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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 5  |  Issue : 2  |  Page : 91-93

Gingival depigmentation to enhance esthetics by two different modalities


1 Department of Periodontology, Chandra Dental College and Hospital, Safedabad, Barabanki, India
2 Department of Periodontology, Kothiwal Dental College and Research Institute, Moradabad, India
3 Department of Oral Medicine and Radiology, Sardar Patel Postgraduate Institute of Medical and Dental Sciences, Uttar Pradesh, India

Date of Web Publication28-Jan-2016

Correspondence Address:
Abhishek Gautam
Q/No.B/14, C/O Dr. Abha Rani, Magadh University Campus, Bodhgaya, Gaya, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-6360.175027

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  Abstract 


Gingival pigmentation is present in all races of the human community. The distribution and the intensity of color are different not only among different races but also in different area of the same oral cavity. The presence of pigmentation can be because of various reasons, but melanocyte deposition in basal layer of oral epithelium is one of the main factors for brown pigmentation. These pigmentation of melanin are been removed as cosmetic therapy. This case report presents two different treatment modalities of depigmentation in the same patient and hence giving us a better treatment modality between laser and electrocautery. The clinical results of these two methods have been compared by different criteria, which makes laser above the electrocautery in different ways.

Keywords: Electrocautery; epithelium; laser; melanocyte; pigmentation


How to cite this article:
Gautam A, Raaj V, Singh M, Anusha. Gingival depigmentation to enhance esthetics by two different modalities. Indian J Multidiscip Dent 2015;5:91-3

How to cite this URL:
Gautam A, Raaj V, Singh M, Anusha. Gingival depigmentation to enhance esthetics by two different modalities. Indian J Multidiscip Dent [serial online] 2015 [cited 2019 May 21];5:91-3. Available from: http://www.ijmdent.com/text.asp?2015/5/2/91/175027




  Introduction Top


A smile defines an individual. Not only just limited to teeth and lips but also the clinical presence gingival tissue plays an important role in a healthy and attractive smile. The active melanocyte converts tyrosine to melanoprotein (melanin), which is then transferred to basal and pickle cell layers.[1] The goal of depigmentation is to give patient a better esthetic appearance with optimal comfort. There are various treatment modalities for esthetic depigmentation such as abrasion of tissues with diamond bur, slicing with scalpel, cryosurgery, electrosurgery, gingivectomy with free gingival autografting, acellular dermal matrix allografts, and various types of lasers.[2] This all come with different patient comfort, operator's ease, complications, clinical outcome, and prognosis. This case report presents the comparison between electrosurgery and diode laser.


  Case Report Top


A 21-year-old male patient boy came to the Department of Periodontology at Chandra Dental College and Hospital with the chief complaint of dark blackish gums, and wanted treatment of his gums which interfered in his smile and esthetic. While taking case history patient revealed the presence of pigmentation since birth suggestive of melanin pigmentation with no medical history. On intraoral examination, blackish pigmentation of gingiva was observed, however, the gingiva was healthy and does not had any inflammation [Figure 1]. Scaling of patient was done and hematological investigation was advised. After getting a clear hematological report, the patient was recalled after 1 week for surgery. Considering the patient concern gingival depigmentation using diode laser in maxillary arch and electrocautery in the mandibular arch was planned. Details of the treatment protocol were explained to the patient before starting the treatment and both the techniques were performed. Patient was prepared, and painting and draping were done with betadine before starting the procedure. Diode laser unit (Soft tissue laser) was used for depigmentation of the maxillary arch from 13 to 23 [Figure 2]. As there is no need for anesthesia for the procedure, only topical lignocaine spray was used. Laser tip was moved from mucogingival junction to free gingival margin including papillae. Remnants of the ablated tissues were removed using sterile gauge damped with saline solution. This was repeated until the desired depth of tissue removal was achieved.
Figure 1: Preoperative

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Figure 2: Position of laser in maxillary arch

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Electrocautery unit (electrosurgery unit) was used for deepithelize the hyperpigmented areas in mandibular arch [Figure 3]. Ablation of the pigmented tissues was done using surgical loupes by means of electrocautery unit under standard protective measures. Remnants of ablated tissues were removed with the sterile gauge damped in saline solution. This was repeated until the desired depth of tissue removal was achieved.
Figure 3: Position of cautery unit in mandibular arch

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Surgical area was covered with noneugenol-based periodontal dressing “coe pack” and postoperative instruction was given to the patient. An analgesic was prescribed for pain management and patient was recalled after 1 week for follow-up and removal of periodontal dressing [Figure 4]. Healing was uneventful without any complication in both the maxillary and mandibular arch. On intraoral examination, the gingiva gave a normal, pink healthy appearance. Patient was recalled after 1 month, and postoperative photographs were taken [Figure 5].
Figure 4: One week postoperative

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Figure 5: One month postoperative

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  Discussion Top


Melanin is nonhemoglobin derived brown pigments that often occur in the gingiva as a result of increased deposition of melanosomes in the basal layer. Pigmented gingival tissue forces the patient to go for esthetic treatment. Degree of vascularization, the thickness of the keratinized layer and the amount of the pigment-containing cells determines the color of gingiva.[3] Various treatment plans have a different outcome in respect of pain, bone exposure, bleeding, healing, and patient comfort. The scraping technique using the scalpel is one of the most economic and also does not require extensive instrumentation, but scalpel surgery causes unpleasant bleeding [4] and as patient comfort was concerned, the newer methods were opted. The mechanism of repigmentation is not very clear, but according to the migration theory, active melanocytes moves from the adjacent pigmented tissues and migrate to the treated areas, causing repigmentation.[5] Various study has been carried out in other to now the repigmentation and from one of them, we came to know full clinical baseline repigmentation takes about 1.5–3 years.

Both diode laser and electrosurgery showed excellent result in gingival depigmentation, but the advantage of diode laser is not just limited to patient comfort but also it does not interact much with the dental hard tissue, and it also do not produce any negative effect on the root surface. The laser also showed a bactericidal effect and it was found that there was extraordinarily high reduction of bacteria.[6] There was less mechanical trauma then compared to electrocautery. Healing period was also short in case of diode laser. Minimum tissue burn and bone exposure were marked during the procedure by cautery.


  Conclusion Top


Now-a-day, an increase in demand for esthetic requires removal of excessive gingival pigmentation. In the above-mentioned case no postoperative pain, hemorrhage, infection, or scarring occurred in any of the two arches. Healing was uneventful and patient was satisfied, and he accepted that the procedure was good, and the results were also same as expected. Hence, we conclude that depigmentation can be done by both the instruments and get satisfactory results but the use of diode laser was much effective with ease of use, convenience in dental clinics, and decreased trauma to the patient. Healing was also relatively better in diode laser then electrosurgery at the end of 1 month [Figure 5].

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rosa DS, Aranha AC, Eduardo Cde P, Aoki A. Esthetic treatment of gingival melanin hyperpigmentation with Er: YAG laser: Short-term clinical observations and patient follow-up. J Periodontol 2007;78:2018-25.  Back to cited text no. 1
    
2.
Bhusari BM, Kasat S. Comparison between scalpel technique and electrosurgery for depigmentation: A case series. J Indian Soc Periodontol 2011;15:402-5.  Back to cited text no. 2
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3.
Bergamaschi O, Kon S, Doine AI, Ruben MP. Melanin repigmentation after gingivectomy: A 5-year clinical and transmission electron microscopic study in humans. Int J Periodontics Restorative Dent 1993;13:85-92.  Back to cited text no. 3
    
4.
Sanjeevini H, Pudakalkatti P, Soumya BG, Nayak A. Gingival de-pigmentation: 2 case reports. World J Med Pharm Biol Sci 2012;2:01-4.  Back to cited text no. 4
    
5.
Perlmutter S, Tal H. Repigmentation of the gingiva following surgical injury. J Periodontol 1986;57:48-50.  Back to cited text no. 5
    
6.
Moritz A, Schoop U, Strassi M, Wintner E. Lasers in endodontics. In: Moritzv A, editor. Oral Laser Application. Berlin: Quintessenz; 2006. p. 100.  Back to cited text no. 6
    


    Figures

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



 

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  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
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