Laser-Assisted Management of Amlodipine-Induced Gingival Overgrowth in a Medically Complex Patient

Drug-induced gingival overgrowth (DIGO) is a well-recognized adverse effect associated with several systemic medications, including calcium channel blockers such as amlodipine. Management becomes particularly challenging in medically complex patients requiring continuous anticoagulant and antiplatelet therapy, in which conventional surgical approaches may increase the risk of perioperative bleeding.

We report the case of a 66-year-old male patient with severe, multifocal amlodipine-induced gingival overgrowth associated with generalized severe periodontitis (Stage IV) and a complex cardiovascular history, including previous ischemic strokes. The patient was under long-term anticoagulant and antiplatelet therapy (acenocoumarol adjusted to therapeutic INR and acetylsalicylic acid 100 mg/day), as well as amlodipine 10 mg/day and other cardiovascular medications. Following interdisciplinary evaluation, amlodipine was discontinued, while antithrombotic therapy was maintained due to the patient's high cardiovascular risk. After initial periodontal therapy and partial lesion regression, persistent fibrotic gingival enlargements were surgically excised using a diode laser (810-980 nm) without interruption of antithrombotic medication.

Laser-assisted excision was performed uneventfully, providing excellent hemostatic control with no intraoperative or postoperative bleeding and without the need for sutures. Histopathological examination confirmed the diagnosis of DIGO. Complete healing was observed at the 15-day follow-up, with no recurrence or complications. Potential risks associated with laser use, such as thermal damage to adjacent tissues, were minimized through appropriate parameter selection and surgical technique.

This case highlights the usefulness of diode laser surgery as a safe and effective therapeutic option for the management of severe DIGO in patients requiring continuous antithrombotic therapy. Its excellent hemostatic properties and minimal invasiveness make it particularly valuable in special care dentistry and in interdisciplinary management of high-risk cardiovascular patients.