Cryosurgical treatment of melanin-pigmented gingiva

A comparative evaluation of management of hyperpigmented gingiva using surgical stripping technique and diode laser: A clinical study

Background

To compare the treatment outcome of laser and its effectiveness in the management of gingival hyperpigmentation over scalpel surgical method.

Methods

The patients were selected and were divided into two groups by the split-mouth design. Group A: Right half upper and lower central incisors to premolars were treated using the laser technique. GROUP B: Left half upper and lower central incisors to premolars were treated by Scalpel technique. This study was a comparative, split-mouth analytical study, and the results were observed for a period of 9 months.

Results

Diode laser technique gave better results in this perio-esthetics procedure as compared to scalpel technique. However, recurrence of pigmentation has been reported even after this duration. Diode laser was superior over the scalpel technique in the aspect of operator convenience, reduced postoperative bleeding, and reducing the incidence of repigmentation in terms of intensity and extent of pigmentation. Patient comfort was more in scalpel technique.

Conclusion

Laser can be used for better periodontal esthetic procedure over the standard scalpel technique, although repigmentation was reported in both groups. But delayed healing occurred on the laser side due to the thermal effect of the laser on the adjacent tissues. Provision of such advanced instruments to dental surgery can give better satisfaction to patient clientele in terms of good esthetic results.

A Successful Esthetic Approach of Gingival Depigmentation Using Microneedling Technique and Ascorbic Acid (Vitamin C)

A gingival depigmentation is a periodontal plastic procedure that is performed in order to remove melanocytic pigmentation. A variety of different modalities have been proposed for removing hyperpigmentation involving surgical scraping, gingival autograft, cryotherapy, electrosurgery, and lasers. However, the microneedling technique is a nonsurgical procedure that creates microholes to facilitate the penetration of topical medications across the connective tissues. Case Description. A healthy female patient aged 25 years with a pigmented gingiva seeking gingival depigmentation. On examination, a dark brown ribbon of hyperpigmentation was observed within the mandibular attached gingiva. The case was diagnosed as physiological moderate gingival pigmentation (pigmentation index score = 3). The patient was interested in achieving aesthetic results with minimally invasive, nonexpensive procedures. Based on the patient's concerns, the microneedling technique using vitamin C was suggested and consented. We used a dermapen device to microneedle the gingiva until bleeding pinpoints were observed; then, topical ascorbic acid was applied. After 3 days, our outcomes revealed an excellent aesthetic pink gingival appearance. Conclusions and Practical Implications. Compared to other minimally invasive techniques, our technique is less expensive and more risk-free. Our novel technique of using dermapen and topical ascorbic acid has shown promising results to our case which gives new perspectives for its application in gingival depigmentation.

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.

Efficacy of liquid nitrogen and electrocautery assisted gingival depigmentation in term of patient's perception, histological wound healing - A randomized triple blind clinical trial

BACKGROUND

Hyper-melanin pigmentation of the gingiva (GMP) is one of the imperative contributory factors for smile-sensitive individuals. Numerous gingival depigmentation (GD) procedures have been attempted in the literature to evaluate the clinical outcome mostly. Hence, a randomized clinical-histopathological triple-blinded trial was planned to evaluate the pain experienced by the patient, gingival wound healing, and density of melanocytes following liquid nitrogen-assisted GD (LNAGD) and electrocautery-assisted GD (ECAGD) procedures.

MATERIALS AND METHODS

Thirty-two arches with bilateral physiologic labial/buccal GMP extending from distal aspect tooth #14-24 and #34-44 in 16 healthy individuals were selected and were equally treated with LNAGD and ECAGD techniques. Dummett oral pigmentation index and Hedin melanin index were evaluated at baseline and 3 months' postoperatively (PO). The visual analog scale was utilized for the intensity of pain assessment at baseline (immediately after treatment) and 1st day and 7th day PO. Histological wound healing and density of melanocytes were evaluated using Gal et al.'s wound-healing assessment index and Patsakas et al.'s criterion, at baseline (0), 8, 24, 72, and 96 h; 1st, 2nd, 3rd, and 4th week; and 3 months and at 0 and 3 months' PO, respectively. Statistical analysis was done using one-way ANOVA, post hoc Tukey, unpaired, and paired "t" test.

RESULTS

Both groups showed a statistically significant influence on the parameters evaluated.

CONCLUSION

The LNAGD had a substantial superior result in terms of early wound healing, reduction in density of melanocytes, reduction in pain experienced by the patient, with reduction and delay in the recurrence of GMP.

Evaluation of surgical scalpel versus semiconductor diode laser techniques in the management of gingival melanin hyperpigmentation: A split-mouth randomized clinical comparative study

Background

"Black gums" due to melanin pigmentation of the gingiva is one reason for the demand of cosmetic therapy. Clinicians are often faced with challenge to achieve gingival esthetics in such cases because of its recurrence. Although many procedures were described in literature for gingival depigmentation, only few are mentioning about the intensity of repigmentation. Hence, this study was designed to compare two different techniques for treatment of gingival melanin pigmentation.

Materials and Methods

Twenty patients who were not esthetically pleased with the color of gingiva were selected. A randomized, split-mouth, depigmentation procedure was performed using surgical scalpel and diode laser techniques. Clinical parameters such as plaque and gingival index, bleeding, pain perception, wound healing, recurrence, and intensity of repigmentation were evaluated. Paired t-test and Chi-square test were used for analysis of data.

Results

No bleeding was reported in patients treated with diode laser. Moderate pain was reported by patients treated with surgical scalpel, whereas none was reported in diode laser group. No statistically significant difference was observed for both treatment techniques in terms of wound healing, reappearance of gingival pigmentation, and intensity of the same at the end of 6 and 9 months postsurgically.

Conclusion

Similar outcomes were observed for both the techniques. Few patients who resulted in no recurrence at 9 months were followed even up to 3 years. Hence, further studies should be done to know the underlying mechanisms. Keeping in mind of armamentarium and cost, surgical scalpel technique remained as the "gold standard" procedure for treatment of gingival melanin pigmentation.

A comparison of gingival depigmentation by Er:YAG laser and Kirkland knife: osmotic pressure and visual analog scale

Background: The aim of this study was to compare osmotic pressure (OP) 1 week after the gingival depigmentation in two diffeent methods: Er: YAG laser and Kirkland knife. Methods: This study included 20 patients, 13 women, and 7 men who had esthetic complaints of gingival melanin hyperpigmentation. The left side of the maxilla and mandible were depigmented with Er:YAG laser using air and water spray and the right side was removed with a Kirkland knife. Gingival biopsies were obtained from attached gingiva of operation sides with approximate dimensions of 2 mm × 2 mm before and 1 week after the depigmentation. The visual analog scale (VAS) was used to evaluate the pain level experienced by each patient. Results: Patients reported no pain at the gingivoplasty sides after 4 days and at the laser sides after 3 days. There were not statistical differences between laser and gingivoplasty groups according to values of OP (P > 0.05). Conclusion: According to results of wound healing, OP and VAS, two depigmentation procedures can be used safely and effectively.

Cryogun cryotherapy for oral leukoplakia and adjacent melanosis lesions

BACKGROUND

Our previous study has shown that cryogun cryotherapy is a good and effective treatment modality for oral leukoplakia.

METHODS

In this study, we used cryogun cryotherapy to treat 72 oral leukoplakia and adjacent smoking-induced melanosis (OLM) lesions on the buccal mucosae.

RESULTS

Of 72 OLM lesions, 14 had epithelial hyperplasia with parakeratosis, 24 had epithelial hyperplasia with hyperkeratosis, 26 had mild dysplasia, seven had moderate dysplasia, and one had severe dysplasia. Complete regression was achieved in all 72 OLM lesions after a mean of 3.3 ± 1.3 cryogun cryotherapy treatments. We found that OLM lesions in patients without smoking habit, with the greatest diameter < 2.8 cm, with epithelial dysplasia, or with a surface keratin thickness ≤ 50 μm needed significantly fewer mean number of cryogun cryotherapy treatment to achieve complete regression than those OLM lesions in patients with smoking habit, with the greatest diameter ≥ 2.8 cm, without epithelial dysplasia, or with a surface keratin thickness > 50 μm (all P-values < 0.001), respectively. Univariate logistic regression analyses showed that the greatest diameter, epithelial dysplasia, smoking habit, and surface keratin thickness were the factors influencing the cryogun cryotherapy treatment number (all P-values < 0.001). However, only the greatest diameter < 2.8 cm (P < 0.001) was an independent factor influencing the number of cryogun cryotherapy treatment required to achieve complete regression of the OLM lesion by multivariate logistic regression analyses.

CONCLUSION

Cryogun cryotherapy is an effective treatment modality for OLM lesions.

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.

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.

Evaluation of pain on use of electrosurgery and diode lasers in the management of gingival hyperpigmentation: A comparative study

Background:

Gingival depigmentation is a periodontal plastic surgical procedure whereby the gingival hyperpigmentation is removed by various techniques such as electrosurgery, cryosurgery, abrasion with diamond bur and lasers. The aim of this study was to determine the pain levels during the gingival depigmentation procedure using electrosurgery and lasers.

Materials and Methods:

Twenty patients, both male and female, between the ages of 20 and 40 years were randomly allocated into two groups of 10 patients each: Those undergoing depigmentation with electrosurgery (Group I) and those by diode lasers (Group II). Patients of both groups were asked to define the level of pain and discomfort by using the Visual Analog Scale (VAS) intraoperatively, 24 h post-operatively and 1 week post-operatively.

Results:

Both the groups showed a decrease in the pain levels, which was statistically highly significant 1 week post-operatively when compared 24 h post-operatively. There was a statistically highly significant difference in the pain levels between the electrosurgery and the lasers groups after 24 h (P < 0.001), with the lasers group demonstrating lesser pain and discomfort. Although there was no significant difference between the two groups intraoperatively and 1 week post-operatively on comparison, lesser mean scores were observed for the lasers group.

Conclusion:

The growing concern for esthetic requires the removal of hyperpigmentated gingival areas to create a confident and pleasant smile, which could be easily attained by using either electrosurgery or lasers. This study concluded that lasers produce lesser pain and discomfort compared with electrosurgery during gingival depigmentation.

Gingival depigmentation: A split mouth comparative study between scalpel and cryosurgery

Gingival hyperpigmentation is a major esthetic concern for many people. Although it is not a medical problem, many people complain of dark gums as unesthetic. Gingival depigmentation is a periodontal plastic surgical procedure, whereby the hyperpigmentation is removed or reduced by various techniques. For depigmentation of gingival, different treatment modalities have been reported, such as scalpel, cryosurgery, electrosurgery, lasers, etc., this article compares the management of three cases with scalpel and cryosurgery and also highlights the relevance of cryosurgery.

Complication After Cryosurgery Treatment for Gingival Melanin Pigmentation: A Case Report

INTRODUCTION

Gingival melanin pigmentation (GMP) is considered a physiologic or racial situation. Complaints of "black gums" are common, and demands for depigmentation are usually made for esthetic reasons. In this case report, a cryosurgical depigmentation procedure is described and the effectiveness and complications of cryosurgery are examined.

CASE PRESENTATION

A 40-year-old, systemically healthy female presented with esthetic problems associated with GMP. Cryosurgery was performed from the midline by cross-segments from canine to canine for the treatment of maxillary and mandibular gingival tissues. One month after the cryosurgery procedure, a bone sequestrum became apparent between the mandibular right central incisor and canine, and it was removed from the area. A 2-mm gingival recession was observed 1 month after the surgery to remove the sequestrum.

CONCLUSIONS

Methods such as cryosurgery seem to be effective in the treatment of GMP. Various complications can be observed in the application of cryosurgical procedures, such as infection, hemorrhage, recession, and pain. Anatomic structures of the pigmented sites, the width of the gingiva, the length of the keratinized gingiva, the dose, and application distance of cryosurgenic gas must be carefully considered.

Effectiveness of cryogen tetrfluoroethane on elimination of gingival epithelium and its clinical application in gingival depigmentation-histological findings and case series

OBJECTIVE

To histologically assess and clinically co-relate the effectiveness of cryogen Tetrafluoroethane (TFE) for gingival depigmentation procedure.

MATERIAL AND METHODS

Twelve patients having unaesthetic gingival melanin pigmentation were included in the study. Gingival tissues of eight patients having gingival melanin pigmentation undergoing gingivoplasty or gingivectomy for crownlengthening were exposed to the cryogen and this was used for the histological examination. Gingivectomies were done after 8, 24, 96 hours and after a week of application of tetrafluoroethane. Four fair skinned patients complaining of unaesthetic gingival hyperpigmentation underwent gingival depigmentation using Tetrafluoroethane cryogen.

RESULTS

Histologically after 96 hours of application of cryogen there was complete loss of retepegs and epithelial detachment from the corium was evident. Complete re - epithelialisation was noted after a week and was clinically correlated.

CONCLUSION

We therefore, concluded that histologically tetrafluoroethane can effectively destroy gingival epithelium without causing damage to the connective tissue and clinically the color of the gingiva had more pleasing appearance 6 months postoperatively. Hence the cryogen can be used safely for depigmentation procedure.

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 Gingival Depigmentation using Tetrafluoroethane Cryosurgery and Gingival Abrasion Technique: Two Years Follow Up

OBJECTIVE

A comparative evaluation of the gingival depigmentation by using Tetrafluoroethane cryosurgery and the gingival abrasion technique - 2 years of follow up.

MATERIAL AND METHODS

Ten systemically healthy patients who were aged 18 to 36 years were selected for the study. Tetrafluoroethane was used for the cryosurgical depigmentation and the gingival abrasion technique used a coarse flame shaped bur. The presence or absence of pigmentation was tabulated, based on the GPI (Gingival Pigmentation Index). For the statistical analysis, Freidman's test was used.

RESULTS

The keratinization was completed within a week after the application of the cryogen and about 10 days after the gingival abrasion technique was done. The statistical analysis which was done after 90th, 180th days and 2 years. The p-value which was obtained (p<.001) showed the superiority of cryosurgery over the gingival abrasion. During the follow up period, no side effects were seen for both the techniques and the improved aesthetics was maintained upto 2 years.

CONCLUSION

The use of cryogen Tetrafluoroethane is easy, practical and inexpensive as compared to gingival abrasion, due to its high rate of recurrence. Hence, it is more acceptable to the patients and the operator. Further studies are needed to assess the long term effectiveness of the cryosurgical method of depigmentation.

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.

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.

Liquid nitrogen cryotherapy in the management of oral lesions: a retrospective clinical study

BACKGROUND #ENTITYSTARTX00026;

OBJECTIVES

The purpose of this study was to evaluate effectiveness and convenience of cryosurgical procedure, to assess the events during postoperative healing and to find out the incidence of recurrence

MATERIALS AND METHODS

This study was conducted in the Department of Oral and Maxillofacial Surgery, KLESVK Institute of Dental Sciences, Belgaum. The 40 patients selected for the study were divided into 2 groups of 20 patients each irrespective of age and sex. Group I 20 patients with Pre-Malignant Lesions Group II 20 patients with Oral Mucous Cyst

RESULTS

It was observed that all the 20 patients of mucocele were cured without any complication and recurrence, but in 20 patients of leukoplakia 5 patients had recurrence which was directly attributed to their persisting habits.

CONCLUSION

We state that this modality of treatment is promising with good results and has certain advantage over other modalities of treatment.

Effects of ascorbic acid on gingival melanin pigmentation in vitro and in vivo

BACKGROUND

Gingival melanin pigmentation may cause esthetic concerns, even if no serious medical problem is present. As an inhibitor of melanin formation, ascorbic acid is often used to treat skin melanin pigmentation. Thus, the present study investigated the effects of ascorbic acid on gingival melanin pigmentation in vitro and in vivo.

METHODS

The effects of ascorbic acid on melanin formation were evaluated in vitro in B16 mouse melanoma cells and three-dimensional human skin models. In addition, a clinical trial was performed to investigate the inhibitory effects of a gel containing ascorbic acid 2-glucoside (AS-G gel) on gingival melanin pigmentation. This study used a double-masked, split-mouth design on 73 subjects with symmetric gingival melanin pigmentation. AS-G gel was applied to one side of the gingiva for 12 weeks, whereas placebo gel was applied to the other side as a control. Luminance (L*)-value, which describes the lightness of gingiva, was determined by spectrophotometry to obtain an objective measure of melanin pigmentation every 4 weeks.

RESULTS

Ascorbic acid significantly inhibited tyrosinase activity and melanin formation in B16 mouse melanoma cells (P <0.01 and P <0.05, respectively). The inhibitory effects of ascorbic acid on melanin formation were also significant in three-dimensional human skin models (P <0.01). Moreover, in the clinical trial, a significant relative change in pigmentation was seen after 4 weeks with the application of AS-G gel compared to placebo (L*-value ratio).

CONCLUSION

Ascorbic acid (AS-G) has potential for the treatment of gingival melanin pigmentation.

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.

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 the Efficacy of the Acellular Dermal Matrix Allograft with Partial Thickness Flap in the Elimination of Gingival Melanin Pigmentation. A Comparative Clinical Study with 12 Months of Follow-Up

Acellular dermal matrix (ADM) has been used as a substitute for gingival allografts. The aim of this study was to evaluate the effectiveness of ADM with partial thickness flap in the elimination of gingival melanic pigmentations. Fifteen patients presenting bilateral gingival melanin pigmentation were selected for this study. Each side of the pigmentation was randomly assigned to be part of a group. The sites of the experimental group had a partial thickness flap raised, excised, followed by adaptation and suture of the ADM. On the opposite side (ie, sites from the control group), the oral epithelium was removed with a diamond bur. The healing process was evaluated at 1 and 2 weeks, and 1, 3, 6, 9, and 12 months postoperatively. Images of the patient's follow-up were digitalized, and occurrence and quantification of clinical repigmentation were evaluated. After 12 months, minimal repigmentation (mean 3.14 +/- 7.45%) was noted in 8 of 15 sites from the ADM group, while significant repigmentation (mean 55.84 +/- 27.25%) was seen in 15 of 15 abrasion sites. According to our results, it can be concluded that ADM may be successfully used in the elimination or greater reduction of gingival melanic pigmentations, and is more efficient than epithelium abrasion after 12 months (p < 0.0001).

CLINICAL SIGNIFICANCE

Gingival pigmentation is a common finding in several ethnic groups. Although physiologic melanin pigmentation is not a medical problem, cosmetic demands may turn it into a problem of social acceptance in different cultures. In this way, different treatment modalities have been used with the aim of removing pigmentations for esthetic reasons. In the present study, the use of ADM with partial thickness flap resulted in more effective elimination of gingival melanin pigmentation, as repigmentation occurred later and was much weaker when compared to the outcomes of epithelial abrasion.

Gingival melanin pigmentation and its treatment with the CO2 laser

OBJECTIVE

There are only a few reports in the literature evaluating the effects of the carbon dioxide (CO2) laser on gingival melanin pigmentation (GMP). This study was performed to evaluate the effects of the CO2 laser at superpulse mode, applied for gingival depigmentation.

STUDY DESIGN

GMP at the anterior maxillary and mandibular gingiva of 10 patients was treated using the superpulsed CO2 laser (10 watts, 0.8 mm spot size, 20 Hz, 10 milliseconds). Pigmented areas were measured on pre- and postoperative standard digital images by the aid of an image- analyzing software. Statistical analysis of the data was performed by Mann Whitney U test.

RESULTS

Ablation of the hyperpigmented gingiva was accomplished with minimal carbonization and almost no bleeding. Postoperative healing was uneventful with no significant postoperative pain. Two cases of partial repigmentation were observed during 24-month follow-up. Statistical analysis of the data revealed a significant difference between pre- and postoperative measurements of pigmented area.

CONCLUSION

Application of the superpulse mode of CO2 laser appears to be an effective and safe method for the elimination of GMP.

Gingival depigmentation by erbium:YAG laser: clinical observations and patient responses

BACKGROUND

Melanin, carotene and hemoglobin are the most common natural pigments contributing to the normal color of the gums. Although physiologic and ethnic melanin pigmentation is not a medical problem, complaints about "black gums" are common. Gingival depigmentation has been carried out using non-surgical and surgical procedures. Recently, laser ablation has been recognized as a most effective, pleasant and reliable technique.

METHODS

The study included 10 patients who requested cosmetic therapy for melanin pigmented gums. Treatment was carried out using an erbium:YAG laser. The laser beam was set at 500 mJ/10 pulses/second. The beam was defocused to produce a 3 mm diameter circle, thus reducing the beam penetration to 2 to 4 microm/pulse while increasing the treated surface. The "brush" technique was applied until the gingival surface appeared clinically free of pigmentation. Patients were observed for 6 months. Each patient filled out a personal evaluation questionnaire for clinical analysis.

RESULTS

Between 500 to 1,100 pulses/cm2 were recorded and a total of 800 to 2,200 pulses were required per patient, depending on the epithelium thickness and pigmentation. Treatment required only topical anesthesia. Healing was uneventful and required no supportive therapy. None of the patients experienced severe pain during or post-operatively. Mild pain or itching was common during the first week. Treatment was reported as generally pleasant. Follow-up during the 6 months showed no recurrences.

CONCLUSIONS

Depigmentation of gingival melanin pigmentation by erbium:YAG laser radiation in a defocused mode was a safe and effective procedure. The esthetic results were pleasing and healing was uneventful. Since the erbium:YAG laser is available in the dental office, it seems to be the laser of choice for this procedure.

Vaporization of melanin in oral tissues and skin with a carbon dioxide laser: a canine study

PURPOSE

This study tested the efficacy of carbon dioxide (CO2) laser vaporization in ablating gingival, oral mucosal, and cutaneous melanin in dogs.

MATERIALS AND METHODS

Three mongrel dogs with pigmentation of the oral mucosa, gingivae, and skin were used. Biopsy specimens from the melanin sites were obtained from all 3 dogs before laser application. Removal of the melanin sites was performed by using a 3 W continuous-wave CO2 laser. Biopsies of the treated areas were performed 1, 2, 4, and 6 weeks after laser treatment in all 3 dogs and also, at 11 weeks in 1 dog. The histologic sections were stained with hematoxylin and eosin and Masson-Fontana dye. A computerized morphometric program calculated the average percentage of the melanin layer in the Masson-Fontana-stained sections.

RESULTS

Clinical and histologic examination showed the CO2 laser to be effective in eliminating the pigmented areas in all tissues treated. No recurrence of melanin was detected in either the oral mucosa or gingiva at any of the follow-up times. In the skin, however, a small amount of melanin repigmentation was noticeable.

CONCLUSIONS

CO2 laser surgery proved an effective tool for obliterating superficial melanin discoloration. To prevent recurrence of the pigmentation, the area must be cleared completely of melanin, directing the laser beam carefully along the visible margins of the area.