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ePaper created 2016-07-29, 16:53:04 | version 1.38.0
07 2 2016 laser research | 2,780 nm was used with the following parameters: goldhandpiece,Z6tip,60 %water,40 %air,HMode, 3.0 W,20 pps,directionofthetipwasslightlyparallel or with 30 degree to the gum surface (Fig. 2), up to thesecondpremolaronboththerightandleftsideof the maxillary and mandibular anterior gingiva. We worked at a distance of 2 to 3 mm in non-contact mode with 30 degrees to the gum surface, with slow shaving movements until the removal of the pig- mented layers of the epithelial cells and the connec- tive tissue to remove melanin pigmentation (Figs. 3 & 4). After the total removal of the pigmented layers of the gum (Fig. 5), an additional application of the Er,Cr:YSGG of 2,780 nm was done using different pa- rameters: gold handpiece, Z6 tip, 0 % water, 0 % air, non-contact mode, S Mode, 2.0 W, 50 pps, direction of the tip 45 degrees to the gum surface. The aim of this procedure was to dehydrate the surface of the connective tissue and by consequence melting the nerve endings, which in the end leads to a reduction or absence of postoperative pain. This method is also referred to as “laser bandage”. Thepatientwasprescribedsalinemouthwashthree times daily for one week, as well as application of vitamin E three times daily for seven days and para cetamol500 mg,twotabletseveryeighthoursincase of pain. The patient was advised to avoid hot meals during the first couple of days after surgery. No infection or significant postoperative complica- tions, such as pain or bleeding, were encountered. The patientwasreviewedtwo,fourandsevendaysafterthe procedure (Figs. 6–8). The fifteen-month follow-up showednosignsofrecurrenceofthepigmentation. Discussion Numerous modalities for depigmentation have been used and described in the literature. First, re- moving pigmented layers can be performed by using chemical methods9 or surgical methods such as sur- gical scalpel technique10 , surgical abrasion9 , cryosur- gery11, 12 , electrosurgery13 and laser14–17 . Chemical methods are not recommended because the chemical action cannot be restricted to the oper- Fig. 4 Fig. 6 Fig. 8 Fig. 3 Fig. 5 Fig. 7 Fig. 3: Immediate comparison after depigmentation of half of the upper-maxilla gingiva. Fig. 4: Immediate comparison after depigmentation of the upper-maxilla gingiva. Fig. 5: Immediate postoperative photo of the depigmentation of the upper and lower maxillary gingiva. Fig. 6: Postoperative appearance of the gingiva after two days. Fig. 7: Postoperative appearance of the gingiva after four days. Fig. 8: Postoperative appearance of the gingiva after seven days. 22016