Gingival Pigmentation Research Articles

Comparison of Bur Abrasion and CO2 Laser in Treatment of Gingival Pigmentation: 6 Months Follow-Up.

Pigmentation of gingiva is an aesthetic problem. Until now, various methods have been introduced for removal of gingival pigmentation. The purpose of this study was to compare bur abrasion and CO2 laser methods in removing gingival pigmentation. Twelve patients aged 20-40 years old with the chief complaint of physiologic gingival pigmentation participated in this study. For these patients, gingival depigmentation was performed using two treatment modalities including bur abrasion and CO2 laser in a split-mouth design. Gingival depigmentation was performed in the right half of the anterior maxillary and mandibular sextants using bur abrasion method by means of diamond bur on a high-speed headpiece with vigorous water irrigation and the left half of the anterior maxillary and mandibular sextants using a CO2 laser. CO2 laser was set at: peak power 252 watts, repeat time 20 ms and pulse duration 200 microsecond which was used in a non-contact position. The area of pigmentation was calculated via gridlines in the Microsoft Paint software 1 and 6 months after the procedure. Gingival recession was also determined before, and at 1 and 6 months after the procedure. The area of gingival pigmentation was not statistically significantly different between the two treatment modalities before the procedure (p = 0.452), 1 month (p = 0.443) and 6 months after the procedure (p = 0.202). There was no statistically significant difference in the variance of pigmented area at different times in the two methods. In both CO2 laser and bur abrasion methods, the mean area of pigmentation was statistically significantly different in the follow-up period (p < 0/001), in a way that the change in the area of pigmentation was statistically significant 1 month after treatment (p <0.001) and also 6 months after treatment (p < 0.001) compared to before. The change in the area of pigmentation between 1 and 6 months after treatment was not statistically significant in both CO2 laser (p = 0.157) and bur abrasion method (p = 0.150). No increase in gingival recession was observed in any of the patients. Both treatment modalities can effectively treat gingival pigmentation. No increase in gingival recession was observed. Conventional method and CO2 laser were not statistically significantly different during a follow-up period of 1 and 6 months.

Clinical evaluation of platelet-rich fibrin membrane in the gingival depigmentation procedure: A case report

Gingival pigmentation, which is caused by the deposition of melanin pigment, may not be a medical problem but is still a primary esthetic concern for many people. Esthetic gingival depigmentation performed in such patients leads to excellent results. The platelet concentrate, which is often addressed as a windfall in the regenerative therapy in periodontology, accelerates wound healing by excellent neovascularisation. It also promotes fast cicatricle tissue remodeling. This case report highlights the effectiveness of Platelet-rich fibrin (PRF) membrane in the depigmentation procedure. Keywords: Gingival Depigmentation, Esthetics, Platelet-rich fibrin.

English

BACKGROUND Gingival melanin pigmentation (GMP) is a common aesthetic concern. The gold standard for depigmentation, is surgery. Recently soft tissue lasers have gained popularity. The purpose of this study was to compare and evaluate the clinical efficacy of surgical blade and laser treatment in terms of pain perception and wound healing outcomes, 7 and 14 days following the procedures for the treatment of gingival depigmentation. METHODS This 14 day follow up comparative clinical study, utilized a split mouth design, in the anterior region. Fifteen patients with moderate to heavy bilateral gingival pigmentation were included as per the criteria by Dummett et al. The patients’ right side (group 1) was treated with surgical blade and the left side (group 2) with diode laser (Picasso, AMD LASERS™) by a trained clinician. Pain perception was assessed using Visual Analog Scale (VAS) and wound healing was assessed using clinical parameters. RESULTS Data was analysed using paired t test and Wilcoxon’s signed rank test. P value of &lt; 0.05 was considered statistically significant. On day 7, more than 70 % patients had slight pain in group 1. Whereas, 47 % experienced no pain in group 2. The mean difference in VAS scores between the groups at day 7, was statistically significant. No statistically significant distinction in wound healing was observed 7 days following both procedures. No pain, and complete epithelialisation was noted in both groups on day 14. CONCLUSIONS Pain experienced by the patients was slightly more in the scalpel group compared to laser. There was no difference in wound healing between both groups. KEY WORDS GMP, Gingival Melanin Pigmentation, VAS Scale, Depigmentation, Wound Healing, Laser, Surgical Blade, Split Mouth Design

Correlation Of Skin Colour and Gingival Pigmentation Among Middle Aged Women In Chennai A Hospital Based Analysis

Correlation Of Skin Colour and Gingival Pigmentation Among Middle Aged Women In Chennai A Hospital Based Analysis

Penatalaksanaan Depigmentasi Gingiva Fisiologis dengan Teknik Sederhana (Laporan Kasus)

Background: Pigmentation of gingiva is a condition where the color of gingiva is purple, brown, or black instead of coral pink. Gingival pigmentation is caused by melanin pigment and occurs through three stages, namely melanocyte activation, melanin synthesis, and melanin expression. Gingival pigmentation can affect the aesthetic appearance of a smile. Thus, several depigmentation techniques are used to overcome this problem using a scalpel, laser, bur, cryosurgery, electrosurgery, and radiosurgery with respective pros and cons. Case: A 44-year-old woman complains regarding her upper front gum discoloration with a physiological gingival pigmentation. Result diagnosis: A case is reported herein, which conventional ablation depigmentation technique using bur. Conclusion: The method used in this case is recommended due to the easy, simple, and safe procedure, low cost, and less working time than the other techniques.

Gingival Depigmentation

Gingival hyperpigmentation is the condition where melanin deposition occurs in the suprabasal cell layers of the gingival epithelium. Gingival hyperpigmentation is a multifactorial benign condition which causes esthetic concern to the person. Melanin is a nonhemoglobin-derived pigment formed by melanocytes, which are dendritic cells of neuroectodermal origin in the basal and spinous layers. Melanin is a brown-colored pigment, and it is the result of endogenous pigmentation. The deposition of melanin pigment darkens the color of the gingiva. Many individuals visit the dentist or periodontist to seek the treatment of hyperpigmentation of the gingiva. Gingival pigmentation is usually considered as a genetic factor and affects different races differently. Various treatment modalities are available to remove gingival hyperpigmentation which includes scalpel technique, abrasion using diamond bur, laser therapy, electrosurgery, cryotherapy, chemical cauterization, depigmentation followed by gingival autografts, or platelet-rich fibrin. The present case report describes the case of gingival hyperpigmentation managed by scalpel technique and abrasions by diamond bur which is a simple and a cost-effective technique with satisfactory results.

ESTHETIC MANAGEMENT OF GINGIVAL HYPERPIGMENTATION USING LASER AND SCALPEL TECHNIQUE – CASE SERIES

The complaint of darkly pigmented gums is common particularly in patients having a very high smile line and possess esthetic problems for them. The degree of gingival pigmentation depends on melanoblast activity. Various treatment options are in practice for depigmentation which include scalpel gingivectomy, free gingival graft surgery, use of chemicals, such as 90% phenol and 95% alcohol, bur abrasion, electrosurgery, cryosurgery, and lasers. Among the various techniques, lasers offer a promising therapeutic option since it is simple, painless, and predictable. The laser has been recognized as the most effective and reliable technique having many advantages as compared to other conventional treatment modalities. It provides a bloodless and painless surgery. KEYWORDS: Scalpel, LASER, depigmentation, esthetics.

Correlation of Skin Colour and Gingival Pigmentation Among Middle-Aged Women in Chennai A Hospital-Based Analysis

The aim of the study was to correlate gingival pigmentation skin colour among middle-aged women since middle-aged women tend to undergo drastic hormonal changes which can result in gingival hyperpigmentation. Female patients with a mean age of 40 years were categorised as fair, medium-dark on the basis of skin colour and they were correlated with the level or amount of gingival pigmentation. The level of gingival pigmentation increases along with the level of skin pigmentation from fair to dark which is proved as statistically significant with a P-value of 0.017. Gingival pigmentation is one of the major aesthetic concerns, especially in women with the limitation of the study it is found that the level of gingival pigmentation increased along with an increase in the intensity of skin pigmentation.

Rejuvenating the smile with dental and gingival harmony- A case report

Appearance of dentition is of concern to a large people seeking dental treatment. People are giving a lot importance to the red and white aesthetics i.e the teeth and the gums. Apart from just colour of these dental components, harmony within these structures is of utmost important which includes shade, shape and size of teeth along with gingival esthetics. Gingival esthetics includes gingival architecture along with its colour Principles of esthetics must be followed for beautiful result. With introduction of digital smile designing, work on improving smile became more predictable. Using the technology, it becomes easy to guide best esthetics possible. Communication with patient showing their future result is possible. Due to high cost and need for special software makes it impossible to use for every patients seeking for smile correction. This case report describes the conventional and innovative approach of smile designing using an acrylic guide for correcting dimensions of teeth and ginigival zenith postion. Gingival pigmentation was also corrected to obtain esthetically pleasing gingival. Proper mock-up of diagnostic cast following all the rules of esthetics was done to visualize the final outcome. With introduction of veneers, conservative tooth preparation with high esthetics gain has become popular for management of unesthetic teeth. Keywords: Smile design, Digital smile design, Mock up, Gingival zenith, Veneers.

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.

Prevalence of gingival pigmentation patterns and its correlation with gingival phenotype and gender in an Indian population

Prevalence of gingival pigmentation patterns and its correlation with gingival phenotype and gender in an Indian population

Efficacy of 980 nm diode laser and 2940 nm Er: YAG laser in gingival depigmentation: A comparative study.

Gingival hyper-pigmentation is an esthetics problem in patients with excessive gingival display. Laser ablation has been suggested recently as the most effective, pleasant, and reliable technique for gingival depigmentation compared to blade surgery. The present study aimed to identify and compare the effectiveness of two types of lasers, Er:YAG laser-2940nm and Diode laser-980nm, in gingival depigmentation in the maxilla and mandible. 20 participants, 16 males, and 4 females, whose ages ranged between 18 and 35years, were recruited using simplified random sampling. Oral pigmentation was measured at pre- and two postoperative follow-ups, 1month, and 6months, according to the oral pigmentation index. Furthermore, the study assessed postoperative intensity of pain using the Visual Analogue Scale, bleeding and healing process in both groups. There was a significant decrease in the oral pigmentation index scores, 1month (0.90±0.64) and 6months (1.55±0.60) after the operation (P<.001). No significant differences were detected between the two study groups regarding the mean ranking on the oral pigmentation index pre-operatively (P=.547), 1month after the operation (P=.154), and 6months after the operation (P=.831). The Er:YAG laser and Diode laser both significantly reduced gingival pigmentation with no significant differences between the effectiveness of the two types of laser in treating gingival hyper-pigmentation.

A Concise Review of Gingival Depigmentation Techniques and Re-Pigmentation

Gingiva pigmentation has an impact on patient’s esthetics and formulates pscyhological negativity. Gingivalpigmentation is most predominant and endogenous pigmentation among oral mucosa. The gingivalpigmentation can be physiologic and pathologic. It can be a genetic trait in some population. The physiologicmelanin pigmentation does not possess a medical problem, it is mainly associated with individuals withhigh smile line and excessive gingival display. Pigmentation of gingiva is due to deposition of melanin inbasal and suprabasal layer of epithelium. The gingival depigmentation is a esthetical correction techniquewhere hyperpigmentation is removed. The treatment depends on patient need and skin complexion. Propertreatment method is required for treating the unesthetic gingival pigmentation. Perio-esthectic is focused onproper equilibrium of both pink and white(teeth) tissue. To overcome this problem wide array of methodare put forth which include scalpel method, cryosurgery, gingival ablation method, electrocautery, chemicalmethod, lasers and grafts. Each technique has its own advantages and disadvantages.

Comparison between Scalpel and Laser technique for gingival depigmentation-A Split mouth study.

INTRODUCTION An esthetic smile is a perfect balance between hard and soft tissues of the mouth. Gingiva plays an important role in the esthetic appearance of an individual. Gingival pigmentation is considered to be unaesthetic by patients, and it may have a psychological impact on them. Gingival depigmentation is a periodontal plastic surgery procedure, and variety of depigmentation techniques have been described in the literature. The aim of this study was to compare the efficacy of diode laser and scalpel in gingival depigmentation procedure. MATERIAL AND METHOD A total of 12 patients with age range between 20 -40 years were selected in the randamized, split mouth study. The maxillary arch was divided into two segments: 1.Segment I- right first premolar to right central incisors. 2.Segment II- left first premolar to left central incisors. These two segments were randomly assigned to surgical scalpel and diode laser techniques modalities. The research included the following clinical evaluation parameters at baseline and 3 months: Dummet Oral Pigmentation Index (DOPI) by Dummet and Gupta (1964)and VAS for pain. RESULTS There is clinically no significant difference between the Dummet Oral Pigmentation Index (DOPI)and Visual analogue scale for pain between Laser and Scalpel for gingival depigmentation. CONCLUSION Therefore, within the limitation of this study it can be concluded that scalpel technique is still considered the gold standard treatment for gingival depigmentation. KEY WORDS- diode laser, Visual analogue scale (VAS), Dummet Oral Pigmentation Index (DOPI).

Evaluation the rate of recurrence of gingival pigmentation removed by cryotherapy and electrosurgery for 6 months

Evaluation the rate of recurrence of gingival pigmentation removed by cryotherapy and electrosurgery for 6 months

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.

Assessment of Parameters Influencing Physiologic Gingival Pigmentation Using a Novel Classification System

Background: Depigmentation has become an important treatment modality among the general population due to the growing esthetic concern about the pigmentation. Previous studies have not considered parameters such as anatomical distribution of gingiva, intensity of pigmentation, and skin color in their classification systems. The purpose of this study was to assess physiologic gingival pigmentation in individuals based on certain gingival parameters and their correlation with skin color for better treatment strategies using a new classification system. Methods: The study was carried out in Ragas Dental College using a cross-sectional design. A total of 112 female dental students were examined for skin color and gingival parameters. The facial gingiva of upper anterior teeth was assessed for gingival phenotype, intensity and distribution of pigmentation. Descriptive statistics were used to describe the data and the associations between variables were done using chi-square test (P < 0.05). Results: It was found that skin color has a significant association with the intensity of pigmentation (P = 0.0001). In both dark and fair skinned individuals, Class II pigmentation (47%, 23.2%) with thick phenotype (62.5%, 35%) was most prevalent. Dark-skinned individuals were also found to have a generalized distribution of melanin pigmentation (19%) with high intensity of pigmentation (28.5%) predominantly. Fair-skinned individuals had a patchy distribution of melanin pigmentation with low intensity of pigmentation (37%). Conclusions: The association of skin color with various parameters affecting gingival pigmentation can help in determining the depigmentation treatment strategies.

Gingival Depigmentation: A Surgery for Aesthetics

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Penatalaksanaan Perawatan Hiperpigmentasi Pada Gingiva Dengan Metode Scrapping Menggunakan Pisau Bedah: Studi Kasus

Hyperpigmentation is a disorder of the gingiva caused by various factors including heredity, disease, drugs, smoking habits. This can occur because of the accumulation of melanin pigment in the basal gingival layer resulting in a brownish or blackish color on the surface of the gingiva which when viewed aesthetically is not good because it is not like the normal gingival color of coral pink. Objective: to get the gingival color back to normal, namely coral pink. Management in cases of pigmentation using the surgical method by scrapping using a scalpel No.15. In this study there were 3 cases, namely, case 1, a 20-year-old female patient had genetic or genetic hyperpigmentation. Case 2, a 27-year-old male patient had genetic or genetic hyperpigmentation. Case 3, a 24-year-old female patient had gingival pigmentation due to smoking habits. The results of surgical management in all three cases, namely the gingival depigmentation method by scrapping gave a good esetetic result, but for gingival hyperpigmentation in cases 1 and 2 it could recur later.

The Pseudolesions of the Oral Mucosa: Differential Diagnosis and Related Systemic Conditions

Pseudolesions are defined as physiological or paraphysiological changes of the oral normal anatomy that can easily be misdiagnosed for pathological conditions such as potentially malignant lesions, infective and immune diseases, or neoplasms. Pseudolesions do not require treatment and a surgical or pharmacological approach can constitute an overtreatment indeed. This review aims to describe the most common pseudolesions of oral soft tissues, their possible differential diagnosis and eventual related systemic diseases or syndromes. The pseudolesions frequently observed in clinical practice and reported in literature include Fordyce granules, leukoedema, geographic tongue, fissured tongue, sublingual varices, lingual fimbriae, vallate papillae, white and black hairy tongue, Steno’s duct hypertrophy, lingual tonsil, white sponge nevus, racial gingival pigmentation, lingual thyroid, and eruptive cyst. They could be misdiagnosed as oral potential malignant disorders, candidiasis, Human Papilloma Virus (HPV)-related affections, oral autoimmune diseases, or benign and malignant tumors. In some cases, pseudolesions feature in a syndromic panel, for example, fissured tongue in Melkersson–Rosenthal syndrome. It is strictly fundamental for dentists to know and to distinguish oral pseudolesions from pathological conditions, in order to avoid overtreatment.