Letter to the Editor: Re: A Stab-and-Roll Biopsy Technique to Maintain Gingival Epithelium for Desquamative Gingivitis
- Autores: Pablo Ignacio Varela Centelles, Juan M. Seoane Romero, Antonio Liñares González, Juan Manuel Seoane Lestón
- Localización: Journal of periodontology, ISSN 0022-3492, Vol. 86, Nº. 5, 2015, págs. 609-609
- Idioma: inglés
- Enlaces
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Resumen
To the Editor:
Re: A Stab-and-Roll Biopsy Technique to Maintain Gingival Epithelium for Desquamative Gingivitis. Endo H, Rees TD, Allen EP, et al. (J Periodontol 2014;85:802-809.) We have read with great interest the published article by Endo et al.,1 in which a novel technique, the stab-and-roll biopsy, is proposed for retaining the gingival epithelium in desquamative gingivitis (DG) diagnostic biopsies. However, the results of the retrospective case series reported in this paper should be interpreted with caution because there may be some limitations for the generalization of the results because of the fact that the biopsies were undertaken by a single expert operator, as the authors accurately acknowledge. The external validity of their investigation may also be compromised because they have included in their series cases of mucous membrane pemphigoid, oral lichen planus, and pemphigus vulgaris only, whereas desquamative gingivitis also is associated with erythema multiforme, graft-versus-host disease, lupus erythematosus, paraneoplastic pemphigus, epidermolysis bullosa acquisita, linear immunoglobulin A disease, plasma cell gingivitis, dermatitis herpetiformis, foreign body gingivitis, psoriasis, and idiopathic desquamative gingivitis. Although these latter disorders are less common, they exhibit different degrees of epithelial and connective-epithelial affectation that have to be considered.2 Bearing in mind that DG may occur at any gingival site and that gingival thickness varies within the arches according to anatomic factors, a potential selection bias should also be taken into account.
In any case, loss of the gingival epithelium in DG biopsies is a crucial event that frequently results in non-diagnostic biopsies.3 This phenomenon has been attributed to an inadequate surgical technique, surgical site selection, or improper tissue handling.1 Regarding the surgical technique, the main component of the forces in the stab-and-roll approach is vertical, and this may well be an advantage for preserving the epithelium when compared with the conventional technique. However, the critical point of the former is the removal of the sample using a non-serrated tissue forceps: This procedure is undertaken without prior liberation of the bottom of the specimen, and this method increases the risk for artifacts (compression, crush, and fragmentation).4 In this sense, our suggestion for thick gingivae and expert surgeons is to release the base of the specimen with a scalpel. In the opposite situation, we would recommend to include the periosteum in the specimen and to free the tissue sample using a curet.
Finally, proper tissue handling using a small, non-traumatic forceps or a non-toothed Adson forceps would prevent the loss of cytologic details due to an excessive compression of the sample and minimize crush artifacts.5 However, additional clinical trials focusing on the performance of the stab-and-roll technique versus the conventional approach are needed. These future studies may also explore the potential advantages of using a hand punch for DG biopsies that include periosteum in the samples obtained from the attached gingiva at interdental areas.
The authors report no conflicts of interest related to this letter.
