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Ibrahim SSA, Mandil IA, Ezzatt OM. Injectable platelet rich fibrin effect on laser depigmented gingiva: a clinical randomized controlled split mouth trial with histological assessment. J Appl Oral Sci 2024; 32:e20230307. [PMID: 38536994 PMCID: PMC11018297 DOI: 10.1590/1678-7757-2022-0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/16/2023] [Accepted: 01/22/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE To determine whether intra-mucosal injection of injectable platelet-rich fibrin (i-PRF) can promote healing after Diode Laser Gingival Depigmentation (DLGD). METHODOLOGY A total of 20 arch sites of hyperpigmented gingiva of 10 patients underwent DLGD. For each patient, two arch sites were randomly assigned for either intra-mucosal injection of i-PRF (G1-i-PRF) (n=10 sites) or no treatment (G2-Control): (n=10 sites). Wound Healing Score (WHS), patient satisfaction, and Pigmentation Index (DOPI) were measured at 1 week and 1 and 3 months postoperatively. Histological assessment of tissue specimens was performed at baseline and 1 week. RESULTS The percentage change in WHS at 1 week was significantly higher in G1 (58.34±15.43) compared to G2 (37.50±11.79). At day 1, 50% of patients in G1 were pain free compared with 75% in G2, who had mild pain. Mean DOPI decreased significantly at 3 months in both groups (P-value <0.001), without significant differences between groups. G1 specimens showed significantly higher epithelial thickness (P-value <0.001), as well as a higher number of blood vessels and less percentage of inflammatory cells. CONCLUSIONS i-PRF demonstrated better clinical and histological healing potential and less patient discomfort compared to sites without treatment after DLGD. Registered at https://clinicaltrials.gov/ as (NCT05283668).
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Affiliation(s)
- Suzan Seif Allah Ibrahim
- Ain-Shams University, Faculty of Dentistry, Department of Oral Medicine, Periodontology and Oral Diagnosis, Cairo, Egypt
- Nahda University, Faculty of Dental Medicine, Department of Oral Medicine, Periodontology Oral Diagnosis and Radiology, Beni Suef, Egypt
| | - Ibrahim Abu Mandil
- Ain-Shams University, Faculty of Dentistry, Department of Oral Medicine, Periodontology and Oral Diagnosis, Cairo, Egypt
| | - Ola Mohamed Ezzatt
- Ain-Shams University, Faculty of Dentistry, Department of Oral Medicine, Periodontology and Oral Diagnosis, Cairo, Egypt
- Ain-Shams University, Faculty of Dentistry, Central Lab of Stem Cells and Biomaterial Applied Research (CLSBAR), Cairo, Egypt
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Mikhail FF, El Menoufy H, El Kilani NS. Assessment of clinical outcomes and patient response to gingival depigmentation using a scalpel, ceramic bur, and diode laser 980 nm. Clin Oral Investig 2023; 27:6939-6950. [PMID: 37878070 PMCID: PMC10630251 DOI: 10.1007/s00784-023-05310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
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.
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Affiliation(s)
- Faten Fawzy Mikhail
- Surgery & Oral Medicine Department, Oral & Dental Research Institute, National Research Centre, 33 El Buhouth St., Ad Doqi, Dokki, Giza, 12622, Egypt.
| | - Hala El Menoufy
- Laser Research Centre, Faculty of Dentistry, Misr University for Science and Technology (MUST), 6Th of October City, Giza, Egypt
| | - Naglaa Shawki El Kilani
- Laser Research Centre, Faculty of Dentistry, Misr University for Science and Technology (MUST), 6Th of October City, Giza, Egypt
- Oral Medicine, Periodontology, Diagnosis, and Radiology Department, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
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Jazzar A, AlDehlawi H. Efficacy and Risks of Different Treatments for Oral Hyperpigmentation: A Systematic Review and Network Meta-Analysis. J Clin Med 2023; 12:6567. [PMID: 37892705 PMCID: PMC10607256 DOI: 10.3390/jcm12206567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Oral-pigmented lesions have raised aesthetic concerns, leading to multiple depigmentation techniques. This systematic review and network meta-analysis aimed to assess the efficacy of different treatments for oral hyperpigmentation. METHODS A computerized search was conducted on Science Direct, Medline via PubMed, Scopus, and Web of Science using the relevant keywords. English-language studies published between 2013 and 2023 that focused on patients with oral pigmented lesions subjected to different treatment modalities, such as laser or surgical intervention, were compared to determine their efficacy and safety profile. Data were analyzed using R software, applying frequentist models. RESULTS A total of 27 studies were included. In contrast to the CO2 laser, Er: YAG laser was linked to a higher risk of bleeding (RR = 2.73, p < 0.01), whereas the diode laser had the most favorable score in minimizing bleeding index (P-score = 0.86). In terms of lower risk and postoperative pain score (RR = 0.01, p < 0.01), the Er,Cr:YSGG laser had the most favorable result (P-score = 1.00). The Er: YAG laser demonstrated the highest probability of preventing recurrence (RR = 0.28, p < 0.01), followed by the diode laser (RR = 0.42, p < 0.01). CONCLUSIONS The choice of treatment for oral pigmentation should be based on individual patient needs and the desired outcomes. The Er: YAG laser seems highly effective in preventing pigment recurrence, the diode laser emerges as a top contender in managing bleeding risks, and the Er,Cr:YSGG laser is particularly efficacious in managing postoperative pain.
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Affiliation(s)
- Ahoud Jazzar
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
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Mostafa D, A.Alaizari N, M.AlOtaibi S, Ahmed Aldosari N, Rabie Al-Anazi J, S.Alsughayer R, M.AlFayir H, S.AlHarthi M, H.AlAnazi M. Gingival Depigmentation Using Microneedling Technique With Topical Vitamin C: A Prospective Case Series. Cureus 2023; 15:e35345. [PMID: 36974245 PMCID: PMC10039435 DOI: 10.7759/cureus.35345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Gingival pigmentation is mainly physiological due to the production of melanin. This study aimed to evaluate the effectiveness of a microneedling technique using topical ascorbic acid in treating gingival hyperpigmentation. Methods A case-series study was established, and 16 out of 42 participants enrolled in this study according to the inclusion and exclusion criteria. A microneedling technique was performed using a Dermapen instrument, followed by the topical application of ascorbic acid on the pigmented gingiva. Variations in the Dummett oral pigmentation index (DOPI) and Hedin melanin index (HMI) scores were considered for each patient. A one-month follow-up was conducted on all patients. Results All the reported cases demonstrated noticeable improvement at the end of the sessions. Moreover, seven patients showed complete depigmentation of the gingiva. Analysis using paired T-tests showed a statistically significant lower post-treatment DOPI score with a mean difference of 1.8 ± 0.7, 95% CI: 0.17-1.49. Similarly, the HMI score was lower post-treatment with a mean difference of 3.1 ± 0.7, 95% CI: 2.74-3.50. Conclusions Microneedling combined with topical ascorbic acid is a novel, non-invasive dental technique that can effectively treat gingival hyperpigmentation.
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Laser as an innovative tool, its implications and advances in dentistry: A systematic review. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY 2022. [DOI: 10.1016/j.jpap.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Liu S, Zhang X, Zhou Q. Efficacy of Periodontal Endodontics Combined with Diode Laser (DL) Therapy on Severe Periodontitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:5689900. [PMID: 36285164 PMCID: PMC9588349 DOI: 10.1155/2022/5689900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/17/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022]
Abstract
Background For a long time, the impact of severe periodontitis on the pulp has been the focus of periodontal clinical research. Whether the teeth with severe periodontitis should be treated with pulp has also become the focus of clinical research. Aims To explore the effect of periodontal endodontic therapy combined with DL therapy on severe periodontitis. Materials and Methods The clinical data of 100 patients with severe periodontitis from January 2020 to July 2022 were selected and included in the retrospective study. According to the different retrieval treatment methods, they were divided into the control group and the treatment group with 50 cases in each group. The control group received periodontal endodontic treatment, and the treatment group received DL treatment on the basis of the control group. The differences in periodontal probing depth (PD), toothache degree, bleeding index (BI), inflammatory factors, plaque index (PLI), and attachment loss (AL) between the two groups were compared and analyzed. Results After 3 months of treatment, the bleeding index (BI), plaque index (PLI), and periodontal probing depth (PD) of the treatment group were significantly lower than those of the control group, and the difference was statistically significant (P < 0.05). The attachment loss (AL) of the group was not significantly different from that of the control group (P > 0.05). Before treatment, there was no significant difference in the levels of inflammatory factors between the two groups (P > 0.05). After 3 months of treatment, the levels of IL-6 and CRP in the treatment group were significantly lower than those in the control group, and the difference was statistically significant (P < 0.05). Before treatment, there was no significant difference in the levels of inflammatory factors between the two groups (P > 0.05). After 3 days of treatment, the VAS score of the treatment group was significantly lower than that of the control group, and the difference was statistically significant (P < 0.05).After treatment, there were no complications during follow-up in the two groups. Conclusion The application of DL treatment has a significant effect, which can promote the healing of periodontal tissue, reduce the depth of periodontal pockets, and reduce the degree of toothache, thereby providing a reference for clinical treatment.
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Affiliation(s)
- Sijia Liu
- Wuhan Hospital of Traditional Chinese Medicine, Department of Stomatology, No. 303 Sixin Avenue, Hanyang, Wuhan 430000, Hubei, China
| | - Xu Zhang
- Wuchang Hospital Affiliated to Wuhan University of Science and Technology (Stomatology), No. 116 Yangyuan Street, Wuchang District, Wuhan 430063, Hubei, China
| | - Quanying Zhou
- Wuhan 9th Hospital, Department Stomatology, No. 20, Jilin Street, Qingshan District, Wuhan 430080, Hubei, China
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Esmaeili S, Shahbazi S, Asnaashari M. Gingival Melanin Depigmentation Using a Diode 808-nm Laser: A Case Series. J Lasers Med Sci 2022; 13:e41. [PMID: 36743137 PMCID: PMC9841391 DOI: 10.34172/jlms.2022.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/18/2022] [Indexed: 01/27/2023]
Abstract
Introduction: Gingival hyperpigmentation is caused by an increase in the amount of melanin production or the number of melanocytes in the epithelium, which can impair smile esthetics. The current study aimed to report the experience of using a diode laser for gingival depigmentation of three different patients. Case Presentation: Three adult patients are presented with hyperpigmentation in labial gingivae of both jaws. The depigmentation was done using a diode laser at a wavelength of 808 nm, fiber diameter of 300 μm, and power of 1 W and in continuous mode. All three patients showed proper resolution of hyperpigmented areas in short- and long-term follow-up sessions. However, degrees of recurrence were noticeable in two cases. Conclusion: The 808-nm diode laser can be utilized safely and efficiently in gingival depigmentation, resulting in an acceptable cosmetic outcome.
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Affiliation(s)
| | | | - Mohammad Asnaashari
- Correspondence to Mohammad Asnaashari, Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd., Tehran, Iran. Tel: + 989121145860; ,
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A Successful Esthetic Approach of Gingival Depigmentation Using Microneedling Technique and Ascorbic Acid (Vitamin C). Case Rep Dent 2022; 2022:3655543. [PMID: 35509675 PMCID: PMC9061044 DOI: 10.1155/2022/3655543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/23/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022] Open
Abstract
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.
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Moeintaghavi A, Ahrari F, Fallahrastegar A, Salehnia A. Comparison of the Effectiveness of CO2 and Diode Lasers for Gingival Melanin Depigmentation: A Randomized Clinical Trial. J Lasers Med Sci 2022; 13:e8. [PMID: 35642240 PMCID: PMC9131294 DOI: 10.34172/jlms.2022.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/01/2021] [Indexed: 10/26/2023]
Abstract
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.
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Affiliation(s)
- Amir Moeintaghavi
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzaneh Ahrari
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Fallahrastegar
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asma Salehnia
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
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