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Association of Two Lasers in the

of Traumatic Fibroma: Excision with
Nd:YAP laser and Photobiomodulation
Using InGaAlP: A Case Report

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Irineu Gregnanin Pedrona, Karen Muller Ramalhob, Luciano Artioli Moreirac,

Patrcia Moreira de Freitasd
a
b
c
d

Researcher, Periodontist of the Dentists Officers Staff, Brazilian Air Force, Hospital da Aeronauticade
So Paulo, Brazil.
PhD Student, Department of Stomatology, School of Dentistry, University of So Paulo, Brazil; Special Laboratory of Laser in Dentistry (LELO), School of Dentistry, University of So Paulo, Brazil.
Professor, Department of Stomatology and Laser in Dentistry, School of Dentistry, Cruzeiro do Sul
University, So Paulo, Brazil.
Professor, Department of Restorative Dentistry, School of Dentistry, University of So Paulo, Brazil;
Special Laboratory of Laser in Dentistry (LELO), School of Dentistry, University of So Paulo, Brazil.
Summary: Traumatic or irritation fibroma is a common benign exophytic oral lesion that develops secondary to
tissue injury. It is the most common benign reactive lesion, and the treatment of choice is surgical excision. The
use of lasers in different dental procedures has become very common in the last few years. In oral surgeries, it
use is usually associated with no or little bleeding and a better postoperative period. Nd:YAP (Neodymium:Yttrium-Aluminum-Perovskite) laser has been reported in the literature mainly in hard tissue procedures. The literature contains no reports of the use of ND:YAP laser in oral soft tissues surgery. This report describe the use of
Nd:YAP laser (1.34 m, 250 mW, 30 Hz) on the excision of a traumatic fibroma in combination with daily phototherapy with low-intensity laser (InGaAlP; 660 nm;40 mW; 3 J/cm2). The excision of the fibroma using the
Nd:YAP laser consisted was a quick clinical procedure, without bleeding. During the days following surgery, the
patient reported no pain or discomfort. The wound healing of the soft tissue was satisfactory and no scarring
could be seen in the region of the surgery. The excision of the fibroma with the Nd:YAP laser is a safe, quick procedure, and the postoperative photobiomodulation with low-intensity laser reduces edema and improves wound
healing.
Keywords: Nd:YAP laser, InGaAlP, irritation fibroma, oral surgery, oral pathology.

J Oral Laser Applications 2009; 9: 49-53.

raumatic fibroma, also known as irritation fibroma,

is a common benign exophytic oral lesion that develops secondary to tissue injury. The traumatic fibroma is among the most common benign reactive
lesions.1,2 A review of benign oral soft tissue tumors in
white Americans older than 35 years identified irritation fibroma as the second most common benign oral

Vol 9, No 1, 2009

lesion.1 Fibroma is a result of a chronic repair process

that includes granulation tissue and scar formation resulting in a fibrous submucosal mass. Recurrences are
rare and may be caused by repetitive trauma at the
same site. This lesion does not have a risk for malignancy3. The most common sites of traumatic fibroma
are the tongue, buccal mucosa, and lower labial mu-

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For the removal of both lesions, a Nd:YAP laser (Lokki

DT Laser; Vienne, France) with 1.34 m wavelength
was used. Local anesthesia was applied on the lesion
areas. Lesions were removed using the Nd:YAP laser
with a 200-m-diameter optic fiber and the following
parameters: 250 mJ and 30 Hz (Figs 3 and 4). The operations were performed without bleeding (Figs 5 and
6). After excision, lesions were fixed in 10% formol
and sent to pathology analysis, confirming the clinical
diagnosis of fibroma. Immediately following fibroma removal with Nd:YAP laser and 5 days postoperatively,

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Description of clinical procedures (cases 1 and 2)

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Case 1: A 32-year-old female patient reported a mass

on the tongue increasing in volume. Clinically, the patient presented a lesion on the lateral border of the
tongue, with no alteration of the color and no symptoms (Fig 1). The lesion had a sessile base. The patient
was norm reactive and presented extreme anxiety related to surgical procedures.
Case 2: A 44-year-old female patient complained of
a red-colored mass with increasing volume on the jugal
oral mucosa with a sessile base (Fig 2). The patient was
norm reactive. The etiology of the trauma was related
to absence of a first molar.

CASE REPORT

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cosa. Clinically, they appear as broad-based lesions,

lighter in color than the surrounding normal tissue,
with the surface often appearing white because of hyperkeratosis or with surface ulceration caused by secondary trauma. The growth potential of fibroma does
not exceed 10 to 20 mm in diameter.4 Surgical excision
is the treatment of choice. Differential diagnosis of
other lesions, including benign tumors (neurofibroma,
neurilemona, granular cell tumor, salivary gland tumors, lipoma) and mucocele should be ruled out by
biopsy.3 The application of high intensity lasers such as
CO2 ( = 10.6 m), Nd:YAG ( = 1.64 m), Er:YAG
(= 2.94 m), Er:YSGG (2.78 m) and diode lasers
for oral surgery are well established in the literature.
The use of neodymium:yttrium-aluminum-peroviskite
(Nd:YAP) laser in dentistry has been largely restricted
to hard tissues, and there are still no studies in the literature describing its use in surgical operations. This
case report illustrates the excision of a traumatic fibroma using the Nd:YAP laser (1.34 m) followed by
photobiomodulation with InGaAlP laser.

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laser phototherapy (LPT) was performed (InGaAIP
ti
laser, 670 nm, 40 mW, 3 J/cm2, 3 s/point;
te Dentoflex; on
ss e n cate 6
So Paulo, Brazil). The irradiation was performed
points above and around the region of the excision, in
order to obtain a better postoperative period, with less
pain and edema, and to improve wound healing (Fig 7).
During the subsequent days after the surgery, no pain
medication was required and no pain or discomfort
was reported by the patients. The wounds healed
properly in both cases and no scarring could be seen in
the region of the surgery.

DISCUSSION
This case report described the use of Nd:YAP laser on
the treatment of a traumatic fibroma. Different wavelengths of high power lasers have been used to perform oral soft tissue surgery, such as CO2 ( = 10.6
m), Er:YAG ( = 2.94 m), Er:YSGG ( = 2.78 m),
Nd:YAG ( = 1.64 m), and diode lasers.5,6 The literature supports their clinical indication as an alternative
method for soft-lesion surgery. The high intensity lasers
used in surgery procedures have shown several advantages compared to conventional treatment, such as the
easier technique, reduction of operation time, less
trauma induced in the tissue, less or no bleeding during
the procedure, better visualization of the surgical site,
and greater comfort for and better acceptance by patients. Up to the present, there are no reports in the
literature using Nd:YAP laser for the treatment of benign oral lesions, or even for any oral surgical procedures. The use of Nd:YAP laser has been mostly
described for hard-tissue management, especially in
restorative dentistry and endodontic procedures. Studies are relatively common which describe the use of
Nd:YAP laser on root canal cleaning and bacterial reduction, dentin hypersensitivity treatment, periodontics, or which evaluate roughness, microleakage and
mineral content of enamel and dentin after irradiation,
or analyze temperatures after Nd:YAP ablation. 7-15
Oral soft tissues consist of collagen, water, pigmented
connective tissue, blood, and lymphatic vessels; each of
these structures may be considered target chromophores and all commercially available laser wavelengths in dentistry will interact with these components
to a greater or lesser extent. What is of prime importance is the predominant chromophore in the target
tissue and the best laser wavelength to achieve maximum absorption of light energy. Laser surgery can promote homeostasis, avoiding the need for dressing or
sutures. Depending on the wavelength, it can lead to

The Journal of Oral Laser Applications

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Fig 1 Traumatic fibroma on the lateral border of the tongue.

Fig 2 Traumatic fibroma in oral jugal mucosa.

Fig 3 Excision of the traumatic fibroma on the lateral border of

the tongue using a Nd:YAP laser.

Fig 4 Excision of the traumatic fibroma in oral jugal mucosa using

a Nd:YAP laser.

Fig 5 Immediately after surgery, showing peripheral zone of

edema.

Fig 6 Immediately postoperatively, showing peripheral zone of

edema.

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18,22
intensity laser therapy.
It has been shown that cthis
tio
therapy presents advantages such as paintecontrol, anti- n
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inflammatory action, increase of collagen production,

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fibroblastic proliferation, and increase of local microvascularization.18-20,22,23 This biological effect occurs due to the increase of ATP synthesis, increase of
nuclear acid production, and gene expression.20,24 In
the current study, laser phototherapy contributed to
wound healing after fibroma excision.

CONCLUSION

Fig 7 Laser phototherapy.

It can be concluded that the excision of traumatic fibroma with Nd:YAP laser is a safe, quick procedure,
and postoperative laser phototherapy can reduce
edema and improve wound healing.

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better homeostasis and greater potential for cutting,
but irrespective of wavelength, all soft tissue healing is
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whereas longer wavelengths (Er,Cr:YSGG 2780 nm,
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The denatured proteins from tissue and plasma give
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ACKNOWLEDGMENTS
The patients visited the Stomatology Clinic of the Dental School of
the University of Cruzeiro do Sul (UNICSUL).

Contact address: Irineu Gregnanin Pedron, Departamento

de Estomatologia, Faculdade de Odontologia, Universidade
de So Paulo, Av. Prof. Lineu Prestes, 2227 - Cidade Universitria, So Paulo, SP, Brazil 05508-900. Tel/Fax: +55-113091-7813. e-mail: igpedron@usp.br

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