Aim: The present study was undertaken to evaluate patient response and recurrence of pigmentation following gingival depigmentation carried out with a surgical blade and diode laser. Materials and Methods: Twenty patients who were esthetically conscious of their dark gums and requested treatment for the same were selected for this study. Complete phase I therapy was performed for all the patients before performing the gingival depigmentation procedures with laser and scalpel on a split-mouth basis. Patients were evaluated for pain 1 day, 1 week , wound healing and melanin repigmentation Melanin Pigmentation Index immediately and at 1 week, 1 month and 3 months, respectively. Results: The final results were statistically analyzed and significance was evaluated. The results of this study indicated that both scalpel and laser were efficient for gingival depigmentation.
|Published (Last):||18 June 2018|
|PDF File Size:||18.48 Mb|
|ePub File Size:||11.60 Mb|
|Price:||Free* [*Free Regsitration Required]|
Department of Periodontics and Oral Implantology, Dr. 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.
Gingival melanin pigmentation occurs in all races. Melanin pigmentation is the result of melanin granules produced by melanoblasts intertwined between epithelial cells at the basal layer of gingival epithelium. In some populations, gingival hyperpigmentation is seen as a genetic trait irrespective of age and gender; hence it is termed physiologic or racial gingival pigmentation.
Also, gingival melanosis is frequently encountered among dark-skinned ethnic groups, as well as in medical conditions such as Addison's syndrome, Peutz-Jegher's syndrome, and Von Recklinghausen's disease neurofibromatosis. Earlier studies have shown that no significant difference exists in the density of distribution of melanocytes between light-skinned and dark-skinned, and black individuals.
However, melanocytes of dark-skinned and black individuals are uniformly highly reactive than in light-skinned individuals. Gingival depigmentation is a periodontal plastic surgical procedure whereby the hyperpigmentation is removed or reduced by various techniques. The patient demand for improved esthetics is the first and foremost indication for depigmentation. Various depigmentation techniques have been employed.
Selection of the technique should be based on clinical experiences and individual preferences. One of the first and still popular techniques to be employed is the surgical removal of undesirable pigmentation using scalpels.
The procedure essentially involves surgical removal of gingival epithelium along with a layer of the underlying connective tissue and allowing the denuded connective tissue to heal by secondary intention. The new epithelium that forms is devoid of melanin pigmentation.
Methods aimed at removing the pigment layer:[ 7 ]. This article demonstrates a comparative evaluation of managing gingival pigmentation using scalpel and cryosurgery techniques with 1-month follow-up. A year-old male patient visited the Department of Periodontology, complaining of dark gums. History revealed that it was present since childhood suggestive of physiological melanin pigmentation [ Figure 1a ].
Patient was systemically healthy without any habits. Patient's oral hygiene was good. Patient was explained about the treatment options available and the possibility of repigmentation after certain period.
Phase I therapy was carried out during the initial visit. A split mouth approach comparing scalpel technique with that of cryosurgery was planned. Local infiltration of lignocaine was administered. Case II: Preoperative a case I: Preoperative, b depigmentation using scalpel technique, c excised specimen, d immediate postoperative, e depigmentation using cryosurgery technique, f the frozen site thawed spontaneously within 1 min, g ghosting effect 2 nd day , h postoperative 4 weeks follow-up.
There was absolutely no bleeding during the procedure. Postoperative instructions were given to the patient, nonsteroidal anti-inflammatory in the form of diclofenac sodium was given thrice daily for 3 days. Patient was recalled after 1-week for re-evaluation. Wound healed uneventfully on both the sides. After 1-week, the pack was removed, and the surgical area was examined. On 1-month postoperative follow-up, the healing was uneventful without any postsurgical complications.
The gingiva appeared pink, healthy, and firm giving a normal appearance [ Figure 1h ]. The patient was very impressed with such a pleasing esthetic outcome. Depigmentation was not carried out for mandibular anterior region because they were of no esthetic concern for the patient. An year-old female had a chief complaint of black gingiva [ Figure 2a ]. The procedures were performed with the same method as described in the previous case. The wound healed well after 2 weeks.
No pain or bleeding complications were found. The gingiva became pink and healthy within 4 weeks [ Figure 2b ]. A year-old female had a chief complaint of black gingiva [ Figure 3a ].
The procedures were performed with the same method as in the previous case. The wound healed well after 4 weeks. The gingiva became pink and healthy within 4 weeks [ Figure 3b ]. In all the above three cases, no postoperative pain, hemorrhage, infection or scarring occurred in any of the sites on the first and subsequent visits.
The healing was uneventful. The patient's acceptance of the procedure was good, and the results were excellent, as perceived by the patient.
The follow up period showed no repigmentation. One of the first, and still popular, techniques to be employed was the surgical removal of undesirable pigmentation using scalpels. An attempt was made to remove gingival pigmentation surgically on the maxillary left quadrant of the patient. In this particular case, the scalpel method of depigmentation gave satisfactory results from both clinical and patients point of view. However, scalpel surgery causes unpleasant bleeding during and after the operation, and it is necessary to cover the surgical site with periodontal dressing for 7—10 days.
The area healed completely in 10 days with normal appearance of gingival. We found that the scalpel technique was relatively simple and versatile and that it required minimum time and effort. Cryosurgery is that branch of therapeutics that makes use of local freezing for the controlled destruction or removal of living tissues. The effect of low temperature on living tissues has been the subject of fascinating studies since Robert Boyle reported almost years ago that cells were killed by freezing.
The biologic effect of physical factors such as cold behaves like ionizing radiation and the maximum lethal effect is obtained when they are applied to cells undergoing mitosis. Cryogen is a substance used for cryosurgery. Over the years, several cryogens have been used. They include the following. A colorless, nonchlorofluorocarbon, nonflammable gas, 1, 1, 1, 2 TFE is usually used as a coolant or refrigerating systems and electronic circuits.
There are human and animal toxicology studies evaluating the safety of TFE. The dose of cryogen and the choice of delivery method depend on the size, tissue type, and depth of the lesion. The area of the body on which the lesion is located, and the required depth of freeze also should be considered. Additional patient factors to consider includes the thickness of the epidermis and underlying structures, the water content of the skin, and local blood flow.
This is also known as open-spray technique. The hand held or table top cryosurgical unit filled with liquid nitrogen is used, select a spray tip that sprays within the border of the lesion. For single short freeze, no local anesthesia is required.
The spray tip is held 1 cm away from the lesion, and a steady spray of liquid nitrogen is directed at the center of the lesion. Freeze time commences once the solid ice has formed over the entire area. The lesion is allowed to thaw slowly that is, come back to room temperature. Thaw time is usually double of freeze time. In this technique, liquid nitrogen is circulated so as to cool the tip of the cryoprobe, which is to be applied to the lesion.
Hence, freezing occurs by conduction. This technique is slower than spray technique. The depth of penetration of the ice ball is difficult to estimate, and prolonged freezing could cause excessive tissue destruction. The shelf life of liquid nitrogen is not adequate for storage for long periods due to its faster rate of evaporation even in a closed container. Discomfort like stinging, burning sensation or pain on prolonged freezing is experienced during the procedure.
The tissue freezes solid taking on the appearance of a ball of ice. Thawing occurred in 15—20 s with progression from the periphery to the center of the ice ball. At 12 h an elevated white fluid filled blister appeared which increased in size slightly up to 24 h. The roof of the blister area consisted of a white membrane, outlined by an indistinct red halo. At 48 h the blister ruptured, exposing a smooth underlying surface. At the periphery, the ragged blister membrane remains discernible.
Repair and reepithelization take place deep to the slough, which separates off after leaving a clean surface. In Mayer et al. They observed unusual multinucleated giant cells in the epithelium near the periphery of the frozen area after 12 h. They also found that surface repair was completed between 24 and 48 h of injury.
Tal et al. The authors concluded that the low cryodose can effectively destroy oral gingival epithelium without causing significant morphologic damage to the underlying lamina propria. In a 2—5 years clinical observation by Tal et al.
Patients did not report side effects, nor did they require additional treatment during the 5 years period after surgery. In a simple and effective cryosurgical technique to eliminate the pigmentation Yeh[ 15 ] in subjects of abnormal deposition of melanin in gingiva in 20 patients with dark gingiva were treated by direct application of liquid nitrogen with a cotton swab for 20—30 s. The treated gingiva appeared normal within 1—2 weeks after one or two cryosurgical treatments, the acceptance of the treatment was excellent.
This was a simple, bloodless cryosurgery for the depigmentation of gingiva, requiring no local anesthesia or sophisticated equipment. He concluded that TFE may be used as an off-label product with minor complications in melanin depigmentation of gingiva.
Study record managers: refer to the Data Element Definitions if submitting registration or results information. Preoperative and postoperative photographic and clinical observations about the gingival melanin pigmentation were made according to Dummett-Gupta Oral Pigmentation Index scoring criteria given by Dummett C. The investigators compared the intensity of pigmentation in each patient in recall sessions after 1month and 3mounth postoperative. It has an affinity for hemoglobin and melanin, so it is an excellent soft tissue laser and is applicated for cutting and coagulating gingival tissue. Today,sparse studies have been published assessing physiologic gingival pigmentation using diode laser,therefore the aim of this study was to evaluate the effect of diode laser on the treatment of gingival pigmentation in adult patients. Secondary Outcome Measures : changes in pigmentation based on standard digital photographs and index of Dummett et al.
Gingival depigmentation: A split mouth comparative study between scalpel and cryosurgery
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.