The effect of Erbium:YAG Laser for the Fibronectin Expression in Gingival Epithelium with Nifedipine induced Gingival Overgrowth

Abstract

Background: Gingival overgrowth is one of the side-effects seen as a result of the regular administration of the calcium channel blocker anti-hypertensive drug Nifedipine. Fibronectin (FN), is an adhesive high molecular weight extra cellular matrix glycoprotein which plays an important role in influencing cell growth, adhesion, migration as well as extracellular matrix organization. It also contributes to fibroblast attachment and proliferation, and participates in the regulation of tissue fibrosis. Erbium: YAG laser was approved in 1997 by the U.S. Food and Drug Administration for hard and soft tissue treatment in dentistry. Several studies have been published to demonstrate its efficacy for bone cutting, plaque and subgingival calculus removal, as well as having an antiseptic effect on both soft and hard periodontal tissues. Conventional scaling in combination with Erbium: YAG laser has unexpectedly showed complete healing with normalization of the gingiva, making further surgical treatment for gingival volume reduction unecessary. Objectives:The aim of this study was to investigate the expression of fibronectin and its connection with the development of drug-induced gingival overgrowth. It also explores the effect of Erbium:YAG laser on the amount of fibronectin expression. Materials and methods:Paraffin embedded biopsies were obtained from 3 groups of patients: 10 normal patients (group C), 10 patients who underwent conventional scaling with surgical correction of gingival enlargement caused by the regular administration of nifedipine (group A), and 10 patients undergoing scaling and surgical removal of the overgrown gingiva due to the regular administration of nifedipine followed by Erbium:YAG laser treatment (group B). All Specimens were stained with Hematoxyin and Eosin to allow analyses of tissue morphology as well as immunostaining to detect fibronectin. Staining intensity in all groups was calculated by semi quantitative analysis. The results were subjected to statistical analysis.Results: Fibronectin stained less intensely nifedipine induced gingival hyperplasia after one single laser application when compared to gingival over growth without laser therapy. Conclusion:Erbium: YAG laser could be considered an effective option for the nonsurgical treatment of drug-induced gingival overgrowth which surpassing surgical procedures. It also promoted fast healing and ensured a higher surgical compliance when compared to the conventional techniques.