Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › Erosive Lichen Planus
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2thlaserSpectatorHere is a case that came in today. Notice the Erosive Lichen Planus throughout. This patient has a fairly unremarkable medical history, has seen everyone, the periodontist, the dermatologist, the internist, now me. She is rinsing with Peridex, and has some topical ointments prescribed to her by the physician. The biopsies were conclusive by the periodontist of Erosive Lichen Planus. How can the, a, laser help, can it help, this patient. How would you start? I have idea’s, but am looking to you experts here, Bob, Del, Glenn, Ron’s, Pat, Al…others, to give advise, even though you haven’t seen the case, or history. Very interesting case. She is a RN.
Mark
2thlaserSpectatorOk, I will reply to my own stupid mistake!!! (I am cracking up on how stupid I am), Here are the pictures.
Ok, now let’s move forward, geez!!!
Mark
Alfred WyattSpectatorMark,
I treated a case very similar to this a few months ago and there was also a clinical presentation at the ALD on erosive lichen planus.The recommendation is to start with a small less conspicuous area preferably with an erbium laser. ( I used the hoyaC.B.@10Hz/30mJ which is also the setting used for apthous ulcers) The lecturer (I’m sorry I can’t remember his name right now) says thatthis is important to start small and shallow because this lesion can actually become more prevalent if treated too aggressively. The erbium is the best laser in this situation because it penetrates mch less than the other wavelengths. Give it a shot with a small area and take it slow.
Alfred Wyatt
2thlaserSpectatorAlfred,
I really appreciate your response. That is the exact route I was planning. I will keep all in touch as this progresses. Any more advice from others?
Thanks,
Mark
PatricioSpectatorMark and Alfred,
I have been looking at two cases and wondering whether to try a course of treatment so I will be very interested in your results. This would be a great service fe can successfully treat this problem.
Pat
Andrew SatlinSpectatorMark,
I have also struggled with a handful of these cases over the years. Please keep us posted. I am very interested in following your treatment/results over time.
Thanks!
Andy
2thlaserSpectatorHey guys, thanks for the input, and I WILL keep you all in touch as it goes, WITH documentation. Any suggestions are welcome.
Sincerley,
Mark
whitertthSpectatorI think i would try a small test area first..low wattage maybe .75 with a little air and water(14/8)…I would normally coat at the end with no water and air to apply a “laser band aid” but I think i would hesitate here doing that as the tissue is very sensitive and I wouldnt want to over dry the area…I would be careful next to any gingival margins as this tissue is very sensitive and u may get a recession type response if u were too aggressive.. only my 2 cents….. let me know
p.s. it was a pleasure talking to u today
Robert Gregg DDSSpectatorHi Mark,
Back from CDA Anaheim…whew!
There are three laser approaches to these lesions:
1. Surface modify or coat them by coagulating the surface proteins of the lesion with either:
a. erbium (2.8, 2.9) at a low setting (water prevents char and pain.)
b. CO2 (10.0) at a low setting say 3.0 watts cw (no water).
c. holmium (2.1) at low setting say 2.0 watts free running (no water).2. Biostim with diode or Nd:YAG
3. Combo of both may give the most relief–in which I would biostim first, then coag the surface.
These ain’t easy……
Bob
Robert Gregg DDSSpectatorIs that you Alfred??? Good to see you posting here. Had a nice time in Florida meeting and hangin’ with Al. What a nice guy….
Bob
Alfred WyattSpectatorHi Bob,
Thanks to you and Glenn, I finally decided to visit and talk on this ite as opposed to being an inactive observer.It’s good to have direct access to people who are experiencing the same cases and answers to the same questions that you are. You continue to be the source of a vast wealth of laser research and principles that are hard to find.By the way, when are those LSU studies going to press and what journal will they appear in? Look foward to seeing you soon.Alfred
Robert Gregg DDSSpectatorHowdy Alfred,
I thought that was you…..Glad you are participating!
Thanks for the kind comments. Ron Schalter deserves all the credit for making this site available and hospitable to ALL laser users, not just members of an elite group, company, or academy. And Glenn is an incredible asset to this forum, posting as I told him at CDA “warts and all”! Look for some of my clinical case posts soon–when I figure out all the details of picture taking, computer downloading, editing, resizing, uploading………
Prof Yukna received word back from J. Perio that they needed some addition materials in his paper. He said it was justifiable comments. But then he decided to submit instead to the International Academy of Dental Research (IADR) and present his paper this June in Sweden. He felt this was a better venue and more prestigious than J Perio.(???)
Tom Lee, DDS, MS (prosthodontist) who was the Director of the AEGD program at UCLA when I was faculty member there visited with me at CDA. He has always been a good friend and supporter. He was the one who said we needed to get our stuff into mainstream dental journals, not the laser dedicated journals, so the entire profession could access them. I showed him the histo and told him it was going into IADR, and he was impressed and excited for us.
On another note, we have submitted Yukna’s histo to FDA for a new 510(k) clearance/claim for “bone regeneration”. We received a letter and preliminary review asking for additional information. This was a very positive development as the claim is getting thoughtful consideration. Ray et all has prepared a response to the questions from FDA, and we are hopefull we have answered FDA’s questions…..We’ll know more in a few months.
Thanks for asking.
Bob
Kenneth LukSpectatorHi Bob,
I have a patient with lichen planus.
What parameters would you suggest on Biostim with diode?
Should I use my 980 to coag the surface (as I don’t have an Erbium) ?
Ken
Robert Gregg DDSSpectatorHi Ken,
I wouldn’t try to coag the surface with a near infrared laser on these.
I would biostim at say 1 watt or less–to the comfort of the patient–for 2-3 minutes per site.
Bob
2thlaserSpectatorGood Recommendation Bob. We are still treating that same case, and we have combined the biostim of the diode with the Erbium. The mandible has cleared totally, the maxilla we are still dealing with. I noticed the patient have a slight relapse, and this was due to stress in her life, and her hygiene went erratic for a bit. I got her in the hygiene chair, and then attacked the area a bit more aggressively, and now I am noticing control again. I have a few doctors in Europe I am conversing with, and researching this with them, as they are laser users as well. ANY input from any of you, Alfred, Bob, anybody, is helpful. Thanks everyone!!!
Mark -
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