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ePaper created 2016-07-29, 16:53:04 | version 1.38.0
| research 06 laser 2 2016 Er,Cr:YSGG treatment of gingival melanin hyperpigmentation Authors: Dr Habib Zarifeh, Dr Monique Hanna & Dr Dany Salameh, Lebanon Introduction Inthepastfewdecades,theimprovementofintra- oral soft tissue aesthetics has become a significant element in clinical dentistry, including gingiva, which isthemostcommonlyaffectedintraoraltissue,caus- inganunpleasantappearance.1, 2 Infact,oralpigmen- tationisadiscolorationoftheoralmucosaorgingiva due to several exogenous and endogenous factors, such as drugs, heavy metals, genetics, endocrine dis- turbance, and inflammation.3–5 Also, melanin produced by melanocytes can cause melanin pigmentation,3–5 varying from light to dark brown or black, according to the quantity and distri- bution of active melanin in the tissue.4 Oral pigmen- tation occurs in people of all races.6 Indeed, oral pig- mentation increases in darker-skinned individuals. However, there is no difference in the number of me- lanocytes between fair-skinned and dark-skinned people. The variation is related to differences in the activity of melanocytes.7 Severalprocedureshavebeensuggestedforgingi- val depigmentation, varying from bur abrasion, sur- gical scraping, cryotherapy, and electrosurgery to laser therapy. Various lasers, such as carbon dioxide (CO2) laser, Nd:YAG laser, semiconductor diode laser, argon laser, Er:YAG laser and Er,Cr:YSGG laser, have been indicated as an efficient, pleasant and reliable method with minimal postoperative discomfort and faster wound healing for depigmentation proce- dures.8 Ahealthy39-year-oldmalewithnoprevioussurgi- calhistoryandnoallergiesandnocurrentmedication had a chief complaint of dark pigmented areas in the anteriorpartoftheupperandlowermaxillarygingiva, stating that he was an occasional smoker. During the clinical examination, no abnormalities nor gum dis- easewererevealed,butdeepmelaninpigmentationin theupperandlowermucosa,alongwiththemarginal gingiva, was noticed. This lead to a dark gum colour and by consequence a less aesthetic smile (Fig. 1). Laser depigmentation procedure was planned. The process was explained to the patient and his consent obtained. Digital images of the pigmented gingiva were takenpreoperativelyandonpostoperativevisits.La- ser safety protocols were respected. The patient was treated with local anaesthesia. A Er,Cr:YSGG laser of Fig. 2 Fig. 1 Fig. 1: Melanin pigmentation (preoperative photo). Fig. 2: Melanin depigmentation procedure. 22016