A beautiful smile surely enhances the individual’s self-confidence. The esthetics of smile though majorly influenced by the color, shape, and position of the teeth, is also influenced by the color of the gingival tissues. The color of gingiva is influenced by the vascular supply, thickness and degree of keratinization of the epithelium, and presence of various pigments. Among these, the major factor contributing to the color of gingiva is melanin. Gingival hyperpigmentation does not pose any medical problem, but many patients may consider this an esthetic problem, particularly patients who have excessive gingival display or gummy smile. The most common cause is physiologic pigmentation i.e. melanin production, although some adverse habits such as smoking can further stimulate melanin pigmentation, and so intensity of pigmentation is also related to the duration of smoking and number of cigarettes consumed.
Treatment Modalities Gingival depigmentation is a treatment to remove melanin hyperpigmentation of the gingiva and various methods have been used for this procedure with different degrees of success including gingivectomy, gingivectomy with free gingival autografting, acellular dermal matrix allograft, electrosurgery, cryosurgery and abrasion with diamond bur. The drawbacks of these techniques are intraoperative and post-operative bleeding, need for anaesthesia, need of periodontal pack/dressing, risk of post-operative infection, edema etc.
Laser with different wavelengths have been used easily with well-tolerated and good esthetic outcomes. In depigmentation process the epithelial tissue exhibiting excessive melanin pigments is ablated using diode lasers. PIOON Laser offers various wavelengths that can either be used in contact or non-contact manner to perform this procedure. In the present case only topical anesthesia was applied, wavelength of 980nm was used in contact mode in scrapping motion at ablative settings for removal of the pigmented epithelium and a part of connective tissue, leaving behind the rest of connective tissue intact. After the procedure, laser bandage was done, postoperative instructions were given and patient was kept on follow up.
Hanaa M. El Shenawy et al in 2015 used 980nm wavelength and concluded that the use of diode laser is a safe and effective treatment modality that provides optimal aesthetics with minimal discomfort in patients with gingival hyperpigmentation. Eser Elemek in 2018 also suggested that the use of 810nm diode laser for gingival depigmentation resulted in complete healing with maximum esthetic outcome and minimum patient discomfort.
Rationale behind Use of Lasers Laser is absorbed by pigments (melanin and haemoglobin) in the soft tissue, thus making it an excellent modality for depigmentation procedure with minimal amount of bleeding. It also offers easy handling of tissues, less chairside time, potential decontamination and sterilization. It also forms protein coagulum on the wound surface which act as a biological wound dressing, sealing the ends of sensory nerve endings hence obsoleting the need of periodontal packs/dressings, thereby making the aesthetic laser treatment more acceptable for the patients.
Conclusion The use of a diode laser is a safe, effective, quick, and minimally invasive. They provide optimal aesthetics with reduced discomfort to the patients during and after procedure.
References - Hanaa M. El Shenawy et al. Treatment of Gingival Hyperpigmentation by Diode Laser for Esthetical Purposes. Open Access Maced J Med Sci. 2015 Sep 15; 3(3): 447–454 and Eser Elemek. Gingival melanin depigmentation by 810 nm diode laser. Eur J Dent 2018; 12:149-52.
Preoperative View (Courtesy- Dr. Sana Farista)
Postoperative View (Courtesy- Dr. Sana Farista)