Dummett Oral Pigmentation Index Research Articles

A Clinical Comparison of ErCr:YSGG Laser and Scalpel Techniques in Gingival Depigmentation.

Gingival depigmentation impacts patient self-confidence and quality of life. This study compares the Er,Cr:YSGG laser to the traditional scalpel technique for reducing gingival hyperpigmentation, assessing their effectiveness and other relevant factors. We conducted a double-blind, randomized trial with a split-mouth design. Forty participants were selected from the university's dental clinic and randomly assigned to receive either the Er,Cr:YSGG laser (2780 nm) or surgical scalpel. Pain intensity and smile satisfaction were assessed post-surgery, and treatment duration was evaluated. The Dummett Oral Pigmentation Index (DOPI) was used to determine the initial severity of pigmentation and to track both reduction and potential repigmentation over time. The Gingival Melanosis Record (GMR) was used to evaluate the presence and extent of pigmentation and to monitor recurrence after 1 and 12 months. Both the Er,Cr:YSGG laser and surgical scalpel similarly reduced GMR and DOPI scores over time, without significant differences at 12 months (p > 0.05). A significant examiner variability was noted in GMR scoring (β &#61; -1.2 for Examiner 2; p < 0.001). Power analysis indicated a higher confidence for detecting treatment effects in DOPI (75%) compared to GMR (55%). Patient satisfaction with smile significantly improved (p < 0.001). Treatment type did not influence postoperative pain levels. The Er,Cr:YSGG laser required longer surgery times (p < 0.001). Under the conditions of the present study, both Er,Cr:YSGG laser and surgical scalpel were equally effective in reducing gingival hyperpigmentation. Although lasers offer better bleeding control and require less anesthesia than the scalpel technique, clinicians should also consider surgery duration, cost, and expertise when selecting a treatment method. Future research should focus on long-term outcomes and economic evaluations, utilizing standardized clinical measures.

A Comparative Evaluation of Gingival Depigmentation by Scalpel versus Diode Laser versus Electrosurgery: A Clinical In vivo Study

Context: Melanin pigmentation of the gingiva exists in all ethnicities and genders. Demand for repigmentation is mainly for esthetic reasons. Gingival depigmentation is a mucogingival surgical procedure where depigmentation is done by various techniques. However, the selection of a method depends on the clinical experiences and individual preferences. Aim: The aim of the study is to compare the pain score using the Visual Analog Scale (VAS) and the recurrence rate of gingival pigmentation, using the three different techniques, i.e., scalpel, laser, and electrosurgery. Settings and Design: This randomized control trial was conducted on 30 systemically healthy patients divided into two groups. Materials and Methods: A split-mouth design was adopted and pigmentation was removed using scalpel and laser in Group I and scalpel and electrocautery in Group II. Dummett Oral Pigmentation Index scale and VAS were used to appraise the potency of hyperpigmentation and pain of the patient, respectively. Statistical Analysis Used: Independent t-test was used for the comparisons. P &lt; 0.05 was considered statistically significant. Results: The pain intensity was up high in patients treated with scalpel compared to laser and electrocautery, which was statistically highly significant. Conclusion: The findings suggest that laser depigmentation still serves to be the best modality considering the bloodless field and reduced postoperative pain.

Validity and Reliability of Polarized vs Non-Polarized Digital Images for Measuring Gingival Melanin Pigmentation.

This study aimed to compare the validity and reliability of polarized and non-polarized intraoral photography for the measurement of gingival melanin pigmentation. A case series study was conducted on ten patients scheduled for gingival depigmentation. A total of 976 polarized and non-polarized image samples were collected, capturing two rows above the gingival margin, for analysis. These images were taken both before and one year after the depigmentation procedure. Three independent evaluators assessed the photographs (an orthodontist, a general dentist, and a layperson). The Dummett Oral Pigmentation Index (DOPI) and Gingival Melanosis Record (GMR) indices were used to measure the level of gingival pigmentation. The study found no significant differences between polarized and non-polarized images taken before and after depigmentation. Both methods of imaging received similar scores from the evaluators. The orthodontist identified more pigmented slides than the layperson and the general dentist. Both polarized and non-polarized photographic methods may be used for assessing gingival pigmentation. However, further research is warranted to confirm this finding and examine additional factors.

Pink Gingiva is it the Needle or the Light!

Objectiv: Gingival depigmentation is an aesthetic periodontal procedure that is carried out to eliminate gingival hyperpigmentation. Numerous depigmentation modalities are used namely surgical scraping, gingival autograft, cryosurgery, electrosurgery, and lasers. Microneddling(MN) is a novel technique that is conservative involving the creation of micro wounds and has been tried for depigmentation. Material and Methods: A 23 yrs old female patient without any systemic conditions reported to the Outpatient Department of Periodontology, Krishnadevaraya College of dental sciences and Hospital, with the chief complaint of dark-colored gums. Depigmentation with micro needling was done in the lower anterior and laser in the upper anterior region. Result: There was a considerable reduction in the oral pigmentation scores (Dummett Oral Pigmentation Index) using both techniques in the first and the fourth week. The Visual Analogue Scale score showed lesser pain in the microneedling area. Conclusion: Depigmentation using microneedling and lasers is effective. Microneedling is a simple, economical, and viable option for the removal of gingival depigmentation.

Comparison of Er,Cr:YSGG laser and diode laser in the treatment of gingival melanin pigmentation: a randomized clinical trial.

This investigation has aimed to compare the efficiency of clinical depigmentation and repigmentation rate of erbium chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) and diode lasers during a 1-year follow-up and to evaluate patient satisfaction. Twenty-two participants were divided into Er,Cr:YSGG laser and diode laser groups using computer-aided randomization. Dummett Oral Pigmentation Index (DOPI) and photographic assessment with ImageJ Software version 10.2 were performed at the preoperative period and postoperative 1st month, 6th month, and 12th month. Moreover, the study assessed intra- and postoperative intensities of pain and postoperative patient aesthetic satisfaction using the Visual Analog Scale in both groups. The median values of DOPI did not differ statistically between the groups according to time (p > 0.05). In the Er,Cr:YSGG group, the extension of repigmentation was less as compared to the diode group at 1-year follow-up (p = 0.045). In the Er,Cr:YSGG group, the patients felt less intraoperative pain and discomfort compared to the diode group (p = 0.007). No significant differences were found between the two groups in terms of patient aesthetic satisfaction at the 1st and 12th months. The findings indicate that diode and Er,Cr:YSGG lasers can be used safely in depigmentation treatment, while the Er,Cr:YSGG laser has been shown to have superiorities in pain management and patient comfort parameters. Clinical Trial No.: NCT05304624.

Gingival Depigmentation Using Microneedling Technique With Topical Vitamin C: A Prospective Case Series.

Introduction Gingival pigmentation is mainly physiological due to the production of melanin. This study aimed to evaluate the effectiveness of a microneedling technique using topical ascorbic acid in treating gingival hyperpigmentation. Methods A case-series study was established, and 16 out of 42 participants enrolled in this study according to the inclusion and exclusion criteria. A microneedling technique was performed using a Dermapen instrument, followed by the topical application of ascorbic acid on the pigmented gingiva. Variations in the Dummett oral pigmentation index (DOPI) and Hedin melanin index (HMI) scores were considered for each patient. A one-month follow-up was conducted on all patients. Results All the reported cases demonstrated noticeable improvement at the end of the sessions. Moreover, seven patients showed complete depigmentation of the gingiva. Analysis using paired T-tests showed a statistically significant lower post-treatment DOPI score with a mean difference of 1.8 ± 0.7, 95% CI: 0.17-1.49. Similarly, the HMI score was lower post-treatment with a mean difference of 3.1 ± 0.7, 95% CI: 2.74-3.50. Conclusions Microneedling combined with topical ascorbic acid is a novel, non-invasive dental technique that can effectively treat gingival hyperpigmentation.

Identifying Gingival Pigmentation Patterns and Skin Color and Its Co-relation With Serum Ferritin Levels in Thalassemic Patients

Background: Patients with β-thalassemia major (β-TM), a genetic issue due to hemoglobin (Hb) synthesis disorder, require life-long erythrocyte transfusion. The purpose of this study is to evaluate and compare gingival pigmentation and skin color with serum ferritin levels of patients with β-TM, using the Dummett's oral pigmentation index (DOPI) and Fitzpatrick skin scale, respectively.Methods: A total of 100 patients were monitored at a thalassemia care center. Each patient's gingival pigmentation and skin color were matched with DOPI and the skin scale under natural light. Serum ferritin levels, the interval of blood transfusions, and iron chelation medications were studied. A gingival pigmentation score and skin color type were compared with the serum ferritin.Results: A significant correlation was found between age, serum ferritin, pigmentation score, and skin color, which means as serum ferritin level increases, gingival pigmentation score increases, and skin color darkens.Conclusion: This study evaluated the correlation between gingival pigmentation and skin color with serum ferritin levels and established gingival pigmentation as a sign of iron deposition in β-TM patients. This is the simplest and least invasive method for evaluating serum ferritin level parameters in β-TM patients.

Oral mesotherapy technique for the treatment of physiologic gingival melanin hyperpigmentation using locally injectable vitamin C: a clinical and histologic cases series.

Vitamin C (ascorbic acid) is widely used in dermatology for skin depigmentation. However, there are very few clinical studies on the efficacy of vitamin C in gingival depigmentation. This preliminary case series aims to present the clinical effectiveness, histologic changes, and patient-reported outcomes of intra-epidermal vitamin C injections (oral mesotherapy) for managing patients with gingival melanin hyperpigmentation. Five patients were administered locally injectable vitamin C (once per week for 4 to 5 visits) in maxillary or mandibular anterior pigmented gingiva. The depigmentation effect was evaluated using the Dummett Oral Pigmentation Index (DOPI) and Gingival Pigmentation Index (GPI). Digital photographs were used to assess gingival luminescence (L*) and pigmented surface area (PSA). Parameters were recorded at baseline and at 1 and 3 months. Melanocyte histopathologic count was determined at baseline and at 3 months. Pain, gingival color change, and patient satisfaction scores were also assessed. Median GPI, DOPI, and PSA were significantly reduced (P ≤ .05) from baseline to 1 month. There was no statistically significant change from 1 month to 3 months. L* value significantly increased from baseline to 3 months. A median pain score of 3 (scale of 0 to 10) was observed on the day of the procedure. A score of 3 (scale of 0 to 4) was reported for the gingival color and scores 3 and 4 (scale of 0 to 4) for the overall patient satisfaction. Oral mesotherapy using locally injectable vitamin C is a nonsurgical, minimally invasive, and efficient technique for gingival depigmentation. Indian patients were satisfied with the gingival color obtained and the overall treatment experience. As all the branches of medicine, specifically dentistry, direct to minimally invasive approaches, mesotherapy shows great importance to reduce the surgical interventions, especially when esthetic outcomes are needed. Oral mesotherapy using locally injectable vitamin C can be a useful nonsurgical technique for achieving gingival depigmentation in the esthetic zone.

The comparison of some depigmentation techniques towards reccurence of gingival hyperpigmentation: a systematic review

Objective: To compare the best gingival depigmentation technique toward the recurrence of gingival hyperpigmentation. Methods: PubMed and Wiley Online Library were conducted to identify articles from January 2013 to November 2018 about the techniques of depigmentation gingiva in patient with gingiva hyperpigmentation. After the selection of articles, 121 articles were obtained but only 3 articles meet the requirements. Dummett oral pigmentation index (DOPI) and Hedin melanin index (HMI) were used to compare the techniques of gingival depigmentation. Results: The clinical parameters have shown reduction of the pigmentation from a patient, in 1, 3 and 6 months. In the second article showed the DOPI only in baseline and 6 months. In third article showedthe DOPI only in baseline and 1 month. Conclusion: The conventional surgical technique eliminates all the hyperpigmentation and showed the less recurrence.

Efficacy of liquid nitrogen and electrocautery assisted gingival depigmentation in term of patient's perception, histological wound healing - A randomized triple blind clinical trial.

Background:Hyper-melanin pigmentation of the gingiva (GMP) is one of the imperative contributory factors for smile-sensitive individuals. Numerous gingival depigmentation (GD) procedures have been attempted in the literature to evaluate the clinical outcome mostly. Hence, a randomized clinical-histopathological triple-blinded trial was planned to evaluate the pain experienced by the patient, gingival wound healing, and density of melanocytes following liquid nitrogen-assisted GD (LNAGD) and electrocautery-assisted GD (ECAGD) procedures.Materials and Methods:Thirty-two arches with bilateral physiologic labial/buccal GMP extending from distal aspect tooth #14–24 and #34–44 in 16 healthy individuals were selected and were equally treated with LNAGD and ECAGD techniques. Dummett oral pigmentation index and Hedin melanin index were evaluated at baseline and 3 months' postoperatively (PO). The visual analog scale was utilized for the intensity of pain assessment at baseline (immediately after treatment) and 1st day and 7th day PO. Histological wound healing and density of melanocytes were evaluated using Gal et al.'s wound-healing assessment index and Patsakas et al.'s criterion, at baseline (0), 8, 24, 72, and 96 h; 1st, 2nd, 3rd, and 4th week; and 3 months and at 0 and 3 months' PO, respectively. Statistical analysis was done using one-way ANOVA, post hoc Tukey, unpaired, and paired “t” test.Results:Both groups showed a statistically significant influence on the parameters evaluated.Conclusion:The LNAGD had a substantial superior result in terms of early wound healing, reduction in density of melanocytes, reduction in pain experienced by the patient, with reduction and delay in the recurrence of GMP.

Melanocyte Response Following Depigmentation by Cryosurgery and Mucosal Excision: A Comparative Clinical and Histopathological Study.

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.

Gingival depigmentation by Er,Cr:YSGG laser and diode laser: a split mouth, clinical trial study.

The Aim of this study was to evaluate the effectiveness of Diode laser and Er,Cr:YSGG laser ablation on the treatment of physiologic gingival melanin hyperpigmentation. This research design was split mouth, double blind, and clinical trial. The power of the diode laser was set at 1 W, fiber 320 µ, irradiation mode: continuous-wave with treatment mode of contact tip and Er,Cr:YSGG laser (2780 nm) was set at 100 MJ, frequency of 15 Hz, total power of 1.75 W, 10% water and 20% air. Bleeding, pain, healing, Dummett oral pigmentation index (DOPI) and Hedin melanin score changes and repigmentation were assessed. Patients were followed for 6 months. A total number of 14 patients were involved in this study. There were statistically significant differences in reduction of DOPI and Hedin melanin score in each treatment groups separately while diode laser group had better results (P < 0.0001). There was no statistically significant difference between groups in terms of repigmentation. There was more pain in diode laser group (P < 0.0001) and there was more bleeding in Er,Cr:YSGG laser group (P = 0.0156). Gingival healing was more in Er,Cr:YSGG laser group (P < 0.0001). Diode laser had more efficiency for reduction of DOPI and Hedin melanin index scores.

Correlation of environmental tobacco smoke to gingival pigmentation and salivary alpha amylase in young adults.

Objective:Passive smoking leads to melanin pigmentation on gingiva. However, documentation of gingival pigmentation and salivary amylase activity in passive smokers relative to the duration of exposure to environmental tobacco smoke (ETS), is incomplete and requires further investigation. Thus, this study aimed to assess effects of ETS exposure on gingival pigmentation in young adults. In addition, to correlate a number of years of exposure to an extent, the intensity of gingival pigmentation and salivary amylase activity.Materials and Methods:A total of 200 nonsmokers aged 18–35 years with a positive history of ETS exposure were recruited for the study. Duration and source of ETS were assessed using a questionnaire. Gingival pigmentation was assessed using gingival pigmentation index for the extent and Dummett oral pigmentation index for intensity. The skin color of all patients was also assessed. Pearson Chi-square test and one-way ANOVA was used to statistically analyze the data.Results:Number of years of exposure to passive smoking was highly significant to the extent and intensity of gingival pigmentation (P < 0.001). ETS from home environment was highly significant to the intensity of pigmentation. Environmental sources of ETS contributed to pigmentation as the majority of patients reported exposure from vehicles and workplace. The salivary amylase levels were inversely proportional to the duration of exposure to ETS.Conclusion:Within limitations of this cross-sectional observational study, it was concluded that there was a strong correlation between ETS exposure and gingival pigmentation. Duration of exposure was significant to an extent, the intensity of pigmentation and salivary amylase activity.

Efficacy of Conventional Laser Irradiation Versus a New Method for Gingival Depigmentation (Sieve Method): A Clinical Trial.

Introduction: Diode laser irradiation has recently shown promising results for treatment of gingival pigmentation. This study sought to compare the efficacy of 2 diode laser irradiation protocols for treatment of gingival pigmentations, namely the conventional method and the sieve method. Methods: In this split-mouth clinical trial, 15 patients with gingival pigmentation were selected and their pigmentation intensity was determined using Dummett's oral pigmentation index (DOPI) in different dental regions. Diode laser (980 nm wavelength and 2 W power) was irradiated through a stipple pattern (sieve method) and conventionally in the other side of the mouth. Level of pain and satisfaction with the outcome (both patient and periodontist) were measured using a 0-10 visual analog scale (VAS) for both methods. Patients were followed up at 2 weeks, one month and 3 months. Pigmentation levels were compared using repeated measures of analysis of variance (ANOVA). The difference in level of pain and satisfaction between the 2 groups was analyzed by sample t test and general estimate equation model. Results: No significant differences were found regarding the reduction of pigmentation scores and pain and scores between the 2 groups. The difference in satisfaction with the results at the three time points was significant in both conventional and sieve methods in patients (P = 0.001) and periodontists (P = 0.015). Conclusion: Diode laser irradiation in both methods successfully eliminated gingival pigmentations. The sieve method was comparable to conventional technique, offering no additional advantage.

A comparative and observational assessment of gingival condition and il-1β level in vitiligo and nonvitiligo

Introduction: Vitiligo is an autoimmune skin disorder that causes loss of skin pigment. Loss of skin pigment in oral mucosa may also become prominent and tend to be more noticeable in people with darker skin. There is much less information concerning this condition in gingiva. Therefore, an initial attempt has been made to compare clinical gingival status and biochemical assessment in vitiligo and nonvitiligo patients. Materials and Methods: This observational pilot study includes 45 patients of age group 20–40 years were divided as nonvitiligo pigmented gingivitis as observational 1 group, nonvitiligo nonpigmented gingivitis as control group, and vitiligo with gingivitis as observational 2 group. The clinical parameters assessed were plaque index, gingival index (GI), gingival bleeding index (GBI), dummett oral pigmentation index, and biochemical parameter such as gingival crevicular fluid (GCF) interleukin-1 beta (IL-1β) levels. Results: On intergroup examination using unpaired t -test and statistical analysis, vitiligo group showed highly significant results in GI (P < 0.001) and GBI (P < 0.001) than nonvitiligo group. Furthermore, the GCF IL-1β levels were found to be lesser (34.16 ng/ml) in vitiligo group as compared to nonvitiligo groups. Conclusion: At similar plaque level, higher gingival inflammation and bleeding were found in vitiligo patients. The loss of pigmentation of gingiva was evident in vitiligo patients. The possible defensive role of melanin is evident clinically.

Relationship of Facial Skin Complexion with Gingiva and Tooth Shade on Smile Attractiveness

Background: A Smile is the most visible record of the dentist care. There are three important factors that play an important role when planning and designing any fixed or removable aesthetic and functional restoration. They include; Facial skin complexion, gingival tissue pigmentation and Tooth shade respectively. Objective: The objective of this study was to determine a relationship of facial skin complexion with the gingiva and tooth shade on smile attractiveness. Methods: This cross-sectional, analytical study was conducted at the Operative Dentistry Department of Altamash Institute of Dental Medicine, Karachi, Pakistan. It included 250 patients from 18-68 years of age of either gender over a period of 1 year from 15th October 2014 to 15th October 2015 respectively. The Facial skin complexion was determined by the Ideal Balance Quick Stick Makeup shade guide manufactured by (Revlon Foundation Makeup Shade Guide, USA) and was divided into three skin tone groups (Fair, Medium and Dark) respectively. The intensity and location of Gingival tissue pigmentation was determined by Dummett-Oral Pigmentation Index (DOPI). Lastly, the shade of middle one-third of labial surface of maxillary teeth was recorded visually with the help of a Vitapan 3D- Master shade Guide (VITA Zahnfabrik, Bad Sackingen, Germany) under a standardized natural day lightening procedure. Results: The data was analyzed by using the SPSS version 20.0 (Statistical Package for Social Sciences for Windows, SPSS Inc. Chicago). Out of 250 participants; 162 were male and 88 were female participants. The most common shade recorded was 2M1 (14.4%) followed by 3M2 (13.6%), 2L1.5 (10.8%) and 2R1.5 (9.6%). Among the males, the most common shade recorded was 3M2 (18.5%) and among the females the most common shade recorded was 2M1 (21.5%). The Value 2 shade was commonly seen in (45.2%), followed by Value 3; (31.2%), Value 1; (13.2%) and Value 4 (10.1%) of patients; However no shade was recorded for Value 5 shade group. The Medium skin complexion was more commonly seen in 60.4% of male participants and a Fair skin complexion was seen in 60.2% of female participants respectively. Conclusion: The prevalence of gingival tissue pigmentation was more found on the attached gingiva and interdental papilla (class II) and more severe in dark-skinned people and lesser in fair-skinned people. People having a fair skin complexion had a lower tooth shade value with the teeth appearing more darker in color whereas, people having a darker skin complexion had a higher tooth shade value with the teeth appearing more lighter in color. The respective male gender had a lower tooth shade value whereas females had a higher tooth shade value. The aging patients had a darker shade of teeth because of a lower tooth shade value respectively.

A comparative evaluation of management of melanin pigmented gingiva using a scalpel and laser

Objective: There are only a few case reports in the literature evaluating the effects of the diode laser on gingival melanin pigmentation. This study was performed to evaluate the efficacy of melanin depigmentation using a scalpel and diode lasers based on effective removal of gingival pigmentation, recurrence, and patient acceptability. Study Design: Gingival melanin pigmentation at the anterior maxillary or mandibular gingiva at 20 sites from 7 patients was included. Pigmented areas were measured on pre-and post-operative 1 and 6 months using Dummett Oral Pigmentation Index. This was a split mouth study where gingival depigmentation was carried out using a scalpel and diode laser. For one quadrant scalpel techniques were used and for other quadrant laser ablation was done. Results: Ablation of the hyperpigmented gingiva was accomplished with minimal carbonization and almost no bleeding. Postoperative healing was uneventful with no significant postoperative pain. Statistical analysis of the data revealed a significant difference between pre- and post-operative measurements of pigmented area. No significant changes in pigmentation were seen between 1 and 6 months follow-up with both the procedures. Conclusion: Application of diode laser appears to be an effective and safe method for the elimination of gingival melanin pigmentation.Clinical Relevance To Interdisciplinary Dentistry Esthetics plays an important role in treatment planning

Comparison of Surgical Stripping; Erbium‐Doped:Yttrium, Aluminum, and Garnet Laser; and Carbon Dioxide Laser Techniques for Gingival Depigmentation: A Clinical and Histologic Study

Gingival melanin depigmentation procedures are commonly associated with recurrence of pigmentation, which starts with migration of melanocytes from the adjacent free gingiva. The extent and rate of recurrence varies according to the treatment modalities used and duration of follow-up. The aim of this study is to compare the surgical stripping; carbon dioxide (CO2); and erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser techniques for gingival depigmentation and to evaluate their effect on histologic changes in melanocyte activity and clinical repigmentation. In this study, 140 sites from 35 patients with bilateral melanin hyperpigmentation were treated with surgical stripping (two sites per patient), "epithelial-peel" (CO2 laser, 2 to 4 W, continuous wave),and "brushstroke" (Er:YAG laser, 180 mJ, 10 Hz, long pulse) techniques. Surgical microscope monitoring was performed intraoperatively. Patient preference and perception of pain, change in Dummett oral pigmentation index (DOPI), Hedin index, and change in area of pigmentation from baseline to 6 months postoperatively were recorded. Twenty samples each from the three treatment modalities were selected for histologic analysis using hematoxylin and eosin and dihydroxyphenylalanine oxidase special stains. At the 6-month postoperative visit, 15 of 70 (21.4%) and three of 20 (15%) of the surgical-treated; 10 of 35 (28.6%) and six of 20 (30%) of the Er:YAG-laser-treated; and eight of 35 (22.8%) and four of 20 (20%) of the CO2-laser-treated sites showed clinical and histologic repigmentation, respectively. Paired t test, analysis of variance, and χ(2) tests were used for statistical analyses. P values for comparison of microscopic evaluation, change in DOPI, Hedin index, and area of pigmentation were 0.001, which were statistically significant. Comparison for patient preference and pain indices gave statistically significant values for Er:YAG laser depigmentation (P = 0.001). Clinical repigmentation after gingival depigmentation is an outcome of histologic changes in the melanocyte activity and density of the melanin pigments. Surgical stripping for gingival depigmentation remains the gold standard; however, Er:YAG laser and CO2 lasers can be effectively used but with distinct differences.

The relationship of tooth color to eye color, facial skin complexion and gingival pigmentation

Background: The selection of a color for the edentulous patient is difficult because the natural teeth are no longer present to act as a guide. The aim of the present study is to evaluate the relationship of tooth color to eye color, facial skin complexion, and gingival pigmentation. Materials and Methods: A total of 140 subjects (80 females and 60 males) from Al-Taji village were examined in this study. The participants ranged in age from (18 – 35 years). Each subject was seated on a chair in an upright position under day light between (10 a.m. and 1 p.m.). Direct visual examination was used to evaluate eye color and face complexion. The Dummett oral pigmentation index (DOPI), was used to estimate gingival pigmentation of the maxillary arch. The shades of the maxillary central and lateral incisors were obtained by using (Vivadent), basic colors selector Results: The statistical analysis of the data revealed a non significant relation between tooth color and other parameters (eye color, facial skin complexion and gingival pigmentation). In addition, the light yellow teeth were most commonly seen (61.42%), while brown teeth were the least (0.71%). Conclusions: The results of this study indicate that depending on eye color, facial skin complexion and gingival pigmentation in order to match tooth color is not appropriate.