Print this page Email this page Users Online: 492
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 11  |  Issue : 2  |  Page : 58-60

A novel approach for the management of gingival hyperpigmentation: Diode laser


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 Publication29-Dec-2017

Correspondence Address:
Dr. Mohammad Arif Khan
Department of Periodontology, Career P.G. Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-1385.221995

Rights and Permissions
  Abstract 

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 Top


Melanin is a nonhemoglobin-derived pigment formed by the cells called melanocytes that located mainly in the basal layer of the oral epithelium.[1] 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.[2] 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.[3],[4]

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 Top


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].
Figure 1: Preoperative view

Click here to view


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].
Figure 2: Intraoperative view

Click here to view


Pulse length and pulse interval were used for 80 μs. The procedure was carried out from canine to canine region [Figure 3].
Figure 3: Depigmentation done

Click here to view


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.
Figure 4: Periodontal dressing placed

Click here to view


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].
Figure 5: Postoperative view after 3 months

Click here to view



  Discussion Top


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.[1],[5] 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).[6] Scalpel technique is most economical and relatively simple as compared to other techniques, but it causes unpleasant bleeding during and after surgery.[7] Cryosurgery causes prolonged swelling because during surgery, depth of penetration cannot be controlled, and result of which more soft tissue destruction.[8] Electrosurgery takes lesser time and causes minimum bleeding, but use on prolonged time induces heat accumulation and causes undesired tissue destruction.[9] 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.[10] 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.[11]


  Conclusion Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Dummett CO. Oral pigmentation:First symposium of oral pigmentation. J Periodontol 1960;31:356-60.  Back to cited text no. 1
    
2.
Dummett CO, Barens G. Oromucosal pigmentation: An updated literary review. J Periodontol 1971;42:726-36.  Back to cited text no. 2
[PUBMED]    
3.
Brown FH, Houston GD. Smoker's melanosis. A case report. J Periodontol 1991;62:524-7.  Back to cited text no. 3
[PUBMED]    
4.
Patsakas A, Demetriou N, Angelopoulos A. Melanin pigmentation and inflammation in human gingiva. J Periodontol 1981;52:701-4.  Back to cited text no. 4
[PUBMED]    
5.
Ciçek Y, Ertas U. The normal and pathological pigmentation of oral mucous membrane: A review. J Contemp Dent Pract 2003;4:76-86.  Back to cited text no. 5
    
6.
Farnoosh AA. Treatment of gingival pigmentation and discoloration for esthetic purposes. Int J Periodontics Restorative Dent 1990;10:312-9.  Back to cited text no. 6
[PUBMED]    
7.
Gnanasekhar JD, Al-Duwairi YS. Electrosurgery in dentistry. Quintessence Int 1998;29:649-54.  Back to cited text no. 7
[PUBMED]    
8.
Bishop K. Treatment of unsightly oral pigmentation: A case report. Dent Update 1994;21:236-7.  Back to cited text no. 8
[PUBMED]    
9.
Hirschfeld I, Hirschfeld L. Oral pigmentation and a method of removing it. Oral Surg Oral Med Oral Pathol 1951;4:1012-6.  Back to cited text no. 9
[PUBMED]    
10.
Featured wavelength: Diode – The diode laser in dentistry (Academy report) wavelengths. Acad Laser Dent 2000;8:13.  Back to cited text no. 10
    
11.
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.  Back to cited text no. 11
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed751    
    Printed33    
    Emailed0    
    PDF Downloaded125    
    Comments [Add]    

Recommend this journal