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

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

BACKGROUND

Gingival hyperpigmentation is a major concern for a significant number of patients, as a relevant aesthetic or cosmetic need. Oral melanin pigmentation is considered to be multifactorial and could be related to physiological or even pathological reasons and can be the consequence of a variety of local or systemic factors. This pigmentation varies individually across races or age groups and is without any gender predilection. Evidence gleaned from literature is presented from case-control studies and from the authors' own research work in prospective, split-mouth, double-blinded, clinical trials comparing treatment modalities in effecting depigmentation.

METHODS

A systematic review of published articles, using suitable assay criteria, was carried out to formulate a consensus on laser-assisted modalities. A total of 295 published sources were subject to critical analysis and resulted in six papers that were subject to data scrutiny. Additionally, evidence is presented on clinical protocols and treatment outcomes.

RESULTS

Analysis of randomized clinical studies identified the use of two laser wavelength groups-near infrared diode and erbium group of mid-infrared lasers. Several areas of analysis were examined, and inconsistent degrees of significance were obtained to establish which laser group was optimal and if they were any better than scalpel depigmentation.

CONCLUSION

A definitive conclusion is wanting as studies with scientific and standardized protocols of evaluation are yet to provide a take on comparative assessments between different techniques of depigmentation.

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

BACKGROUND

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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.

Comparative Evaluation of Gingival Depigmentation by Tetrafluroethane Cryosurgery and Surgical Scalpel Technique. A Randomized Clinical Study

Introduction:

Importance of good smile cannot be underestimated in enhancement of beauty, self-confidence and personality of a person. Health and appearance of gingiva is an essential part of attractive smile. Gingival pigmentation gives rise to unesthetic smile line. In present world, with increasing awareness to esthetic, people have become highly concerned about black gums. Various treatment modalities like abrasion, scrapping, scalpel technique, cryosurgery, electrosurgery and laser are available for treatment of gingival pigmentation. The present study was conducted with an objective of comparing efficacy of gingival depigmentation by cryosurgery and scalpel technique.

Method:

A Randomized control split mouth study was conducted for 25 patients with gingival pigmentation. Gingival pigmentation Index (GPI) for pigmentation and Visual Analoug Scale (VAS) for pain was evaluated for both test (Cryosurgery) and control sites (Scalpel technique) at baseline, 1month, 3months and 6 months.

Results:

GPI score was 3 and 2 for 21/25 and 4/25 control sites and was 22/25 and 3/25 test sites respectively at baseline. Both the groups showed significant reduction in GPI score i.e., 0 at 1 and 3 months interval after treatment. GPI score increased to 1 for 5/25 sites treated with scalpel technique and 2/25 sites treated with cryosurgery at 6 months interval (P =0.0691). This indicates recurrence rate for pigmentation is higher after scalpel treatment. VAS Score was 3 for 10/25 sites treated with scalpel and was 2 for 12/25 sites treated with cryosurgery (P <0.001).

Conclusion:

It can be concluded that cryosurgery can be effectively and efficiently used for depigmentation by keeping patients acceptance and comfort in mind and also the long term results and ease of use when compared to scalpel technique.