hyperplasia refers to tissue growth into the oral cavity , located over the alveolar ridges or the soft tissues of the vestibular sulcus .
its etiology is multifactorial , but some irritative factors are more commonly associated , such as periodontal disease , poor oral hygiene , smoking , and poor denture fitting .
the treatment of this kind of lesion includes elimination of the causing factors and surgical removal of the lesion .
if the causal factor persists , the tissue becomes more fibrous over time [ 2 , 3 ] .
the most common techniques used for removing the hyperplastic lesion are surgical scalpel , electrical scalpel , carbon dioxide laser , erbium : yag laser , neodymium : yag laser , and diode laser .
the co2 laser is an appropriate option for surgical procedures in soft tissues since it operates at a wavelength of 10.6  n , which is within the medium range of the electromagnetic infrared spectrum .
this wavelength is absorbed by tissues with high water content [ 4 , 5 ] .
this energy is transformed into heat , causing cell rupture from water boiling ; therefore , tissues with high water content suffer less damage .
many advantages of the co2 laser include the possibility of minimal bleeding , decreasing edemas , flexibility of the wound healing tissue , reduced postoperative pain , and no need of a conventional suture [ 610 ] .
these positive aspects of the use of a co2 laser has allowed an improvement in maxillofacial surgeries . despite some disadvantages of co2 laser , such as the delay in the initial repair chronology due to heat necrosis [ 11 , 12 ] , this technique provides suitable repair without scar formation and constitutes an alternative to the conventional incision and suture method .
a sixty - three - year caucasian old female presented at the dental clinic of the university ( so jose dos campos dental school  unesp ) looking for dental treatment .
the clinical exam showed completely edentulous and presented a hyperplastic lesion over the alveolar ridge extending to the vestibular sulcus in the lower anterior region ( figures 1 and 2 ) . according to the patient
, two previous surgeries were performed to remove the excess of mucosa , but it relapsed twice .
this lesion could impair the retention and stability of a future prosthesis . considering this clinical situation and the relapse history ,
the procedures for the confection of a complete denture consisted of a single impression of the upper and lower arch with an irreversible hydrocolloid to record the ridge and lesion area .
casts were obtained ( figure 3 ) , and experimental bases ( figure 4 ) with wax ridges were made , outlining the lesion area .
the teeth were mounted following the wax ridges ( figure 5 ) and aesthetic approval was received from the patient . after an adequate aesthetic result was obtained , the lesion area outlined at the lower cast was removed with a burr ( figure 6 ) to the extension of the denture base .
this area of the cast was covered with wax ( figure 7 ) , and both the upper and lower dentures were cured ( figure 8) .
the lesion removal was made using a carbon dioxide laser ( sharplan 15  f , israel - fapesp 97/07645 - 2 ) , and to carry out the vaporization the co2 laser was used in continuous mode with a focused beam with diameter of 4  mm and 8  watt ( figure 9 ) the vaporized area was clinically evaluated to verify the absence of bleeding ( figure 10 ) .
safety glasses , masks , and procedure gloves protected the professionals who participated in the surgery , and vaporization was done under constant aspiration of the plume .  
dentures were positioned , and the lower denture was immediately rebased with a soft tissue conditioner to stabilize the denture and facilitate wound healing ( figure 11 ) .
postoperative examination was done after seven days and showed satisfactory tissue repair at the surgical area ( figure 12 ) .
the postsurgical exams were done after 7 , 14 , 21 , and 30 days ( figure 13 ) of continual wearing of the prosthesis .
the clinical results of the case report presented are in agreement with other studies utilizing co2 laser for soft tissues . in the current study ,
the co2 laser was used in continuous mode to control the extension of thermal damage using a focused beam to reduce its intensity .
.   histologically demonstrated that the co2 laser , in both the pulse and continuous modes , allowed superficial ablation with minimal thermal damage .
some authors , like dobry et al . , also affirmed that the pulse mode caused less thermal damage , but that a longer actuation time was needed with the tissue .
the advantages of using a co2 laser has been clinically demonstrated in the present study , presenting minimal bleeding during the surgery with no need of sutures while also presenting a good healing response , with minimal wound contraction , less inflammatory reaction , and good re - epithelialization with no scar formation .
these conditions were also found in the studies of de arruda paes and niccoli - filho   and keng and loh   who clinically demonstrated that co2 laser is ideal for use in these kind of surgeries , bringing comfort and aesthetics to the patient .
explained that less wound contraction occurs because the co2 laser does not remove the tissue collagen .
.   showed that co2 laser is effective in vaporizing oral mucosa and achieving haemostasis by vessel coagulation .
these findings are in agreement with niccoli - filho et al .   who also demonstrated that good aesthetic and functional characteristics were quickly achieved in an oral surgery using co2 laser , enabling an earlier prosthetic rehabilitation .
thus , the co2 laser is a useful instrument , which provides control of the surgical field and esthetic and functional results .
the technique presented in this paper was easily executable and allowed a better prediction of the surgery results .
based on the results of the present case report we can conclude : the use of a co2 laser radiation allowed good haemostasis at the surgical area , absence of infections and post operative comfort ; the use of co2 laser radiation to remove hyperplastic tissue make the use of prosthesis feasible and promoted an immediately condition to reestablish the aesthetic and functional aspects .
 the aim of this study was to present a case report of the surgical removal of hyperplasia in the oral cavity , using carbon dioxide ( co2 ) laser radiation and rehabilitation with a complete denture . 
 epulis fissuratum occurs in complete denture patients , because a constant irritative action induces the mucosa to grow under poorly fitting dentures . 
 these lesions must be removed , and to avoid a relapse , new complete dentures should be made to maintain healthy surgical tissues . 
 the clinical sequence presented in this case shows a completely edentulous patient with epulis fissuratum on the lower alveolar ridge extending to the vestibular sulcus of the anterior region of mandible . 
 immediate complete dentures were made prior to the lesion removal with co2 laser radiation , providing satisfactory results in oral function and tissue health . 
1. Introduction
2. Case Report
3. Discussion
4. Conclusion