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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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Comparison of Er,Cr:YSGG laser and diode laser in the treatment of gingival melanin pigmentation: a randomized clinical trial. Lasers Med Sci 2023; 38:79. [PMID: 36847909 DOI: 10.1007/s10103-023-03738-w] [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: 08/17/2022] [Accepted: 02/18/2023] [Indexed: 03/01/2023]
Abstract
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.
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Meghana ISS, Bhat AR, Bhandary R, Thomas B. Potential of Lasers in the Realm of Aesthetic Dentistry: A Narrative Review. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1758031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AbstractIn contemporary dental practice, patients' interests are taken into account in terms of function and appearance. The importance in everyday circumstances, current advertising, and the media in general highlight their effect on an attractive appearance. Many academics in the field of dental aesthetics have stated equivocally that when examining the impact of tooth appearance necessitates a multidisciplinary approach. Laser technology in cosmetic dentistry is in its early stages of development and has a lot of potential in the future. Also, with expanding use of lasers in clinical dentistry, treatment planning and prognosis will see a significant improvement in the future. The introduction of this technology has turned dentistry into a painless, bloodless field with increased predictability and instant outcomes. Furthermore, these techniques can help a cosmetic dentist regulate gingiva and osseous outlines with greater creativity in the pursuit of aesthetic dental principles with more efficient use of patient time. Even from the patient standpoint, the reduced requirement for suturing and faster healing times improves case acceptance and enables the increased demand for aesthetic dentistry. The resolution of this paper is to deliver an overview of various laser applications in aesthetic dentistry and its pros and cons over the conventional approaches.
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Affiliation(s)
- Ivaturi Sri Sai Meghana
- Department of Periodontology, A B Shetty Memorial Institute of Dental Sciences, NITTE Deemed to be University, Mangalore, Karnataka, India
| | - Amitha Ramesh Bhat
- Department of Periodontology, A B Shetty Memorial Institute of Dental Sciences, NITTE Deemed to be University, Mangalore, Karnataka, India
| | - Rahul Bhandary
- Department of Periodontology, A B Shetty Memorial Institute of Dental Sciences, NITTE Deemed to be University, Mangalore, Karnataka, India
| | - Biju Thomas
- Department of Periodontology, A B Shetty Memorial Institute of Dental Sciences, NITTE Deemed to be University, Mangalore, Karnataka, India
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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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Arif RH, Kareem FA, Zardawi FM, Al-Karadaghi TS. Efficacy of 980 nm diode laser and 2940 nm Er: YAG laser in gingival depigmentation: A comparative study. J Cosmet Dermatol 2020; 20:1684-1691. [PMID: 32966666 DOI: 10.1111/jocd.13733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gingival hyper-pigmentation is an esthetics problem in patients with excessive gingival display. Laser ablation has been suggested recently as the most effective, pleasant, and reliable technique for gingival depigmentation compared to blade surgery. AIM The present study aimed to identify and compare the effectiveness of two types of lasers, Er:YAG laser-2940 nm and Diode laser-980 nm, in gingival depigmentation in the maxilla and mandible. PATIENTS/METHODS 20 participants, 16 males, and 4 females, whose ages ranged between 18 and 35 years, were recruited using simplified random sampling. Oral pigmentation was measured at pre- and two postoperative follow-ups, 1 month, and 6 months, according to the oral pigmentation index. Furthermore, the study assessed postoperative intensity of pain using the Visual Analogue Scale, bleeding and healing process in both groups. RESULTS There was a significant decrease in the oral pigmentation index scores, 1 month (0.90 ± 0.64) and 6 months (1.55 ± 0.60) after the operation (P < .001). No significant differences were detected between the two study groups regarding the mean ranking on the oral pigmentation index pre-operatively (P = .547), 1 month after the operation (P = .154), and 6 months after the operation (P = .831). CONCLUSIONS The Er:YAG laser and Diode laser both significantly reduced gingival pigmentation with no significant differences between the effectiveness of the two types of laser in treating gingival hyper-pigmentation.
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Muruppel AM, Pai BJ, Bhat S, Parker S, Lynch E. Laser-Assisted Depigmentation-An Introspection of the Science, Techniques, and Perceptions. Dent J (Basel) 2020; 8:E88. [PMID: 32781667 PMCID: PMC7558501 DOI: 10.3390/dj8030088] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/24/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Alex Mathews Muruppel
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genova, Italy
| | - B.S. Jagadish Pai
- Faculty for Diploma in Laser Dentistry, University of Genova in India, Bangalore 560071, India;
| | - Subraya Bhat
- College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam 32241, Saudi Arabia;
| | - Steven Parker
- Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (S.P.); (E.L.)
| | - Edward Lynch
- Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (S.P.); (E.L.)
- School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
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Nammour S, El Mobadder M, Namour M, Namour A, Rompen E, Maalouf E, Brugnera Junior A, Brugnera AP, Vescovi P, Zeinoun T. A Randomized Comparative Clinical Study to Evaluate the Longevity of Esthetic Results of Gingival Melanin Depigmentation Treatment Using Different Laser Wavelengths (Diode, CO 2, and Er:YAG). PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:167-173. [PMID: 31951510 DOI: 10.1089/photob.2019.4672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Samir Nammour
- Department of Dental Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Marwan El Mobadder
- Department of Dental Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Mélanie Namour
- Department of Dental Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Amaury Namour
- Department of Dental Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Eric Rompen
- Department of Dental Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Elie Maalouf
- Faculty of Dentistry, Lebanese University, Hadath, Beirut, Lebanon
| | | | - Ana Paula Brugnera
- Department of Dental Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Paolo Vescovi
- Unit of Oral Pathology and Medicine and Laser-Assisted Oral Surgery, Department of ENT/Dental/Ophthalmological and Cervico-Facial Sciences, Faculty of Medicine and Surgery, University of Parma, Parma, Italy
| | - Toni Zeinoun
- Faculty of Dentistry, Lebanese University, Hadath, Beirut, Lebanon
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Gul M, Hameed MH, Nazeer MR, Ghafoor R, Khan FR. Most effective method for the management of physiologic gingival hyperpigmentation: A systematic review and meta-analysis. J Indian Soc Periodontol 2019; 23:203-215. [PMID: 31143000 PMCID: PMC6519100 DOI: 10.4103/jisp.jisp_555_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background and Aim: Gingival hyperpigmentation is an esthetic problem. The aim of the present study was to identify most effective treatment modality for managing generalized physiological gingival pigmentation. Materials and Methods: A systematic review and meta-analysis were done (1919 to October 2018) using PubMed, CINHAL, Dental and Oral Science, and manual searches. Twenty-five articles were finally reviewed. Only human clinical trials were considered with physiological gingival pigmentation treated with different depigmentation methods and compared with surgical stripping. The outcome was the achievement of gingival depigmentation and its recurrence. RevMan software was used for data analysis. Results: Of 26,132 articles, 25 met the inclusion criteria. Seventeen were randomized control trials and 8 were nonrandomized control trials. Most of the studies were on laser. The control group was scalpel surgery. Majority of studies showed no difference in compared treatment modality. A meta-analysis compared laser ablation with surgical stripping revealed a nonsignificance difference regarding recurrence (P = 0.75) and depigmentation (P = 0.23) and a statistically significant difference regarding postoperative pain favoring laser ablation (P ≤ 0.05). Conclusions: Surgical stripping has been the conventional treatment of choice, but our review showed that new techniques are equally effective or even better. Laser especially diode laser was the most frequently used technique and showed better esthetic outcomes, less pain, faster healing, and patients' preference and satisfaction after treatment. However, laser showed more regimentation at 6-month evaluation. More good quality randomized controlled trials with different depigmentation methods are needed to draw strong conclusions.
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Affiliation(s)
- Meisha Gul
- Department of Surgery, Section of Dentistry, JHS Building, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Hasan Hameed
- Department of Surgery, Section of Dentistry, JHS Building, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Rizwan Nazeer
- Department of Operative Dentistry, Bahria University Medical and Dental College, Karachi, Pakistan
| | - Robia Ghafoor
- Department of Surgery, Section of Dentistry, JHS Building, Aga Khan University Hospital, Karachi, Pakistan
| | - Farhan Raza Khan
- Department of Surgery, Section of Dentistry, JHS Building, Aga Khan University Hospital, Karachi, Pakistan
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Jokar L, Bayani M, Hamidi H, Keivan M, Azari-Marhabi S. 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. J Lasers Med Sci 2019; 10:131-138. [PMID: 31360382 PMCID: PMC6499571 DOI: 10.15171/jlms.2019.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Leila Jokar
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Arak University of Medical Sciences, Arak, Iran
| | - Mojtaba Bayani
- Department of Periodontics, School of Dentistry, Arak University of Medical Sciences, Arak, Iran
| | - Hamid Hamidi
- Department of Dermatology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | | | - Saranaz Azari-Marhabi
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bakhshi M, Mojahedi SM, Asnaashari M, Rahmani S, Namdari M. Gingival depigmentation by Er,Cr:YSGG laser and diode laser: a split mouth, clinical trial study. Laser Ther 2018; 27:203-213. [PMID: 32158066 DOI: 10.5978/islsm.27_18-or-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background and aims The Aim of this study was to evaluate the effectiveness of Diode laser and Er,Cr:YSGG laser ablation on the treatment of physiologic gingival melanin hyperpigmentation. Materials and methods This research design was split mouth, double blind, and clinical trial. The power of the diode laser was set at 1 W, fiber 320 µ, irradiation mode: continuous-wave with treatment mode of contact tip and Er,Cr:YSGG laser (2780 nm) was set at 100 MJ, frequency of 15 Hz, total power of 1.75 W, 10% water and 20% air. Bleeding, pain, healing, Dummett oral pigmentation index (DOPI) and Hedin melanin score changes and repigmentation were assessed. Patients were followed for 6 months. Results A total number of 14 patients were involved in this study. There were statistically significant differences in reduction of DOPI and Hedin melanin score in each treatment groups separately while diode laser group had better results (P < 0.0001). There was no statistically significant difference between groups in terms of repigmentation. There was more pain in diode laser group (P < 0.0001) and there was more bleeding in Er,Cr:YSGG laser group (P = 0.0156). Gingival healing was more in Er,Cr:YSGG laser group (P < 0.0001). Conclusion Diode laser had more efficiency for reduction of DOPI and Hedin melanin index scores.
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Affiliation(s)
- Mahin Bakhshi
- Oral Medicine Department. School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Masoud Mojahedi
- Department of laser. School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Asnaashari
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Rahmani
- Oral Medicine Department. School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Namdari
- Department of Community Oral Health. School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ipek H, Kirtiloglu T, Diraman E, Acikgoz G. A comparison of gingival depigmentation by Er:YAG laser and Kirkland knife: osmotic pressure and visual analog scale. J COSMET LASER THER 2018; 21:209-212. [PMID: 30118615 DOI: 10.1080/14764172.2018.1511912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
| | - Tugrul Kirtiloglu
- Department of Periodontology, Faculty of Dentistry, University of Ondokuz Mayis , Samsun , Turkey
| | - Emine Diraman
- Department of Molecular Biology, Faculty of Science, University of Ondokuz Mayis , Samsun , Turkey
| | - Gokhan Acikgoz
- Department of Periodontology, Faculty of Dentistry, University of Aydin , Istanbul , Turkey
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Salahi Alasbahi R, Hamadah O. A comparative clinical study between the efficacy of Nd:YAG laser and Diode laser in the management of physiologic gingival melanin pigmentation. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/ors.12355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Omar Hamadah
- Department of Oral Medicine; University of Damascus Dental School; Damascus Syria
- Biomedical Laser Laboratory; Higher Institute for Laser Application and Research; Damascus University; Damascus Syria
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Gholami L, Moghaddam SA, Rigi Ladiz MA, Molai Manesh Z, Hashemzehi H, Fallah A, Gutknecht N. Comparison of gingival depigmentation with Er,Cr:YSGG laser and surgical stripping, a 12-month follow-up. Lasers Med Sci 2018; 33:1647-1656. [PMID: 29654420 DOI: 10.1007/s10103-018-2501-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 04/01/2018] [Indexed: 11/30/2022]
Abstract
Gingival melanin hyperpigmentation is an esthetic concern for many individuals. In this study, we compared the standard surgical removal method with two different Er,Cr:YSGG laser settings in order to find the best treatment method. In 33 dental arches, the following three treatment groups were comparatively evaluated: (1) surgical stripping, (2) removal with laser setting 1 (4.5 W, 50 Hz, 100% water, 80% air, 60 μs, 800 μm Tip; MZ8), and (3) laser setting 2 (2.5 W, 50 Hz, 20% water, 40% air, 700 μs, 800 μm Tip; MZ8). We comparatively evaluated pain, patient satisfaction and wound healing, treatment time, and the amount of bleeding. Re-pigmentation was evaluated after 1 and 12 months by Hedin and Dummet pigmentation scores. Laser setting 1 had the best results regarding pain and patient satisfaction, although not statistically significant (P > 0.05). Wound healing results were better using lasers compared to surgical stripping (P < 0.05). Laser setting 1 was a faster procedure with mild amounts of bleeding. The least amount of bleeding was seen with laser setting 2. After 1 month, only two cases of the laser setting 2-treated areas showed an isolated pigmented area in the papilla; at 12 months, the mean Hedin indexes were still less than 2 and mean Dummett index less than 1 in all treatment techniques, with the lowest scores seen in the laser setting 1 sites. Based on our results, Er,Cr:YSGG laser can be more convenient for gingival depigmentation compared to surgical blade. Although not statistically significant, laser setting 1 with shorter pulse duration and higher water spray showed better overall results. However, laser setting 2, with longer pulse duration and less water spray, resulted in better coagulative effects and can be used to control bleeding wherever necessary in clinical practice.
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Affiliation(s)
- Leila Gholami
- Department of Periodontology, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Somayeh Ansari Moghaddam
- Oral and Dental research center, Department of Periodontology, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Ayoub Rigi Ladiz
- Oral and Dental research center, Department of Periodontology, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zohreh Molai Manesh
- Dentist, Oral and Dental research center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hadi Hashemzehi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran.
| | | | - Norbert Gutknecht
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen, Aachen, Germany
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14
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Seker BK. Treatment of gingival melanin hyperpigmentation with Er,Cr:YSGG laser: Short-term follow-up of patient. J COSMET LASER THER 2018; 20:148-151. [DOI: 10.1080/14764172.2017.1288256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Basak Kusakci Seker
- Department of Periodontology, Faculty of Dentistry, Eskisehir Osmangazi University, Eskişehir, Turkey
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Mahajan G, Kaur H, Jain S, Kaur N, Sehgal NK, Gautam A. To compare the gingival melanin repigmentation after diode laser application and surgical removal. J Indian Soc Periodontol 2018; 21:112-118. [PMID: 29398855 PMCID: PMC5771107 DOI: 10.4103/jisp.jisp_152_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The aim of the present study is to compare the gingival melanin repigmentation after diode laser application and surgical removal done by scraping with Kirkland knife. Materials and Methods: This study was a randomized split-mouth study where 10 patients presenting with unattractive, diffuse, dark brown to black gingival discoloration on the facial aspect of the maxillary gingiva were treated by diode laser application and surgical removal and followed up for 3-, 6-, and 9-month intervals. Results: The results showed a statistically significant difference in repigmentation between the groups at the interval of 3 months (P = 0.040), but the difference was statistically not significant at 6 months (P = 0.118) and 9 months (P = 0.146). On surgically treated sites, all cases showed repigmentation of the gingiva, but in laser treated, there were two individuals which did not show repigmentation of the gingiva even at the end of 9-month observation time. Conclusion: The incidence of repigmentation was slightly less in laser-treated sites as compared to surgical depigmentation although the difference was statistically significant only up to 3 months.
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Affiliation(s)
- Gaurav Mahajan
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - Harjit Kaur
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - Sanjeev Jain
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - Navnit Kaur
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - Navneet Kaur Sehgal
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - Aditi Gautam
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
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Mojahedi SM, Bakhshi M, Babaei S, Mehdipour A, Asayesh H. Effect of 810 nm diode laser on physiologic gingival pigmentation. Laser Ther 2018; 27:99-104. [PMID: 30087528 DOI: 10.5978/islsm.18-or-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/25/2018] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Seyed Masoud Mojahedi
- Department of Laser, Dental school, Shahid Behehsti University of Medical Sciences, Tehran
| | - Mahin Bakhshi
- Department of Laser, Dental school, Shahid Behehsti University of Medical Sciences, Tehran
| | - Somayyeh Babaei
- Department of Oral Medicine, Dental school, Arak University of Medical Sciences, Arak
| | - Aida Mehdipour
- Department of Pediatric, Dental school, Qom University of Medical Sciences, Qom
| | - Hamid Asayesh
- Department of Medical emergency, Qom University of Medical Sciences, Qom
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Pavlic V, Brkic Z, Marin S, Cicmil S, Gojkov-Vukelic M, Aoki A. Gingival melanin depigmentation by Er:YAG laser: A literature review. J COSMET LASER THER 2017; 20:85-90. [PMID: 28985086 DOI: 10.1080/14764172.2017.1376092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Laser ablation is recently suggested as a most effective and reliable technique for depigmentation of melanin hyperpigmented gingiva. To date, different lasers have been used for gingival depigmentation (CO2, diode, Nd:YAG, Er:YAG and Er,Cr:YSGG lasers). The use of Er:YAG laser for depigmentation of melanin hyperpigmented gingiva has gained increasing importance in recent years. The purpose of this study was to report removal of gingival melanin pigmentation using an Er:YAG laser in a literature review. The main outcomes, such as improvement of signs (clinical parameters of bleeding, erythema, swelling and wound healing), symptoms (pain) and melanin recurrence/repigmentation were measured. The literature demonstrated that depigmentation of gingival melanin pigmentation can be performed safely and effectively by Er:YAG laser resulting in healing and an esthetically significant improvement of gingival discoloration. Thus, Er:YAG laser seems to be safe and useful in melanin depigmentation procedure. However, the main issue in giving the final conclusion of the optimal Er:YAG laser use in melanin depigmentation is that, to date, studies are offering completely discrepant Er:YAG laser procedure protocols (complex settings of laser parameters), and different criteria for the assessment of depigmentation and repigmentation (recurrence), thus hampering the comparison of the results. Therefore, further studies are necessary to give an optimal recommendation on the use of Er:YAG laser in gingival melanin hyperpigmentation.
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Affiliation(s)
- Verica Pavlic
- a Department of Periodontology and Oral Medicine , Institute of Dentistry , Banja Luka , Bosnia and Herzegovina.,b Department of Periodontology and Oral Medicine, Medical Faculty , University of Banja Luka , Banja Luka , Bosnia and Herzegovina
| | - Zlata Brkic
- c Department of Periodontology and Oral Medicine , Militar Medical Academy , Belgrade , Serbia
| | - Sasa Marin
- d Department of Oral Surgery, Medical Faculty , University of Banja Luka , Banja Luka , Bosnia and Herzegovina
| | - Smiljka Cicmil
- e Department of Periodontology and Oral Medicine, Medical Faculty , University of East Sarajevo , Foca , Bosnia and Herzegovina
| | - Mirjana Gojkov-Vukelic
- f Department of Periodontology and Oral Medicine, Faculty of Dentistry , University of Sarajevo , Sarajevo, Bosnia and Herzegovina
| | - Akira Aoki
- g Section of Periodontology, Department of Hard Tissue Engineering , Tokyo Medical and Dental University , Tokyo , Japan
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Houshmand B, Janbakhsh N, Khalilian F, Talebi Ardakani MR. Efficacy of Conventional Laser Irradiation Versus a New Method for Gingival Depigmentation (Sieve Method): A Clinical Trial. J Lasers Med Sci 2017; 8:88-94. [PMID: 28652902 DOI: 10.15171/jlms.2017.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Diode laser irradiation has recently shown promising results for treatment of gingival pigmentation. This study sought to compare the efficacy of 2 diode laser irradiation protocols for treatment of gingival pigmentations, namely the conventional method and the sieve method. Methods: In this split-mouth clinical trial, 15 patients with gingival pigmentation were selected and their pigmentation intensity was determined using Dummett's oral pigmentation index (DOPI) in different dental regions. Diode laser (980 nm wavelength and 2 W power) was irradiated through a stipple pattern (sieve method) and conventionally in the other side of the mouth. Level of pain and satisfaction with the outcome (both patient and periodontist) were measured using a 0-10 visual analog scale (VAS) for both methods. Patients were followed up at 2 weeks, one month and 3 months. Pigmentation levels were compared using repeated measures of analysis of variance (ANOVA). The difference in level of pain and satisfaction between the 2 groups was analyzed by sample t test and general estimate equation model. Results: No significant differences were found regarding the reduction of pigmentation scores and pain and scores between the 2 groups. The difference in satisfaction with the results at the three time points was significant in both conventional and sieve methods in patients (P = 0.001) and periodontists (P = 0.015). Conclusion: Diode laser irradiation in both methods successfully eliminated gingival pigmentations. The sieve method was comparable to conventional technique, offering no additional advantage.
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Affiliation(s)
- Behzad Houshmand
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noushin Janbakhsh
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Khalilian
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yilmaz HG, Albaba MR, Caygur A, Cengiz E, Boke-Karacaoglu F, Tumer H. Treatment of recurrent aphthous stomatitis with Er,Cr:YSGG laser irradiation: A randomized controlled split mouth clinical study. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 170:1-5. [PMID: 28359996 DOI: 10.1016/j.jphotobiol.2017.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/07/2017] [Accepted: 03/16/2017] [Indexed: 11/28/2022]
Abstract
The present randomized controlled split mouth clinical study aimed to investigate the efficacy of Er,Cr:YSGG laser irradiation on pain reduction and healing rate of recurrent aphthous stomatitis. 40 patients with RAS were recruited for this study and RAS ulcerations of each patient were randomly assigned to the control or test group. In the test group, Er,Cr:YSGG laser with non-contact mode was used to irradiate RAS lesions. In the placebo group, RAS lesions were irradiated with the same device without laser emission. Pain was evaluated with visual analog scale (VAS) while a clinician graded healing of RAS (HRAS). In the placebo group at immediate; scores of VAS presented no statistically significance; in the test group, laser application showed significant pain reducing, at 1st day control. In the test group, a significantly healing effect at 1st day control was observed and this effect was maintained throughout the study. In the placebo group, scores of HRAS were statistically significant at controls on 3, 7, 10days. Statistically significant difference between the scores of VAS and HRAS was found for all control days except day 10 according to the intergroup comparisons. Based on these findings, Er,Cr:YSGG laser application at 0.25W without water may be appropriate to reduce pain and also accelerate the healing of RAS.
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Affiliation(s)
- Hasan Guney Yilmaz
- Department of Periodontology, Faculty of Dentistry, Near East University, Mersin, Turkey.
| | - Mohammed Rateb Albaba
- Department of Periodontology, Faculty of Dentistry, Near East University, Mersin, Turkey
| | - Ayse Caygur
- Department of Periodontology, Faculty of Dentistry, Near East University, Mersin, Turkey
| | - Esra Cengiz
- Department of Restorative Dentistry, Faculty of Dentistry, Mersin University, Mersin, Turkey
| | - Fatma Boke-Karacaoglu
- Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Hayriye Tumer
- Department of Periodontology, Faculty of Dentistry, Near East University, Mersin, Turkey
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Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki AA, Romanos GE, Taniguchi Y, Sasaki KM, Zeredo JL, Koshy G, Coluzzi DJ, White JM, Abiko Y, Ishikawa I, Izumi Y. Periodontal and peri-implant wound healing following laser therapy. Periodontol 2000 2017; 68:217-69. [PMID: 25867988 DOI: 10.1111/prd.12080] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 12/18/2022]
Abstract
Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO2 , neodymium-doped yttrium-aluminium-garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft-tissue management. With development of the erbium-doped yttrium-aluminium-garnet (Er:YAG) and erbium, chromium-doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft-tissue management to hard-tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri-implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti-inflammatory agents, phototherapy using lasers and light-emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low- and high-level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri-implant diseases. This article discusses the outcomes of laser therapy in soft-tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri-implant treatment, focusing on postoperative wound healing of periodontal and peri-implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.
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Chawla K, Lamba AK, Tandon S, Faraz F, Gaba V. Effect of low-level laser therapy on wound healing after depigmentation procedure: A clinical study. J Indian Soc Periodontol 2016; 20:184-8. [PMID: 27143832 PMCID: PMC4847466 DOI: 10.4103/0972-124x.176393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The aim of the present study is to evaluate and compare the effects of low-level laser therapy (LLLT) on wound healing after depigmentation procedure. MATERIALS AND METHODS In this study, 12 patients with bilateral melanin hyperpigmentation were treated with surgical stripping using a blade. After completion of the surgical process and bleeding stasis, any of the symmetrical surgical sites was randomly assigned for LLLT (test site) using a defocused diode laser at 1 mm distance for 5 min. After every laser exposure, the surgical site was coated with plaque disclosing solution (erythrosine) on the 3(rd), 7(th), and 15(th) day. A photograph of the surgical site was taken using a Digital SLR Camera, which was placed at 30 cm distance at 55 mm zoom, 1/100 shutter speed, f 14 aperture size, and ISO 4000 with a ring flash. The area of the stained parts of the photographs was evaluated using image analysis software. RESULTS At day 3, test site showed 1.26 ± 0.23 mm(2) and control site showed 1.45 ± 0.21 mm(2) stain uptake by the tissue which was statistically significant. At day 7 and day 15, the test sites exhibited 1.24 ± 0.30 mm(2) and 1.12 ± 0.25 mm(2) stain uptake, whereas the control site showed 1.37 ± 25 mm(2) and 1.29 ± 0.28 mm(2) staining, respectively, which were not statistically significant. CONCLUSION Within the limitations of this study, the findings revealed that LLLT promotes wound healing after depigmentation procedure until the 3(rd) day. On the 7(th) and 15(th) day, the difference in healing was not statistically significant.
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Affiliation(s)
- Kirti Chawla
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Arundeep Kaur Lamba
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Shruti Tandon
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Farrukh Faraz
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Varun Gaba
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Bakhshi M, Rahmani S, Rahmani A. Lasers in esthetic treatment of gingival melanin hyperpigmentation: a review article. Lasers Med Sci 2015; 30:2195-203. [PMID: 26370204 DOI: 10.1007/s10103-015-1797-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/10/2015] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Mahin Bakhshi
- Oral Medicine Department , School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Rahmani
- Oral Medicine Department , School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Rahmani
- Department of Medical Surgical Nursing, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Özcan M, İşler SC, Bozkaya S, Özcan G. Complication After Cryosurgery Treatment for Gingival Melanin Pigmentation: A Case Report. Clin Adv Periodontics 2015; 5:56-60. [PMID: 32689720 DOI: 10.1902/cap.2013.120124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 05/23/2013] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- Mustafa Özcan
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Sıla Cagrı İşler
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Suleyman Bozkaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University
| | - Gönen Özcan
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Lin YH, Tu YK, Lu CT, Chung WC, Huang CF, Huang MS, Lu HK. Systematic review of treatment modalities for gingival depigmentation: a random-effects poisson regression analysis. J ESTHET RESTOR DENT 2014; 26:162-78. [PMID: 24418367 DOI: 10.1111/jerd.12087] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
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.
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Affiliation(s)
- Yi Hung Lin
- Division of Periodontics, Department of Dentistry, Changhua Christian Hospital, Changhua, Taiwan
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Giannelli M, Formigli L, Bani D. 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. J Periodontol 2013; 85:554-61. [PMID: 23826649 DOI: 10.1902/jop.2013.130219] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Chen CK, Chang NJ, Ke JH, Fu E, Lan WH. Er:YAG laser application for removal of keratosis using topical anesthesia. J Dent Sci 2013. [DOI: 10.1016/j.jds.2012.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hegde R, Padhye A, Sumanth S, Jain AS, Thukral N. Comparison of Surgical Stripping; Erbium-Doped:Yttrium, Aluminum, and Garnet Laser; and Carbon Dioxide Laser Techniques for Gingival Depigmentation: A Clinical and Histologic Study. J Periodontol 2013; 84:738-48. [DOI: 10.1902/jop.2012.120094] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Giannelli M, Formigli L, Lasagni M, Bani D. A new thermographic and fluorescent method for tuning photoablative laser removal of the gingival epithelium in patients with chronic periodontitis and hyperpigmentation. Photomed Laser Surg 2013; 31:212-8. [PMID: 23597422 DOI: 10.1089/pho.2012.3457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Ribeiro FV, Cavaller CP, Casarin RCV, Casati MZ, Cirano FR, Dutra-Corrêa M, Pimentel SP. Esthetic treatment of gingival hyperpigmentation with Nd:YAG laser or scalpel technique: a 6-month RCT of patient and professional assessment. Lasers Med Sci 2013; 29:537-44. [PMID: 23291916 DOI: 10.1007/s10103-012-1254-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Fernanda V Ribeiro
- Dental Research Division, School of Dentistry, Paulista University, Av. Dr. Bacelar, 1212, 4° andar, Vila Clementino, 04026-002, São Paulo, São Paulo, Brazil,
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Kumar S, Bhat GS, Bhat KM. Development in techniques for gingival depigmentation – An update. Indian J Dent 2012. [DOI: 10.1016/j.ijd.2012.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Singh V, Giliyar SB, Kumar S, Bhat M. Comparative Evaluation of Gingival Depigmentation by Diode Laser and Cryosurgery Using Tetrafluoroethane: 18-Month Follow-Up. Clin Adv Periodontics 2012. [DOI: 10.1902/cap.2012.110008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Şimşek Kaya G, Yapıcı Yavuz G, Sümbüllü MA, Dayı E. A comparison of diode laser and Er:YAG lasers in the treatment of gingival melanin pigmentation. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:293-9. [DOI: 10.1016/j.tripleo.2011.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 03/01/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
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Pasupuleti MK, Reddy N R, D R, S S, Swamy N. Aesthetic gingival depigmentation procedures: clinical and patient responses. INTERNATIONAL JOURNAL OF STOMATOLOGY & OCCLUSION MEDICINE 2012. [DOI: 10.1007/s12548-011-0030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Allen EP, Gladkova ND, Fomina YV, Karabut MM, Kiseleva EB, Feldchtein FI, Altshuler GB. Successful Gingival Depigmentation With Laser-Patterned Microcoagulation: A Case Report. Clin Adv Periodontics 2011. [DOI: 10.1902/cap.2011.110010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lee KM, Lee DY, Shin SI, Kwon YH, Chung JH, Herr Y. A comparison of different gingival depigmentation techniques: ablation by erbium:yttrium-aluminum-garnet laser and abrasion by rotary instruments. J Periodontal Implant Sci 2011; 41:201-7. [PMID: 21954425 PMCID: PMC3175500 DOI: 10.5051/jpis.2011.41.4.201] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 07/16/2011] [Indexed: 11/08/2022] Open
Abstract
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.
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Affiliation(s)
- Kwang-Myung Lee
- Department of Periodontology, Kyung Hee University School of Dentistry, Seoul, Korea
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Yilmaz HG, Bayindir H, Kusakci-Seker B, Tasar S, Kurtulmus-Yilmaz S. Treatment of amalgam tattoo with an Er,Cr:YSGG laser. ACTA ACUST UNITED AC 2010; 1:50-4. [DOI: 10.1111/j.2041-1626.2010.00011.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rosa DSA, Aranha ACC, de Paula Eduardo C, Aoki A. Esthetic Treatment of Gingival Melanin Hyperpigmentation With Er:YAG Laser: Short-Term Clinical Observations and Patient Follow-Up. J Periodontol 2007; 78:2018-25. [DOI: 10.1902/jop.2007.070041] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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