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The world population is continuously getting older in developed and undeveloped countries. According to WHO over 20% of the population in Europe is over 65 years old. Geriatric population in North Macedonia is presented with 16% and with high prevalence of anodontia over 45, 1%, poor oral hygiene and urgent demand of prosthodontics treatment. Aging is a process with different and specific changes of all systems and organs, including the orophacial system. In this population, the number of remaining teeth is evidently reduced, their condition has changed, and soft and hard oral tissues are affected. It is very important to discover all the factors that lead to the development of leukoplakia and other precancerous lesions as early as possible. Precancerous lesions and oral carcinoma are more common in the elderly compared to the younger population. Almost 90% of oral cancers occur in patients older than 50 years. Early detection of oral mucosa diseases in elderly and potentially malignant disorders requires careful examination because of high malignant transformation frequency. The aim of the study was to determine the condition of oral soft tissues in geriatric prosthodontics patients, their general health and the impact of oral health on their quality of life. The value of the VELscope instrument as an adjunct to oral examination in geriatric prosthodontics patients was also evaluated. The study was performed in the University Dental Clinic Ss’ Panteleimon in Skopje, NM. Clinical protocol for 300 patients over 60 years old was questionnaire with risk factors, clinical intra and extraoral observation and VELscope mucosal tissue examination. Tissue changes were classified as inflammatory, traumatic, dysplastic and other. Abnormal tissue was associated with auto fluorescence loss and dark appearance in contrast to the surrounding healthy tissue. In 21% of patients abnormal premalignant lesions were detected. Leukoplakia was the most common premalignant disorder 42 (12, 6%), 16 (4, 8%) had lichen planus, 6 (1, 8%) cheilitis actinica and 5 patients (1, 5%) were diagnosed with squamous cell carcinoma. We found 118 inflammatory lesions (35, 4%) where 58 (17, 4%) were denture stomatitis, 18 (5, 4%) angular cheilitis, traumatic lesions were found in 38 patients (11, 4%) and 4 (1, 2%) were diagnosed with epulis fissuratum. In 54 patients (16, 2%) we diagnosed infectious changes from which aphtous ulcerations and candidiasis were most common. The VELscope fluorescence instrument can be used as a part of diagnostic process to detect abnormal tissue and oral lesions that might have been overlooked. A validation of the study was carried out and it was approved by the ethics committee of the Faculty for dentistry Ss Cyril and Methodius University Skopje on 18.12.2018. No. 02-38363.

Background: The erosive-atrophic form of oral lichen planus (OLP) is associated with severe pain and burning sensation and is often unresponsive to treatment. Topical corticosteroids are considered as a medication of first choice but they can produce adverse effects. Therefore, new therapeutic approaches are required. Aim: The aim of this study was to investigate the effectiveness of biomodulation with diode laser in patients presenting with long-standing erosive-atrophic OLP. Materials and methods: Twelve patients, clinically and histologically diagnosed with OLP, participated in this study. The level of pain and the clinical scores of total 59 lesions were recorded before treatment using visual analog scale and Thongprasom sign scoring system respectively. All patients received low level laser therapy (LLLT) with diode laser (810 nm) with parameters (0.5 W, 30 s, 1.2 J/cm2) three times weekly for a month. The response rate was assessed according to the decrease in pain and sign scores. Treatment efficacy index was calculated. Results: There was a significant reduction in pain after LLLT (p Conclusion: The present results indicate that LLLT is an effective and harmless modality for management of erosive-atrophic OLP.

Purpose: With the advance of the modern technologies, the identification of dysplastic changes in the oral mucosa on a molecular level seems to have transferred into the dental office. With the new methods, however, new responsibilities and problems arise. The current review is an attempt to present the advantages and disadvantages of the clinical technologies used for early diagnostics of the oral precancerous lesions. Materials and Methods: This study is based on an extensive literature review and personal clinical experience with these contemporary evaluating methods of oral precancerous lesions. Results: The results from the pathohistological evaluation reveal stratified squamous epithelium with pronounced parabasal hyperplasia, disturbed maturation and loss of polarity of the basal cells. The latter demonstrates hyperchromatic polymorphic nuclei and single mitotic figures in half of the epithelial thickness. The morphological data points to a moderate epithelial dysplasia. Conclusion: The loss of autofluorescence seems to be the most promising non-invasive method for identification of epithelial dysplasia in the oral cavity. The presence of some non-dysplastic lesions, which can also be non-fluorescent, i.e. produce “false negative” results, is one of the disadvantages of this method. Despite that most modern technologies are practical and convinient, they should be approached with a critical eye and should not be used as single and independent diagnostic means but only as an adjunct to the established classical methods of diagnostics.

Introduction: A venous lake (VL) is a vascular lesion with common occurrence in many patients, manifested as a dark blue-to-violet compressible papule, caused by dilation of venules. The main reasons for the treatment of VL are aesthetic. The haemorrhaging episodes or impairment of oral normal functions are also under considerations. Treatment of lip VL includes surgical excision, selective photocoagulation, cryotherapy, sclerotherapy and electrodessication. The high-intensity diode laser is an option. The 980 nm diode laser is selectively absorbed by haemoglobin and selectively destroys blood vessels, minimising injury to the surrounding healthy skin.Aim: The purpose of this study was to evaluate the effectiveness of diode laser in the treatment of VL lesions with the accent on the postoperative defects and aesthetic results.Methods: 35 patients aged 37 to 71 were included in this study. A 980 nm diode laser was used in noncontact mode, under local anaesthesia in continuous wave (2-3W, for 20-60s). All patients received only one procedure.Results: Healing process was completed within 2 to 4 weeks after treatment with no scarring. None of the typical adverse effects were observed in the process of healing.Conclusions: Selective photocoagulation is an effective method for treatment of VL. Lower morbidity, minimal patient discomfort and satisfactory functional and aesthetic results are favourable for patients. To optimise the results and to reduce the adverse effects, basic knowledge on lasers and laser-tissue interactions is requisite.

Background: The cosmetic oral mucosa tattoos occur infrequently but the social stigma that may be associated generally with tattoos is motivating factor for its removal. The development of infrared lasers has revolutionized the ability to remove cosmetic oral tattoo effectively. The wave-length of choice is 1,064 nm but there is no relevant histological data regarding effects of Nd:YAG laser on oral tissues after tattoo removal. The aim of this study is to provide histological evidences and to clarify the healing processes in oral mucosa after tattoo removal with 1,064 nm wavelength laser. Methods: Five patients with professional black tattoo of inner lip were included in this study. The clinical procedures were performed using 1,064 nm wavelength. Two equal specimens were taken from the treated and non-treated sites for further histological evaluation. Results: The specimens after the treatment revealed fragmentation of black ink particles up to 1.5 mm below the surface. Mild fibrosis was observed in the superficial submucosal area where collagen fibers replaced the pigment-containing cells altered by the laser. Clinically, the treatment results showed excellent recovery of the oral mucosa. One year later, the laser treated areas were healthy and without esthetical and functional disturbances. Conclusions: Both histological and clinical results advocated Nd:YAG laser treatment as safe and very effective means of removing cosmetic tattoos on the oral mucosa.

Background - In oral pathology, laser devices can provide important advantages, especially in the treatment of certain lesions. However, there is controversy about the use of some wavelengths in the analysis of suspected dysplastic or neoplastic lesions, raising doubt about the laser's suitability for use in biopsy procedures. The present pilot study evaluates the pathomorphological characteristics and suitability of Er:YAG and diode lasers for performing excisional biopsies in the oral mucosa with special emphasis on the extent of the thermal damage zone created. Material and Methods - 10 patients were randomly assigned to one diode or one Er:YAG laser groups. The Er:YAG laser(2940nm) was used in a pulsed wave mode 200mJ/35Hz with a power of 7 W. Power settings for the diode laser(810 nm) were 3 W in a pulsed mode. The thermal damage zone of the two lasers and intraoperative and postoperative complications were assessed and compared.All biopsy specimens were evaluated by optical microscopy by threeblinded pathologists. After establishing the pathomorphological diagnosis of the lesion assessed, the pathologists measured the maximal width of the peripheral thermal damage zone in the specimen in μm and classified it using appropriate index. Results - The peripheral thermal damage zone on the borders of the excisional biopsies was significantly smaller with the Er:YAG laser compared to the diode laser regarding values in μm or pathomorphological index scores. No postoperative complications occurred in any of the two groups. Conclusions - The Er:YAG laser seems to be appropriate for excisional biopsies of benign oral mucosal lesions. The Er:YAG laser offers clear advantages in terms of smaller thermal damage zones over the diode laser. Although in some samples thermal damage was minimally visible, in all samples histological evaluation was clearly possible. The study demonstrated that the Er:YAG laser can be safely used in oral biopsy investigations while ensuring a successful histological evaluation, which is fundamental to correct clinical management.

The principle of a suction cup is used to retain an upper full denture. Alveolar resorption results in loss of the vestibular depth and in diminished functional surface to overcome lateral forces. Traditional surgery has the following characteristics in common-need for incisions with steel scalpels, mechanical excision of the muscle attachment from the periosteum, placement of sutures, significant postoperative discomfort, and delayed healing. When the benefits and risks of alternative treatment modalities are taken into account for this mechanical surgical procedure, minimally invasive laser-assisted soft-tissue excision and ablation seems to be very attractive technique. In the presented case report we used an Er:YAG laser (LiteTouch, Syneron, Israel) to deep the oral vestibulum of upper jaw in edentulous patient. Therefore, were indicated, we recommend the laser assisted operation technique for the partial vestibuloplasty to assure the patients a better postoperative outcome.