Epulis fissuratum is a mucosal hyperplasia that results from chronic low-grade trauma induced by a denture flange. Epulis fissuratum is. epulis fissuratum. 1. EPULIS FISSURATUM By: Aleia S. Guzman; 2. WHAT IS EPULIS FISSURATUM? is a benign hyperplasia of fibrous. A poorly fitted prosthesis can give rise to a plethora of problems like pain, discomfort in mastication and speech and epulis fissuratum. Epulis.
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The aim of this report is to present a case showing fisxuratum treatment of Epulis fissuratum in relation to an ill fitting denture, in a debilitated geriatric patient with a novel fissurratum using liquid nitrogen cryosurgery. Management of geriatric patients can be quite epulix due to the presence of various diseases. Epulis fissuratum associated with an ill fitting denture greatly hinders mastication and produces discomfort and pain to the patient.
The liquid nitrogen cryosurgery can be used effectively in its management, due to its excellent haemorrhage control and postoperative healing. A year-old male reported with Epulis fissuratum in the vestibular sulcus, which e;ulis associated with an ill- fitting denture. The patient was a known hypertensive and diabetic, presently on anti-coagulant therapy with previous history of myocardial infarction.
Liquid nitrogen cryosurgery was used for the treatment of the lesion. During the procedure, nil haemorrhage was achieved and the postoperative healing was satisfactory. Liquid nitrogen cryosurgery hence can be used effectively in debilitated geriatric patients as it has the boon of achieving excellent haemostasis, good healing with minimal postoperative oedema and pain, maintaining an aseptic environment.
This novel peulis can be effectively used by dentists in the treatment of Epulis fissuratum besides it can also be epulia in treatment of other oral eulis tissue pathologies achieving a plethora of benefits.
A poorly fitted prosthesis can give arise to a plethora of problems, notably Epulis fissuratum, residual ridge resorption, ulceration of the soft tissue, etc. Out of which, Epulis fissuratum is considered essentially to be treated due to its masticatory hindrances. It is considered an overgrowth of intraoral tissue resulting from chronic irritation [ 1 ].
This mucogingival hyperplasia located over the soft tissues of the vestibular sulcus, may be considered as a reactive condition of the oral mucosa to excessive mechanical pressure on the avalah. Chronic trauma to the oral mucosa is considered a risk factor for the development of oral carcinoma. Studies have shown that the sharp edges of teeth or the ragged edges of ill fitting dentures have potential to cause oral carcinoma [ 2 ]. Hence ill fitting dentures and fidsuratum sequalae should not be overlooked.
The management of the Epulis fissuratum can be especially challenging in geriatric patients. Geriatric patients often pose with systemic disorders that are tough to deal with.
Diabetes is one such condition that needs efficient management. Anticoagulant intake is another challenge that pulls the cuffs of the dentist, which he can be readily overcome. The main concern for this is the profuse haemorrhage that might arise during the treatment procedure. Besides these patients also have a predilection for myocardial infarction, stroke, etc.
Additionally, at least one chronic disease is found in the majority of elderly persons [ 3 ]. This adala the maintenance of a strict protocol during their management. The advent of various new surgical modalities has made their management much easier. One such novel technique is the cryosurgery.
It is used in a number of dermatological and oral procedures because of its obvious advantage of excellent haemorrhage control and postoperative healing.
A year-old male Fig.
Epulis fissuratum: consequence of ill-fitting prosthesis
The denture was delivered to the patient about 2 years back. On palpation, all the inspectory findings were confirmed and the lesion was soft in consistency and smooth in texture. No fissurqtum ulcerations were present at the time of examination. The patient presented with an array of medical conditions. He presented with Diabetes, Hypertension, previous history of Myocardial infarction and present Anticoagulant therapy. He was diagnosed with Diabetes 12 years back and was under Metformin for the same.
Case Report: Epulis fissuratum: consequence of ill-fitting prosthesis
He also gave a history of Hypertension present for 8 years and under Losartan for the same. The patient had a myocardial infarction about 5 years back.
He underwent angioplasty for the same and was placed under Aspirin from then. According to the American Society of Anaesthesiologists classification [ 4 ], he was classified as ASA Fissurqtum that adqlah patient with severe systemic disease that limits activity, due to the presence of more than two systemic diseases. Hence the patient was referred to cardiologist and haematologist for opinion and consent for the treatment of the Epulis fissuratum.
His INR level was 2. The liquid nitrogen for the gun was procured from Sri Venkateshwara University, Tirupathi Physics department which has a liquid nitrogen plant. The patient was informed in detail about the procedure after which he signed an informed consent form. The procedure was carried out in 3 sittings at 1 week, 2 week and 3 weeks. It was observed fissuratum the cryosurgery technique maintained a clear surgical field with nil haemorrhage accounting to its advantage.
The postoperative period was uneventful and healing was satisfactory Fig. The patient was recalled at 1 month and 2 months for observation. The healing was observed to be good and there was no recurrence of the lesion.
Following the treatment procedure, the ill fitting mandibular denture was relined according to the present residual ridge Fig. The patient was satisfied with its fit, comfort and phonetics. The Management of a debilitated geriatric patient can be an enigma to the Dentist. Treatment of Epulis fissuratum can be of two types: The conservative approach should be the first option as it is non invasive.
However it is quite time consuming. It includes removal of the acrylic flange followed by relining and rebasing after the complete healing of the lesion. The surgical approach includes using any of the following: The surgical scalpel has been used time immemorial for this soft tissue lesion. Electro cauterisation was also used to remove Epulis fissuratum with advantages of haemorrhage control and postoperative healing. But with the advent of lasers, the former has taken a back seat.
Some of the lasers used in dentistry for this purpose is CO 2 laser, Er: Many studies have shown that the carbon dioxide lasers have more promising results than the scalpel [ 67 ]. Better healing was observed with carbon dioxide laser than with the surgical scalpel between postoperative days 7 and This allows the maintenance of an adequate sulcus depth important for achieving a correct peripheral seal for dental prosthesis retention and stability, preventing further recurrences [ 1314 ].
Recently, the liquid nitrogen cryosurgery has also been studied for its utility in this regard. A recent study has shown that the liquid nitrogen cryosurgery has results equal to that of the carbon dioxide laser in terms of haemorrhage control and postoperative healing [ 715 ]. The liquid nitrogen cryosurgery has been used successfully in a number of oral surgical and dermatological procedures.
It is widely used in removing epidermal warts, molluscum contagiosum, hemangiomas, treating chromomycosis [ 16 — 18 ] and also in excision of skin malignancies [ 19 ]. In oral surgical procedures it has been implemented in the management of aggressive primary jaw lesions [ 2021 ] and minor soft tissue surgeries [ 2223 ].
It has the boon of achieving excellent haemostasis, without direct contact with tissue while maintaining an aseptic environment.
It also provides good healing with minimal postoperative oedema and pain. The mechanism behind it is that as the cryosurgery is applied ice crystals are formed intracellularly and progressive necrosis ensues. It is advocated that repeat freezes, as used epulia our case report, adaalh in rather large intracellular ice crystals and it is this increase in size which is more lethal to the cells [ 24 ].
Another advantage is that cryosurgery is a painless procedure because of the immediate blockage of the nerve transmission in that area. Low temperatures have been shown to be capable of blocking neural transmission. It achieves haemostasis by means of necrosing the capillary ends by which it adala the same. Studies have showed the increased presence of platelets in vessels treated with cryosurgery [ 24 ], denoting its role in haemorrhage control.
Another valid advantage of cryosurgery is its low cost when wdalah it with its counterpart techniques. Hence all these properties of cryosurgery make it a best suited technique in treating geriatric patients. The advantages of cryosurgery over the conventional method makes it an important asset in sdalah armamentarium of oral surgeon and has additional advantages of controlling pain and perhaps dealing with lesions in sites that would be difficult to treat by other means.
Hence it can be used in the treatment of Epulis fissuratum, besides it can also be used in treatment of other oral soft tissue pathologies achieving a plethora of benefits. Dentists are treating increased number of elderly patients who have one or more significant comorbidities, which may complicate treatment aralah and reduce ability to carry out post treatment monitoring.
The potential benefit of the treatment and overall prognosis are also important factors that we need to assess and reconcile in shaping treatment strategies. Hence it mandates the modification of treatment plan to suit the geriatric population and to decrease the likelihood of adverse events from dental innervations. The cryosurgery is one such excellent technique which translates benevolence to the geriatric patient.
National Center for Biotechnology InformationU. J Indian Prosthodont Soc. Published online Jul Prasad VyasarayaniA. Madhumiethaand Pratheeth Gundlapalle. Author information Article notes Copyright and License information Disclaimer.
Received Jan 2; Accepted Jul 7. Abstract The aim of this report is to present a case showing the treatment of Epulis fissuratum in relation to an ill fitting fissuratim, in a debilitated geriatric patient with a novel technique using liquid nitrogen cryosurgery.
Liquid nitrogen cryosurgery, Geriatric patient, Haemorrhage control, Soft tissue lesion. Introduction A poorly fitted prosthesis can give arise to a plethora of problems, notably Epulis fissuratum, residual ridge resorption, ulceration of the soft tissue, etc. Case Report A year-old male Fig. Open in a separate window. Discussion The Management of a debilitated geriatric patient can be an enigma to the Dentist. Clinical Significance The advantages of cryosurgery over the conventional method makes it an important asset in the armamentarium of oral surgeon and has additional advantages of controlling pain and perhaps dealing with lesions in sites that would be difficult to treat by other means.
Conclusion Dentists are treating increased number of elderly patients who have one or more significant comorbidities, which may complicate treatment planning and reduce ability to carry out post treatment monitoring.