High-level laser therapy versus scalpel surgery in the treatment of oral lichen planus: a randomized control trial.

OBJECTIVE: To compare the clinical effectiveness of various types of high-level laser therapy (HLLT) toward scalpel excision for the surgical treatment of erosive oral lichen planus (OLP). MATERIALS AND METHODS: The total number of 128 individuals were enrolled in the study. The 35 did not meet the inclusion criteria due to malignancy signs and presence of diabetes mellitus. In total, 8 were lost to follow-up, and 10 were excluded from the analysis, due to analgesics intake. This way 75 patients with the erosive form of OLP were analyzed in three intervention groups (Er:YAG, n = 19; Nd:YAG, n = 15; Er:YAG + Nd:YAG combination, n = 20) and one control group with scalpel excision (n = 21). The therapy effectiveness has been assessed based on the comparison of salivary interleukin (IL)-1ß, IL-6 and interferon (IFN)-γ preoperative levels to 14, 30 days, and 2 years postoperation, as well as pain level and time of epithelization. RESULTS: All HLLT groups demonstrated a significantly (p > 0.05) higher IL-1ß, IL-6, IFNγ and pain level reduction and quicker epithelization toward the control group on the 30th day, except Nd:YAG in case of IFNγ level. The highest IL-1ß, IFNγ and pain level reduction and quicker epithelization on the 30th day was observed in Er:YAG group, followed by Er:YAG + Nd:YAG combination, Nd:YAG respectively. However no significant difference was observed between the HLLT groups with regard to IL-6 level reduction. After a 2-year follow-up, no significant difference was observed between all study groups with regard to all variables. CONCLUSION: HLLT yields a superior clinical outcome compared to the scalpel excision for the surgical treatment of oral lichen planus, whereby the Er:YAG has been proposed as the most effective laser type at the end of the first postoperative month. CLINICAL RELEVANCE: For the surgical treatment of erosive OLP the Er:YAG laser may be a preferable treatment option compared to Nd:YAG and scalpel surgery. TRIAL REGISTRATION: The present trial was registered retrospectively in the German Clinical Trials Register, as a member of WHO international clinical trials registry platform, on the 18.03.2020 with the following number: DRKS00020986.

Short dental implants in patients with oral lichen planus: a long-term follow-up.

Oral lichen planus is associated with the Koebner phenomenon, and trauma may exacerbate oral lesions. Short dental implants, as alternatives to bony augmentation, would reduce the number of interventions and their morbidity. However, we know of no studies that have analysed the long-term outcomes of short implants in patients with oral lichen planus. We have therefore designed a retrospective study of such patients treated with short implants (≤8.5mm long), with survival of implants as the main outcome. The secondary outcomes were marginal bone loss and the development of complications. We calculated the implants' survival and compared the outcomes statistically between erosive and reticular oral lichen planus. Sixty-six short implants were placed in 23 patients with a mean (SD) age of 58 (7) years. The mean (SD) peri-implant bone loss was 0.96 (0.89) mm mesially and 0.99 (1.1) mm distally. Sixty-five of the 66 implants survived with a mean (SD) follow-up of 68 (32) months, and there were no significant differences between erosive and reticular disease. Stable long-term outcomes can be expected for short implants placed in patients with oral lichen planus, and graftless rehabilitation of missing teeth could be possible in these patients if short implants were used.

Molecular classification of autofluorescence excision margins in oral potentially malignant disorders.

OBJECTIVE: To define molecular differences between autofluorescence and white light defined excision margins in oral potentially malignant disorders (OPMD) using transcriptome expression profiles. MATERIALS AND METHODS: Excisional biopsy specimens were taken from 11 patients at three different sites for each lesion: centre, white light margin and autofluorescence margin. The lesions were diagnosed histopathologically as oral epithelial dysplasia, oral lichenoid dysplasia, oral lichen planus or other. Transcriptome analysis was performed by RNA sequencing, hierarchical clustering, differential expression and biological pathway analysis. RESULTS: For hierarchical clustering, the samples broadly clustered according to histology rather than the margins with lichenoid samples clustering together. Differential expression analysis showed that independent of histology, there was greater molecular dysregulation between the lesion centre and autofluorescence margin compared to the lesion centre and white light margin. Furthermore, the autofluorescence and white light margins were molecularly distinct, indicating the white light margins harboured abnormality. CONCLUSION: Our results indicate that the molecular profile of OPMD changes with divergence away from the centre of the lesion, and that autofluorescence determined margins are superior to the white light margin in achieving a clear molecular margin when excising an OPMD.

[The research progress of CO(2) laser in the treatment of oral lichen planus].

Oral lichen planus (OLP) is a common oral mucosal disease. The etiology of OLP is not clear. The treatment of OLP is difficult as some of the OLP patients have little effects to the conventional mucosal treatments. In recent years, laser therapy has been adopted to treat patients with OLP. The CO(2) laser therapy has drawn much attention of doctors and scholars because of its advantages in treating the OLP. This review article mainly discusses the principle, effects and some state-of-the-art progresses in OLP treatment using CO(2) laser.

Interventions for the management of oral lichen planus: a review of the conventional and novel therapies.

OBJECTIVE: This narrative review focuses on the rationale and role of conventional and newer therapies in the management of oral lichen planus (OLP) with emphasis on randomized controlled trials (RCTs) reported over two decades. MATERIALS AND METHODS: Literature search was conducted to identify RCTs for the management of OLP from 1 January 1995 to 31 December 2015; Medline and Cochrane databases complemented with manual search were used. Primary outcome as resolution of pain was evaluated with the analysis of clinical resolution of erythema and ulceration as secondary outcome. RESULTS: The search provided 260 abstracts, of which 70 full-text articles were included. Majority of trials used topical steroids with very few trials on newer therapies. It was found that topical steroids are effective for symptomatic management of OLP with equal efficacy shown by topical calcineurin inhibitors and retinoids. However, the side effect of transient burning sensation with relapse was more with calcineurin inhibitors. CONCLUSION: Although the newer therapies offer advantage over steroids for the management of OLP in recalcitrant cases, extensive lesions, and cases unresponsive to steroids, but sufficient clinical data on their use are still lacking. Hence, more RCTs with large sample size, adequate treatment duration, and long-term follow-up are required for clinical utility.

Monitoring carcinogenesis in a case of oral squamous cell carcinoma using a panel of new metabolic blood biomarkers as liquid biopsies.

INTRODUCTION: One of the common malignant tumors of the head and neck worldwide with generally unfavorable prognosis is squamous cell carcinoma (OSCC) of the oral cavity. Early detection of primary, secondary, or recurrent OSCC by liquid biopsy tools is much needed. CASE PRESENTATION: Twelve blood biomarkers were used for monitoring a case of OSCC suffering from precancerous oral lichen ruber planus mucosae (OLP). After curative R0 tumor resection of primary OSCC (buccal mucosa), elevated epitope detection in monocytes (EDIM)-Apo10, EDIM-transketolase-like-1 (TKTL1), squamous cell carcinoma antigen (SCC-Ag), total serum lactate dehydrogenase (LDH), and its anaerobic isoforms (LDH-4, LDH-5) decreased to normal levels. Three and six months after surgery, transformation of suspicious mucosal lesions has been accompanied with an increase of EDIM scores, total serum LDH values, and a metabolic shift from aerobic (decrease of LDH-1, LDH-2) to anaerobic (increase of LDH-4, LDH-5) conditions. Two months later, secondary OSCC was histopathologically analyzed after tissue biopsy. Cytokeratin fraction 21-1 (CYFRA 21-1), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) were not affected during the clinical course of carcinogenesis. CONCLUSIONS: A combination strategy using a standardized panel of established (metabolic) blood biomarkers (TKTL1, LDH, LDH isoenzymes) is worth and can be recommended among others (apoptosis resistance-related Apo10, SCC-Ag) for early detection and diagnosis of primary, secondary, and recurrent OSCC. A tandem strategy utilizing (metabolic pronounced) routine liquid biopsies with imaging techniques may enhance diagnosis of OSCC in the future. Although we demonstrated the diagnostic utility of separated liquid biopsies in our previous study cohorts, further investigations in a larger patient cohort are necessary to recommend this combination strategy (EDIM blood test, LDH value, metabolic shift of LDH isoenzymes, and others, e.g., SCC-Ag or immunophenotyping) as a diagnostic tool for the addition to the OSCC staging system and as a routine procedure in the aftercare.

Dental implants in patients with oral mucosal diseases - a systematic review.

To reveal dental implants survival rates in patients with oral mucosal diseases: oral lichen planus (OLP), Sjögren's syndrome (SjS), epidermolysis bullosa (EB) and systemic sclerosis (SSc). A systematic literature search using PubMed/Medline and Embase databases, utilising MeSH and search term combinations identified publications on clinical use implant-prosthetic rehabilitation in patients with OLP, SjS, EB, SSc reporting on study design, number, gender and age of patients, follow-up period exceeding 12 months, implant survival rate, published in English between 1980 and May 2015. After a mean observation period (mOP) of 53·9 months (standard deviation [SD] ±18·3), 191 implants in 57 patients with OLP showed a survival rate (SR) of 95·3% (SD ±21·2). For 17 patients with SjS (121 implants, mOP 48·6 ± 28·7 months), 28 patients with EB (165 implants, mOP 38·3 ± 16·9 months) and five patients with SSc (38 implants, mOP 38·3 ± 16·9 months), the respective SR was 91·7 ± 5·97% (SjS), 98·5 ± 2·7% (EB) and 97·4 ± 4·8% (SSc). Heterogeneity of data structure and quality of reporting outcomes did not allow for further comparative data analysis. For implant-prosthetic rehabilitation of patients suffering from OLP, SjS, EB and SSc, no evidence-based treatment guidelines are presently available. However, no strict contraindication for the placement of implants seems to be justified in patients with OLP, SjS, EB nor SSc. Implant survival rates are comparable to those of patients without oral mucosal diseases. Treatment guidelines as for dental implantation in patients with healthy oral mucosa should be followed.

Clinical trial analyzing the impact of continuous defocused CO2 laser vaporisation on the malignant transformation of erosive oral lichen planus.

The erosive oral lichen planus (OLP) represents a management challenge to the clinician and can have debilitating consequences to patients' quality of life. The aims of this work were to determine the incidence of malignant transformation to squamous cell carcinoma (SCC) in patients undergoing traditional symptomatic treatments (oral salve containing lidocaine hydrochloride or systemic diclofenac) compared to patients that were managed with a defocused continuous CO2 laser beam. A total of 171 patients with histologically confirmed erosive OLP were included into this study. After treatment, patients were assessed until completion of wound healing, at least every 3-6 months for the first 2 years, and every 6-12 months thereafter. The study included 87 women (50.9%) and 84 men (49.1%). A total of 103 patients (60.2%) underwent symptomatic conservative treatment, and 68 patients (39.8%) underwent continuous defocused CO2 laser treatments. SCC developed in 16 patients (9.4%), 2 patients (2.9%) after continuous defocused CO2 laser treatment and 14 patients (13.6%) with symptomatic treatment only. This study provides insight into the potential impact of the CO2 laser in the management of patients with erosive OLP and the influence on the recurrence rate of erosive OLP, as well as malignant transformation to oral SCC.

Treatment of Oral Mucosal Lesions by Scalpel Excision and Platelet-Rich Fibrin Membrane Grafting: A Review of 26 Sites.

PURPOSE: One of the preferred treatment options for oral mucosal lesions (eg, leukoplakia and lichen planus) is excision, with or without the use of a coverage agent. Platelet-rich fibrin (PRF) membranes are popular fibrin scaffolds with entrapped platelets that release various growth factors and cytokines to support and enhance wound healing. The aim of the present report was to describe the technique, postoperative wound care, and clinical results of PRF membrane grafting after excision of superficial potentially malignant oral lesions. MATERIALS AND METHODS: Autologous PRF membrane was fabricated and grafted over 26 wounds created by excision of small, superficial, potentially malignant lesions of oral mucosa (or fiberotomy in cases of oral submucous fibrosis) and assessed clinically at 7, 15, 30, and 60 days. RESULTS: Healing was satisfactory in all cases, with minimal and manageable complication at 1 site. CONCLUSION: The results of the present study suggest that PRF membrane is a successful coverage agent that aids in the healing of superficial oral mucosal wounds. Additional comparative studies are required to establish its efficacy compared with that of other agents.

Surgical approach to oral lichen planus by submucosal autologous fat grafting.

Oral lichen planus is a chronic autoinflammatory mucositis. Oral lesions are predominantly white; they tend to be bilateral while involving the buccal mucosa especially cheek, tongue, gums, lips, and palate. Many topical and systemic agents are currently used with unpredictable results. Fat grafting is characterized by the placement of multiple parcels of purified fat with blunt cannulas; at the beginning, it was introduced to improve facial aesthetics. Recently, it has been translated to other surgical cases such as posttraumatic deformities and craniofacial anomalies and as ancillary reconstructive procedure after tumor resections. The successful results of this procedure encouraged us to use this approach to a clinical case of oral lichen planus refractory to conventional therapy.

Efficacy of diode laser in the management of oral lichen planus.

Oral lichen planus (OLP) is a common chronic disease of uncertain aetiology. Treatment of patients with symptomatic OLP represents a therapeutic challenge. Despite numerous existing remedies, there are many treatment failures. The diode laser therapy is used as a possible alternative method in the treatment of lichen planus. The patient with OLP lesions was treated using diode laser (940 nm) for the symptomatic relief of pain and burning sensation. The patient was assessed before, during and after the completion of the treatment weekly. The treatment was performed for 2 months and the patient showed complete remission of burning sensation and pain (visual analog scale 0%). The follow-up was performed for 7 months and no recurrence of burning sensation was found. Diode laser therapy seems to be an effective alternative treatment for relieving the symptoms of OLP.

Malignant transformation of a potentially low risk lichenoid reaction.

Lichenoid reaction represents a family of oral lesions identical, both clinically and histologically to oral lichen planus. The triggering factor for this lesion varies from medicines to dental materials, usually demonstrating a cause-effect relationship unlike lichen planus. We present a typical case of lichenoid reaction on the buccal mucosa that appeared in response to betel quid which progressed to carcinoma during a follow-up period of 6 months. Lichenoid reactions occurring in response to known carcinogens and that occurring in risk group population has to be observed more cautiously.

New clinical approach for use of Er:YAG laser in the surgical treatment of oral lichen planus: a report of two cases.

The aim of this clinical report is to demonstrate the efficiency of Er:YAG laser in reducing symptoms and lymphoplasmocytic infiltrate in case of oral lichen planus (OLP). In addition to medical therapy and conventional surgery, laser has been proposed for the treatment of this disease, but currently, use of Er:YAG laser (2940 nm) has not been reported. Two clinical cases of female patients who came to our clinic with lesions in the internal portion of the cheek and in the hard palate mucosa close to the upper right molars, surgically treated by Er:YAG laser, are described. The parameters used were as follows: energy, 80-120 mJ; frequency, 6-15 Hz; non-contact hand piece; spot size diameter, 0.9 mm; pulse duration, 100 µsec (VSP) to 300 µsec (SP) ; fluences, 12.6-18.9 J/cm(2); and air/water spray (ratio: 6/5). In the two patients, the peeling of the lesions was completed with much less discomfort (<25% in visual analogue scale). A very small recurrence was observed in one case (cheeks) after 15 months, and the same protocol was applied successfully. The use of this wavelength offers several advantages including, a good and fast healing process, a very low level of discomfort during and after intervention, and a rapid disappearance of symptoms. Even if this methodology seems to be an interesting new surgical approach in the management of non-erosive OLP, this clinical report has to be considered as a preliminary one because of the limited number of cases. As a consequence, further studies and long-term follow-up will be necessary.

Removal of oral lichen planus by CO2 laser.

The aim of this case report is to present a histologically diagnosed oral lichen planus excised by the CO2 laser. Oral lichen planus is a chronic inflammatory mucocutaneous disease of unknown etiology. Different treatments have been used to manage this condition. A 46 year-old female was referred to the Laser Clinic of the Dental School of the Federal University of Bahia to excise a lesion characterized by white patches on the oral mucosa, which was causing pain and burning sensation and had not respond to treatment with triamcinolone and corticosteroids for 3 months. CO2 laser was used to remove the lesion and the conclusive histopathological diagnosis was oral lichen planus. The patient was followed up over 1 year with no signs of lesion recurrence. The use of the CO2 laser was found to be useful and effective to treat lichen planus.

Repair of oral mucosal defects using artificial dermis: factors related to postoperative scar contracture.

OBJECTIVE: To clarify wound-healing situations with artificial dermis used for the repair of oral mucosal defects, we investigated the incidence of postoperative scar contracture and studied factors related to cicatrization. STUDY DESIGN: Forty patients who underwent repair of oral mucosal defects using artificial dermis participated in this study. The degree of scar contracture was recorded 1 month after surgery. To study the factors related to cicatrization, patient characteristics of sex, age, excision region, fixation used, size of the graft, and number of days for silicon seat removal were examined. Logistic regression analysis was used for analysis of the relationship between cicatrization and patient characteristics. RESULTS: One month after surgery, 70% of patients had no contracture, 22.5% of patients had moderate contracture, and 7.5% of patients had severe contracture. A significant correlation was found between cicatrization and the minimum diameter of the artificial dermis (P < .001). CONCLUSIONS: Reducing the minimum diameter of the artificial dermis may contribute to a decrease in scar contracture.

Removal of oral lichen planus by CO2 laser

The aim of this case report is to present a histologically diagnosed oral lichen planus excised by the CO2 laser. Oral lichen planus is a chronic inflammatory mucocutaneous disease of unknown etiology. Different treatments have been used to manage this condition. A 46 year-old female was referred to the Laser Clinic of the Dental School of the Federal University of Bahia to excise a lesion characterized by white patches on the oral mucosa, which was causing pain and burning sensation and had not respond to treatment with triamcinolone and corticosteroids for 3 months. CO2 laser was used to remove the lesion and the conclusive histopathological diagnosis was oral lichen planus. The patient was followed up over 1year with no signs of lesion recurrence. The use of the CO2 laser was found to be useful and effective to treat lichen planus.

O objetivo deste relato de caso é apresentar a remoção cirúrgica com o laser de CO2 de um líquen plano diagnosticado histologicamente. O líquen plano da cavidade oral é uma doença muco-cutânea crônica de etiologia desconhecida. Tratamentos diferentes têm sido usados para sua resolução. Uma paciente do sexo feminino de 46 anos de idade foi encaminhada para a Clinica de Laser da Faculdade de Odontologia da Universidade Federal da Bahia para a remoção de uma lesão na boca caracterizada pela presença de manchas brancas que estava causando dor e ardimento não havia respondido a tratamento com triamcinolone e corticoides durante 3 meses. O laser de CO2 foi utilizado para remover a lesão e o diagnóstico histopatológico conclusivo foi o de líquen plano de cavidade oral. A paciente foi acompanhada durante 1 ano sem sinal de recorrência da lesão. O uso do laser de CO2 foi considerado útil e efetivo no tratamento do líquen plano.

Potentially malignant disorders of the oral and oropharyngeal mucosa; present concepts of management.

In spite of tremendous progress in the field of molecular biology there is yet no single marker that reliably predicts malignant transformation of a potentially malignant disorder of the oral mucosa. Therefore, it is recommended to excise or laser any oral of oropharyngeal leukoplakia/erythroplakia, if feasible, irrespective of the presence or absence of dysplasia. However, it is actually unknown whether such removal truly prevents the possible development of a squamous cell carcinoma. Therefore, lifelong follow-up is recommended at intervals of no more than 6 months. At present, oral lichen planus is more or less accepted as being a potentially malignant disorder. There are no means to prevent such event. The efficacy of follow-up of oral lichen planus is questionable.

CO2 laser evaporation of oral lichen planus.

Oral lichen planus is a relatively common disease of the oral mucosa. The buccal mucosa and lateral border of the tongue are mostly involved, although the condition can occur anywhere in the oral cavity. The erosive type in particular can cause spontaneous pain during eating. In the period from 1975 to 2003, a group of 21 patients with 39 lesions of oral lichen planus which caused pain, even after conservative therapy, were treated with CO2 laser evaporation. During a follow-up period of 1-18 years (mean 8 years) 21 patients were pain free (85%) and 6 patients (15%) experienced painful recurrence after treatment. After retreatment with CO2 laser evaporation there were no complaints of pain. Among the many treatments available, high-potency topical corticosteroids remain the most consistent and effective. In patients whose condition is unresponsive to topical corticosteroids, CO2 laser evaporation can cause long-term remission of symptoms, and may even be the treatment of first choice in patients suffering from painful oral lichen planus.

Aplicación del frío en el liquen del plano bucal / Cold application in oral lichen planus

Los buenos efectos terapéuticos de la crioterapia, su gran poder refrigerante y los resultados satisfactorios en el tratamiento de los tejidos bucales lesionados, atribuibles a sus propiedades anestésica, antimicrobiana, antiinfecciosa, cicatrizante e inmunológica, garantizaron la curación rápida y menos dolorosa del liquen plano bucal, pues la reparación y reepitelización de la mucosa bucal tratada se produjeron generalmente entre los 7 y 14 días de aplicada dicha técnica, para satisfacción de los integrantes de la casuística. La evaluación de los beneficios crioquirúrgicos se basó en la medición del tiempo de congelación entre 20 y 30 segundos y la descongelación entre 91 y 120 segundos. La criocirugía mostró ser una técnica inocua, sencilla, atraumática y eficaz para tratar esta afección.

The good therapeutic effects of cryotherapy, its strong coolant power and satisfactory results in treating injured oral tissues, attributable to its anesthetic, antimicrobial, anti-infective, immunologic and healing properties warranted a rapid and less painful cure of oral lichen planus, because restoration and reepithelialization of treated oral mucosa occurred generally between 7 and 14 days of having applied this technique, with the satisfaction of patients. The evaluation of cryosurgical benefits was based on measuring the time of freezing between 20 and 30 seconds and of thawing between 91 and 120 seconds. Cryosurgery proved to be an atraumatic, safe, effective and simple technique to treat this condition.