Gingival Melanin Hyperpigmentation Research Articles

Management of Gingival melanin hyperpigmentation using two surgical techniques (Clinical and histologic study)

Management of Gingival melanin hyperpigmentation using two surgical techniques (Clinical and histologic study)

Evaluation of the Effectiveness of the Carbon Dioxide (CO2) Laser in Minor Oral Surgery: A Systematic Review.

Introduction: Lasers in oral surgery have been extensively studied in recent years. Laser treatment is now a well-known technology that is frequently employed on oral soft tissues. The carbon dioxide (CO2) laser was one of the first soft tissue removal lasers. Because of the strong affinity of the CO2 laser to water, it is best used for removing, vaporizing, and coagulating these tissues. In minor oral surgery, CO2 laser therapy has shown advantages. Therefore, this study examined the CO2 laser use in minor oral soft tissue surgery. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were followed in this study. A question for research encompassing the inclusion criteria for the participants, intervention, comparison, outcome, and study design (PICOS) was formulated. The search queries were entered into the PubMed/Medline, Scopus, and Embase databases. Consideration was given to publications published between January 1, 2018 and March 15, 2023. Results: The research included 37 studies after narrowing search results, eliminating duplicate titles, and conducting an eligibility review (three animal studies, seven case reports, three case series, and twenty-four clinical studies). CO2 lasers alone or in combination with other therapies successfully treated oral potentially malignant disorders (OPMDs), oral tumors, oral fibrous-epithelial lesions, gingival melanin hyperpigmentation, pyogenic granuloma, socket preservation, mucocele, high labial frenulum attachment, and so on. CO2 lasers reduced intra- and postoperative complications and adverse effects, improved postoperative functional results, ablated tissues with precision, and minimized disease recurrence and malignant transformation. Conclusion: Our study found that the CO2 laser in oral minor surgeries is successful, but further randomized clinical trials and multicenter studies are recommended to compare CO2 laser surgery to other treatments.

Comparison of Diode Laser and Scalpel technique in the treatment of Gingival Melanin hyperpigmentation

Background: A smile can bring happiness into one’s life and also create positivity in the surrounding environment. Black or brown gums is a very common problem among all races of men and women that one complains to a periodontist. Depigmentation of melanin hyperpigmented gingiva can be carried out using scalpel and diode laser. Material & Methods: 10 patients having uniformly dense band of bilateral physiologic gingival hyperpigmentation on the facial aspect of maxillary and mandibular gingiva were included in this study. Each patient underwent initial phase 1 therapy (oral hygiene instructions, scaling and root planning) 1 week before the depigmentation procedure. A split mouth study was followed. In test group depigmentation was done by Laser and in control group depigmentation was done by scalpel. Followup was done at 1 week,1 month , 3 months and 6 months. Results: There was no statistical significance in plaque and gingival index in both the groups. At 6 months in group A, repigmentation was seen in 7 patients and in group B, repigmentation was seen in 6 patients. Conclusion: The methods used here produced desired results and above all, the patients were satisfied with the outcome, which is the ultimate goal of any therapy. The scalpel remains the gold standard because of its convenience and cost effectiveness, but with proper adhesion to safety measures, the diode laser can also be used to remove gingival pigmentation efficiently.

Evaluation of Surgical Scalpel Versus Semiconductor Diode Laser Technique in the Management of Gingival Melanin Hyperpigmentation Along with Crown Lengthening: A Split Mouth Randomized Clinical Comparative Study

Evaluation of Surgical Scalpel Versus Semiconductor Diode Laser Technique in the Management of Gingival Melanin Hyperpigmentation Along with Crown Lengthening: A Split Mouth Randomized Clinical Comparative Study

CLINICAL FEATURES OF GINGIVAL HYPERPIGMENTATION IN VIETNAMESE OUTPATIENTS

Background: Gingival esthetics was considered one of the most significant aspects of aesthetic smiles, especially in those with gingival hyperpigmentation. Understanding the features, distribution, and causes impacting gingival pigmentation was critical for developing an effective treatment plan. Objectives: The prevalence of gingival hyperpigmentation in outpatients at Can Tho University of Medicine and Pharmacy Hospital; the association between gingival hyperpigmentation and age, gender, smoking status, and skin color. Material and Methods: Descriptive cross-sectional method; convenience sampling. Results: In a total of 100 outpatients, the rate of gingival hyperpigmentation was 53%, of which 40% had mild gingival hyperpigmentation according to DOPI (grade 1), 13% had moderate gingival hyperpigmentation (grade 2), and 13% had heavy gingival hyperpigmentation disease (grade 3). The study collected 3/6 groups of gingival melanin hyperpigmentation according to Ponnaiyan's classification. Of all the hyperpigmentation groups according to Hedin's classification, the hyperpigmentation group forming a long continuous ribbon accounted for a high proportion (45% in the maxilla, 40% in the mandible). The rates of gingival hyperpigmentation in the group of 40-year-old patients and the others were 48.8% and 75%, respectively. Conclusion: There was a statistically significant relationship between gingival melanin pigmentation and skin color. The percentage of melanin pigmentation was higher in those with dark skin. There were no differences in the ratios for age, gender, or smoking status.

Transepithelial Gingival Depigmentation Using a New Protocol with Q-Switched Nd:YAG: An In Vivo Observational Study.

Gingival melanin hyperpigmentation is a para-physiological condition that may have a negative impact on smile esthetics. In the present study, the use of the Q-Switched Nd:YAG laser, according to a defined protocol, was proposed to treat Gingival Melanin Hyperpigmentation with a transepithelial approach. A total of 10 Patients with different grades of gingival hyperpigmentation were treated with Q-Switched Nd:YAG in one to four laser sessions without local anesthesia. The grade of depigmentation was evaluated by comparing Oral Pigmentation Index (OPI) and Melanin Pigmentation Index (MPI) at baseline and three weeks after the laser session. Additionally, oral discomfort rated by the Numeric Rating Scale (NRS) was recorded one, three, and five days after the procedure. Complete depigmentation was achieved in all cases. Patients reported no-little discomfort (NRS 0 to 3) during the laser session that lasted a maximum of five days. No major complications were reported, and no recurrences were observed at least after one year of follow-up. In addition, patients were available to be re-treated if necessary. These findings suggested that the Q-Switched Nd:YAG could be an effective and well-tolerated approach in the treatment of gingival melanin hyperpigmentation.

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.

Expression of tyrosinase gene in gingiva: A pilot study.

Melanin is the predominant pigment responsible for the color of skin, hair, iris of eyes, and oral mucosa. Tyrosinase (TYR) is the key enzyme involved in melanin synthesis. Studies in dermatology have shown a positive correlation between TYR enzyme levels and melanin pigmentation of the skin. However, no study has been conducted to assess TYR levels in the gingiva. Hence the present study was conducted to assess TYR levels in gingival melanin hyperpigmentation. To assess the TYR gene expression in gingiva in individuals with moderate to severe gingival melanin hyperpigmentation. Subjects with a chief complaint of blackish appearance of gums with an unesthetic smile were included in the study. Informed consent was obtained. Scaling and root planning were done and subjects were recalled after 2 weeks. The gingival depigmentation procedure was performed using the conventional scalpel technique under adequate local anesthesia. The selected sites underwent conventional gingival depigmentation technique using Bard-Parker handle no: 3 and blade no: 11. The excised layer of epithelium along with a thin layer of underlying connective was sent to the laboratory to assess the TYR gene expression by real-time polymerase chain reaction technique. The levels of the TYR enzyme activity in the gingival tissues from the selected sites were assessed. Table 1 and Graph 1 show the levels of TYR enzyme gene expression in the gingival tissue. TYR gene expression and the degree of gingival melanin hyperpigmentation are positively correlated. Hence the assessment of TYR enzyme activity in gingiva could be of great value in today's cosmetologically conscious individuals.

Comparison of Diode Laser and Conventional Method in Treatment of Gingival Melanin Hyperpigmentation

Purpose: The goal of this study is to compare the scalpel and diode laser methods for treating gingival hyperpigmentation in terms of postoperative discomfort and wound healing. Materials & Methods: Sixteen systemically healthy individuals diagnosed with light or moderate gingival hyperpigmentation were enrolled for this study. Patients were randomly assigned to one of two treatment groups: scalpel or laser. Dummett’s oral pigmentation index was recorded at baseline. Early wound healing and post-operative discomfort were evaluated on the 7th day by using the VAS form. Comparisons between the groups were tested using the Mann-Whitney U test and P-value < 0.05 was considered significant. Results: Total epithelization was observed in the laser group, whereas the epithelization was incomplete in the scalpel group at the end of the observation period. The pain perception on the first two days after the surgery was significantly higher in the scalpel group than in the laser group. (p=0,002 and p=0,038, respectively). No significant differences were found between the fourth- and seventh-day when surgical techniques were compared regarding pain perception (p>0,05). Similarly, pain perceptions of female and male individuals showed no significant difference (p>0,05). Conclusion: In the treatment of gingival hyperpigmentation, both surgical techniques were clinically successful. Although the treatment process was long, according to the results of our study, the laser technique is superior to the scalpel method in terms of patient comfort. The choice of the method may vary depending on the available equipment and the clinician’s preference or request of the patient.

Vitamin C as a non-surgical gingival depigmentation agent – Case study

The teeth and gums (gingiva) are an important component of an aesthetic smile. Gingival melanin hyperpigmentation results in an unaesthetic smile, especially in individuals with a gummy smiles. Vitamin C is a water-soluble vitamin that is essential for the growth and maintenance of healthy bones, teeth, gums, ligaments, and blood vessels and is involved in important metabolic functions. It has been used for the depigmentation of hyperpigmented spots on the skin. There is limited documentation on the use of Vitamin C as a depigmenting agent for gingival melanin hyperpigmentation. This article discusses the application of Vitamin C as a non-surgical gingival depigmentation agent.

Effects of ozonated olive oil and photobiomodulation using diode laser on gingival depigmented wound: A randomized clinical study

Objective:Photobiomodulation (PBM) using diode laser is regarded an effective modality for the repair of tissues and control of pain. Ozone, owing to its biocompatibility, healing, and antimicrobial properties, is used in dentistry as well. This study was carried to clinically compare and evaluate the healing of gingival depigmented wounds using ozonated oil and PBM.Materials and Methods:A laser depigmentation procedure was conducted on seven patients exhibiting bilateral upper and lower gingival melanin hyperpigmentation, followed by the application of ozonated oil (Group 1) and laser PBM (Group 2). The clinical parameters are taken namely Visual Analog Scale and Healing Index (HI), were evaluated on the 3rd, 7th, and 15th day.Results:Statistical analysis showed better HI in Group I as compared to Group II on the 3rd day, but it was comparable in both groups on the 7th and 15th day.Conclusion:The application of ozonated oil was found to be more efficacious in promoting the initial healing of wound in comparison to PBM. Both ozonated oil and PBM also showed the same capabilities in reduction of the postoperative pain.

GINGIVAL DEPIGMENTATION AND PINK AESTHETICS: A CASE REPORT

The colour of gingiva has a tremendous impact on the overall aesthetics of an individual. Clini­cally, gingival melanin hyperpigmentation is presented as ‘black gum’, which is a common aesthetic problem especially for those who have a gummy smile. It mainly affects the self-esteem, appear­ance, and confidence of an individual, and it can also have a psychological impact on many pa­tients. Gingival depigmentation can be carried out as part of its treatment using various methods. A case is reported here where scalpel surgery was performed.

Comparative evaluation of the efficacy of diode laser and cryosurgery (Using 1,1,1,2 tetrafluroethane) for the treatment of gingival pigmentation

Introduction: Cosmetic expectations have increased with time and pigmentation of gingiva is a negative factor in an otherwise acceptable “smile window”. Amongst the various treatment modalities for depigmentation like scalpel technique, cryosurgery, laser, abrasion etc, there seems to be a need to compare efficacy of cryosurgery with TFE and Diode laser. Objective: The objective was to compare the efficacy of cryosurgery with 1,1,1,2 tetrafluroethane and Diode Laser for the treatment of gingival pigmentation. Materials and Methods: A randomized controlled split mouth study was conducted for 10 patients with gingival pigmentation, wherein one quadrant was treated with the TFE cooled swab( Group A) and the other quadrant was treated using diode laser (980nm at 1W) (Group B). Pre and post treatment photographs, VAS pain scores, were evaluated by the clinician at 4 days, 1 week, 1month and also number of analgesics required to be taken by the patient following treatment with both the techniques. Results: Clinically significant results were seen in both the groups. Mild erythema was seen immediately after the application of cryogen following which a whitish slough could be separated from the underlying connective tissue at fourth day. In group B, a white fibrin slough was seen 24hrs after the procedure. The healing was uneventful and complete epithelialization takes place in 3-4 weeks in both the groups. Though, the patient acceptance was good for both the procedures, mild pain and discomfort was experienced by the patient in group B. Conclusion: Depigmentation of gingival melanin hyperpigmentation by cryosurgery using TFE and diode laser were found to be an effective procedures, however the patient compliance and acceptance was greater in Tetrafluoroethane cryosurgery when compared to the Diode laser. Keywords: Cryosurgery, Laser, Depigmentation, Tetrafluroethane.

Gingival peeling and periodontal aesthetics: a case report.

Melanic pigmentations (MP) are dark stains located on the masticatory mucosa. These pigmentations are consequence of the excess of melanin production by the melanocytes located in the basal layer of the epithelium, between epithelial cells and connective tissue cells. The MP of the periodontium are the results of the melanin granules transfer from the melanocytes to the keratinocytes, in a process called epidermal melanin. This study aims to report a clinical case of dermabrasion for treatment of gingival melanin hyper pigmentation of a female patient, 21 years of age, non smoker, under orthodontic treatment and without systemic alterations. This patient attended the Clinic of Specialization in Periodontics of the Brazilian Association of Dentistry (ABO) with the aesthetic of her smile as the chief complain, due to the excess of melanin on the gingival tissues, in the anterior superior region. The epithelial dermabrasion technique, with hand tools, promoted aesthetic results on the melanic depigmentation.

Dermoscopic findings in benign racial gingival melanin hyperpigmentation and evaluation of its surgical management

Background Dermoscopic features of mucous membrane pigmented lesions are not the same as present in the skin. A major esthetic problem for a lot of people is gingival hyperpigmentation. Even though it is not a medical issue, a lot of methods are used in the treatment of this problem. Objective To figure out dermoscopic patterns of benign racial gingival melanin hyperpigmentation and to assess the role of dermoscopic evaluation in its management. Patients and methods A total of 20 patients were included in this study. Their age ranged from 23 to 30 years. They were selected for depigmentation procedures in the esthetic zone using a scalpel blade. Dermoscopic imaging and analysis of the patterns were done for all lesions. Clinical parameters were recorded. Recurrences of pigmentation were evaluated by clinical and dermoscopic examination at 4 weeks, 6 months, and 12 months postoperatively. Results Dermoscopic features of benign racial gingival hyperpigmentation analyzed were dotted-globular pattern, pigment network pattern, fish scale-like pattern, and a hyphal pattern. All patients showed excellent gingival wound-healing response, with no adverse complications, and no repigmentation was observed. Conclusion Dermoscopy is effective in diagnosis and evaluation of management of gingival melanin hyperpigmentation. Surgical gingival depigmentation is effective in esthetic treatment of gingival melanin hyperpigmentation.

Evaluation of surgical scalpel versus semiconductor diode laser techniques in the management of gingival melanin hyperpigmentation: A split-mouth randomized clinical comparative study

Background:“Black gums” due to melanin pigmentation of the gingiva is one reason for the demand of cosmetic therapy. Clinicians are often faced with challenge to achieve gingival esthetics in such cases because of its recurrence. Although many procedures were described in literature for gingival depigmentation, only few are mentioning about the intensity of repigmentation. Hence, this study was designed to compare two different techniques for treatment of gingival melanin pigmentation.Materials and Methods:Twenty patients who were not esthetically pleased with the color of gingiva were selected. A randomized, split-mouth, depigmentation procedure was performed using surgical scalpel and diode laser techniques. Clinical parameters such as plaque and gingival index, bleeding, pain perception, wound healing, recurrence, and intensity of repigmentation were evaluated. Paired t-test and Chi-square test were used for analysis of data.Results:No bleeding was reported in patients treated with diode laser. Moderate pain was reported by patients treated with surgical scalpel, whereas none was reported in diode laser group. No statistically significant difference was observed for both treatment techniques in terms of wound healing, reappearance of gingival pigmentation, and intensity of the same at the end of 6 and 9 months postsurgically.Conclusion:Similar outcomes were observed for both the techniques. Few patients who resulted in no recurrence at 9 months were followed even up to 3 years. Hence, further studies should be done to know the underlying mechanisms. Keeping in mind of armamentarium and cost, surgical scalpel technique remained as the “gold standard” procedure for treatment of gingival melanin pigmentation.

CVDentus bur for epithelial abrasion in the treatment of melanin pigmentation: case report

Introduction: The gingival melanin hyperpigmentation (GMH) is resulted from an abnormal deposition of melanin, but it is not a pathology. However, GMH is an esthetic problem for some people. Some alternatives of treatment for this situation exist. The epithelial abrasion has been an interesting alternative because it has a satisfactory esthetic outcome, is a fast procedure, of easy execution, and low cost. Recently, tips adapted in ultrasound (CVDentus) can bean alternative approach. Objective: To report a clinical case of GMH treated by the technique of the epithelial abrasion with association of instrument adapted in ultrasound. Case report: Patient aged 28 years, melanoderm, sought treatment due to esthetic dissatisfaction because of intense dark color in the maxillary gingiva. The GMH removal was proposed through the technique of the epithelialabrasion CVD bur. Conclusion: The technique of epithelial abrasion using CVD bur was effective in removing GMH at one-year follow-up showing to be easy and safe technique.

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.

CVDentus bur for epithelial abrasion in the treatment of melanin pigmentation: case report

The gingival melanin hyperpigmentation (GMH) is resulted from an abnormal deposition of melanin, but it is not a pathology. However, GMH is an esthetic problem for some people. Some alternatives of treatment for this situation exist. The epithelial abrasion has been an interesting alternative because it has a satisfactory esthetic outcome, is a fast procedure, of easy execution, and low cost. Recently, tips adapted in ultrasound (CVDentus) can be an alternative approach. Objective: To report a clinical case of GMH treated by the technique of the epithelial abrasion with association of instrument adapted in ultrasound. Case report: Patient aged 28 years, melanoderm, sought treatment due to esthetic dissatisfaction because of intense dark color in the maxillary gingiva. The GMH removal was proposed through the technique of the epithelial abrasion CVD bur. Conclusion: The technique of epithelial abrasion using CVD bur was effective in removing GMH at one-year follow-up showing to be easy and safe technique.

Gingival depigmentation by free gingival autograft: a case series

A pleasing smile is desired by all, and forms the main focus of aesthetic dentistry. However, pigmented gums can be a major cause of embarrassment for patients, especially those with a gummy smile. Attempts have been made to meet these cosmetic demands by various methods such as using a surgical blade, diamond burs, electrosurgery, cryosurgery or a laser, but with limited results. Therefore, in the present case series, a free gingival autograft was used for treating gingival melanin hyperpigmentation with a follow-up of six months with no signs of repigmentation. CPD/Clinical Relevance: This review outlines a method of free gingival autograft as a treatment modality for gingival pigmentation.