold scalpel

Abstract

Background We aim to evaluate the presence of histological artefacts in the surgical margins of human oral fibro-epithelial hyperplasias excised with lasers of different wavelengths, and also electrosurgical scalpel and cold scalpel. Moreover, we aim to determine if some of these instruments could impair the normal histological diagnosis of these lesions. Material and Methods We included 130 consecutive surgical samples of 80 females and 50 males (mean age of 53.82±16.55) with a histological diagnosis of an oral benign fibrous-epithelial hyperplasias. The samples were categorized into 6 groups according to the type of instrument used: CO2 laser group, diode laser group, Er:YAG laser group, Nd:YAG laser group, electrosurgical scalpel group and cold scalpel group. Histological instrument-induced changes were microscopic evaluated and related with clinical and pathological variables. Results The instrument with highest tissue damage extension (TDE) was the electrosurgical scalpel (1002.2µm±434.92), followed by diode laser (913.73 µm±322.45), Nd:YAG (899.83µm±327.75), CO2 laser (538.37µm±170.50), Er:YAG laser (166.47µm±123.85), and at last with fewer alterations the cold scalpel group (2.36µm±7.27) ( P < 0.001). The most regular incision was observed in CO2 laser group, followed by Er:YAG laser, Nd:YAG laser, electrosurgical scalpel and diode laser group with the less regular incision using cold scalpel as comparison ( P < 0.001). A correlation was found between the incision score and TDE ( P < 0.001). Regarding histological diagnosis, no case showed any limitation of diagnosis related with the use of any instrument evaluated. Conclusions Our results suggest that lasers can be used for the excision of oral benign fibrous-epithelial hyperplasias, without hispathological diagnosis limitations, as long as the physical properties of each laser are known and respected. Er:YAG laser have shown to be a laser with few tissue damage extension and with good incision regularity, been a possible instrument of choice for the surgical removal of these lesions. Key words: CO2 laser, diode laser, Er:YAG laser, Nd:YAG laser, oral mucosa.

Histological Effects of an Innovative 445 Nm Blue Laser During Oral Soft Tissue Biopsy

“…Due to the important role of the biopsy, as the specimen taken is uniquely and thus not repeatable, even from a medical-legal point of view, this procedure needs to be performed within the full safety margins [14,15]. Since laser has been used in a versatile way as a useful device in the surgical field, even for biopsies, there have been several studies aimed to test its safety [10,18,20]; but there are several authors who, especially in the past, valued controversies in the use of these devices in the field of biopsy surgery [14,15,24]. The critical aspect is not the difficult diagnosis of the specimen, since the various laser devices are now able to guarantee a histological diagnosis, if used with the right parameters and by a skilled operator, but the legibility of the peri-incisional margins of the specimen.…”

“…The diode laser, compared to the cold blade or the Er: YAG laser [6,10,39], causes greater tissue thermal damage, but it still allows a good reading of the specimens. The ex vivo effect of the Er: YAG laser on soft tissues showed peripheral thermal damage using a power of 3.9 W, and remained within 1 mm, while with intermediate parameters the thermal effect was lower [20]; but the lack of tissues with blood flow in vivo, presented in our study, should be considered.…”

“…When a laser device is used in oral soft tissues surgery, many advantages could be described, such as easier surgical access, mostly in sites that are difficult to approach and do not offer a cleavage plan; better ergonomics [8]; accurate cut [9]; antimicrobial action of the surgical site [10]; more effective hemostasis, with intraoperative bleeding control and better visibility [5]; no sutures for intraoperative coagulation, with a second intention healing [6]; reduction of post-operative pain and edema [11]; reduction in the use of a local anesthetic [12]; reduced postoperative complications, such as dehiscence, and faster healing [7]; and faster and easier use [6]. By contrast, it requires a learning curve [13].…”

Q-Switch Nd:YAG Laser-Assisted Decontamination of Implant Surface

“…Lasers were introduced in the management of periodontal and peri-implantitis diseases due to their following characteristics: reduction of damaged or inflamed tissues by photonic curettage of granulation tissues, the antimicrobial effects on biofilms in conjunction with an exogenous dye: application of antimicrobial photodynamic therapy/photoactivated disinfection (aPDT/PAD) and the photobiomodulation effect that promotes wound healing and tissue regeneration [31]. The absorption of the laser's energy produces thermal changes such as protein denaturation (50 • C), protein coagulation (60 • C), vaporization and ablation (100 • C) and tissue carbonization if the temperature is greater than (200 • C) [32]. The heat generated by laser beam may damage the implant surfaces.…”

Healing Assessment of Oral Mucosal Wounds Using Erbium, Chromium: Yttrium-Scandium-Gallium-Garnet Laser Versus Scalpel Blades

“…The scalpel group appeared moderate number of inflammatory cells infiltration present in slides section, see (Figures 2, 3, and (15,16) Despite the fact that, the erbium laser founds (9,15,20) .…”