Dental Tribune United Kingdom Edition

June 4-10, 2012United Kingdom EditionClinical22 Treatment of gingival hyperpigmentation Drs Prabhuji, S Madhupreetha and V Archana discuss using the diode laser for aesthetic purposes T he colour of the gingiva is various among differ- ent individuals and it is thought to be associated with cutaneous pigmentation. It de- pends on the vascular supply of the gingiva, epithelial thick- ness, degree of keratinisation of the epithelium and the pres- ence of pigmented cells. Oral pigmentation is the discolouration of the mucosa or gingiva. It can be either due to physiological or patho- logical conditions. Melanin, a brown pigment, is the most common pigment associated with the etiology of oral pig- mentation. Gingiva is the most com- mon site of pigmentation in the oral cavity. This hyperpig- mentation is seen as a genetic variation in some populations independent of their age and sex. Hence it is termed as physiological or racial gingival pigmentation. Melanosis of the gingiva is frequently present is dark skinned ethnic groups as well as in different medical conditions. Although pigmen- tation of the gingival is com- pletely a benign condition, is an aesthetic problem in many individuals. Gingival depigmentation is a periodontal surgical proce- dure in which the gingival hy- perpigmentation is eliminated or reduced by different tech- niques. Gingival depigmentation Various depigmentation tech- niques have been employed with similar results .Selection of a technique should be based on clinical experience and in- dividual preferences. The various methods in- cludes gingivectomy, gingivec- tomy with free gingival auto grafting, electrosurgery, cryo- surgery, radiosurgery, chemi- cal agents such as 90 per cent phenol and 95 per cent alcohol, abrasion with diamond bur, Nd:YAG laser, semiconductor diode laser and CO2 laser. One of the most common techniques for depigmenta- tion is the surgical removal of undesirable pigmenta- tion using scalpels. In this procedure, gingival epithe- lium is removed surgically along with a layer of underly- ing connective tissue. The de- nuded connective tissue then heals by secondary intention. Laser ablation of gingival depigmentation has been rec- ognised as one of the effective techniques. Different lasers have been used for gingival depigmentation including carbon dioxide (10.600nm), diode (810nm), Neodymium: Yttrium Aluminium garnet (1.064nm) and Erbium: YAG (2.940nm) lasers. The diode laser was intro- duced in dentistry a few years back. The diode laser is a sol- id-state semiconductor laser that typically uses a combina- tion of Gallium (Ga), Arsenide (Ar), and other elements, such as Aluminium (Al) and Indium (In), to change electrical ener- gy into light energy. It also can be delivered through a flex- ible quartz fibre optic hand- piece and has a wavelength of 819nm.This energy level is absorbed by pigmentation in the soft tissues and makes the diode laser an excellent hemo- static agent. It is used for soft tissue removal in a contact mode. The power output for dental use is generally around two to 10 watts. It can be either pulsed or continuous mode. The present case series de- scribes simple and effective depigmentation techniques Fig 2 Use of the FOX diode laser to treat gingival pigmentationFig 1 Pre-op situation Fig 3 Immediate post-op situation Fig 5 Three months post-opFig 4 One week post-op Fig 6 Pre-op situation Fig 8 Immediate post-op situationFig 7 Use of the FOX diode laser to treat gingival pigmentation Fig 9 One week post-op ‘One of the most common techniques for depigmenta- tion is the surgical removal of undesir- able pigmentation using scalpels’