Effect of laser on depigmentation of the gingiva

1. Effect of diode laser depigmentation on
gingival tissues
Mennatalla Ashraf , Hajar
Abdulsamad ,Amira Youssef
Elazzab ,Marwa Ahmed Fares
Under Supervision of:
A Porf Samah Kamel
Lecture D

2. 1
A beautiful smile highly depends on the
appearance of the teeth and gingival show. The
shape, position and color of the teeth, and level
and color of the gingival tissue play an
important role in smile harmony.

3. 1
 Gingival hyperpigmentation is a benign
condition which occurs due to excessive
melanin deposition (ethnic/physiologic) in
the basal and supra-basal epithelial layers.
Clinical pigmentation may not be a
medical problem, but it can be of cosmetic
concern to patients.
• Certain laser configurations specially target
soft tissues with affinity toward
hemoglobin and melanin, making lasers
highly efficient when used to treat soft
tissue problems.
Introduction

4.  It can be caused either physiologically or pathologically.
Physiologic gingival pigmentation (PGP) is the most common type, which results from excessive
melanin deposition. We classified PGP in patients as follows:
1. Mild: Pink to slightly brown
2. Moderate: Dark brown or black
3. Severe: Mixed in color
 Pathological disorders are also implicated in the pathogenesis of oral pigmentation, it may be
local or systemic factors including genetics, tobacco use, antimalarial agents and tricyclic
antidepressants may cause gingival pigmentation.
 Although gingival melanin pigmentation does not represent a pathological problem, patients
with a gummy smile or excessive gingival display usually complain of a “black gum” and
request cosmetic therapy.
Hyperpigmentation1

5. 1
Diode Laser
Depigmentation
 Gingival depigmentation is a treatment to remove melanin hyperpigmentation of the
gingiva by:
Gingivectomy chemotherapy.
Scalpel
technique
 some of these techniques are prone
to side effects and complications.
 Recently lasers have been used to
ablate cells containing and
producing the melanin pigment.

6. *
Comparison between scalpel technique
and laser technique:
 The findings of the present study suggest that gingival
depigmentation was effective with both scalpel and
laser techniques. However, the laser treated sites
showed reduced pain experienced by the patient.
 The operator comfort was better in case of laser
technique compared to scalpel technique.
 Recurrence rate of gingival pigmentation was faster in
scalpel technique as compared to laser technique.

7. Assessing Wound Healing After
One Week:
(A)Scalpel treated area on the
left quadrant.
(B) Laser treated area on the
right quadrant.
Bleeding during surgery was
compared between both techniques.
Laser treated areas showed relatively
less bleeding compare to scalpel
technique .

8.  Diode lasers exhibit thermal effects using the hot-tip effect
caused by heat accumulation at the end of the fiber; thus,
depigmentation is performed using only the tip of the fiber.
 Lasers allow for controlled cutting with a limited depth of
necrosis.
 It has an inherent ability to be absorbed within the
chromophores (wavelength-specific light-absorbing
substances) with a specific target tissue.
 In this way, they cause tissue-specific ablation in a layer-
by-layer and cell-by-cell manner.
 The damage of melanocytes decreases with depth.
 The remaining melanocytes may be fewer than normal, they
may produce enough melanin to re-pigment the newly
formed mucosa during and after the healing period.
Method of laser action

9. Procedure2
 Before applying the laser, the operating staff and the patients should wear
special laser-protective eye glasses corresponding to laser wavelength.
 Highly reflective instruments or instruments with mirrored surfaces
should be avoided.
 The dentist should check the patient’s gingiva and collect medical
information.
 In all cases, the entire surface of each maxillary and mandibular gingiva
that required treatment was irradiated in a single session.

10.  Precautionary postoperative instructions such as avoiding smoking and eating
hot and spicy food for the first 24 hours were given to all patients. Also patients
were advised not to traumatize the area during the healing period which is 4 -7
days after treatment.
 Exclusion criteria :Pregnant and lactating women, medically compromised
subjects, smokers and subjects having history of postsurgical keloid. Patients in
whom, gingival hyperpigmentation was associated with other syndromes,
lesions and conditions.
 No periodontal dressing was placed and no antibiotics were prescribed. The
procedure was completed within 20 to 25 minutes. The patients were then
followed up for 3 subsequent visits, after one week, one month then 3 months.

11. 3
 Diode lasers are very effective for
soft tissue applications including
incision, hemostasis and coagulation.
 Minimal swelling and scarring
 Less or no postsurgical pain
 There is no need of sutures or
surgical dressings
 There is no or very limited bleeding
 Diode laser is able to accelerate
wound healing, , to promote
angiogenesis, to augment growth
factor release and to prevent root
surface ablation.
 Smaller units in size as well as lower
financial costs are other beneficial
characteristics of diode laser.
 The diode lasers very effective
bactericidal action on periodontal
pathogens makes the adjunctive use
of antibiotics unnecessary.
Advantages

12. Side effects4
 The laser surgery has few disadvantages as:
 Delayed inflammatory reactions can occur with mild post-operative
discomfort lasting for 1-2 weeks.
 Epithelial regeneration may lag in comparison to that after conventional
surgery.
 In addition, the use of sophisticated equipment makes the treatment
quite expensive. A loss of tactile sensitivity can also occur when using
lasers .
 Some patients can experience slight swelling and redness after treatment.

13. 5 Results
Preoperative view showing diffuse melanin
pigmentation.
Post operative view 1 week later

14. Postoperative view one month later. Postoperative view three month later.

15. There was slight bleeding in only few cases
immediately after treatment, while the
remaining cases showed no bleeding signs.
There was a statistically significant change
in prevalence of bleeding after treatment,
as none of the cases showed any signs of
bleeding 1 week, 1 month and 3 months
after ablation.

16. References:
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877838/
( 15 Sep 2015)
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415499/
( 24 Oct 2016)
 https://jola.quintessenz.de/jola_2009_04_s0227.pdf (4,2009)
 https://europepmc.org/article/pmc/pmc5386779 (1, Mar 2017)
 https://www.oralhealthgroup.com/features/diode-lasers-for-
periodontal... (December 1, 2009)
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6062679/
(7 Aug 2015)