Gingival melanin pigmentation and its treatment with the CO2 laser

Assessment of clinical outcomes and patient response to gingival depigmentation using a scalpel, ceramic bur, and diode laser 980 nm

OBJECTIVE

This research compares the clinical outcomes of gingival depigmentation procedures with conventional scalpel, ceramic trimmer bur, and diode laser techniques.

MATERIALS AND METHODS

Twenty-four individuals with physiologic gingival hyperpigmentation received random allocation to one of three treatment groups: scalpel, ceramic bur, or diode laser. Pain score, operation time, bleeding index, degree of epithelialization, wound healing, Dummett-Gupta Oral Pigmentation Index (DOPI), and Takashi Index score changes were all investigated at different time points.

RESULTS

At 12-h follow-up, significant variations in pain scores were seen between the laser and scalpel groups (p = 0.003) but not between the laser and ceramic bur groups. The diode laser group completed the procedure significantly quicker than the scalpel and ceramic bur groups (p = 0.004 and p = 0.001, respectively). The ceramic trimmer bur and diode laser groups showed significantly less bleeding tendency than the scalpel group. Wound healing and the degree of epithelialization were similar in all groups. DOPI and Takashi indices significantly decreased compared to baseline in all groups, with no significant difference recorded between all groups.

CONCLUSION

While diode lasers are a safe and effective treatment option for gingival hyperpigmentation, providing optimal aesthetics with reduced discomfort to patients, a ceramic trimmer bur can also be used as a simple and affordable alternative to a laser in gingival depigmentation procedures.

CLINICAL RELEVANCE

Gingival hyperpigmentation is a major aesthetic issue for many individuals. Laser and ceramic trimmer bur treatments produce equivalent aesthetic outcomes for gingival hyperpigmentation.

Aesthetic Gingival Melanin Pigmentation Treatment in Smokers and Non-Smokers: A Comparison Study Using Nd:YAG Laser and Ceramic Bur

Aesthetic concerns are increasing rapidly; thus, several approaches have been suggested for treating gingival melanin pigmentation. Lasers have been reported as an effective new tool, and the Nd:YAG laser beam has an affinity for melanin and haemoglobin. However, ceramic gingival bur is simple and has less bleeding effect during operation than conventional techniques. This study aimed to compare the outcomes of gingival depigmentation using the Nd:YAG laser and ceramic bur in two different groups (smokers and non-smokers). A total of 40 patients presenting with gingival melanin pigmentation were enrolled in this split-mouth study. The sample was divided into two groups: smokers and non-smokers. Treatment was performed using the Nd:YAG laser (3 W, 60 mJ/pulse, and 50 Hz) and ceramic bur with a one-week interval between the two methods. Clinical indices were recorded, including intraoperative bleeding, wound healing, post-operative pain, and the recurrence of pigmentation, and follow-up periods were determined in the 3rd, 6th, and 9th months postoperatively. Both treatments promoted a similar pain experience and recurrence rate of pigmentation (p > 0.489, p = 1.000, respectively). Bleeding during surgery and complete healing recovery after one week were statistically significantly higher when using ceramic bur (p = 0.00, p = 0.041, respectively). Concerning the effect of smoking on the treatment, a higher recurrence rate was observed in SG than N-SG in laser sites (50%, and 95%, respectively) and bur sites (60%, and 85%, respectively), but statistically no significant difference was observed (p > 0.080). In conclusion, both procedures are adequate for aesthetic gingival depigmentation treatment. The Nd:YAG laser showed greater effectiveness in controlling bleeding, while ceramic bur showed a faster clinical recovery. Furthermore, smokers were more likely to have low depigmentation treatment stability.

Comparison of Er,Cr:YSGG laser and diode laser in the treatment of gingival melanin pigmentation: a randomized clinical trial

This investigation has aimed to compare the efficiency of clinical depigmentation and repigmentation rate of erbium chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) and diode lasers during a 1-year follow-up and to evaluate patient satisfaction. Twenty-two participants were divided into Er,Cr:YSGG laser and diode laser groups using computer-aided randomization. Dummett Oral Pigmentation Index (DOPI) and photographic assessment with ImageJ Software version 10.2 were performed at the preoperative period and postoperative 1st month, 6th month, and 12th month. Moreover, the study assessed intra- and postoperative intensities of pain and postoperative patient aesthetic satisfaction using the Visual Analog Scale in both groups. The median values of DOPI did not differ statistically between the groups according to time (p > 0.05). In the Er,Cr:YSGG group, the extension of repigmentation was less as compared to the diode group at 1-year follow-up (p = 0.045). In the Er,Cr:YSGG group, the patients felt less intraoperative pain and discomfort compared to the diode group (p = 0.007). No significant differences were found between the two groups in terms of patient aesthetic satisfaction at the 1st and 12th months. The findings indicate that diode and Er,Cr:YSGG lasers can be used safely in depigmentation treatment, while the Er,Cr:YSGG laser has been shown to have superiorities in pain management and patient comfort parameters. Clinical Trial No.: NCT05304624.

Long-Term Esthetically Depigmented Gingiva in a Short Operative Duration, Using Two Modes of 940 nm Diode Lasers-A Randomized Clinical Trial

AIM

This study aims to compare the effectiveness of the two modes of 940 nm diode lasers on gingival depigmentation.

METHODS

Twenty patients (11 females and 9 males) participated in this study; they were free of any systemic or local condition and randomly assembled into two groups: continuous wave (CW) and pulsed groups, in contact modes. The diode laser was of 940 nm wavelength and 1-2 W irradiation power for the two modes in all cases. A single session of irradiation was applied to the facial gingivae of the upper and lower anterior segments. Photographs were taken preoperatively and postoperatively for all patients, and a questionnaire and follow-up were carried out for the next four weeks and after three years.

RESULTS

The intraoperative duration of both modes was considerably short, with a short chair time subsequently. A statistically significant decrease in the intensity of pain, discomfort, and bleeding (p ≤ 0.05) was noticed during the first week of follow-up within each group. Nonetheless, the two groups showed a close pattern of decline with no statistically significant differences between them. It was also clear that pain and discomfort were strongly correlated with each other within each group, and the correlation was statistically significant. On the other hand, carbonization was minimal in a few cases treated with CW mode but still not statistically significant. Finally, although the gingival pigmentation index (GPI) differences were not statistically significant between the two groups, they were significant within each group.

CONCLUSIONS

The diode laser (940 nm) offered an effective and safe modality, providing an optimal aesthetic result that can meet patient satisfaction with minimal pain, bleeding, discomfort, intraoperative time, and the possibility of recurrence in the treatment of gingival hyperpigmentation.

Comparison of the Effectiveness of CO2 and Diode Lasers for Gingival Melanin Depigmentation: A Randomized Clinical Trial

Introduction: Gingival hyperpigmentation is an esthetic concern for some individuals. This study compared the effectiveness of CO2 and diode lasers for gingival depigmentation. Methods: This randomized, split-mouth, clinical trial consisted of 12 patients with the chief complaint of hyperpigmented gingival areas. The upper right and left anterior segments and the mandibular anterior segment were randomly allocated to one of the treatment groups. The segments in group 1 underwent gingival depigmentation with a diode laser (810 nm) at 6 W and pulsed mode, whereas group 2 was ablated with a diode laser at 3 W and continuous mode. The removal of gingival pigments in group 3 was contemplated with a CO2 laser (10600 nm, 3 W, continuous mode). The operation chair time, bleeding during the procedure and post-operative pain were recorded. The gingival color and esthetic appearance were measured before the operation and at 1 week and 6 months later. Results: There was no significant difference in the bleeding scores, pain level, and color alteration values between the groups (P>0.05). The operation chair time was significantly shorter when the diode laser was applied at pulsed mode (P<0.05). The segments treated with the diode laser (pulsed or continuous mode) showed a higher esthetic appearance at the 6-month follow-up compared to those ablated with the CO2 laser (P<0.05). Conclusions: Higher esthetic appearance is expected when using the diode laser for gingival depigmentation compared to the CO2 laser. The application of the diode laser at pulsed mode could be recommended for gingival depigmentation, as it produced pleasing esthetic outcomes at reduced chair time.

Gingival Depigmentation Using Diode 980 nm and Erbium-YAG 2940 nm Lasers: A Split-Mouth Clinical Comparative Study

Background

Gingival hyperpigmentation, “black gum,” refers to black discrete single or multiple pigments on the gingiva. Several factors may play a role in gingival hyperpigmentation ranging from physiologic pigmentation to manifestations of systemic diseases. Several techniques have been used for gingival depigmentation to lighten its color.

Methods

Fifteen patients exhibiting nonsmoking melanin hyperpigmentation, with the mean age of 28.6 ± 7.8 years, were recruited. The facial gingiva of the anterior teeth and premolars of each jaw was divided into two halves. The right or left side of each jaw quadrant randomly received either diode laser operating at 980 nm wavelength or erbium-YAG laser at 2940 nm. Parameters such as degree of gingival depigmentation, bleeding, pain, patient satisfaction, and wound healing were assessed and compared between the two techniques. The subjects were followed up to six months for melanin pigmentation recurrence.

Results

Both techniques were efficient for gingival depigmentation. Nevertheless, bleeding during surgery was statistically higher for Er:YAG laser technique as compared to diode laser. Wound healing showed statistically nonsignificant differences between the two lasers, although Er:YAG seems to give better outcomes than the diode. The patients were satisfied with both laser techniques during and after gingival depigmentation. However, the pain score was higher for Er:YAG laser than for diode laser.

Conclusion

This study demonstrated that both lasers' techniques are efficient for gingival depigmentation. However, diode laser seems to show less painful experience and relatively better bleeding control.

Evaluation of Pain Perception and Wound Healing After Laser-Assisted Frenectomy in Pediatric Patients: A Retrospective Comparative Study

Background: The maxillary labial frenulum is an attachment that connects the upper lip to the gingival tissue, and when it is too closely attached to gingival margin due to inadequate plaque control, it may put gingival health at risk. Objective: This study aimed to assess postoperative pain perception and wound healing after laser-assisted frenectomy in a pediatric population retrospectively. Methods: This study is based on the clinical records of the patients who received laser-assisted frenectomy treatment due to mucogingival problems at the pediatric dentistry department. Twenty-two patients were treated with either 2780 nm Er,Cr:YSGG laser (Waterlase iPlus; Biolase Technology, Irvine, CA, USA) or 940 nm diode laser (Epic10; Biolase Technology). The analyzed data included age, gender, frenulum insertion type, type of dental laser, postoperative pain perception, and wound healing. Postoperative pain evaluation was performed using Wong-Baker Faces Pain Rating Scale after 3 h, 1 day, 1 week, and 2 weeks. Wound surface healing was assessed through photography. Images were uploaded to the software, and changes in the wound surface area were measured in square millimeters on the day of frenectomy and on postoperative first day, first week, and second week. Results: Er,Cr:YSGG group had statistically significant better wound healing results after 1 and 2 weeks, respectively (p < 0.05). No significant difference was found between 2780 nm Er,Cr:YSGG laser and 940 nm diode laser groups in terms of pain perception. Conclusions: It can be concluded that both laser wavelengths are a safe and useful tool for frenectomies in pediatric patients with less pain. Er,Cr:YSGG laser achieved faster healing than 940 nm diode laser. Clinical Registration number: Clinical Trials gov ID NCT04368715.

Laser-Assisted Depigmentation-An Introspection of the Science, Techniques, and Perceptions

BACKGROUND

Gingival hyperpigmentation is a major concern for a significant number of patients, as a relevant aesthetic or cosmetic need. Oral melanin pigmentation is considered to be multifactorial and could be related to physiological or even pathological reasons and can be the consequence of a variety of local or systemic factors. This pigmentation varies individually across races or age groups and is without any gender predilection. Evidence gleaned from literature is presented from case-control studies and from the authors' own research work in prospective, split-mouth, double-blinded, clinical trials comparing treatment modalities in effecting depigmentation.

METHODS

A systematic review of published articles, using suitable assay criteria, was carried out to formulate a consensus on laser-assisted modalities. A total of 295 published sources were subject to critical analysis and resulted in six papers that were subject to data scrutiny. Additionally, evidence is presented on clinical protocols and treatment outcomes.

RESULTS

Analysis of randomized clinical studies identified the use of two laser wavelength groups-near infrared diode and erbium group of mid-infrared lasers. Several areas of analysis were examined, and inconsistent degrees of significance were obtained to establish which laser group was optimal and if they were any better than scalpel depigmentation.

CONCLUSION

A definitive conclusion is wanting as studies with scientific and standardized protocols of evaluation are yet to provide a take on comparative assessments between different techniques of depigmentation.

Gingival Melanin Depigmentation by 808 nm Diode Laser: Report of a Case

Gingival hyperpigmentation frequently poses an aesthetic problem, especially in patients with gingival smile. This paper presents the use of a 808 nm pulsed diode laser for gingival depigmentation in a 22-year-old male patient, with a frequency of 20,000 Hz, a peak power of 5 W, and a pulse width of 26 microseconds, using a 400 nm flexible optic fiber. The hyperpigmented gingival tissue was removed without bleeding or postoperative pain. Three weeks later, the gum resumed its normal, firm, and pink appearance. No significant recurrence was noted after a follow-up of 4 months. However, perfect control of this device is necessary to avoid certain consequences such as bone exposure or gingival fenestrations.

The effect of non-thermal atmospheric pressure plasma application on wound healing after gingivectomy

Recent studies have indicated the potential benefits of Non-thermal atmospheric pressure plasma (NTAPP) as a novel therapeutic approach. The purpose of the current study was thus to assess the effect of NTAPP on gingival wound healing. Fifteen patients with bilaterally symmetrical gingival hyperplasia were included in the study. After gingivectomy and gingivoplasty, the left-hand side of the symmetrical surgical area was irradiated with NTAPP (plasma jet kINPen 11). Digital photographs of the gingival wounds were taken at baseline and days 3, 7, and 14. Wound epithelialisation was evaluated. Landry Wound Healing Index (WHI) scores and visual analogue scale (VAS) scores were also recorded. There were significant differences between the epithelialisation of the NTAPP-treated sites and the control sites after the surgical procedures. The NTAPP-treated sites had significantly smaller stained surface areas compared with the control sites on the 3rd, 7^th , and 14th days (P < .05). The NTAPP-treated sites had better WHI scores than the control sites throughout the follow-up period (P < .05). It can be concluded that NTAPP enhances epithelialisation and stimulates wound healing after gingivectomy and gingivoplasty. However, further clinical studies with larger sample sizes are needed to determine the exact benefits of NTAPP for gingival wound healing.

Laser Treatment for Melanin Gingival Pigmentations: A Comparison Study for 3 Laser Wavelengths 2780, 940, and 445 nm

The normal appearance of the gingiva is pink to light red, and this appearance may change due to many factors and might be noticeable causing aesthetic concerns. In the Gulf area, the gingival melanin pigmentation is of the main type of concern, and patients expect the pigmentation to be removed for aesthetic reasons. Many techniques have been used to remove the melanin pigmentation such as using surgical blades, diamond or ceramic burs, chemicals, and lasers. This study is comparing the results of three lasers (Er, Cr, YSGG 2780 nm, Diode 940 nm, and 445 nm) in the removal of melanin gingival depigmentation. Clinical outcome parameters including bleeding, wound healing, pain, duration of procedure, color improvement, patient satisfaction, and relapse rate after 2 years were assessed. Conclusion. Within the limitation of this study, all three wavelengths were fast, effective in peeling the pigmentations and well tolerated by the patients. The esthetical results were excellent, and the patients were highly satisfied. Suggestion. To have a bigger number of samples in future papers, and histological studies might be included to explore the different impacts of each wavelength on the gingival melanin pigmentation specifically and on the gingival tissue generally.

A Randomized Comparative Clinical Study to Evaluate the Longevity of Esthetic Results of Gingival Melanin Depigmentation Treatment Using Different Laser Wavelengths (Diode, CO2, and Er:YAG)

Background: Gingival melanin hyperpigmentation is due to excessive deposition of melanin granules. The duration of pigmentation reappearance after treatment using different laser wavelengths remains controversial. Objective: The study aims to assess the longevity of gingival depigmentation (GD) and the consistency in esthetic results as three laser wavelengths (Er:YAG laser, CO₂ laser, and diode laser, 980 nm) were used in two different groups (smokers and nonsmokers). This is attained by comparing the periods of time in each group before pigmentation reappearance. Methods: Seventy-two subjects were divided into daily smokers (S) and nonsmokers. Subjects underwent a randomized GD with: Erbium laser (Er), CO₂ laser (CO₂), and Diode laser (Diode). The subjects were divided into six groups: S and nonsmokers were treated with three different wavelengths. Irradiation was performed until there was no visible pigmentation. For qualitative measurement, Hedin Melanin Index (HMI) was used, before treatment, after 2 weeks, and until 60 months. Pigmentation reappearance of degree 1 or above of the HMI was noted. Descriptive statistics were also calculated. Results: HMI showed a 0 in all groups after 14 days of treatment. The time before pigmentation rebound was: Diode > CO₂ > S-Diode > S-CO₂ > Er > S-Er. The first signs of relapse shown among all groups were seen in the group S-Er group. The longest time before rebound was observed with the Diode group for the nonsmoker. Conclusions: Diode laser provides the longest-term stability in treatment. Smoking negatively affects the longevity of GD. Er laser gives the shortest time before the reappearance of gingival pigmentation.

A Comparison of 940 nm Diode Laser and Cryosurgery With Liquid Nitrogen in the Treatment of Gingival Physiologic Hyperpigmentation Using Split Mouth Technique: 12 Months Follow Up

Introduction: Gingival hyperpigmentation is excessive deposition of melanin pigments in the epithelium of gingiva which affects facial esthetics. Various surgical methods for gingival depigmentation have been used to treat the darkened color of pigmented gingiva. This study compared the use of 940 nm diode laser and liquid nitrogen cryosurgery in the treatment of gingival physiologic hyperpigmentation in terms of gingival depigmentation, postoperative pain, healing duration, pigmentation recurrence, and patients' satisfaction. Methods: Fifteen systemically healthy patients (11 females and 4 males; 17-35 years of age) with bilateral gingival physiologic hyperpigmentation were enrolled in this split-mouth randomized study. Maxillary anterior labial gingiva of each patient was divided into left and right halves, and each half was randomly depigmented by either laser or cryosurgery. Patients were given questionnaires to evaluate the procedures and were followed up in 3, 7, 10, 17 and 21 days postoperatively for the assessment of gingival healing and 1, 3, 6 and 12 months after the treatments to detect any sign of pigmentation recurrence. Results: The severity of post-op pain measured by visual analogue scale (VAS) was mild to average and showed no significant difference between the 2 modalities (P>0.05). There was no considerable swelling or hemorrhage after the treatment procedures and the healing duration was significantly shorter in laser (P<0.05). The degree of pigmentation in all gingival sites treated by laser reached and remained at zero until the last follow up (1 year) and reached zero in 9 out of 15 cryosurgerytreated sites. All patients were completely satisfied with the laser, and 9 out of 15 were completely satisfied with cryosurgery. No pigmentation recurrence was observed during any follow-up periods. Conclusion: Removal of gingival physiologic hyperpigmentation by laser therapy and cryotherapy was effective and safe. The efficiency of the laser was better than cryotherapy.

WITHDRAWN: Ethical and legal ramifications of using diode lasers for nonsurgical periodontal therapy

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Effect of 810 nm diode laser on physiologic gingival pigmentation

Background and aims

Physiologic gingival pigmentation (PGP) is the most common type of gingival pigmentation causing esthetic concerns particularly in gummy smile patients. Laser therapy is an effective and noninvasive treatment modality for such patients. This study aimed to evaluate the efficacy of diode laser for treatment of PGP.

Subjects and methods

This quasi-experimental study (one-group pretest-post-test design) was conducted on 20 patients complaining of gingival melanin pigmentation. The gingiva of the anterior segment of the arch was ablated with 810 nm diode laser until the entire visible pigmentation was removed. Clinical observations for the intensity of pigmentation were made at baseline, one month and three months, postoperatively. Data were analyzed using SPSS and Friedman test.

Results

Preoperatively, the mean score of gingival melanin pigmentation in the maxilla and mandible was 2.95. At one month postoperatively, the mean scores of the maxilla and mandible were 1.53 and 1.55, respectively. After three months, the mean rank of scores of the maxilla and mandible was 1.53 and 1.50, respectively. The difference between the pre- and postoperative mean scores was statistically significant (P < 0.001).

Conclusion

Diode laser therapy is an effective and minimally invasive modality for gingival depigmentation. But further investigations with long-term follow ups are warranted in this respect.

Efficacy of surgical laser therapy in the management of oral pigmented lesions: A systematic review

BACKGROUND

Oral pigmentation, especially in the gingiva poses esthetic problems. Laser therapy has been widely used for cosmetic therapy in dentistry. The aim of the present study was to systematically review the efficacy of surgical laser therapy (SLT) in the management of oral pigmented lesions (OPL).

MATERIALS AND METHODS

The addressed focused question was "Is SLT effective in the management of OPL?" Databases (MEDLINE via PubMed; EMBASE; Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) were searched from 1970 up to and including February 2017.

RESULTS

Ten studies were included. The reported number of OPL ranged between 8 and 140. Oral pigmented sites included, gingiva, buccal and labial mucosa, alveolar mucosa and lips. Lasers used in the studies included Q-switched alexandrite, Neodymium-doped yttrium aluminium garnet, diode, Erbium: yttrium aluminium garnet and carbon dioxide laser. Laser wavelength, power output and number of irradiations were 635-10,600nm, 1-10W and 1 to 9 times, respectively. The follow up period ranged from 6 to 24months. All studies reported SLT to be effective in the treatment of OPL. In five studies, recurrence of OPL occurred which ranged from 21.4% to 45%.

CONCLUSIONS

Lasers are effective in the management of OPL including physiologic gingival pigmentation, smokers' melanosis and pigmentation in Laugier-Hunziker syndrome. Different laser types (CO_2, Er:YAG and Diode) showed comparable outcomes in the treatment of OPL.

Treatment of oral hyperpigmentation and gummy smile using lasers and role of plasma as a novel treatment technique in dentistry: An introductory review

Gingival hyperpigmentation and the condition known as gummy smile are very common dental cosmetic problems. Gingival hyperpigmentation arises due to the excess presence of melanin in certain regions of the gums. In the case of gummy smile, more than the required amount of gingival tissue is exposed upon smiling. An aesthetically pleasing smile should expose only a negligible amount of gingival tissue. Gummy smile and gingival hyperpigmentation can have detrimental effects on the aesthetic quality of a smile, and thereby a wide variety of treatment options must be taken into consideration depending patient outcome objectives. The use of a laser as a treatment modality is considered to be a promising option for such cases. We aim to explain the effects of using a laser on the gingiva and discuss the advantages and disadvantages of this type of treatment and the resulting alteration of the genetic composition of the gingival tissue. This article reviews the histological aspects and biological effects of a laser treatment for oral hyperpigmentation and gummy smile and analyzes the use of the laser as a modality to improve the smiles of people with hyperpigmentation and excessive gingival display. We also attempt to provide insight into the use of plasma as a novel technology for medical and dental research and its future implications with regard to, dental soft tissue procedures.

Er, Cr:YSGG laser for the treatment of ankyloglossia

Ankyloglossia or tongue-tie is the result of a short and tight lingual frenum causing difficulty in speech, feeding problems in infants due to the limitation of tongue movement. This report presents a case of a 22-year-old female with tongue-tie who complained of difficulty in speech following which she underwent frenectomy procedure with erbium, chromium: yattrium-scandium-gallium-garnet laser without any complications. She was referred to the speech therapist after the procedure.

Lasers in esthetic treatment of gingival melanin hyperpigmentation: a review article

The health and suitability of mouth components play an important role towards defining facial attractiveness. An important component of the oral cavity is the color of the gingival tissue. Gingival melanin hyperpigmentation is caused by several reasons and affects people across ethnicity, race, age, and both gender. Lasers are presently being used for gingival melanin depigmentation. In this article, we reviewed studies on laser parameters, duration of gingival healing, pain perception during and after the operation, scores used for the evaluation of gingival melanin hyperpigmentation, follow-up period, treatment results, and recurrence reports. We conclude that laser ablation for gingival depigmentation is one of the most pleasant, reliable, acceptable, and impressive techniques available for treating gingival melanin hyperpigmentation.

Treatment of Gingival Hyperpigmentation by Diode Laser for Esthetical Purposes

BACKGROUND:

Gingival hyperpigmentation is a common esthetical concern in patients with gummy smile or excessive gingival display. Laser ablation has been recognized recently as the most effective, pleasant and reliable technique. It has the advantage of easy handling, short treatment time, hemostasis, decontamination, and sterilization effect.

AIM:

In the present study we wanted to explore the efficacy of a 980 nm wavelength diode laser in gingival depigmentation clinically by using both VAS and digital imaging method as means of assessment.

METHODS:

Diode laser ablation was done for 15 patients who requested cosmetic therapy for melanin pigmented gums. The laser beam delivered by fiberoptic with a diameter of 320 µm, the diode laser system has 980 nm wave lengths and 3 W irradiation powers, in a continuous contact mode in all cases, the entire surface of each pigmented maxillary and mandibular gingiva that required treatment was irradiated in a single session. Clinical examination and digital image analysis were done and the patients were followed up for 3 successive months.

RESULTS:

There was a statistically significant change in prevalence of bleeding after treatment, as none of the cases showed any signs of bleeding 1 week, 1 month and 3 months after ablation. No statistically significant change was observed in the prevalence of swelling after treatment The VAS evaluation demonstrated that only 4 patients complained of mild pain immediately after the procedure. No pain was perceived from the patients in the rest of the follow up period. There was no statistically significant change in prevalence of pain immediately after treatment compared to pain during treatment. There was a decrease in cases with mild pain after 1 week, 1 month as well as 3 months compared to pain during treatment and immediately after treatment.

CONCLUSION:

Within the limitations of this study, the use of diode laser was shown to be a safe and effective treatment modality that provides optimal aesthetics with minimal discomfort in patients with gingival hyperpigmentation.

Laser therapy of a dermal nevus in the esthetic zone of the nasal tip: A case report and comprehensive literature review

This case report demonstrates the ablation of a dermal nevus using a diode laser in the esthetically very demanding facial area of the nasal tip. The clinical outcome shows good results and a high level of patient satisfaction. Due to effective wound granulation and healing, elaborate skin grafts could be avoided. The application of the contact laser ensures safe treatment in highly perfused areas thanks to haptic feedback and good coagulative effect. The method should therefore be considered as an alternative to other ablative procedures for benign lesions in the facial area.

Aesthetic Depigmentation of Gingival Smoker's Melanosis Using Carbon Dioxide Lasers

Melanic pigmentation results from melanin produced by the melanocytes present in the basal layer of the oral epithelium. One of the most common causes of oral pigmentation is smoker melanosis, a condition associated with the melanocyte stimulation caused by cigarette smoke. This paper aims to illustrate the use of a carbon dioxide laser in the removal of the gingival melanic pigmentation for aesthetic reasons in a 27-year-old female patient with history of a smoking habit. The carbon dioxide laser vaporisation was performed on the gingival mucosa with effective and quick results and without any complications or significant symptoms after the treatment. We conclude that a carbon dioxide laser could be a useful, effective, and safe instrument to treat the aesthetic complications caused by oral smoker melanosis.

Diagnosis of oral pigmentations and malignant transformations

BACKGROUND

Oral pigmentation is a common finding in the mouth. Pigmentation can be either normal or abnormal discoloration of oral mucous membrane. The purpose of this review mainly focuses on the main oral pigmented lesions, in order to help the clinicians establish a better approach towards the patients with pigmented oral lesions and to provide thorough knowledge regarding such lesions for patient reassurance, early definitive diagnosis and prompt treatment.

METHODS

Relevant data concerning oral pigmented lesions, clinical features and the possibility of malignant transformation of such lesions were reviewed thoroughly from pubmed literature published in English. Pigmented lesions affecting the skin were not included in our review.

RESULTS

Few pigmented lesions have been identified and their tendency to become malignant has been reported in the literature. The oral lesions showing malignant transformation reported were mostly case series. Unfortunately, due to lack of long-term studies, follow ups and randomized controlled studies in this respect it was difficult to draw a statistical analysis. This information is quite crucial for general dental practitioners to improve their understanding regarding oral lesions and to differentiate between normal and diseased conditions, so that they can master the skill of differential diagnosis, definitive diagnosis and prompt treatment.

CONCLUSION

Oral pigmentation may present as focal, multifocal or diffused macular or tumefactive lesions. They may greatly vary in color as blue, purple, brown, gray or black depending on the quantity and site of melanin in the tissues [1]. Etiology of pigmentation can be multi factorial. Mostly pigmentation is physiologic but at times it can be a precursor of severe diseases. Lesions may be caused by localized harmless accumulations of melanin, hemosiderin or exogenous metals or they may be a sign of underlying systemic or genetic disease. A few lesions may be associated with life-threatening medical conditions that require immediate intervention. The differential diagnosis for any pigmented lesion is extensive, as it includes examples of endogenous and exogenous pigmentations. Although biopsy is a helpful and necessary aid in the diagnosis of focally pigmented lesions, with diffuse pigmentation lesions require a thorough dental and medical history and laboratory investigations.

Systematic review of treatment modalities for gingival depigmentation: a random-effects poisson regression analysis

OBJECTIVE

Repigmentation variably occurs with different treatment methods in patients with gingival pigmentation. A systemic review was conducted of various treatment modalities for eliminating melanin pigmentation of the gingiva, comprising bur abrasion, scalpel surgery, cryosurgery, electrosurgery, gingival grafts, and laser techniques, to compare the recurrence rates (Rrs) of these treatment procedures.

MATERIAL AND METHODS

Electronic databases, including PubMed, Web of Science, Google, and Medline were comprehensively searched, and manual searches were conducted for studies published from January 1951 to June 2013. After applying inclusion and exclusion criteria, the final list of articles was reviewed in depth to achieve the objectives of this review. A Poisson regression was used to analyze the outcome of depigmentation using the various treatment methods.

RESULTS

The systematic review was based on case reports mainly. In total, 61 eligible publications met the defined criteria. The various therapeutic procedures showed variable clinical results with a wide range of Rrs. A random-effects Poisson regression showed that cryosurgery (Rr = 0.32%), electrosurgery (Rr = 0.74%), and laser depigmentation (Rr = 1.16%) yielded superior result, whereas bur abrasion yielded the highest Rr (8.89%).

CONCLUSIONS

Within the limit of the sampling level, the present evidence-based results show that cryosurgery exhibits the optimal predictability for depigmentation of the gingiva among all procedures examined, followed by electrosurgery and laser techniques.

CLINICAL SIGNIFICANCE

It is possible to treat melanin pigmentation of the gingiva with various methods and prevent repigmentation. Among those treatment modalities, cryosurgery, electrosurgery, and laser surgery appear to be the best choices for treating gingival pigmentation.

Cryosurgery by tetrafluoroethane: An answer to black gums

To highlight the effect of 1,1,1,2 tetrafluoroethane (TFE), a new material for cryosurgery of gingival melanin pigmentation (GMP). Five patients were treated using a TFE-cooled swab and the pre- and post-treatment photographs were compared. Complete keratinization took place in 3-4 weeks after application without any trace of pigmentation. During the follow-up period, no side effects were observed and the improved esthetics were maintained upto 1 year.

Comparative evaluation of photoablative efficacy of erbium: yttrium-aluminium-garnet and diode laser for the treatment of gingival hyperpigmentation. A randomized split-mouth clinical trial

BACKGROUND

The use of lasers in periodontology is a matter of debate, mainly because of the lack of consensual therapeutic protocols. In this randomized, split-mouth trial, the clinical efficacy of two different photoablative dental lasers, erbium:yttrium-aluminum-garnet (Er:YAG) and diode, for the treatment of gingival hyperpigmentation is compared.

METHODS

Twenty-one patients requiring treatment for mild-to-severe gingival hyperpigmentation were enrolled. Maxillary or mandibular left or right quadrants were randomly subjected to photoablative deepithelialization with either Er:YAG or diode laser. Masked clinical assessments of each laser quadrant were made at admission and days 7, 30, and 180 postoperatively by an independent observer. Histologic examination was performed before and soon after treatment and 6 months after irradiation. Patients also compiled a subjective evaluation questionnaire.

RESULTS

Both diode and Er:YAG lasers gave excellent results in gingival hyperpigmentation. However, Er:YAG laser induced deeper gingival tissue injury than diode laser, as judged by bleeding at surgery, delayed healing, and histopathologic analysis. The use of diode laser showed additional advantages compared to Er:YAG in terms of less postoperative discomfort and pain.

CONCLUSIONS

This study highlights the efficacy of diode laser for photoablative deepithelialization of hyperpigmented gingiva. It is suggested that this laser can represent an effective and safe therapeutic option for gingival photoablation.

A new thermographic and fluorescent method for tuning photoablative laser removal of the gingival epithelium in patients with chronic periodontitis and hyperpigmentation

OBJECTIVE

The purpose of this study was to optimize gingival laser photoablation by thermographic and autofluorescent feedbacks.

BACKGROUND DATA

Photoablative laser treatment is commonly used for gingival de-epithelization in patients with chronic periodontitis or hyperpigmentation. The reduction of collateral thermal damage of periodontal tissues is crucial for optimal treatment outcome.

METHODS

Nineteen patients with chronic periodontitis, seven of whom showing gingival hyperpigmentation, were subjected to de-epithelization with an 810 nm diode laser used in continuous (1 W, 66.67 J/cm2) or pulsed wave mode (69 μJ, 18 μs, 8000 Hz, corresponding to peak/mean power of 3.8 W/0.6 W, 40 J/cm2), depending upon individual gingival features. Photoablation was controlled in real time with a 405 nm violet light probe, which stimulated a yellow autofluorescence of the laser-coagulated tissue. The temperature at the target tissue was controlled with an infrared thermographic probe. When appropriate, small biopsies were taken to evaluate epithelial ablation and thermal effects.

RESULTS

The energy density transferred to the treated tissue surface was computed based on the irradiation modality of the target tissues. Laser photoablation performed under thermographic control yielded complete removal of the gingival epithelium with minimal injury to the underlying lamina propria. Irradiation-evoked autofluorescence, conceivably the result of epithelial keratins, allowed very sharp recognition of the borders between laser-ablated and intact epithelium, thus preventing repeated irradiation.

CONCLUSIONS

This study further supports the favorable characteristics of photoablative diode laser for gingival de-epithelization. Concurrent thermographic and fluorescent analysis can provide substantial help to the setup of a safe and well-tolerated protocol.

Esthetic treatment of gingival hyperpigmentation with Nd:YAG laser or scalpel technique: a 6-month RCT of patient and professional assessment

This double-masked, randomized controlled trial with a split-mouth design aimed to compare patient- and professional-centered outcomes using different therapeutic approaches-neodymium-yttrium aluminum garnet (Nd:YAG) laser or scalpel technique-for gingival depigmentation. Patients presenting bilateral melanin gingival hyperpigmentation and who requested cosmetic therapy were recruited. Contralateral quadrants were randomly assigned to receive Nd:YAG laser (settings: 6 W, 60 mJ/pulse, and 100 Hz) or scalpel technique. Patient morbidity experienced at intratherapy and during the first postoperative week was evaluated. In addition, after 6 months, the cosmetic results achieved for the different therapeutic approaches were evaluated by patients and professionals. The chair time of each technique was also calculated. Patient-oriented outcomes concerning intratherapy morbidity did not demonstrate any differences between groups (p > 0.05), although a higher extent of discomfort/pain was experienced in the side treated by the scalpel technique compared to the Nd:YAG laser procedure during the first posttherapy week (p < 0.05). Regarding to cosmetic outcomes, no differences between techniques were observed for patient and professionals (p > 0.05). Significantly higher chair time was required for the scalpel technique than for the Nd:YAG laser therapy (p < 0.05). The Nd:YAG laser or the scalpel technique may be successfully used for the treatment of melanin gingival hyperpigmentation. However, the use of the Nd:YAG laser has presented advantages in terms of less discomfort/pain during the posttherapy period and a reduction of treatment chair time.

Management of gingival hyperpigmentation by semiconductor diode laser

Gingival hyperpigmentation is caused by excessive deposition of melanin in the basal and suprabasal cell layers of the epithelium. Although melanin pigmentation of the gingiva is completely benign, cosmetic concerns are common, particularly in patients having a very high smile line (gummy smile). Various depigmentation techniques have been employed, such as scalpel surgery, gingivectomy, gingivectomy with free gingival autografting, cryosurgery, electrosurgery, chemical agents such as 90% phenol and 95% alcohol, abrasion with diamond burs, Nd:YAG laser, semiconductor diode laser, and CO₂ laser. The present case report describes simple and effective depigmentation technique using semiconductor diode laser surgery – for gingival depigmentation, which have produced good results with patient satisfaction.

Split mouth de-epithelization techniques for gingival depigmentation: A case series and review of literature

Gingival melanin pigmentation occurs in all races of mankind. Although clinical melanin pigmentation does neither present itself as a medical problem nor a disease entity, it is a major esthetic concern for many people, especially Asians. Esthetic gingival depigmentation procedures can be performed in such patients with excellent results. This case series presents a split mouth de-epithelization procedure using popular surgical techniques such as scalpel, bur abrasion or electrosurgery. These techniques were successfully used to treat gingival hyperpigmentation. Although we found that electrosurgery increased the efficacy of our work, giving a cleaner and neater work field, it required a lot of precision. In contrast, scalpel de-epithelization was easy and technique-friendly, giving excellent results and patient satisfaction. However, the cases are being followed-up to study the factors affecting the rate and length of time required for repigmentation and to study the repigmentation patterns. This case series also reviews the advantages and disadvantages of various techniques available for depigmentation, and reiterates that the scalpel technique still serves as a gold standard for depigmentation.

A comparison of different gingival depigmentation techniques: ablation by erbium:yttrium-aluminum-garnet laser and abrasion by rotary instruments

PURPOSE

The aim of this study is to compare two different gingival depigmentation techniques using an erbium:yttrium-aluminum-garnet (Er:YAG) laser and rotary instruments.

METHODS

Two patients with melanin pigmentation of gingiva were treated with different gingival depigmentation techniques. Ablation of the gingiva by Er:YAG laser was performed on the right side, and abrasion with a rotary round bur on the opposite side.

RESULTS

The patients were satisfied with the esthetically significant improvement with each method. However, some pigment still remained on the marginal gingival and papilla. The visual analog scale did not yield much difference between the two methods, with slightly more pain on the Er:YAG laser treated site.

CONCLUSIONS

The results of these cases suggest that ablation of the gingiva by an Er:YAG laser and abrasion with a rotary round bur is good enough to achieve esthetic satisfaction and fair wound healing without infection or severe pain. Prudent care about the gingival condition, such as the gingival thickness and degree of pigmentation along with appropriate assessment is needed in ablation by the Er:YAG laser procedure.

Esthetic treatment of gingival melanin hyperpigmentation with a Nd:YAG laser and high speed rotary instrument: comparative case report

Purpose

The purpose of this study was to evaluate the clinical effectiveness of and patient's satisfaction with treatment of gingival melanin hyperpigmentation with a Nd:YAG laser and a high speed rotary instrument.

Methods

Three patients with melanin hyperpigmentation in the anterior parts of the gingiva were chosen for this case study. Clinical photographs were taken at the preoperative state and three patients were treated under local anesthesia. In the maxilla, the gingival deepithelization was conducted with a high speed diamond bur, whereas, in the mandible with a Nd:YAG laser. Clinical photographs were taken immediately after the procedures and at the 1st, 2nd, and 4th week to evaluate clinical color changes. A week after the procedure, the patients filled out a questionnaire about any pain or discomfort. At the 4th week after the procedure, the patients filled out questionnaires about esthetic aspects of the results of treatment.

Results

In all cases, both anterior gingival areas were depigmented with satisfaction and the patients did not complain of severe pain or discomfort. At the 1st week of healing, the gingiva showed moderate to fast epithelization. Two weeks after the procedure, clinically, the gingiva showed almost complete healing. Four weeks after the procedure, there was significant improvement in gingival melanin hyperpigmentation.

Conclusions

The Nd:YAG laser and the high speed rotary instruments seem to be effective for the esthetic treatment of gingival melanin hyperpigmentation.

Comparison of conventional surgery and CO2 laser on intraoral soft tissue pathologies and evaluation of the collateral thermal damage

OBJECTIVE

The aim of the study was to compare conventional surgery with carbon dioxide (CO(2)) laser applied on oral soft tissue pathologies and to evaluate the effect of collateral thermal damage on histopathological diagnosis. Anesthesia need, postoperative pain, and intraoperative and postoperative complications were examined as part of the comparison.

METHODS

Forty-three patients (32 female and 11 male) with a mean age of 54 (54 +/- 7.0) requiring soft tissue surgeries were randomly assigned to receive treatment either with conventional surgery using a scalpel or with a CO(2) laser technique. Anesthesia method and need, postoperative pain, systemic pain medications if needed, and intra- and postoperative complications were recorded. Excised tissues were evaluated histopathologically for the effect of thermal damage.

RESULTS

All patients were anesthetized with local anesthesia in the conventional group whereas only 10 (42%) patients needed local anesthesia after topical anesthetic application in the laser group. In the conventional group, 18 (90%) patients need analgesics after the operation, compared with seven (29%) patients in the laser group. No intra- or postoperative complications were seen for either procedure. Histological examination of 39 specimens showed that collateral thermal damage on the incision line did not affect the histopathological diagnosis.

CONCLUSIONS

CO(2) laser is an effective instrument for soft tissue excisional biopsies with minimal intraoperative and postoperative complications and good pain control. CO(2) laser applications are suggested as an alternative method to conventional surgery on oral soft tissues.

Spontaneous pigmentation of non-pigmented palatal tissue after periodontal surgery

BACKGROUND

A 22-year-old African American female was referred for augmentation of keratinized gingiva around implants at the right and left maxillary second premolar sites. Presurgical evaluation revealed generalized melanosis of the buccal gingiva and a lack of keratinized tissue around implants at sites #4 and #13. No pigmentation was noted on the palatal tissues.

METHODS

Thick free gingival grafts were harvested bilaterally from the non-pigmented palate and secured to the recipient sites with bioabsorbable sutures. Hemostasis was achieved at the palatal donor sites with moistened gauze, and an acrylic stent was delivered for patient comfort.

RESULTS

Both palatal donor sites healed with spontaneous pigmentation. The pigmentation intensified with time but resulted in no adverse outcome.

CONCLUSIONS

Post-surgical healing in patients with gingival pigmentation is not entirely predictable, as multiple studies have demonstrated widely inconsistent results in regards to gingival pigmentation upon healing. When performing periodontal plastic surgery in patients with pigmented oral tissues, it is important to discuss all possible outcomes, including spontaneous pigmentation.

Lasers and the treatment of chronic periodontitis

For many intraoral soft-tissue surgical procedures the laser has become a desirable and dependable alternative to traditional scalpel surgery. However, the use of dental lasers in periodontal therapy is controversial. This article presents the current peer-reviewed evidence on the use of dental lasers for the treatment of chronic periodontitis.

Remodeling of the rat gingiva induced by CO2 laser coagulation mode

BACKGROUND AND OBJECTIVES

This study was conducted to clarify the morphologic characteristics and subsequent repair process of coagulation necrosis produced by pulsed CO(2) laser irradiation with relatively low fluence, and thereby to evaluate the clinical efficacy of this irradiation mode.

STUDY DESIGN/MATERIALS AND METHODS

Wounding of rat gingiva to produce coagulation necrosis was done with a CO(2) laser with a fluence of 326 J/cm(2). The structural characteristics of the wound and subsequent repair process were examined by means of histology, immunohistochemistry, and electron microscopy.

RESULTS

At 6 hours after irradiation, the cells in the laser wound appeared histologically intact but had lost the immunoreactivity to antibodies against Hsp47 and exhibited various ultrastructural signs of cell death. This wound area was lined by Hsp70-positive cells. At 1-day post-irradiation, the uptake of BrdU rapidly increased in the adjacent epithelium and connective tissue. The re-epithelization commenced at 1 day and was completed by 7 days. The necrotic tissue gradually became integrated within the newly formed connective tissue and the original contour of the gingiva was retained during the repair process. The repair process of the laser-induced wound progressed more rapidly than that of a scalpel-made wound.

CONCLUSIONS

The present study suggests that the coagulation necrosis produced by the low fluence pulsed CO(2) laser does not disturb the repair process but promotes its steady progress and subsequent tissue remodeling. This laser mode will pave the way for more conservative and minimally invasive surgery for treating a wide variety of oral soft tissue disorders.

Cryosurgical treatment of gingival melanin pigmentation with tetrafluoroethane

OBJECTIVE

To introduce 1,1,1,2 tetrafluoroethane (TFE), as a new material for cryosurgery of gingival melanin pigmentation (GMP).

STUDY DESIGN

Twenty-one patients with GMP were treated using a TFE-cooled cotton swab. Standard digital images of pigmented areas were measured preoperatively and postoperatively with image-analyzing software. The Mann-Whitney U test was used for statistical analysis.

RESULTS

Keratinization was completed 3 to 4 weeks after application, without any trace of pigmentation. Statistical analysis revealed a significant difference between preoperative and postoperative measurements of pigmented areas (P < .05). During the follow-up period, no side effects were observed and improved esthetics were maintained up to month 30.

CONCLUSIONS

The clinical outcomes of cryosurgery with TFE for treatment of GMP are very satisfactory. The use of TFE for cryosurgical treatment of GMP is practical and inexpensive. Moreover, unlike other cryosurgery methods no special equipment is required, and it is safe to store in the dental clinic.

Lasers and soft tissue: 'fixed' soft tissue surgery

Within a general practice setting, there are few benign pathological conditions of the attached or keratinised gingival complex that are not amenable to simple surgical intervention. The majority of surgical procedures are adjunctive to the delivery of restorative dentistry. There is an understandable dogma worldwide towards the management of soft tissues as they interface with restorative procedures. Contemporary teaching, both at undergraduate and postgraduate level, would recognise the need for a period of wound healing and stability, based on scalpel-induced incisional therapy. The use of laser wavelengths, based on predictable evidence-based protocols, has re-defined the surgical management of keratinised mucosa that is bound to the underlying periosteum and bone. This can be seen as being of benefit to the clinician in determining the outcome, and the patient in achieving quality results.

Treatment of Gingival Hyperpigmentation by Erbium-Doped:Yttrium, Aluminum, and Garnet Laser for Esthetic Purposes

BACKGROUND

The normal color of gingiva is pink. Gingival hyperpigmentation is mostly caused by the physiologic deposition of melanin by melanocytes. In "gummy smile" patients, melanin gingival hyperpigmentation causes an esthetic problem and may cause physiologic disturbances. Methods to remove gingival hyperpigmentation vary, but it seems that the most reliable and satisfactory procedure is laser ablation.

METHODS

Six white patients (five females and one male), who complain of having dark-brown to black gingival hyperpigmentation were included in the study. Three of them were smokers. Laser ablation was performed by an erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser (settings: 250 mJ, 15 Hz, with water and air and using the defocused mode) without using topical or local anesthesia. Each patient required about 20 to 25 minutes for completion of the procedure. After 4 days, another laser ablation (with the same previous settings) was performed to ensure good results. Patients were evaluated a month after completion of treatment and on a semiannual basis. The follow-up period ranged between 6 and 18 months.

RESULTS

In all patients, no discomfort, pain, or bleeding complications were found intraoperatively or 4 days postoperatively. Ablated wounds healed almost completely within 4 days. No recurrence of gingival hyperpigmentation was found during the follow-up periods. Achieved results were satisfactory for patients and the operator.

CONCLUSIONS

Taking into account the advantages of using lasers, it seems to be that the depigmentation of melanin hyperpigmented gingiva by the Er:YAG laser is a reliable and satisfactory procedure. Esthetic results were satisfactory for patients and the operator, and no repigmentation was found during the follow-up period.

Evaluation of Patient Perceptions After Frenectomy Operations: A Comparison of Carbon Dioxide Laser and Scalpel Techniques

BACKGROUND

A frenum that encroaches on the margin of the gingiva may interfere with plaque removal and cause tension. Frenectomy is the complete removal of the frenum that can be made by scalpels or with soft tissue lasers. The aim of this article was to compare the degree of postoperative pain, such as discomfort and functional complications (eating and speech), experienced by patients after two frenectomy operation techniques.

METHODS

Forty patients requiring frenectomy were randomly assigned to have treatment either with a conventional technique or with a carbon dioxide (CO2) laser. The postoperative pain and functional complication ratings of each patient were recorded using a visual analog scale on days 1 and 7.

RESULTS

The results indicated patients treated with the CO2 laser had less postoperative pain and fewer functional complications (speaking and chewing) (P <0.0001 each) and required fewer analgesics (P <0.001) compared to patients treated with the conventional technique.

CONCLUSIONS

This clinical study indicates that CO2 laser treatment used for frenectomy operations provides better patient perception in terms of postoperative pain and function than that obtained by the scalpel technique. Considering the above advantages, when used correctly, the CO2 laser offers a safe, effective, acceptable, and impressive alternative for frenectomy operations.