the term is a misnomer as the lesion does not contain pus nor it is granulomatous . it is considered as a capillary haemangioma of lobular subtype as suggested by mills , cooper , and fechner , which is the reason they are often quite prone to bleeding . the most common intraoral site is marginal gingiva , but lesions have been reported on palate , buccal mucosa , tongue , and lips . extraoral sites commonly involve the skin of face , neck , upper and lower extremities , and mucous membrane of nose and eyelids . being a non - neoplastic growth , excisional therapy is the treatment of choice but some alternative approaches such as cryosurgery , excision by nd : yag laser , flash lamp pulsed dye laser , injection of corticosteroid or ethanol , and sodium tetradecyl sulfate sclerotherapy have been reported to be effective . there are only anecdotal reports of successful treatment of mucosal pyogenic granulomas with diode laser . in this report , we seek to highlight the therapeutic success achieved with diode laser in the treatment of intraoral pyogenic granuloma . a 50-year - old female patient reported to the out patient department of oral medicine and radiology , with a complain of localized gingival growth for 3 months . the outgrowing mass was not painful but often bled while eating , rinsing , or sometimes spontaneously . patient reported a similar growth in the gingiva about 3 years ago , which was treated in the same institute by surgical excision . intraoral examination revealed an oval - shaped , pedunculated mass - like growth seen in relation to the buccal aspect of gingiva with respect to 23 , 24 region , measuring approximately 2.5  3.5 cm . this discrete nodular , erythematous enlargement was covering almost two - third of the crown of 24 [ figure 1 ] . on palpation , the mass was soft to firm in consistency and readily bled on probing . pyogenic granuloma. based on the clinical findings and the previous biopsy report , the case was provisionally diagnosed as recurrent pyogenic granuloma . a discrete nodular , erythematous enlargement covering almost two - third of the crown of 24 no bony abnormalities were seen on intraoral periapical radiographic examination . the lesion was treated by soft - tissue diode laser manufactured by picasso ( kavo , usa ) , with following specifications : wavelength 808 nm (  10 ) , output energy 0.17.0 w , and input power 300 va . we used 810-nm wavelength and 7 w power , keeping it in continuous / interrupted pulse mode . the tip was kept at a distance of about 1 mm from the soft tissue throughout the procedure , and it took 45 min to completely excise the mass . the diode laser provided an optimum combination of clean cutting of the tissue and haemostasis [ figures 2 and 3 ] . she was not prescribed any antibiotics , analgesics , or anti - inflammatory medication and was subjected to routine scaling and curettage . she revisited after 5 days for follow - up visit , but failed to keep further appointments . diode laser ( picasso - kavo ) tip was kept almost at a distance of 1 mm from the soft tissue . also , there was minimal bleeding during the procedure the excised mass [ figure 4 ] was sent for histopathologic evaluation which showed hyperplastic stratified squamous parakeratotic epithelium with an underlying fibrovascular stroma . the stroma consisted of a large number of budding and dilated capillaries , plump fibroblasts and areas of extravasated blood , and a dense chronic inflammatory cell infiltrate . although pyogenic granuloma may appear at any age , 60% cases are observed between the ages of 10 and 40 ; incidence peaks during the third decade of life and women are twice as likely to be affected . the clinical presentation is generally of a dull red , sessile , or pedunculated smooth surfaced nodule that may easily bleed , crust , or ulcerate . . they may typically begin as small , red papules that rapidly enlarge to become pedunculated raspberry - like nodules . rarely , patient may develop multiple satellite angiomatous lesions after excision of a solitary pyogenic granuloma . oral pyogenic granulomas show a striking predilection for the gingiva as seen in the present case , which accounts for 75% of all cases . gingival irritation and inflammation that result from poor oral hygiene may be a precipitating factor in many patients . the lip , tongue , and buccal mucosa are the next most common sites . in majority of cases , minor trauma and/or chronic irritation recently , angiopoietin-1,2 and ephrin b2 agents in other vascular tumours such as bartonella henselae , b. quintana , and human herpes virus 8 have been postulated to play a part in recurrent pyogenic granuloma . multiple pyogenic granulomas with satellite lesions may occur as a complication of tumour removal or trauma . viral oncogenes , hormonal influences , microscopic arteriovenous malformation along with inclusion bodies and gene depression in fibroblasts have all been implicated . differential diagnosis of pyogenic granuloma includes haemangioma , peripheral giant cell granuloma , peripheral ossifying fibroma and metastatic carcinoma , and amelanotic melanoma . although the conventional treatment for pyogenic granuloma is surgical excision , a recurrence rate of 16% has been reported . other methods used by various workers include cauterization with silver nitrate , sclerotherapy with sodium tetra decyl sulfate and monoethanolamineoleate ligation , absolute ethanol injection dye , laser therapy using continuous and pulsed co2 and nd : yag systems have been used for a variety of intraoral soft tissue lesions such as haemangioma , lymphangioma , squamous papilloma , lichen planus , focal melanosis , and pyogenic granuloma , because they carry the advantage of being less invasive and sutureless procedures that produce only minimal postoperative pain . rapid healing can be observed within a few days of treatment , and as blood vessels are sealed , there are both a reduced need for post - surgical dressings and improved haemostasis and coagulation . it also depolarizes nerves , thus reducing post - operative pain , and also destroys many bacteria and viral colonies that may potentially cause infection . reduced post - operative discomfort , oedema , scarring , and shrinkage have all been associated with its use . white et al proposed that laser excision is well tolerated by patients with no adverse effects . they also stated that co2 and nd : yag laser irradiation is successful in surgical treatment . meffert et al used the flash lamp pulsed dye laser on a mass of granulation tissue and concluded that previously resolute tissue responded well to the series of treatments with pulsed dye laser . diode laser has shown excellent results in cutaneous pyogenic granulomas with only minimal pigmentary and textural complications . gonzales et al demonstrated both symptomatic and clinical clearing of the lesions with excellent cosmetic results in 16 of 18 treated patients . we achieved complete resolution of this lesion located on the upper gingiva with diode laser without producing any complications . hence , diode laser may be a good therapeutic option for intraoral pyogenic granulomas . in conclusion , the use of laser offers a new tool that can change the way in which existing treatments are performed , or serve to compliment them . modern medicine needs to explore and take advantage of current trends to derive maximum benefit in terms of technology , patient 's acceptance and , post - operative management .