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

Comparison of the Diode Laser Wavelengths 445 nm and 810 nm in Gingival Depigmentation - A Clinical Evaluation

Introduction: Nowadays, esthetic appearance plays an important role in the field of dentistry. Discolorations and pigmentations of the gingiva reduce the appearance of a healthy-looking smile. On this occasion, the use of lasers shows a promising approach for a fast and non-aggressive treatment in this field. Different laser wavelengths are being used for gingival depigmentation this clinical study aimed to investigate the effect of the novel laser wavelength (445 nm) in this field and compare it with an 810 nm diode laser. Methods: Two diode laser wavelengths (445 nm and 810 nm) were used for depigmentation. The laser output power chosen was 1 W. An optical fiber with a diameter of 400 µm was used. 21 patients with pigmented gingiva were selected. Depigmentation was carried out in a split-mouth design for a direct comparison of the clinical effect. Outcomes were documented by photograph after one month and six months of follow-up. Results: For each wavelength, 21 volunteers evaluated 21 clinical cases of depigmentation, which means that 441 comparisons were carried out in total regarding the color change from brownish to pinkish. A 100% clarification was achieved for 445 nm. In the 810 nm group, the color change in 44 of 441 cases (10%) could not be clearly identified. No statistically significant difference in pain experience was reported for both laser treatments. Conclusion: The clinical evaluation showed that within the limitations of this study, most of the clinical outcome parameters were highly acceptable by the patients due to mild pain and discomfort for both laser systems.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL RELEVANCE

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

Management of gingival hyperpigmentation induced by increased ferritin level in a HbS-β+ thalassemia patient using diode laser

Diode lasers can be employed for the treatment of gingival hyperpigmentation in HbS-β+ thalassemia patients due to the advantages that lasers provide including good hemostatic effect and less postoperative complications.

Efficacy and Risks of Different Treatments for Oral Hyperpigmentation: A Systematic Review and Network Meta-Analysis

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.

Transepithelial Gingival Depigmentation Using a New Protocol with Q-Switched Nd:YAG: An In Vivo Observational Study

Gingival melanin hyperpigmentation is a para-physiological condition that may have a negative impact on smile esthetics. In the present study, the use of the Q-Switched Nd:YAG laser, according to a defined protocol, was proposed to treat Gingival Melanin Hyperpigmentation with a transepithelial approach. A total of 10 Patients with different grades of gingival hyperpigmentation were treated with Q-Switched Nd:YAG in one to four laser sessions without local anesthesia. The grade of depigmentation was evaluated by comparing Oral Pigmentation Index (OPI) and Melanin Pigmentation Index (MPI) at baseline and three weeks after the laser session. Additionally, oral discomfort rated by the Numeric Rating Scale (NRS) was recorded one, three, and five days after the procedure. Complete depigmentation was achieved in all cases. Patients reported no-little discomfort (NRS 0 to 3) during the laser session that lasted a maximum of five days. No major complications were reported, and no recurrences were observed at least after one year of follow-up. In addition, patients were available to be re-treated if necessary. These findings suggested that the Q-Switched Nd:YAG could be an effective and well-tolerated approach in the treatment of gingival melanin hyperpigmentation.

Efficacy of Combined Treatment with Intense Pulsed Light and Erbium Fractional Laser in Striae Gravidarum

Purpose

Laser and intense pulsed light (IPL) treatments are preferred over invasive procedures due to less pain. This study looked at the efficacy and safety of IPL and Erbium fractional laser for patients with striae gravidarum (SG).

Patients and Methods

All 60 patients with SG were successfully enrolled in the study. IPL treatment was followed by Erbium fractional laser (wavelength 2940 nm) treatment at 4-week intervals for a total of three treatments. SG elasticity was assessed with a SEM575 custom instrument and patients were scored for SG span with an Antera 3D multifunctional skin imaging analyzer. A 3D skin impact system was used to assess patients' epidermal thickness. A visual analog scale (VAS) was used to assess patients' pain scores during the treatment period. Improvement in stretch marks was assessed with the Global Aesthetic Improvement Scale (GAIS). The occurrence of adverse events was recorded at a follow-up of 3 months. Patient satisfaction with the outcome of the treatment was also recorded.

Results

Area of stretch marks decreased from 7.89 ± 0.49 cm² pre-treatment to 4.94 ± 1.16 cm² post-treatment (P < 0.001). The grayness values and atrophy of stretch marks were reduced after treatment. Furthermore, skin elasticity and thickness at the lesions of patients increased significantly after the treatment (P < 0.001), while the width of the stretch marks significantly decreased (P < 0.001). The VAS score was 5.45 ± 1.31, the incidence of adverse events was 25%, and patient satisfaction with the efficacy was 96.67%.

Conclusion

IPL combined with Erbium fractional laser improves the area and atrophy of SG, lightens the color, and increases the elasticity and thickness of the skin, with high treatment safety and remarkable clinical results.

Evaluation of Carbon Dioxide Laser-Assisted Treatment for Gingival Melanin Hyperpigmentation

BACKGROUND

Smile aesthetics has a vital role to play in an individual's life and one of the factors affecting the beauty of the smile is gingival color. A gingival color change or gingival hyperpigmentation causes an unesthetic smile line, especially in patients with a gummy smile, which is also known as a black gummy smile. Numerous gingival depigmentation methods have been performed successfully for ablating gingival melanin pigmented epithelium. Thus, the aim of this study is to evaluate the treatment efficacy of gingival hyperpigmentation by using a carbon dioxide (CO₂) laser.

METHODS

A cross-sectional descriptive study was carried out with 38 patients at a hospital in Vietnam. Ponnaiyan classification and the Hedin melanin index were used to assess the distribution and extent of gingival pigmentation in the study. Pain assessment was performed using the Visual Analog Scale (VAS) to evaluate the intensity of pain during the laser treatment. In addition, clinical evaluation (i.e., wound healing) of each treatment procedure was conducted using the three level Dummett-Gupta Oral Pigmentation Index (DOPI) assessment.

RESULTS

This study showed that less pain was experienced by patients treated by CO₂ laser; the rates of no pain, mild pain and moderate pain after treatment were, respectively, 21%, 76% and 2.6%; there was 100% complete epithelization after 1 week. The DOPI rates for turning from a DOPI score of 1, 2 or 3 to a DOPI score of 0 after a 12-week treatment were 87.5%, 76.9% and 24%, respectively.

CONCLUSIONS

Using a CO₂ laser for gingival melanin pigmentation treatment is a safe and effective procedure.

Gingival Pigmentation Removal With a High-Power Diode Laser in Non-contact Mode: A Proposed Technique With Two Years of Follow-Up

This case report describes the efficacy and advantages of using a high-power diode laser in non-contact mode to remove racial melanin pigmentation from the oral mucosa in an aesthetically sensible area to reduce thermal damage and promote better postoperative results. In the presented case, the lesion was removed under local anesthesia in a single session using high-power diode equipment with circular movements over the lesion (10 seconds maximum for each irradiation cycle, with 30 seconds for thermal relaxation, for a total of two cycles), maintaining an average distance of 2-3 mm from the target tissue without fiber activation (continuous wave, 2 W, delivered by quartz fiber with 300 µ). The patient did not report immediate postoperative pain; however, analgesic use was recorded during the first day after the surgical procedure. The biological response and cosmetic results were satisfactory, with proper lesion removal and adequate cicatrization observed during a two-year follow-up period, without complications or compromise of periodontal tissue esthetics.

Gingival Melanin Depigmentation Using a Diode 808-nm Laser: A Case Series

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.

The Use of Lasers in Dental Materials: A Review

Lasers have been well integrated in clinical dentistry for the last two decades, providing clinical alternatives in the management of both soft and hard tissues with an expanding use in the field of dental materials. One of their main advantages is that they can deliver very low to very high concentrated power at an exact point on any substrate by all possible means. The aim of this review is to thoroughly analyze the use of lasers in the processing of dental materials and to enlighten the new trends in laser technology focused on dental material management. New approaches for the elaboration of dental materials that require high energy levels and delicate processing, such as metals, ceramics, and resins are provided, while time consuming laboratory procedures, such as cutting restorative materials, welding, and sintering are facilitated. In addition, surface characteristics of titanium alloys and high strength ceramics can be altered. Finally, the potential of lasers to increase the adhesion of zirconia ceramics to different substrates has been tested for all laser devices, including a new ultrafast generation of lasers.

Gingival depigmentation with diode and Er,Cr:YSGG laser: evaluating re-pigmentation rate and patient perceptions

OBJECTIVE

To evaluate the efficiency of depigmentation, patient perceptions, and the recurrence rates of physiological gingival pigments during a 2-year follow-up after ablative depigmentation using two laser wavelengths: diode 940 nm and Er,Cr:YSGG 2780 nm.

MATERIALS AND METHODS

Sixty patients exhibiting physiological melanin hyperpigmentation in the buccal maxillary gingiva were randomly divided into two equal groups treated with an Er,Cr:YSGG laser at 2780 nm, and a 940 nm diode laser, respectively. The depigmentation procedure essentially involves the ablation of epithelial tissue exhibiting melanin pigmentation. The intensity and extensity indices of gingival pigments were evaluated at baseline, 1 month, 1 year, and 2 years.

RESULTS

At all time points following depigmentation treatment, oral pigmentation index (OPI) and melanin pigmentation index (MPI) scores were less significantly (p <0.05) compared to the baseline in both groups. Treatment was significantly faster with Er,Cr:YSGG laser and required no anesthesia, with faster healing and less postoperative discomfort after 1-week of treatment, compared to the diode laser treatment (p <0.001). The re-pigmentation intensity and extensity were higher significantly in the Er,Cr:YSGG group than in the diode group at 1 year and 2 years (p <0.05).

CONCLUSION

Both lasers efficiently removed gingival pigments with comparable clinical outcomes and overall positive patient experience. Diode laser treatment exhibited better long-term stability of gingival color, with a lower incidence of re-pigmentation.

CLINICAL RELEVANCE

The color of the gingiva plays an important role in the esthetics of oral soft tissues and the overall ideal smile. Laser-assisted gingival depigmentation is an effective, comfortable, and reliable technique with good esthetical outcomes. The rate of re-pigmentation was affected by the laser wavelength and the technique used.