By John Flucke, DDS - January 24, 2022
Fibroma Removal
I have been using lasers for over two decades, yet I am still amazed at their ease of use and lack of postoperative complications. Prior to bringing lasers into my practice I rarely performed soft tissue surgeries. While I enjoyed the procedures from a professional standpoint, I dreaded patient complaints of postoperative pain and concerns about postoperative bleeding. Over time those concerns had convinced me to refer surgeries to a surgeon’s office. I had begun to adhere to the old adage “better the patient is in my office complaining about the surgeon, than the patient to be in another office complaining about me!”
However when I brought lasers into my practice that philosophy vanished. That’s simply because carefully performed laser procedures have much less postoperative pain than a procedure performed with a blade.
Here is a typical story: A long time patient with high dental anxiety developed a fibroma from accidental biting of the labial mucosa. The fibroma had become fairly large and the accidental biting became increasingly more common. One day during a recare exam the patient asked about options of removing it. The patient stated “I’ve come to the conclusion that whatever you do to get rid of it can’t hurt any more than my constantly biting it!” The patient had become miserable enough that the misery overcame the dental fear.
Fibroma removal is easy and predictable. I always place a few drops of anesthetic into the area to ensure a painless experience. Next, using the laser I circumscribe around the lesion to identify the border of the fibroma. The idea is simply to create a line around the lesion that shows where I need to stop.
Next, depending on your preference, the lesion is elevated by the assistant either by placing a suture through the lesion or by use of a tissue forcep. My preference is to use the forcep, but both work equally well.
The assistant then elevates the lesion by pulling up and the doctor begins removal by holding the laser parallel to the tissue surface. This directs the laser energy under the lesion. The doctor then proceeds to ablate the tissue under the lesion using the aforementioned “finish line” as a guide. Even large fibromas can be removed in this manner in under 5 minutes.
The advantages of the laser are twofold. The laser coagulates as it ablates the tissue. This makes the field much cleaner and improves visualization of the target. It also means that postoperative bleeding is almost nonexistent. The other advantage is that laser wounds heal quickly and painlessly. In the case mentioned above, the very fearful patient took “one ibuprofen” because their fear convinced them “it would hurt” when in reality it was a painless recovery.
Because of the fact that the diode laser has such incredible healing, there is no need for sutures or a second appointment to remove them. Often in as little as 96 hours patients can hardly even tell anything was done due to the healing.
Patients do not want to be referred out of your practice. The trust they have developed in you makes them want to stay with you. Offering procedures such as laser fibroma removal with a laser is just one more way to provide more needed services to a grateful patient base.