Melanin hyperpigmented gingiva is an esthetic problem in many individuals, particularly if the hyperpigmentation is on the facial aspect of gingiva and visible during smile and speech, especially in patients with gummy smile. The normal appearance of the gingiva is pink to light red, with stippling “orange peel texture.” The normal color depends on melanogenesis and distribution of melanin pigment, keratinization, depth of epithelialization, and vascularity of the gingiva.
Pigmentations of oral soft tissues for patients is dominantly an aesthetic problem as lifestyle, social media, and community influence can affect people’s perception of beauty, which has a big impact on the person’s self-confidence and could affect their social interaction and careers.
Gingival depigmentation has been carried out using surgical, chemical, electrosurgical, and cryosurgical procedures. Recently, laser ablation has been recognized as one of the most effective, comfortable, and reliable techniques. Many laser systems such as Q switched Ruby laser, flash-lamp pumped-dye laser, argon laser, CO2 laser, Nd:YAG laser, and Er:YAG laser have been used for dermal depigmentation. Each technique has its own advantages and disadvantages.
The following case show successful depigmentation using an Er,Cr:YSGG laser and gummy smile correction by gingivectomy and lip lengthening.
A 20 year old female patient reported to our clinic with chief complaint of darkened gums and gummy smile. The pigmented regions were most pronounced in the anterior region and the color of the gingiva was dark to black.
An Er,Cr:YSGG system laser (Waterlase, Biolase) was used for gingivectomy and removal of pigmented gingiva. The gingivectomy procedure was performed from upper right to left first molar. For correction of gummy smile, lip lengthening V-Y plasty was performed using scalpel and 3-0 vicryl sutures were placed. On the final healing at 4 weeks, gingiva appeared pale pink which was satisfactory for both patients and operator.
In this case, the use of Er,Cr:YSGG laser for depigmentation of gingiva resulted in complete healing. It was also shown to be a safe and effective method for acceptable esthetic result and maximum patient comfort.
Treatment of gingival hyperpigmentation by Er,Cr:YSGG laser radiation in a defocused mode was found to be a safe and effective procedure. Postoperative patient satisfaction in terms of esthetics and pain was excellent.
The gingiva healed uneventfully and completely regenerated with no infection, pain, swelling, or scarring. Treatment of gingival hyperpigmentation by Er,Cr:YSGG laser radiation in a defocused mode was found to be a safe and effective procedure. Postoperative patient satisfaction in terms of esthetics and pain was excellent. The gingiva healed uneventfully and completely regenerated with no infection, pain, swelling, or scarring.
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