|Year : 2017 | Volume
| Issue : 2 | Page : 58-60
A novel approach for the management of gingival hyperpigmentation: Diode laser
Mohammad Arif Khan1, Deepshri Agrawal2, Charanjeet Singh Saimbi1, Deepti Chandra1, Amrit Rai3
1 Department of Periodontology, Career P.G. Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
2 Department of Periodontology, New Horizon Dental Collage and Research Institute, Bilaspur, Chattisgarh, India
3 Department of Prosthodontics Crown and Bridge, Career P.G. Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
|Date of Web Publication||29-Dec-2017|
Dr. Mohammad Arif Khan
Department of Periodontology, Career P.G. Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
The color of normal gingiva depends on the vascular supply of the gingiva, epithelial thickness, degree of keratinization of the epithelium, and the presence of pigmented cells. Excessive gingival display and gingival hyperpigmentation are major concerns for a large number of patients visiting the dentist. The foremost indication for depigmentation therapy is the demand by a patient for improved esthetics. This case report represents a correction of gingival hyperpigmentation by diode laser with satisfactory and pleasant results.
Keywords: Depigmentation, electrocautery, laser, melanin, scalpel
|How to cite this article:|
Khan MA, Agrawal D, Saimbi CS, Chandra D, Rai A. A novel approach for the management of gingival hyperpigmentation: Diode laser. J Dent Lasers 2017;11:58-60
|How to cite this URL:|
Khan MA, Agrawal D, Saimbi CS, Chandra D, Rai A. A novel approach for the management of gingival hyperpigmentation: Diode laser. J Dent Lasers [serial online] 2017 [cited 2019 May 26];11:58-60. Available from: http://www.jdentlasers.org/text.asp?2017/11/2/58/221995
| Introduction|| |
Melanin is a nonhemoglobin-derived pigment formed by the cells called melanocytes that located mainly in the basal layer of the oral epithelium. Melanin pigmentation in the oral cavity is prominent in black individuals.
Pigmentation depends on the depth of epithelialization, degree of cornification, arrangement of vascularity, and the degree of melanogenesis. Melanin pigmentation is the result of melanin granules produced by melanoblasts. Microscopically, melanoblasts are normally present in the basal layers of the lamina propria, and the number of melanophores in the attached gingiva was approximately 16 times greater than in the free gingiva.,
Melanin hyperpigmentation usually does not present as a medical problem, but patients may complain their black gums are considered to be unaesthetic appearance. This problem is aggravated in patients with a gummy smile or excessive gingival display.
Gingival depigmentation is a periodontal plastic surgical procedure, and different treatment modalities have been available for gingival depigmentation include abrasion with diamond bur, slicing with scalpel, electrosurgery, cryosurgery, gingivectomy with free gingival autograft, and also various types of lasers have been used for gingival depigmentation procedure. The selection of a technique should be based on clinical experience and individual preference. Recently, laser ablation has been recognized as most effective, pleasant, and reliable technique. Here, we report a case of gingival depigmentation of a 25-year-old male patient by diode laser exclusively for esthetic purposes providing an excellent outcome.
| Case Report|| |
A 25-year-old male patient reported to the Department of Periodontology, Career P.G. Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India, with chief complaint of blackish gums and patient requested for cosmetic therapy which will improve the esthetics on smiling [Figure 1].
On intraoral examination revealed that diffused blackish pigmentation of gingiva was seen. Laser-assisted depigmentation procedure was planned only in maxillary anterior region since mandibular region was not visible during talking and smiling. The whole procedure was explained verbally to the patient, and informed consent was taken before procedure.
After applying topical anesthesia (lidocaine 15% topical), diode laser (980 nm) was used for depigmentation procedure. The gingival epithelium and underlying pigmented layer of connective tissue were carefully scraped by diode laser with light brushing strokes using pulsed mode, and the tip has to be kept moving to prevent heating of the tissue [Figure 2].
Pulse length and pulse interval were used for 80 μs. The procedure was carried out from canine to canine region [Figure 3].
The area was irrigated using saline and was covered with periodontal dressing [Figure 4]. The healing was uneventful and satisfactory. No postsurgical complications were encountered.
After 3-months, the color of ablated gingiva was pink in color and healthy in appearance, and there was no recurrence of gingival hyperpigmentation [Figure 5].
| Discussion|| |
Physiologic pigmentation is probably genetically determined, but as Dummett in 1960, suggested that the degree of pigmentation is partially related to physical, mechanical, and chemical stimulation., Pigmentations can be removed for esthetic reasons. Process of removal of melanin from gingiva is called depigmentation. During the process of depigmentation, gingival epithelium along with a layer of underlying connective tissue is removed. After removal of gingival epithelium, denuded connective tissue is healed by secondary intention.
Various gingival depigmentation techniques have been used such as abrasion with diamond burs, scalpel, electrosurgery, cryosurgery, chemical agents (90% phenol and 95% alcohol), and lasers according to patient comfort and efficacy of procedure. Each technique has its own advantages and disadvantages (Farnoosh, 1990). Scalpel technique is most economical and relatively simple as compared to other techniques, but it causes unpleasant bleeding during and after surgery. Cryosurgery causes prolonged swelling because during surgery, depth of penetration cannot be controlled, and result of which more soft tissue destruction. Electrosurgery takes lesser time and causes minimum bleeding, but use on prolonged time induces heat accumulation and causes undesired tissue destruction. The superior efficacy of electrosurgery over scalpel could be explained based on Oringer's (1975) “exploding cell theory.” According to this theory, it is predicted that the electrical energy leads to molecular disintegration of melanin cells present in basal and suprabasal cell layers of operated and surrounding sites. Since the diode laser basically does not interact with dental hard tissues, it is an excellent soft tissue surgical laser and exhibits thermal effects using the “hot-tip” effect caused by heat accumulation at the end of the fiber and produces a relatively thick coagulation layer on the treated surface. The diode laser causes minimal damage to the periosteum and bone under the gingiva being treated, and it has the unique property of being able to remove a thin layer of epithelium cleanly. Although healing of laser wounds is slower than healing of scalpel wounds due to a sterile inflammatory reaction occurs after laser use.
| Conclusion|| |
The application of diode laser appears to be a safe and effective alternative procedure for the treatment of gingival melanin hyperpigmentation. Present case report concluded that the management of gingival hyperpigmentation with diode laser providing excellent esthetic outcome with no infection, pain, swelling, or scarring and also pleasing to the patient which is the ultimate goal of any therapy.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dummett CO. Oral pigmentation:First symposium of oral pigmentation. J Periodontol 1960;31:356-60.
Dummett CO, Barens G. Oromucosal pigmentation: An updated literary review. J Periodontol 1971;42:726-36.
Brown FH, Houston GD. Smoker's melanosis. A case report. J Periodontol 1991;62:524-7.
Patsakas A, Demetriou N, Angelopoulos A. Melanin pigmentation and inflammation in human gingiva. J Periodontol 1981;52:701-4.
Ciçek Y, Ertas U. The normal and pathological pigmentation of oral mucous membrane: A review. J Contemp Dent Pract 2003;4:76-86.
Farnoosh AA. Treatment of gingival pigmentation and discoloration for esthetic purposes. Int J Periodontics Restorative Dent 1990;10:312-9.
Gnanasekhar JD, Al-Duwairi YS. Electrosurgery in dentistry. Quintessence Int 1998;29:649-54.
Bishop K. Treatment of unsightly oral pigmentation: A case report. Dent Update 1994;21:236-7.
Hirschfeld I, Hirschfeld L. Oral pigmentation and a method of removing it. Oral Surg Oral Med Oral Pathol 1951;4:1012-6.
Featured wavelength: Diode – The diode laser in dentistry (Academy report) wavelengths. Acad Laser Dent 2000;8:13.
Ozbayrak S, Dumlu A, Ercalik-Yalcinkaya S. Treatment of melanin-pigmented gingiva and oral mucosa by CO2 laser. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:14-5.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]