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

Comparative Assessment of Gingival Depigmentation Using Scalpel Versus Microneedling With Ascorbic Acid: A Randomized Controlled Trial

Background Gingival pigmentation (GP), characterized by the presence of melanin in the gingival tissues, is a common aesthetic concern in dental practice. While it poses no inherent health risks, the visible discoloration may cause psychological distress for individuals seeking optimal dental aesthetics. Understanding the efficacy of various methods is essential for refining treatment strategies and enhancing patient satisfaction in the realm of gingival depigmentation (GD). Aim The objective of the study was to compare the effectiveness of scalpel and microneedling (MN) with ascorbic acid in the treatment of GD. Materials and methods Sixteen patients who had a complaint of GP were included in the study, of whom eight were allocated for depigmentation with a scalpel, and the other eight patients were treated with the MN technique with ascorbic acid. Postoperative wound healing scores were evaluated on the first and seventh days, respectively. The intensity of depigmentation was assessed at baseline, in the first month, and at the end of the third month, respectively. Results The mean Dummett-Gupta Oral Pigmentation Index (DOPI) score at baseline was 2.65±0.16 and 2.61±0.17 in the surgical and microneedling groups with ascorbic acid, respectively. The mean DOPI score at the end of the third month was 1.67±0.39 and 0.87±0.17 in the scalpel and MN with ascorbic acid groups, respectively. There was a statistically significant difference between the scalpel and MN with ascorbic acid groups at the end of the first and third months, respectively, where MN with ascorbic acid showed aesthetically pleasing outcomes. Patients treated with the scalpel technique showed incomplete healing and ulceration on the first and seventh days after the procedure when compared to the MN technique with ascorbic acid. The healing index scores were statistically significant in the MN with ascorbic acid group. Conclusion The MN technique with ascorbic acid is a successful technique for treating GD. It showed aesthetically gratifying outcomes when compared to the conventional surgical technique.

Vitamin C mesotherapy versus diode laser for the esthetic management of physiologic gingival hyperpigmentation: a randomized clinical trial

BACKGROUND

Physiologic gingival hyperpigmentation is a common esthetic concern that affects individuals of various ethnicities, and can have a significant impact on individual's self-confidence and overall quality of life. Thus, this study aimed to clinically assess the effectiveness of intra-mucosal injection of vitamin C versus 980 nm diode laser for the management of physiologic gingival hyperpigmentation.

METHODS

Twenty-six healthy non-smoker individuals with physiologic gingival hyperpigmentation were randomly assigned to two groups. Group I received intra-mucosal injection of vitamin C (L-Ascorbic acid 1000 mg/5 ml), and group II was managed using diode laser (980 nm, 1.5 W, continuous wave mode). Clinical evaluation of pigmentation intensity and distribution was performed preoperatively, and at 1, 2 and 3 months postoperatively using two different color assessment indices; Dummett-Gupta Oral Pigmentation Index (DOPI), and Gingival Pigmentation Index (GPI). Additionally, the study assessed pain intensity and patients' satisfaction.

RESULTS

Pigmentation scores decreased significantly between pre-operative visit and different follow-up visits for both treatment modalities (p < 0.0001*). When compared to the vitamin C mesotherapy group, the laser group demonstrated significantly lower gingival pigmentation scores (p < 0.0001*). However, both treatment modalities were equally satisfying for the patients.

CONCLUSIONS

Vitamin C mesotherapy and diode laser are both effective in the management of physiologic gingival hyperpigmentation. While diode laser yields better and earlier results, vitamin C mesotherapy offers a cost-effective, safe and minimally invasive approach that is equally satisfying for the patients seeking esthetic enhancements.

TRIAL REGISTRATION

The study was registered on ClinicalTrials.gov (NCT05608057) on (01/11/2022).

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.

Q-switched ruby laser is safe and effective in treating primary gingival hyperpigmentation

BACKGROUND

Physiologic gingival hyperpigmentation (PGH) is a benign condition that results from increased melanin production and is prevalent among darker skin individuals. Although the use of lasers for PGH has gained popularity in recent years, the lasers being used are mostly ablative, and act through a non-selective tissue damage mechanism.

AIMS

The objective of this study was to evaluate the use of a non-ablative 694-nm Q-switched ruby laser (QSRL) for the depigmentation of PGH.

METHODS

A retrospective single-center study of patients diagnosed with PGH and treated with a QSRL Between March 2019 and November 2020.

RESULTS

Four patients were treated with QSRL for 1-3 sessions, until complete depigmentation was achieved. The average follow-up was 11 months (range 7-18 months) with no patient exhibiting re-pigmentation. Adverse events included mild local tenderness and transient erosions in two patients.

CONCLUSION

The 694-nm QSRL is a novel and promising safe and effective method for treating PGH with the advantages of being a non-ablative modality that minimizes tissue damage and optimizes the outcome.

Gingival Depigmentation Using Microneedling Technique With Topical Vitamin C: A Prospective Case Series

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.

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.

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

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

Effects of ozonated olive oil and photobiomodulation using diode laser on gingival depigmented wound: A randomized clinical study

Objective:

Photobiomodulation (PBM) using diode laser is regarded an effective modality for the repair of tissues and control of pain. Ozone, owing to its biocompatibility, healing, and antimicrobial properties, is used in dentistry as well. This study was carried to clinically compare and evaluate the healing of gingival depigmented wounds using ozonated oil and PBM.

Materials and Methods:

A laser depigmentation procedure was conducted on seven patients exhibiting bilateral upper and lower gingival melanin hyperpigmentation, followed by the application of ozonated oil (Group 1) and laser PBM (Group 2). The clinical parameters are taken namely Visual Analog Scale and Healing Index (HI), were evaluated on the 3^rd, 7^th, and 15^th day.

Results:

Statistical analysis showed better HI in Group I as compared to Group II on the 3^rd day, but it was comparable in both groups on the 7^th and 15^th day.

Conclusion:

The application of ozonated oil was found to be more efficacious in promoting the initial healing of wound in comparison to PBM. Both ozonated oil and PBM also showed the same capabilities in reduction of the postoperative pain.

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.

Clinical comparison between Er: YAG and CO2 laser in treatment of oral tumorous lesions: A meta-analysis

BACKGROUND

To compare clinical effect between Er: YAG and CO2 laser in treatment of oral tumorous lesions.

METHODS

A comprehensive search was conducted from 2000 to 2019. The quality assessment was performed by the QUADAS-2 tool (The Cochrane Collaboration, 2011). The clinical value of comparison between Er: YAG and CO2 laser was evaluated by using the pooled estimate of sensitivity and specificity. In addition, sensitivity analysis and bias analysis were applied to ensure the accuracy of the results.

RESULTS

Finally, 268 patients were enrolled in 6 studies and ultimately met the eligibility criteria. The Er: YAG and CO2 groups were 141 and 127, respectively. The meta-analysis showed significant difference in success (risk ratio  = 21.29, 95% confidence interval [1.09, 1.52], P = .002; P for Heterogeneity = .99, I = 0%) and time of surgery ((P of heterogeneity = .29, I = 20%, Z = 25.69, P of over effect < .00001). The recurrence and complications of CO2and Er: YAG groups had no difference.

CONCLUSION

Er: YAG laser had better effects than CO2 laser in eliminating oral tumorous lesions while it needed longer operation time than CO2 laser.

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

BACKGROUND

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

Background

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

Materials and Methods

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

Results

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

Conclusion

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

An insight into gingival depigmentation techniques: The pros and cons

Pigmentation of gingiva not just has an impact on esthetics but also creates psychological negativity. Although a wide array of depigmentation techniques are available to manage this condition, there is a scarcity of literature that guides clinicians to choose the most appropriate technique. Hence, the aim of this review is to evaluate the available depigmentation therapeutic modalities with an emphasis on their merits and demerits. The databases of MEDLINE and Cochrane databases of systematic reviews were searched to collect relevant scientific literature. Cryosurgery followed by lasers has been reported to be the superior techniques with better esthetic results and low rate of recurrence. However, further randomized controlled longitudinal studies are warranted to elaborate the efficiency and effectiveness of available techniques.

Gingival melanin depigmentation by 810 nm diode laser

The color of gingiva is determined by number and size of blood vessels, thickness of epithelium, keratinization degree, and melanin pigments present in epithelium. Melanocytes, located in basal and suprabasal layers of epithelium, are the cells that produce melanin pigments which play a main role for pigmentation of gingiva. In this case series, the use of 810 nm diode laser for depigmentation of gingiva is presented. Two female patients applied with a chief complaint of "darkened gums" due to heavy smoking. In intraoral examination, diffuse melanin pigmentation was observed in both the maxilla and mandible. Under the local anesthesia, 810 nm diode laser was applied for depigmentation at 1.3 W power in continuous mode. Patients were recalled at weeks 1, 4, and 12 to evaluate the healing and recurrence rate. Both the patients had no postoperative pain or edema, and complete healing was observed at week 12. This study revealed that depigmentation with 810 nm diode laser is successful in terms of esthetics and patient comfort.

Comparison of gingival depigmentation with Er,Cr:YSGG laser and surgical stripping, a 12-month follow-up

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.

Histological and Thermometric Examination of Soft Tissue De-Epithelialization Using Digitally Controlled Er:YAG Laser Handpiece: An Ex Vivo Study

OBJECTIVE

The purpose of this study was histological and thermometric examination of soft tissue de-epithelialization using digitally controlled laser handpiece (DCLH) - X-Runner.

BACKGROUND DATA

Commonly used techniques for de-epithelialization include scalpel, abrasion with diamond bur, or a combination of the two. Despite being simple, inexpensive and effective, these techniques are invasive and may produce unwanted side effects. It is important to look for alternative techniques using novel tools, which are minimally invasive and effective.

MATERIALS AND METHODS

114 porcine samples sized 6 × 6 mm were collected from the attached gingiva (AG) of the alveolar process of the mandible using 15C scalpel blade. The samples were irradiated by means of Er:YAG laser (LightWalker, Fotona, Slovenia), using X-Runner and HO₂ handpieces at different parameters; 80, 100, and 140 mJ/20 Hz in time of 6 or 16 sec, respectively. The temperature was measured with a K-type thermocouple. For the histopathological analysis of efficiency of epithelium removal and thermal injury, 3 random samples were de-epithelialized with an HO₂ handpiece, and 9 random samples with an X-Runner handpiece with different parameters. For the samples irradiated with DCLH, we have used three different settings, which resulted in removing 1 to 3 layers of the soft tissue. The efficiency of epithelium removal and the rise of temperature were analyzed.

RESULTS

DCLH has induced significantly lower temperature increase compared with HO₂ at each energy to frequency ratio. The histological examination revealed total epithelium removal when HO₂ handpiece was used at 100 and 140 mJ/20 Hz and when DCLH was used for two- and threefold lasing at 80, 100, and 140 mJ/20 Hz.

CONCLUSIONS

Er:YAG laser with DCLH handpiece may be an efficient tool in epithelium removal without excessive thermal damage.

To compare the gingival melanin repigmentation after diode laser application and surgical removal

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.

Efficacy of Conventional Laser Irradiation Versus a New Method for Gingival Depigmentation (Sieve Method): A Clinical Trial

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.

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

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

Restoring lost gingival pigmentation in the esthetic zone: A case report

BACKGROUND AND OVERVIEW

There is insufficient literature on the lack of oral pigmentation in the esthetic zone. The aim of this case report was to illustrate the potential impact of loss of gingival pigmentation in the esthetic zone, describe its surgical treatment, and discuss the limited literature on this topic.

CASE DESCRIPTION

An African American woman with high smile line had localized loss of gingival melanin pigmentation as a complication after implant failure and attempted guided bone regeneration in site 8. A highly pigmented free gingival graft was collected from the facial-attached gingiva of the maxillary posterior teeth and placed onto the previously de-epithelialized recipient bed in the maxillary front. Some pigmentation of the graft was preserved and was visible a few weeks after surgery; some pigmentation recovered over time. At 6 months after surgery, the patient was satisfied with the esthetics. Complete recovery of pigmentation took 12 months, at which time the patient was ready to proceed with the final prosthetic work.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Gingival pigmentation can be restored using a free gingival graft from a highly pigmented area. When surgical procedures are performed in such cases, loss of gingival pigmentation should be part of the informed consent. However, further research, including histology, is needed.

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

Background:

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

Materials and Methods:

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

Results:

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

Conclusion:

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

Comparison of two different depigmentation techniques for treatment of hyperpigmented gingiva

INTRODUCTION

Demand for cosmetic therapy of gingival melanin pigmentation is common. Re-pigmentation after gingival depigmentation is an important point. The aim of this study is to evaluate the effect of surgical scraping and electrosurgery on postoperative pain, healing and recurrence of pigmentation.

MATERIALS AND METHODS

Fifteen patients with esthetic concern related to black gums were selected and treated by surgical scraping with respect to right quadrant and electrosurgery with respect to left quadrant. Patients were recalled post-operatively to evaluate healing and recurrence of pigmentation. Each patient was asked to complete the Visual Analogue Scale (VAS) index cards 2 and 24 hours postoperatively.

RESULTS

In the initial post-operative period, VAS index cards showed that the discomfort and pain level associated with electrosurgery was significantly higher than conventional scalpel surgery (P < 0.05). Clinically delayed healing was observed in the electrosurgically treated site. Electrosurgery showed better results as compared to epithelial excision for recurrence of pigments. At the end of 15 months, 7 sites in the scalpel excision group showed recurrence, whereas only 4 site showed recurrence in the electrosurgically treated group.

CONCLUSION

The methods used here produced desired results and above all, the patients were satisfied with the outcome. Increased pain level and clinically delayed healing was associated with electrosurgery as compared to scalpel surgery, whereas repigmentation occurred more frequently in scalpel-treated sites.

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

OBJECTIVE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

Comparison of recurrent rate of gingival pigmentation after treatment by liquid nitrogen and cryoprob in 18 months follows-up

BACKGROUND

Cryosurgery is one of the simplest, most effective gingival depigmentation methods. Repigmentation may happen after a while in each method. The aim of this study is to compare the recurrence rate after treatment by liquid nitrogen swap and a cryoprob in 18 months.

MATERIALS AND METHODS

A total of 26 patients with physiologic gingival pigmentation were selected. The anterior sextant was divided into left and right segments; each segment was treated randomly by swap technique or cryoprob. Standard photos were evaluated with photoshop software (Red, Green, Blue, Cyan, Magenta, Yellow, Black [RGB, CMYK]) before and at 2 week, 1, 3, 6, 9, 12, 15, 18 months after the treatment. The results were compared, by the independent t-test and repeated measure ANOVA thereafter least significant difference post-hoc. The viewpoints of patients and physicians regarding the treatment outcomes were obtained by a questionnaire and consequently evaluated qualitatively by McNemar test (P < 0.05 was considered as significant level).

RESULTS

The statistical analysis showed a significant difference in color change after the treatment during 18 months, in each group (P < 0.001). The mean values of RGB had significantly increased after 2 weeks in both methods (P < 0.001), but the differences from 2 weeks to 18 months after treatment were not significant (P > 0.05). The mean values of CMYK significantly decreased after 2 weeks in both methods (P < 0.001), but the differences from 2 weeks to 18 months after treatment were not significant (P > 0.05). Qualitative evaluation showed the preference of the cryosurgery with swap method (P < 0.001). No significant recurrence was observed during 18 months follow-up.

CONCLUSION

Both methods of cryosurgery are appropriate in treatment of gingival depigmentation because no significant recurrence was observed during 18 months follow-up.