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Prasanth T, Jacob O, Karla A. A comparative evaluation of management of hyperpigmented gingiva using surgical stripping technique and diode laser: A clinical study. Med J Armed Forces India 2023; 79:S30-S39. [PMID: 38144666 PMCID: PMC10746736 DOI: 10.1016/j.mjafi.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background To compare the treatment outcome of laser and its effectiveness in the management of gingival hyperpigmentation over scalpel surgical method. Methods The patients were selected and were divided into two groups by the split-mouth design. Group A: Right half upper and lower central incisors to premolars were treated using the laser technique. GROUP B: Left half upper and lower central incisors to premolars were treated by Scalpel technique. This study was a comparative, split-mouth analytical study, and the results were observed for a period of 9 months. Results Diode laser technique gave better results in this perio-esthetics procedure as compared to scalpel technique. However, recurrence of pigmentation has been reported even after this duration. Diode laser was superior over the scalpel technique in the aspect of operator convenience, reduced postoperative bleeding, and reducing the incidence of repigmentation in terms of intensity and extent of pigmentation. Patient comfort was more in scalpel technique. Conclusion Laser can be used for better periodontal esthetic procedure over the standard scalpel technique, although repigmentation was reported in both groups. But delayed healing occurred on the laser side due to the thermal effect of the laser on the adjacent tissues. Provision of such advanced instruments to dental surgery can give better satisfaction to patient clientele in terms of good esthetic results.
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Affiliation(s)
- T. Prasanth
- Associate Professor (Periodontics), Department of Dental Surgery & OHS, Armed Forces Medical College, Pune, India
| | - Oliver Jacob
- Graded Specialist (Periodontics), INHS, Kalyani, India
| | - Ashish Karla
- Classified Specialist (Prosthodontics) & Officer Commanding, MDC, Bolaram, India
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Muthuraj TS, Sarkar P, Renganath MJ, Senthilkumaran PG. Iatrogenic cold urticaria induced by tetrafluoroethane cryosurgery for gingival depigmentation: A rare case report. Clin Adv Periodontics 2023; 13:46-49. [PMID: 35894813 DOI: 10.1002/cap.10217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/28/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Gingival depigmentation procedure has gained widespread popularity in the recent years due to increased esthetic demands among patients. Among the various depigmentation procedures, cryosurgery is inexpensive and straightforward method. This case report discusses a rare complication associated with tetrafluoroethane (TFE) cryosurgical depigmentation method. CASE PRESENTATION A 27-year-old systemically healthy male patient reported with the complaint of esthetic concerns associated with gingival melanin pigmentation. Cryosurgery with TFE was planned for the maxillary first quadrant. The patient developed angioedema immediately after exposure to the TFE cryogen during the procedure. Cold urticaria was considered, and the patient was prescribed nonsedating antihistamines for a week. One month follow-up showed completely healed and depigmented gingiva without any recession or attachment loss. CONCLUSIONS TFE cryosurgery depigmentation was found to be an effective depigmentation procedure. However, various complications including cold urticaria have been associated with its application. Therefore, the procedure's success depends on the proper case selection, complete isolation of the operating area, and preoperative test for gingival tissue response. KEY POINTS Why is this case new information? Cold urticaria formation after applying cryosurgery has never been reported in the literature to the best of the authors' knowledge. What are the keys to the successful management of this case? Preoperative testing for tissue response to cryosurgery will prevent complications like cold urticaria. What are the primary limitations to success in this case? Improper medical history and not taking tissue response test for cryosurgery.
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Affiliation(s)
- Thamil Selvan Muthuraj
- Department of Periodontics and Implantology, Rajas Dental College and Hospital, Tirunelveli, India
| | - Puja Sarkar
- North Bengal Medical College and Hospital, Siliguri, India
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A Successful Esthetic Approach of Gingival Depigmentation Using Microneedling Technique and Ascorbic Acid (Vitamin C). Case Rep Dent 2022; 2022:3655543. [PMID: 35509675 PMCID: PMC9061044 DOI: 10.1155/2022/3655543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/23/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022] Open
Abstract
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.
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Laser-Assisted Depigmentation-An Introspection of the Science, Techniques, and Perceptions. Dent J (Basel) 2020; 8:dj8030088. [PMID: 32781667 PMCID: PMC7558501 DOI: 10.3390/dj8030088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/24/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
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.
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Geier B, Sogin EM, Michellod D, Janda M, Kompauer M, Spengler B, Dubilier N, Liebeke M. Spatial metabolomics of in situ host-microbe interactions at the micrometre scale. Nat Microbiol 2020; 5:498-510. [PMID: 32015496 DOI: 10.1038/s41564-019-0664-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 12/16/2019] [Indexed: 11/09/2022]
Abstract
Spatial metabolomics describes the location and chemistry of small molecules involved in metabolic phenotypes, defence molecules and chemical interactions in natural communities. Most current techniques are unable to spatially link the genotype and metabolic phenotype of microorganisms in situ at a scale relevant to microbial interactions. Here, we present a spatial metabolomics pipeline (metaFISH) that combines fluorescence in situ hybridization (FISH) microscopy and high-resolution atmospheric-pressure matrix-assisted laser desorption/ionization mass spectrometry to image host-microbe symbioses and their metabolic interactions. The metaFISH pipeline aligns and integrates metabolite and fluorescent images at the micrometre scale to provide a spatial assignment of host and symbiont metabolites on the same tissue section. To illustrate the advantages of metaFISH, we mapped the spatial metabolome of a deep-sea mussel and its intracellular symbiotic bacteria at the scale of individual epithelial host cells. Our analytical pipeline revealed metabolic adaptations of the epithelial cells to the intracellular symbionts and variation in metabolic phenotypes within a single symbiont 16S rRNA phylotype, and enabled the discovery of specialized metabolites from the host-microbe interface. metaFISH provides a culture-independent approach to link metabolic phenotypes to community members in situ and is a powerful tool for microbiologists across fields.
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Affiliation(s)
- Benedikt Geier
- Max Planck Institute for Marine Microbiology, Bremen, Germany.
| | - Emilia M Sogin
- Max Planck Institute for Marine Microbiology, Bremen, Germany
| | - Dolma Michellod
- Max Planck Institute for Marine Microbiology, Bremen, Germany
| | - Moritz Janda
- Max Planck Institute for Marine Microbiology, Bremen, Germany
| | - Mario Kompauer
- Institute of Inorganic and Analytical Chemistry, Justus Liebig University Giessen, Giessen, Germany
| | - Bernhard Spengler
- Institute of Inorganic and Analytical Chemistry, Justus Liebig University Giessen, Giessen, Germany
| | - Nicole Dubilier
- Max Planck Institute for Marine Microbiology, Bremen, Germany
- MARUM, University of Bremen, Bremen, Germany
| | - Manuel Liebeke
- Max Planck Institute for Marine Microbiology, Bremen, Germany.
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Dahiya R, Blaggana A, Panwar V, Kumar S, Kathuria A, Malik S. Clinical and histological comparison of platelet-rich fibrin versus non-eugenol periodontal dressing in the treatment of gingival hyperpigmentation. J Indian Soc Periodontol 2019; 23:345-350. [PMID: 31367132 PMCID: PMC6628768 DOI: 10.4103/jisp.jisp_688_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The platelet-rich fibrin (PRF) has proven an immense role in angiogenesis and epithelization in a wound healing process. The present study aims to ascertain PRF's beneficial role in wound healing after depigmentation surgery. Materials and Methods A total of 12 systemically healthy controls included were divided into two groups after scalpel depigmentation procedure. PRF was prepared according to Choukroun's standard protocol. Using split-mouth design after depigmentation, one group received PRF membrane, and in second group non-eugenol periodontal dressing was placed. The participants were evaluated for visual analog scale (VAS), healing index (HI) on 3rd and 5th day. Epithelization test using toluidine blue and histological examination employing punch biopsy was done on the 5th day. Results On statistical scale, VAS, HI, epithelization test, and histological findings were statistically significant in the two study groups. PRF group proved better epithelization test and inflammatory cell infiltration was less in PRF group which confirmed superior wound healing in the group. Conclusion PRF membrane postdepigmentation provided satisfactory patient comfort and enhanced the wound healing cascade.
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Affiliation(s)
- Ritu Dahiya
- Departments of Periodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
| | - Anshu Blaggana
- Departments of Periodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
| | - Vinod Panwar
- Departments of Periodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
| | - Shubham Kumar
- Departments of Periodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
| | - Abhinav Kathuria
- Departments of Periodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
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Chhina S, Gakhar A, Gupta S, ss S, Sharma E, Arora SA. Assessment of Clinical Outcomes and Patient Response to Gingival Depigmentation by Scalpel Surgical Stripping and Diode Laser: A Randomized Split-Mouth Study. JOURNAL OF ADVANCED ORAL RESEARCH 2019. [DOI: 10.1177/2320206818820995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Oral melanin pigmentation is a ubiquitous presentation in the oral cavity. It could be a cause of psychological distress to many subjects due to aesthetic reasons. Aims and Objectives: This study attempts to compare the laser and scalpel depigmentation techniques. It also includes a comparison related to the Visual Analog Scale, patient comfort, healing response and time taken for the procedure and recurrence of pigmentation. Materials and Methods: A total of 10 patients were included in the study. A split-mouth approach comparing the scalpel technique with that of the diode laser technique was planned. Results and Conclusion: The results of the present study revealed that both laser and scalpel techniques are equally effective for depigmentation, yielding aesthetic results.
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Affiliation(s)
- Shivjot Chhina
- Department of Periodontics, ITS Dental College, Hospital & Research Centre, Greater Noida, Uttar Pradesh, India
| | - Abhishek Gakhar
- Department of Periodontics, ITS Dental College, Hospital & Research Centre, Greater Noida, Uttar Pradesh, India
| | - Stuti Gupta
- Department of Periodontics, ITS Dental College, Hospital & Research Centre, Greater Noida, Uttar Pradesh, India
| | - Shradha ss
- Department of Periodontics, ITS Dental College, Hospital & Research Centre, Greater Noida, Uttar Pradesh, India
| | - Ejya Sharma
- Department of Periodontics, ITS Dental College, Hospital & Research Centre, Greater Noida, Uttar Pradesh, India
| | - Sachit Anand Arora
- Department of Periodontics, ITS Dental College, Hospital & Research Centre, Greater Noida, Uttar Pradesh, India
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Penmetsa GS, Mopidevi A, Dwarakanath CD, Raju MAKV. Melanocyte Response Following Depigmentation by Cryosurgery and Mucosal Excision: A Comparative Clinical and Histopathological Study. Contemp Clin Dent 2019; 10:214-219. [PMID: 32308280 PMCID: PMC7145241 DOI: 10.4103/ccd.ccd_364_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS The main aim of this study was to evaluate the melanocyte response following depigmentation by cryosurgery and mucosal excision at both clinical and histopathological levels during 6 months. SUBJECTS AND METHODS A total of 15 individuals, aged 25-45 years with hyperpigmentation on the facial aspect of the gingiva present in the esthetic zone were included. A split-mouth approach was used, wherein one side received depigmentation by a scalpel and the other side received cryotherapy, with the choice of the therapy and side chosen by the spin of the coin. For determining the melanocyte assay, a small amount of gingival tissue that was excised was studied under a special staining technique, i.e., Masson-Fontana method for melanin, a histochemistry procedure which determines the activity of melanin both quantitatively and qualitatively. Clinical and histological observations for the intensity of pigmentation were recorded at baseline and 6 months after surgery. STATISTICAL ANALYSIS USED Paired and unpaired t-test. Results: The mean value of the Dummett Oral Pigmentation Index (DOPI) was 2.44 ± 0.51 at baseline; following depigmentation with scalpel technique, the mean DOPI was 1.05 ± 0.23 at 6 months; and there was a statistically significant difference in the mean DOPI when compared with that of the baseline (P = 0.001). Following depigmentation with cryosurgery technique, the mean DOPI was 0.33 ± 0.48 at 6 months which also varied statistically significantly with that of the baseline (P = 0.001). The mean value of melanin histopathological count (MHC) was 95.53 ± 9.03 at baseline; following depigmentation with the scalpel technique, the mean DOPI was 89.49 ± 7.56 at 6 months, which was not statistically significant (P = 0.795). Following depigmentation with the cryosurgery technique, the mean MHC was 75.38 ± 5.63 at 6 months, which was not statistically significant (P = 0.285). CONCLUSIONS The mean histologic count of the melanocytes, which accounts for the re-pigmentation process has shown low recurrence values in cryosurgery over the scalpel technique even though the difference was not statistically significant.
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Affiliation(s)
- Gautami S. Penmetsa
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Anudeep Mopidevi
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - C. D. Dwarakanath
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - M. A. K. V. Raju
- Department of Orthodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
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Gholami L, Moghaddam SA, Rigi Ladiz MA, Molai Manesh Z, Hashemzehi H, Fallah A, Gutknecht N. Comparison of gingival depigmentation with Er,Cr:YSGG laser and surgical stripping, a 12-month follow-up. Lasers Med Sci 2018; 33:1647-1656. [PMID: 29654420 DOI: 10.1007/s10103-018-2501-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 04/01/2018] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Leila Gholami
- Department of Periodontology, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Somayeh Ansari Moghaddam
- Oral and Dental research center, Department of Periodontology, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Ayoub Rigi Ladiz
- Oral and Dental research center, Department of Periodontology, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zohreh Molai Manesh
- Dentist, Oral and Dental research center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hadi Hashemzehi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran.
| | | | - Norbert Gutknecht
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen, Aachen, Germany
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Mahajan G, Kaur H, Jain S, Kaur N, Sehgal NK, Gautam A. To compare the gingival melanin repigmentation after diode laser application and surgical removal. J Indian Soc Periodontol 2018; 21:112-118. [PMID: 29398855 PMCID: PMC5771107 DOI: 10.4103/jisp.jisp_152_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Gaurav Mahajan
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - Harjit Kaur
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - Sanjeev Jain
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - Navnit Kaur
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - Navneet Kaur Sehgal
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - Aditi Gautam
- Department of Periodontology, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
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Mojahedi SM, Bakhshi M, Babaei S, Mehdipour A, Asayesh H. Effect of 810 nm diode laser on physiologic gingival pigmentation. Laser Ther 2018; 27:99-104. [PMID: 30087528 DOI: 10.5978/islsm.18-or-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/25/2018] [Indexed: 11/06/2022]
Abstract
Background and aims Physiologic gingival pigmentation (PGP) is the most common type of gingival pigmentation causing esthetic concerns particularly in gummy smile patients. Laser therapy is an effective and noninvasive treatment modality for such patients. This study aimed to evaluate the efficacy of diode laser for treatment of PGP. Subjects and methods This quasi-experimental study (one-group pretest-post-test design) was conducted on 20 patients complaining of gingival melanin pigmentation. The gingiva of the anterior segment of the arch was ablated with 810 nm diode laser until the entire visible pigmentation was removed. Clinical observations for the intensity of pigmentation were made at baseline, one month and three months, postoperatively. Data were analyzed using SPSS and Friedman test. Results Preoperatively, the mean score of gingival melanin pigmentation in the maxilla and mandible was 2.95. At one month postoperatively, the mean scores of the maxilla and mandible were 1.53 and 1.55, respectively. After three months, the mean rank of scores of the maxilla and mandible was 1.53 and 1.50, respectively. The difference between the pre- and postoperative mean scores was statistically significant (P < 0.001). Conclusion Diode laser therapy is an effective and minimally invasive modality for gingival depigmentation. But further investigations with long-term follow ups are warranted in this respect.
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Affiliation(s)
- Seyed Masoud Mojahedi
- Department of Laser, Dental school, Shahid Behehsti University of Medical Sciences, Tehran
| | - Mahin Bakhshi
- Department of Laser, Dental school, Shahid Behehsti University of Medical Sciences, Tehran
| | - Somayyeh Babaei
- Department of Oral Medicine, Dental school, Arak University of Medical Sciences, Arak
| | - Aida Mehdipour
- Department of Pediatric, Dental school, Qom University of Medical Sciences, Qom
| | - Hamid Asayesh
- Department of Medical emergency, Qom University of Medical Sciences, Qom
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Suragimath G, Lohana MH, Varma S. A Split Mouth Randomized Clinical Comparative Study to Evaluate the Efficacy of Gingival Depigmentation Procedure Using Conventional Scalpel Technique or Diode Laser. J Lasers Med Sci 2016; 7:227-232. [PMID: 28491257 DOI: 10.15171/jlms.2016.40] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Dark or black coloured gingiva is an esthetic concern especially in subjects with high lip line or gummy smile. Gingival depigmentation procedure is a type of perioplastic surgery where the gingival epithelium is excised with various techniques to lighten the colour of the gingiva. The aim of this study was to compare the clinical efficacy of gingival depigmentation procedure with conventional scalpel technique and diode laser application. Methods: This split mouth randomized study was conducted on 12 subjects (18-40 years of age), exhibiting melanin hyperpigmentation of gingiva. The anterior labial sextant of maxilla and mandible were divided into two halves involving three anterior teeth i.e. central incisor, lateral incisor and canine on each side. The divided areas were randomly allotted for depigmentation procedure either with scalpel technique or diode laser operating at 980 nm wavelength. Various parameters such as bleeding, pain, difficulty of procedure and wound healing were assessed and compared between the two techniques. The level of melanin pigment was assessed with Dummette Gupta index and photographic analysis with the help of adobe software. The subjects were followed up to one year to see for recurrence of melanin pigmentation. Results: Bleeding during surgery, pain score and difficulty of procedure assessed by the operator were statistically higher for scalpel technique as compared to laser technique. Wound healing did not show any statistical significant difference between both techniques. Gingival depigmentation procedures with scalpel as well as laser technique were effective when compared preoperatively and at consecutive postoperative visits, and this was statistically significant. Comparison of melanin depigmentation procedure between scalpel and laser technique did not show any significant differences at all postoperative intervals. Conclusion: The findings of the present study suggest that gingival depigmentation was effective with both scalpel and laser techniques. However, the laser treated sites showed reduced pain experienced by the patient and better operator comfort. Slight melanin repigmentation was observed in three subjects treated with scalpel depigmentation procedure at the end of one year.
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Affiliation(s)
- Girish Suragimath
- Department of Periodontology, School of Dental Sciences, KIMSDU , Karad, Maharashtra, India
| | - Mohini Hemant Lohana
- Department of Periodontology, School of Dental Sciences, KIMSDU , Karad, Maharashtra, India
| | - Siddhartha Varma
- Department of Periodontology, School of Dental Sciences, KIMSDU , Karad, Maharashtra, India
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Chawla K, Lamba AK, Tandon S, Faraz F, Gaba V. Effect of low-level laser therapy on wound healing after depigmentation procedure: A clinical study. J Indian Soc Periodontol 2016; 20:184-8. [PMID: 27143832 PMCID: PMC4847466 DOI: 10.4103/0972-124x.176393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The aim of the present study is to evaluate and compare the effects of low-level laser therapy (LLLT) on wound healing after depigmentation procedure. MATERIALS AND METHODS In this study, 12 patients with bilateral melanin hyperpigmentation were treated with surgical stripping using a blade. After completion of the surgical process and bleeding stasis, any of the symmetrical surgical sites was randomly assigned for LLLT (test site) using a defocused diode laser at 1 mm distance for 5 min. After every laser exposure, the surgical site was coated with plaque disclosing solution (erythrosine) on the 3(rd), 7(th), and 15(th) day. A photograph of the surgical site was taken using a Digital SLR Camera, which was placed at 30 cm distance at 55 mm zoom, 1/100 shutter speed, f 14 aperture size, and ISO 4000 with a ring flash. The area of the stained parts of the photographs was evaluated using image analysis software. RESULTS At day 3, test site showed 1.26 ± 0.23 mm(2) and control site showed 1.45 ± 0.21 mm(2) stain uptake by the tissue which was statistically significant. At day 7 and day 15, the test sites exhibited 1.24 ± 0.30 mm(2) and 1.12 ± 0.25 mm(2) stain uptake, whereas the control site showed 1.37 ± 25 mm(2) and 1.29 ± 0.28 mm(2) staining, respectively, which were not statistically significant. CONCLUSION Within the limitations of this study, the findings revealed that LLLT promotes wound healing after depigmentation procedure until the 3(rd) day. On the 7(th) and 15(th) day, the difference in healing was not statistically significant.
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Affiliation(s)
- Kirti Chawla
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Arundeep Kaur Lamba
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Shruti Tandon
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Farrukh Faraz
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Varun Gaba
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Patil KP, Joshi V, Waghmode V, Kanakdande V. Gingival depigmentation: A split mouth comparative study between scalpel and cryosurgery. Contemp Clin Dent 2015; 6:S97-S101. [PMID: 25821386 PMCID: PMC4374330 DOI: 10.4103/0976-237x.152964] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gingival hyperpigmentation is a major esthetic concern for many people. Although it is not a medical problem, many people complain of dark gums as unesthetic. Gingival depigmentation is a periodontal plastic surgical procedure, whereby the hyperpigmentation is removed or reduced by various techniques. For depigmentation of gingival, different treatment modalities have been reported, such as scalpel, cryosurgery, electrosurgery, lasers, etc., this article compares the management of three cases with scalpel and cryosurgery and also highlights the relevance of cryosurgery.
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Affiliation(s)
- Kaustubh P Patil
- Department of Periodontics and Oral Implantology, Dr. D. Y. Patil Dental College and Hospital, Pune, India
| | - Vaibhav Joshi
- Department of Periodontics and Oral Implantology, Saraswati Dhanwantari Dental College and Hospital, Parbhani, Maharashtra, India
| | - Vijay Waghmode
- Department of Periodontics and Oral Implantology, Dr. D. Y. Patil Dental College and Hospital, Pune, India
| | - Vinayak Kanakdande
- Department of Periodontics and Oral Implantology, Dr. D. Y. Patil Dental College and Hospital, Pune, India
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Gupta G, Kumar A, Khatri M, Puri K, Jain D, Bansal M. Comparison of two different depigmentation techniques for treatment of hyperpigmented gingiva. J Indian Soc Periodontol 2014; 18:705-9. [PMID: 25624625 PMCID: PMC4296453 DOI: 10.4103/0972-124x.147404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/10/2014] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Geeti Gupta
- Department of Periodontics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Ashish Kumar
- Department of Periodontics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Manish Khatri
- Department of Periodontics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Komal Puri
- Department of Periodontics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Deept Jain
- Department of Periodontics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Mansi Bansal
- Department of Periodontics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
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Namdeoraoji Bahadure R, Singh P, Jain E, Khurana H, Badole G. Management of pigmented gingiva in child patient: a new era to the pediatric dentistry. Int J Clin Pediatr Dent 2014; 6:197-200. [PMID: 25206222 PMCID: PMC4086607 DOI: 10.5005/jp-journals-10005-1218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/30/2013] [Indexed: 11/23/2022] Open
Abstract
Gingival health in the form of size, shape, consistency and appearance are essential components responsible for an attractive smile as well as may cause unpleasant appearance. Melanin pigmentation often occurs in the gingiva as a result of an abnormal deposition of melanin which can compromise the confidence level from the age of childhood. The present article describes and discusses the two cases of gingival melanin pigmentation in 12 and 13 years of female patient and their early surgical intervention with successful follow-up of 9 and 6 months. Patients were instructed to prevent sun exposure, intake of hot foods or beverages like cold drinks, tea, coffee and brushing immediately after surgery. How to cite this article: Bahadure RN, Singh P, Jain E, Khurana H, Badole G. Management of Pigmented Gingiva in Child Patient: A New Era to the Pediatric Dentistry. Int J Clin Pediatr Dent 2013;6(3):197-200.
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Affiliation(s)
- Rakesh Namdeoraoji Bahadure
- Lecturer, Department of Pedodontics and Preventive Dentistry, Sharad Pawar Dental College, Wardha, Maharashtra, India, e-mail:
| | - Parul Singh
- Lecturer, Department of Pedodontics and Preventive Dentistry, FODS Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India
| | - Eesha Jain
- Postgraduate Student, Department of Pedodontics and Preventive Dentistry, FODS, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India
| | - Heena Khurana
- Postgraduate Student, Department of Pedodontics and Preventive Dentistry, FODS, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India
| | - Gautam Badole
- Lecturer, Department of Conservative Dentistry, VSPM Dental College, Nagpur, Maharashtra, India
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Lin YH, Tu YK, Lu CT, Chung WC, Huang CF, Huang MS, Lu HK. Systematic review of treatment modalities for gingival depigmentation: a random-effects poisson regression analysis. J ESTHET RESTOR DENT 2014; 26:162-78. [PMID: 24418367 DOI: 10.1111/jerd.12087] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
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.
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Affiliation(s)
- Yi Hung Lin
- Division of Periodontics, Department of Dentistry, Changhua Christian Hospital, Changhua, Taiwan
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18
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Kumar M, Bandyopadhyay P, Kundu D, Mishra L. Cryosurgery by tetrafluoroethane: An answer to black gums. J Indian Soc Periodontol 2013; 17:257-60. [PMID: 23869138 PMCID: PMC3713763 DOI: 10.4103/0972-124x.113093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 08/30/2012] [Indexed: 11/24/2022] Open
Abstract
To highlight the effect of 1,1,1,2 tetrafluoroethane (TFE), a new material for cryosurgery of gingival melanin pigmentation (GMP). Five patients were treated using a TFE-cooled swab and the pre- and post-treatment photographs were compared. Complete keratinization took place in 3-4 weeks after application without any trace of pigmentation. During the follow-up period, no side effects were observed and the improved esthetics were maintained upto 1 year.
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Affiliation(s)
- Manoj Kumar
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Ghatikia, Bhubaneswar, Odisha, India
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19
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Giannelli M, Formigli L, Bani D. Comparative evaluation of photoablative efficacy of erbium: yttrium-aluminium-garnet and diode laser for the treatment of gingival hyperpigmentation. A randomized split-mouth clinical trial. J Periodontol 2013; 85:554-61. [PMID: 23826649 DOI: 10.1902/jop.2013.130219] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The use of lasers in periodontology is a matter of debate, mainly because of the lack of consensual therapeutic protocols. In this randomized, split-mouth trial, the clinical efficacy of two different photoablative dental lasers, erbium:yttrium-aluminum-garnet (Er:YAG) and diode, for the treatment of gingival hyperpigmentation is compared. METHODS Twenty-one patients requiring treatment for mild-to-severe gingival hyperpigmentation were enrolled. Maxillary or mandibular left or right quadrants were randomly subjected to photoablative deepithelialization with either Er:YAG or diode laser. Masked clinical assessments of each laser quadrant were made at admission and days 7, 30, and 180 postoperatively by an independent observer. Histologic examination was performed before and soon after treatment and 6 months after irradiation. Patients also compiled a subjective evaluation questionnaire. RESULTS Both diode and Er:YAG lasers gave excellent results in gingival hyperpigmentation. However, Er:YAG laser induced deeper gingival tissue injury than diode laser, as judged by bleeding at surgery, delayed healing, and histopathologic analysis. The use of diode laser showed additional advantages compared to Er:YAG in terms of less postoperative discomfort and pain. CONCLUSIONS This study highlights the efficacy of diode laser for photoablative deepithelialization of hyperpigmented gingiva. It is suggested that this laser can represent an effective and safe therapeutic option for gingival photoablation.
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Hegde R, Padhye A, Sumanth S, Jain AS, Thukral N. Comparison of Surgical Stripping; Erbium-Doped:Yttrium, Aluminum, and Garnet Laser; and Carbon Dioxide Laser Techniques for Gingival Depigmentation: A Clinical and Histologic Study. J Periodontol 2013; 84:738-48. [DOI: 10.1902/jop.2012.120094] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Giannelli M, Formigli L, Lasagni M, Bani D. A new thermographic and fluorescent method for tuning photoablative laser removal of the gingival epithelium in patients with chronic periodontitis and hyperpigmentation. Photomed Laser Surg 2013; 31:212-8. [PMID: 23597422 DOI: 10.1089/pho.2012.3457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to optimize gingival laser photoablation by thermographic and autofluorescent feedbacks. BACKGROUND DATA Photoablative laser treatment is commonly used for gingival de-epithelization in patients with chronic periodontitis or hyperpigmentation. The reduction of collateral thermal damage of periodontal tissues is crucial for optimal treatment outcome. METHODS Nineteen patients with chronic periodontitis, seven of whom showing gingival hyperpigmentation, were subjected to de-epithelization with an 810 nm diode laser used in continuous (1 W, 66.67 J/cm2) or pulsed wave mode (69 μJ, 18 μs, 8000 Hz, corresponding to peak/mean power of 3.8 W/0.6 W, 40 J/cm2), depending upon individual gingival features. Photoablation was controlled in real time with a 405 nm violet light probe, which stimulated a yellow autofluorescence of the laser-coagulated tissue. The temperature at the target tissue was controlled with an infrared thermographic probe. When appropriate, small biopsies were taken to evaluate epithelial ablation and thermal effects. RESULTS The energy density transferred to the treated tissue surface was computed based on the irradiation modality of the target tissues. Laser photoablation performed under thermographic control yielded complete removal of the gingival epithelium with minimal injury to the underlying lamina propria. Irradiation-evoked autofluorescence, conceivably the result of epithelial keratins, allowed very sharp recognition of the borders between laser-ablated and intact epithelium, thus preventing repeated irradiation. CONCLUSIONS This study further supports the favorable characteristics of photoablative diode laser for gingival de-epithelization. Concurrent thermographic and fluorescent analysis can provide substantial help to the setup of a safe and well-tolerated protocol.
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Kumar S, Bhat GS, Bhat KM. Comparative Evaluation of Gingival Depigmentation using Tetrafluoroethane Cryosurgery and Gingival Abrasion Technique: Two Years Follow Up. J Clin Diagn Res 2013; 7:389-94. [PMID: 23543863 DOI: 10.7860/jcdr/2013/4454.2779] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 10/27/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE A comparative evaluation of the gingival depigmentation by using Tetrafluoroethane cryosurgery and the gingival abrasion technique - 2 years of follow up. MATERIAL AND METHODS Ten systemically healthy patients who were aged 18 to 36 years were selected for the study. Tetrafluoroethane was used for the cryosurgical depigmentation and the gingival abrasion technique used a coarse flame shaped bur. The presence or absence of pigmentation was tabulated, based on the GPI (Gingival Pigmentation Index). For the statistical analysis, Freidman's test was used. RESULTS The keratinization was completed within a week after the application of the cryogen and about 10 days after the gingival abrasion technique was done. The statistical analysis which was done after 90th, 180th days and 2 years. The p-value which was obtained (p<.001) showed the superiority of cryosurgery over the gingival abrasion. During the follow up period, no side effects were seen for both the techniques and the improved aesthetics was maintained upto 2 years. CONCLUSION The use of cryogen Tetrafluoroethane is easy, practical and inexpensive as compared to gingival abrasion, due to its high rate of recurrence. Hence, it is more acceptable to the patients and the operator. Further studies are needed to assess the long term effectiveness of the cryosurgical method of depigmentation.
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Affiliation(s)
- Santhosh Kumar
- Assistant Professor, Department of Periodontics, MCODS, Manipal University , Manipal-576104, India
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23
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Talebi M, Farmanbar N, Abolfazli S, Sarraf Shirazi A. Management of physiological hyperpigmentation of oral mucosa by cryosurgical treatment: a case report. J Dent Res Dent Clin Dent Prospects 2012; 6:148-51. [PMID: 23277862 PMCID: PMC3529929 DOI: 10.5681/joddd.2012.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 08/25/2012] [Indexed: 11/17/2022] Open
Abstract
Melanin hyperpigmentation is the result of melanin granules. "Black gums" may cause esthetic problems. Different treatment modalities have been used with the aim of removing pigmentations for esthetic reasons, all of which have some advantages and disadvantages. Recurrent lesions are the most important concept in all of these treatments. Cryotherapy is a method of tissue destruction by rapid freezing. It is an atraumatic, cost-effective and simple method for treating oral pigmentation. This report presents the effects of cryotherapy on physiologic pigmentations of oral mucosa in a 9-year-old boy. In this case no recurrent lesions were observed after 12 months.
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Affiliation(s)
- Maryam Talebi
- Associate Professor, Department of Pediatric Dentistry, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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24
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Mahesh HV, Harish MR, Shashikumar BM, Ramya KS. Gingival pigmentation reduction: a novel therapeutic modality. J Cutan Aesthet Surg 2012; 5:137-40. [PMID: 23060709 PMCID: PMC3461791 DOI: 10.4103/0974-2077.99458] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: The objective of the present clinical study was to compare the effectiveness of radiofrequency de-epithelialization and conventional (slicing) method in reducing gingival pigmentation on long term basis by split mouth design. Materials and Methods: A total of 28 maxillary gingival units from 4 subjects aged between 15-30 years were considered for this clincal study and the selected gingival units were made plaque free and clinically healthy before subjectiing these sites to one of the procedures. The selected sites were abraded by either the conventional (slicing) method (14 gingival units of 21, 22, 23, 24) or by radiofrequency (14 gingival units of 11, 12, 13, 14). After the procedure periodontal dressing was applied to protect the operated area. After 1 week periodontal dressing was removed and the area was irrigated with saline. Follow up examination was done on 30th, 60th and 90th days to evaluate the recurrence of pigmentation, if any. Results: It was obsereved that, sites operated with conventional (slicing) method, showed higher mean pigmentation than the sites treated with the radioablation during the follow up period of 90 days. Conclusion: When used judiciously, radiofrequency can be clinically valuable, safe and effective method to reduce pigmentation of gingiva.
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Affiliation(s)
- H V Mahesh
- Department of Dentistry, Mandya Institute of Medical Sciences, Mandya, Karnataka, India
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25
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Bhusari BM, Kasat S. Comparison between scalpel technique and electrosurgery for depigmentation: A case series. J Indian Soc Periodontol 2012; 15:402-5. [PMID: 22368368 PMCID: PMC3283941 DOI: 10.4103/0972-124x.92580] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 10/25/2011] [Indexed: 11/05/2022] Open
Abstract
A beautiful smile definitely enhances the personality of an individual and reveals self-confidence. The harmony of the smile is determined not only by the shape, position, and color of the teeth but also by the gingival tissues. Gingival pigmentation results from melanin granules which are produced by melanoblasts. Although melanin pigmentation of the gingiva is a completely benign condition and does not pose any medical problem, complaints of “black gums” are common particularly in patients having a very high smile line. The different treatment modalities that have been reported for depigmentation are bur abrasion, partial thickness flap, cryotherapy, electrosurgery, and lasers. In this paper we have compared the results of electrosurgery and scalpel technique, i.e., partial thickness flap.
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Affiliation(s)
- B M Bhusari
- Department of Periodontics, Y. M. T Dental College, Kharghar, Navi Mumbai, India
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26
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Kumar S, Bhat GS, Bhat KM. Development in techniques for gingival depigmentation – An update. Indian J Dent 2012. [DOI: 10.1016/j.ijd.2012.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Kujan O, Azzeghaiby SN, Tarakji B, Abuderman A, Sakka S. Cryosurgery of the oral and peri-oral region: a literature review of the mechanism, tissue response, and clinical applications. ACTA ACUST UNITED AC 2012; 4:71-7. [DOI: 10.1111/j.2041-1626.2012.00165.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 07/02/2012] [Indexed: 12/01/2022]
Affiliation(s)
| | - Saleh N. Azzeghaiby
- Department of Oral and Maxillofacial Sciences; Faculty of Dentistry; Al-Farabi College, Riyadh; Kingdom of Saudi Arabia; Kingdom of Saudi Arabia
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Singh V, Giliyar SB, Kumar S, Bhat M. Comparative Evaluation of Gingival Depigmentation by Diode Laser and Cryosurgery Using Tetrafluoroethane: 18-Month Follow-Up. Clin Adv Periodontics 2012. [DOI: 10.1902/cap.2012.110008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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29
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Ahmed SK, George JP, Prabhuji MLV, Lazarus F. Cryosurgical Treatment of Gingival Melanin Pigmentation — A 30-Month Follow-Up Case Report. Clin Adv Periodontics 2012; 2:73-78. [DOI: 10.1902/cap.2011.100007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 06/24/2011] [Indexed: 12/25/2022]
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30
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Pasupuleti MK, Reddy N R, D R, S S, Swamy N. Aesthetic gingival depigmentation procedures: clinical and patient responses. INTERNATIONAL JOURNAL OF STOMATOLOGY & OCCLUSION MEDICINE 2012. [DOI: 10.1007/s12548-011-0030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Deepalakshmi D. Root Coverage with a Free Gingival Autograft using an Er, Cr: YSGG Laser. ACTA ACUST UNITED AC 2012. [DOI: 10.5005/jp-journals-10022-1014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Kathariya R, Pradeep AR. Split mouth de-epithelization techniques for gingival depigmentation: A case series and review of literature. J Indian Soc Periodontol 2011; 15:161-8. [PMID: 21976842 PMCID: PMC3183669 DOI: 10.4103/0972-124x.84387] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 04/17/2011] [Indexed: 11/05/2022] Open
Abstract
Gingival melanin pigmentation occurs in all races of mankind. Although clinical melanin pigmentation does neither present itself as a medical problem nor a disease entity, it is a major esthetic concern for many people, especially Asians. Esthetic gingival depigmentation procedures can be performed in such patients with excellent results. This case series presents a split mouth de-epithelization procedure using popular surgical techniques such as scalpel, bur abrasion or electrosurgery. These techniques were successfully used to treat gingival hyperpigmentation. Although we found that electrosurgery increased the efficacy of our work, giving a cleaner and neater work field, it required a lot of precision. In contrast, scalpel de-epithelization was easy and technique-friendly, giving excellent results and patient satisfaction. However, the cases are being followed-up to study the factors affecting the rate and length of time required for repigmentation and to study the repigmentation patterns. This case series also reviews the advantages and disadvantages of various techniques available for depigmentation, and reiterates that the scalpel technique still serves as a gold standard for depigmentation.
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Affiliation(s)
- Rahul Kathariya
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, Karnataka, India
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33
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Lee KM, Lee DY, Shin SI, Kwon YH, Chung JH, Herr Y. A comparison of different gingival depigmentation techniques: ablation by erbium:yttrium-aluminum-garnet laser and abrasion by rotary instruments. J Periodontal Implant Sci 2011; 41:201-7. [PMID: 21954425 PMCID: PMC3175500 DOI: 10.5051/jpis.2011.41.4.201] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 07/16/2011] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The aim of this study is to compare two different gingival depigmentation techniques using an erbium:yttrium-aluminum-garnet (Er:YAG) laser and rotary instruments. METHODS Two patients with melanin pigmentation of gingiva were treated with different gingival depigmentation techniques. Ablation of the gingiva by Er:YAG laser was performed on the right side, and abrasion with a rotary round bur on the opposite side. RESULTS The patients were satisfied with the esthetically significant improvement with each method. However, some pigment still remained on the marginal gingival and papilla. The visual analog scale did not yield much difference between the two methods, with slightly more pain on the Er:YAG laser treated site. CONCLUSIONS The results of these cases suggest that ablation of the gingiva by an Er:YAG laser and abrasion with a rotary round bur is good enough to achieve esthetic satisfaction and fair wound healing without infection or severe pain. Prudent care about the gingival condition, such as the gingival thickness and degree of pigmentation along with appropriate assessment is needed in ablation by the Er:YAG laser procedure.
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Affiliation(s)
- Kwang-Myung Lee
- Department of Periodontology, Kyung Hee University School of Dentistry, Seoul, Korea
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Multifocal oral melanoacanthoma and melanotic macula in a patient after dental implant surgery. J Am Dent Assoc 2011; 142:817-24. [PMID: 21719804 DOI: 10.14219/jada.archive.2011.0270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Oral melanoacanthoma (OMA) is an uncommon, reactive, pigmented mucocutaneous lesion. It is a rapidly growing, well-circumscribed, small, brown-to-black, solitary or multifocal macule that is characterized histopathologically by proliferation of keratinocytes and pigment-laden dendritic melanocytes. CASE DESCRIPTION At the end of a one-month healing period after dental implant surgery, a 63-year-old white woman had pigmented lesions at different oral mucosal sites (hard palate, buccal mucosa and left maxillary tuberosity) that showed macrophages exhibiting iron and melanin in multiple areas of the lamina propria. The authors obtained biopsy specimens from all the lesions for histologic and immunohistochemical analyses and light-microscopy study. CONCLUSIONS AND CLINICAL IMPLICATIONS Surgery could have been causal or incidental to the appearance of these lesions. Clinicians should be aware of this possible event and make a correct and pathologically confirmed differential diagnosis.
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Ribeiro AS, de Aguiar MCF, do Carmo MAV, de Abreu MHNG, Silva TA, Mesquita RA. 660 AsGaAl Laser to Alleviate Pain Caused by Cryosurgical Treatment of Oral Leukoplakia: A Preliminary Study. Photomed Laser Surg 2011; 29:345-50. [DOI: 10.1089/pho.2010.2824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Adriana Spinola Ribeiro
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Tarcília Aparecida Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Kaur H, Jain S, Sharma RL. Duration of reappearance of gingival melanin pigmentation after surgical removal - A clinical study. J Indian Soc Periodontol 2010; 14:101-5. [PMID: 21691546 PMCID: PMC3110462 DOI: 10.4103/0972-124x.70828] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 03/09/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In dentistry, esthetics has a special place. Although gingival melanin pigmentation does not present a medical problem, clinicians are often faced with a challenge of achieving gingival esthetics. MATERIALS AND METHODS A method of de-epithelialization of the pigmented gingiva using Kirkland's gingivectomy knife is described. Twenty patients who were conscious about their gingival melanin pigmentation were selected. The gingiva of the whole of the arch was abraded until the entire visible pigmentation was removed. Clinical observations for intensity of pigmentation were recorded at baseline and then after surgery at monthly intervals over a period of 9 months according to Dummett-Gupta Oral Pigmentation Index scoring criteria proposed by Dummett C. O. in 1964. RESULTS The mean gingival melanin pigmentation score came down to 0.407 after 9 months as compared to preoperative score, which was 2.24. No repigmentation occurred in fair-complexioned persons. In persons with wheatish complexion, repigmentation was seen in 85.71% of the cases, but scores came down to 0.38 postoperatively as compared to 2.27 preoperatively. In dark-complexioned persons, repigmentation occurred in all cases, but the mean scores were 0.93 as compared to 2.40 preoperatively. The difference between preoperative and postoperative mean scores for each segment was put to statistical analysis by applying paired t test and was found to be significant. CONCLUSION As this method has shown statistically significant results, it can be used in patients who are conscious of pigmented gingiva and want an esthetically satisfactory color.
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Affiliation(s)
- Harjit Kaur
- Department of Periodontology and Oral Implantology, Guru Nanak Dev Dental College and Research Institute, Sunam, India
| | - Sanjeev Jain
- Department of Periodontology and Oral Implantology, Guru Nanak Dev Dental College and Research Institute, Sunam, India
| | - Roshan Lal Sharma
- Department of Periodontology and Oral Implantology, Government Dental College and Hospital, Patiala, Punjab, India
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Holtzclaw D, Toscano NJ, Tal H. Spontaneous pigmentation of non-pigmented palatal tissue after periodontal surgery. J Periodontol 2010; 81:172-6. [PMID: 20059430 DOI: 10.1902/jop.2009.090289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A 22-year-old African American female was referred for augmentation of keratinized gingiva around implants at the right and left maxillary second premolar sites. Presurgical evaluation revealed generalized melanosis of the buccal gingiva and a lack of keratinized tissue around implants at sites #4 and #13. No pigmentation was noted on the palatal tissues. METHODS Thick free gingival grafts were harvested bilaterally from the non-pigmented palate and secured to the recipient sites with bioabsorbable sutures. Hemostasis was achieved at the palatal donor sites with moistened gauze, and an acrylic stent was delivered for patient comfort. RESULTS Both palatal donor sites healed with spontaneous pigmentation. The pigmentation intensified with time but resulted in no adverse outcome. CONCLUSIONS Post-surgical healing in patients with gingival pigmentation is not entirely predictable, as multiple studies have demonstrated widely inconsistent results in regards to gingival pigmentation upon healing. When performing periodontal plastic surgery in patients with pigmented oral tissues, it is important to discuss all possible outcomes, including spontaneous pigmentation.
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Shimada Y, Tai H, Tanaka A, Ikezawa-Suzuki I, Takagi K, Yoshida Y, Yoshie H. Effects of ascorbic acid on gingival melanin pigmentation in vitro and in vivo. J Periodontol 2009; 80:317-23. [PMID: 19186973 DOI: 10.1902/jop.2009.080409] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Gingival melanin pigmentation may cause esthetic concerns, even if no serious medical problem is present. As an inhibitor of melanin formation, ascorbic acid is often used to treat skin melanin pigmentation. Thus, the present study investigated the effects of ascorbic acid on gingival melanin pigmentation in vitro and in vivo. METHODS The effects of ascorbic acid on melanin formation were evaluated in vitro in B16 mouse melanoma cells and three-dimensional human skin models. In addition, a clinical trial was performed to investigate the inhibitory effects of a gel containing ascorbic acid 2-glucoside (AS-G gel) on gingival melanin pigmentation. This study used a double-masked, split-mouth design on 73 subjects with symmetric gingival melanin pigmentation. AS-G gel was applied to one side of the gingiva for 12 weeks, whereas placebo gel was applied to the other side as a control. Luminance (L*)-value, which describes the lightness of gingiva, was determined by spectrophotometry to obtain an objective measure of melanin pigmentation every 4 weeks. RESULTS Ascorbic acid significantly inhibited tyrosinase activity and melanin formation in B16 mouse melanoma cells (P <0.01 and P <0.05, respectively). The inhibitory effects of ascorbic acid on melanin formation were also significant in three-dimensional human skin models (P <0.01). Moreover, in the clinical trial, a significant relative change in pigmentation was seen after 4 weeks with the application of AS-G gel compared to placebo (L*-value ratio). CONCLUSION Ascorbic acid (AS-G) has potential for the treatment of gingival melanin pigmentation.
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Affiliation(s)
- Yasuko Shimada
- Division of Periodontology, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
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Arikan F, Gürkan A. Cryosurgical treatment of gingival melanin pigmentation with tetrafluoroethane. ACTA ACUST UNITED AC 2007; 103:452-7. [PMID: 17141535 DOI: 10.1016/j.tripleo.2006.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 08/02/2006] [Accepted: 08/11/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To introduce 1,1,1,2 tetrafluoroethane (TFE), as a new material for cryosurgery of gingival melanin pigmentation (GMP). STUDY DESIGN Twenty-one patients with GMP were treated using a TFE-cooled cotton swab. Standard digital images of pigmented areas were measured preoperatively and postoperatively with image-analyzing software. The Mann-Whitney U test was used for statistical analysis. RESULTS Keratinization was completed 3 to 4 weeks after application, without any trace of pigmentation. Statistical analysis revealed a significant difference between preoperative and postoperative measurements of pigmented areas (P < .05). During the follow-up period, no side effects were observed and improved esthetics were maintained up to month 30. CONCLUSIONS The clinical outcomes of cryosurgery with TFE for treatment of GMP are very satisfactory. The use of TFE for cryosurgical treatment of GMP is practical and inexpensive. Moreover, unlike other cryosurgery methods no special equipment is required, and it is safe to store in the dental clinic.
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Affiliation(s)
- Fatih Arikan
- Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey.
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Azzeh MM. Treatment of Gingival Hyperpigmentation by Erbium-Doped:Yttrium, Aluminum, and Garnet Laser for Esthetic Purposes. J Periodontol 2007; 78:177-84. [PMID: 17199556 DOI: 10.1902/jop.2007.060167] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The normal color of gingiva is pink. Gingival hyperpigmentation is mostly caused by the physiologic deposition of melanin by melanocytes. In "gummy smile" patients, melanin gingival hyperpigmentation causes an esthetic problem and may cause physiologic disturbances. Methods to remove gingival hyperpigmentation vary, but it seems that the most reliable and satisfactory procedure is laser ablation. METHODS Six white patients (five females and one male), who complain of having dark-brown to black gingival hyperpigmentation were included in the study. Three of them were smokers. Laser ablation was performed by an erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser (settings: 250 mJ, 15 Hz, with water and air and using the defocused mode) without using topical or local anesthesia. Each patient required about 20 to 25 minutes for completion of the procedure. After 4 days, another laser ablation (with the same previous settings) was performed to ensure good results. Patients were evaluated a month after completion of treatment and on a semiannual basis. The follow-up period ranged between 6 and 18 months. RESULTS In all patients, no discomfort, pain, or bleeding complications were found intraoperatively or 4 days postoperatively. Ablated wounds healed almost completely within 4 days. No recurrence of gingival hyperpigmentation was found during the follow-up periods. Achieved results were satisfactory for patients and the operator. CONCLUSIONS Taking into account the advantages of using lasers, it seems to be that the depigmentation of melanin hyperpigmented gingiva by the Er:YAG laser is a reliable and satisfactory procedure. Esthetic results were satisfactory for patients and the operator, and no repigmentation was found during the follow-up period.
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Affiliation(s)
- Manal M Azzeh
- Department of Periodontics, Arab Dental Center, Amman, Jordan.
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Pontes AEF, Pontes CC, Souza SLS, Novaes AB, Grisi MFM, Taba M. Evaluation of the Efficacy of the Acellular Dermal Matrix Allograft with Partial Thickness Flap in the Elimination of Gingival Melanin Pigmentation. A Comparative Clinical Study with 12 Months of Follow-Up. J ESTHET RESTOR DENT 2006; 18:135-43; discussion 143. [PMID: 16831185 DOI: 10.1111/j.1708-8240.2006.00004_1.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Acellular dermal matrix (ADM) has been used as a substitute for gingival allografts. The aim of this study was to evaluate the effectiveness of ADM with partial thickness flap in the elimination of gingival melanic pigmentations. Fifteen patients presenting bilateral gingival melanin pigmentation were selected for this study. Each side of the pigmentation was randomly assigned to be part of a group. The sites of the experimental group had a partial thickness flap raised, excised, followed by adaptation and suture of the ADM. On the opposite side (ie, sites from the control group), the oral epithelium was removed with a diamond bur. The healing process was evaluated at 1 and 2 weeks, and 1, 3, 6, 9, and 12 months postoperatively. Images of the patient's follow-up were digitalized, and occurrence and quantification of clinical repigmentation were evaluated. After 12 months, minimal repigmentation (mean 3.14 +/- 7.45%) was noted in 8 of 15 sites from the ADM group, while significant repigmentation (mean 55.84 +/- 27.25%) was seen in 15 of 15 abrasion sites. According to our results, it can be concluded that ADM may be successfully used in the elimination or greater reduction of gingival melanic pigmentations, and is more efficient than epithelium abrasion after 12 months (p < 0.0001). CLINICAL SIGNIFICANCE Gingival pigmentation is a common finding in several ethnic groups. Although physiologic melanin pigmentation is not a medical problem, cosmetic demands may turn it into a problem of social acceptance in different cultures. In this way, different treatment modalities have been used with the aim of removing pigmentations for esthetic reasons. In the present study, the use of ADM with partial thickness flap resulted in more effective elimination of gingival melanin pigmentation, as repigmentation occurred later and was much weaker when compared to the outcomes of epithelial abrasion.
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Affiliation(s)
- Ana E F Pontes
- Department of Surgery, Oral-Maxillo-Facial Traumatology and Periodontology, University of São Paulo, School of Dentistry of Ribeirão Preto, Ribeirão Preto-Brazil
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Esen E, Haytac MC, Oz IA, Erdoğan O, Karsli ED. Gingival melanin pigmentation and its treatment with the CO2 laser. ACTA ACUST UNITED AC 2004; 98:522-7. [PMID: 15529122 DOI: 10.1016/j.tripleo.2004.02.059] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE There are only a few reports in the literature evaluating the effects of the carbon dioxide (CO2) laser on gingival melanin pigmentation (GMP). This study was performed to evaluate the effects of the CO2 laser at superpulse mode, applied for gingival depigmentation. STUDY DESIGN GMP at the anterior maxillary and mandibular gingiva of 10 patients was treated using the superpulsed CO2 laser (10 watts, 0.8 mm spot size, 20 Hz, 10 milliseconds). Pigmented areas were measured on pre- and postoperative standard digital images by the aid of an image- analyzing software. Statistical analysis of the data was performed by Mann Whitney U test. RESULTS Ablation of the hyperpigmented gingiva was accomplished with minimal carbonization and almost no bleeding. Postoperative healing was uneventful with no significant postoperative pain. Two cases of partial repigmentation were observed during 24-month follow-up. Statistical analysis of the data revealed a significant difference between pre- and postoperative measurements of pigmented area. CONCLUSION Application of the superpulse mode of CO2 laser appears to be an effective and safe method for the elimination of GMP.
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Affiliation(s)
- Emin Esen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cukurova University, Adana, Turkey.
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Tal H, Oegiesser D, Tal M. Gingival depigmentation by erbium:YAG laser: clinical observations and patient responses. J Periodontol 2004; 74:1660-7. [PMID: 14682664 DOI: 10.1902/jop.2003.74.11.1660] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Melanin, carotene and hemoglobin are the most common natural pigments contributing to the normal color of the gums. Although physiologic and ethnic melanin pigmentation is not a medical problem, complaints about "black gums" are common. Gingival depigmentation has been carried out using non-surgical and surgical procedures. Recently, laser ablation has been recognized as a most effective, pleasant and reliable technique. METHODS The study included 10 patients who requested cosmetic therapy for melanin pigmented gums. Treatment was carried out using an erbium:YAG laser. The laser beam was set at 500 mJ/10 pulses/second. The beam was defocused to produce a 3 mm diameter circle, thus reducing the beam penetration to 2 to 4 microm/pulse while increasing the treated surface. The "brush" technique was applied until the gingival surface appeared clinically free of pigmentation. Patients were observed for 6 months. Each patient filled out a personal evaluation questionnaire for clinical analysis. RESULTS Between 500 to 1,100 pulses/cm2 were recorded and a total of 800 to 2,200 pulses were required per patient, depending on the epithelium thickness and pigmentation. Treatment required only topical anesthesia. Healing was uneventful and required no supportive therapy. None of the patients experienced severe pain during or post-operatively. Mild pain or itching was common during the first week. Treatment was reported as generally pleasant. Follow-up during the 6 months showed no recurrences. CONCLUSIONS Depigmentation of gingival melanin pigmentation by erbium:YAG laser radiation in a defocused mode was a safe and effective procedure. The esthetic results were pleasing and healing was uneventful. Since the erbium:YAG laser is available in the dental office, it seems to be the laser of choice for this procedure.
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Affiliation(s)
- Haim Tal
- Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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Sharon E, Azaz B, Ulmansky M. Vaporization of melanin in oral tissues and skin with a carbon dioxide laser: a canine study. J Oral Maxillofac Surg 2000; 58:1387-93; discussion 1393-4. [PMID: 11117687 DOI: 10.1053/joms.2000.18272] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study tested the efficacy of carbon dioxide (CO2) laser vaporization in ablating gingival, oral mucosal, and cutaneous melanin in dogs. MATERIALS AND METHODS Three mongrel dogs with pigmentation of the oral mucosa, gingivae, and skin were used. Biopsy specimens from the melanin sites were obtained from all 3 dogs before laser application. Removal of the melanin sites was performed by using a 3 W continuous-wave CO2 laser. Biopsies of the treated areas were performed 1, 2, 4, and 6 weeks after laser treatment in all 3 dogs and also, at 11 weeks in 1 dog. The histologic sections were stained with hematoxylin and eosin and Masson-Fontana dye. A computerized morphometric program calculated the average percentage of the melanin layer in the Masson-Fontana-stained sections. RESULTS Clinical and histologic examination showed the CO2 laser to be effective in eliminating the pigmented areas in all tissues treated. No recurrence of melanin was detected in either the oral mucosa or gingiva at any of the follow-up times. In the skin, however, a small amount of melanin repigmentation was noticeable. CONCLUSIONS CO2 laser surgery proved an effective tool for obliterating superficial melanin discoloration. To prevent recurrence of the pigmentation, the area must be cleared completely of melanin, directing the laser beam carefully along the visible margins of the area.
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Affiliation(s)
- E Sharon
- Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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Yousuf A, Hossain M, Nakamura Y, Yamada Y, Kinoshita J, Matsumoto K. Removal of gingival melanin pigmentation with the semiconductor diode laser: a case report. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 2000; 18:263-6. [PMID: 11572242 DOI: 10.1089/clm.2000.18.263] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This investigation was performed to evaluate the possibility of the removal of canine gingival melanin pigmentation with the semiconductor diode (SCD) laser in vivo. SUMMARY BACKGROUND DATA Recently, a semiconductor laser, which can ablate soft tissue, has been developed. It is already used in dentistry as well as in medicine. METHODS The SCD laser was irradiated on the pigmented area of canine gingival surface with the irradiation output of 3W. The effect of the SCD laser irradiation was evaluated at the two intervals: immediately after irradiation and at 3 weeks following irradiation. In addition, histological examination was performed before irradiation and at the same intervals from the biopsies (4 microm) of unlased and lased areas. RESULTS The SCD laser was effective in removing melanin pigmentation. In histological examination, neither inflammatory cell nor any tissue damage was observed with hematoxylin-eosin staining. At 3 weeks, there was a continuous healing process with the proliferation of squamous epithelial cells. CONCLUSIONS SCD laser irradiation can be considered an alternative procedure for removal of melanin pigmentation.
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Affiliation(s)
- A Yousuf
- Department of Endodontics, Showa University School of Dentistry, Tokyo, Japan
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Yeh CJ. Simple cryosurgical treatment of the oral melanotic macule. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:12-3. [PMID: 10884628 DOI: 10.1067/moe.2000.104851] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- C J Yeh
- Clinic of Oral and Maxillofacial Surgery, Mackay Memorial Hospital, Taitung, Taiwan
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Atsawasuwan P, Greethong K, Nimmanon V. Treatment of gingival hyperpigmentation for esthetic purposes by Nd:YAG laser: report of 4 cases. J Periodontol 2000; 71:315-21. [PMID: 10711623 DOI: 10.1902/jop.2000.71.2.315] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Gingival hyperpigmentation may cause esthetic problems and embarrassment, especially in patients with a gummy smile. This report presents the use of the Nd:YAG laser for gingival depigmentation. Four cases, 3 females and 1 male, ages between 24 to 28 years old, presented with the same chief complaint of unesthetic gingiva caused by melanin hyperpigmentation. The Nd:YAG laser was set at 6 watts, 60 millijoules per pulse, and 100 pulses per second. The procedures were performed with contact mode in all pigmented areas by using a handpiece with a 320 microm diameter fiber optic. Ablation of the gingival hyperpigmented areas were accomplished without any bleeding complications or significant postoperative pain. Three to 4 weeks after the procedures, the hyperpigmented gingiva appeared healthy, pink, and firm. No recurrence of hyperpigmentation had been found in 11 to 13 months of follow-up. However, in delicate areas such as the marginal gingiva, the Nd:YAG laser should be used cautiously.
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Affiliation(s)
- P Atsawasuwan
- Department of Hospital Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Nakamura Y, Hossain M, Hirayama K, Matsumoto K. A clinical study on the removal of gingival melanin pigmentation with the CO(2) laser. Lasers Surg Med 1999; 25:140-7. [PMID: 10455220 DOI: 10.1002/(sici)1096-9101(1999)25:2<140::aid-lsm7>3.0.co;2-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE In a previous study, the possibility of removal of dog gingival melanin pigmentation with CO(2) laser therapy was reported. The present study was designed to investigate the effect of the CO(2) laser on human gingival pigmentation and evaluate the clinical outcome. STUDY DESIGN/MATERIALS AND METHODS A CO(2) laser (output: 6-8 W, pulse duration: 0.2 seconds) was irradiated on the melanin pigmented gingival surface of 10 patients, aged 20-49 years. Follow-up clinical and histopathological evaluations were performed. RESULTS The CO(2) laser was effective in removing melanin pigmentation in all patients. In the histopathological study, no pigmented-laden cells nor any inflammatory cell infiltration was observed following laser irradiation. No re-pigmentation was seen in any case in the first year. However, four of seven cases showed re-pigmentation at 24 months. The re-pigmentation was almost equal to the preoperative state. CONCLUSIONS The CO(2) laser has proved to be another effective, safe, and easily applicable therapy for the removal of gingival melanin pigmentation.
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Affiliation(s)
- Y Nakamura
- Department of Endodontics, School of Dentistry, Showa University, Kitasenzoku, Ohta-ku, Tokyo 145-8515, Japan.
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Yeh CJ. Cryosurgical treatment of melanin-pigmented gingiva. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 86:660-3. [PMID: 9868720 DOI: 10.1016/s1079-2104(98)90199-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Abnormal deposition of melanin in gingiva can often occur. Complaints of "black gums" are common, and demand for depigmentation is usually made for esthetic reasons. A simple and effective cryosurgical technique to eliminate the pigmentation is the subject of this article. STUDY DESIGN Twenty patients with dark gingiva were treated by direct application of liquid nitrogen with a cotton swab for 20 to 30 seconds. RESULTS The treated gingiva appeared normal within 1 to 2 weeks after 1 or 2 cryosurgical treatments. The acceptance of the treatment was excellent. CONCLUSIONS This was a simple, bloodless cryosurgery for the depigmentation of gingiva, requiring no local anesthesia or sophisticated equipment.
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Affiliation(s)
- C J Yeh
- Mackay Memorial Hospital, Taitung, Taiwan
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