This document discusses gingival depigmentation, which is a treatment used to remove excess pigmentation from the gums for aesthetic reasons. It first covers the epidemiology, physiology, and biochemistry of oral pigmentation. It then discusses the classification and distribution of pigmentation, as well as physiological versus pathological pigmentation. The document outlines various treatment procedures for depigmentation including scalpel surgery, cryosurgery, laser ablation, and chemical peeling. It notes that techniques like cryosurgery and lasers have better aesthetic results and lower recurrence rates of pigmentation compared to other methods. The conclusion recommends randomized controlled studies to further evaluate techniques.

1. GINGIVAL
DEPIGMENTATION
DR PRIYANKA N
IST YEAR MDS
DEPARTMENT OF PERIODONTOLOGY

2. INTRODUCTION
EPIDEMIOLOGY
PHYSIOLOGY OF ORAL PIGMENTATION
BIOCHEMICAL EVENTS IN PIGMENTATION
ETIOLOGY
CLASSIFICATIONS
DISTRIBUTION AND INDEX FOR PIGMENTATION
TYPES OF PIGMENTATION – PHYSIOLOGICAL PIGMENTATION
- PATHOLOGICAL PIGMENTATION
TREATMENT PROCEDURES
REPIGMENTATION
RECENT MODALITIES USED FOR GINGIVAL DEPIGMENTATION
CONCLUSION
REFERENCES

4. (Çiçek Y. et al, The Normal and Pathological Pigmentation of Oral Mucous
Membrane: A Review. 2003)
• Oral pigmentation occurs in all races of man though there range varies
from one race to another.
• There were no significant differences in oral pigmentation between males
and females.
• The intensity and distribution of racial pigmentation of the oral mucosa is
variable, not only between races, but also between different individuals of
the same race and within different areas of the same mouth.
• Physiologic pigmentation is probably genetically determined, but as
Dummett suggested, the degree of pigmentation is partially related to
mechanical, chemical, and physical stimulation.
• In darker skinned people oral pigmentation increases, but there is no
difference in the number of melanocytes between fair-skinned and dark-
skinned individuals

5. • The variation is related to differences in the activity of melanocytes.
• Physiological pigmentation of the oral mucosa (mostly gingiva), is clinically
manifested as multifocal or diffuse melanin pigmentation with variable amounts
in different ethnic groups worldwide and it occurs in all races.
• In Caucasians, most melanocytes have striated granules that are incompletely
melanized and vary in size from 0.1 to 0.3 mm. But, the amount is insufficient
to cause pigmentation (less than 10% demonstrate pigmentation).
• A high amount of melanin granules is found in individuals of African and East
Asian ethinicity.15 In dark-skinned and black individuals, an increased melanin
production has long been known to be the result of genetically determined
hyperactivity of melanocytes.
• Melanocytes of dark skinned and black individuals are uniformly highly
reactive, whereas in light skinned individuals, melanocytes are highly variable
in reactivity

8. Round cells with pale staining
cytoplasm.
Lack desmosomes and
tonofilaments but possess long
dendritic processes.
Prescence pf melanosomes.
Replicate throughout their life
although at a much slower rate.

17. Melanin synthesis can be controlled by three major determinants :
- GENES
- UV RADIATIONS
- HORMONES
 Melanocyte Stimulating Hormone(MSH)
 Adreno-Corticotrophic Hormone(ACTH)
 Androgens

55. Patient’s Skin Color
Extent Of Gingival Pigmentation
Lip Line
Upper Lip Curvature
Esthetic Concern
Expectation From The Treatment

69.  Pigmented areas are touched lightly with No. 135 ball-shaped electrodes
or tapping the area with the No. 134 L-shaped electrodes using fully
rectified cut mode (power setting at 11) for thick, hard gingiva and
partially rectified coagulation mode (power setting at 7) for gingiva soft
in consistency and near the mucogingival junction.
 Tiny electrodes (2 mm ACE electrode) are employed in narrow
interdental papillary regions.
 Mahesh et al. observed that depigmented areas treated with RS showed
minimal recurrence compared to conventional (slicing) treatment after
90-day follow-up.
 Based on Oringer's exploding cell theory,he electrically generated
thermal energy influences the molecular disintegration of melanin cells
that are present on the basal and suprabasal cell layer of operated
gingival sites. It was proposed that the LH of RS had some influence on
retarding the development and migration of melanocytes, making RS
more efficient in surgical depigmentation over conventional procedures.

85. CONCLUSION:
The results of this study highlight the effectiveness of dental
lasers, particularly the diode laser for GD. It shows very
promising results in comparison to Er:YAG laser, when
postoperative pain, bleeding, and pigmentation recurrence are
considered. Nonetheless, Er:YAG laser provides a better
tissue healing cascade. Also, we confirm that laser ablation
can be performed without the use of anesthesia provided the
laser parameters are well controlled

86. It is a treatment method used to destroy the overlying gingival epithelium using a
chemical peeling agent.
A variety of chemical agents are available such as phenols, salicylic acid, glycolic
acid,and trichloroacetic acid.
The most commonly used are phenols and alcohols. In a study by Hirschfield in
1951, pigmented gingiva was burnt out by destroying tissue down to and slightly
below the basal layer of mucous membranes using amixture of 90% phenol and
95% alcohol.
However, repigmentation and relapse occurred in all cases shortly after the
application of either agent. As phenols may induce cardiac arrhythmias, cardiac
monitoring is necessary. The inability to control the depth of penetration and
amount of destruction are the main drawbacks of this method. Thereby, these
methods are no longer in use and are unacceptable to the clinicians as well as
patients.

114. • Demand for depigmentation therapy is mostly seen in patients with the
excessive gingival display.
• Gingival biotype, clinician’s expertise, patient preferences, and recurrence
rate, greatly determine the selection of a technique.
• Although a wide range of techniques have been employed, cryosurgery
followed by lasers has been reported to be superior techniques with better
esthetic results and low rate of recurrence.
• Relapse or repigmentation is a critical concern and depends on the
technique employed and follow-up period.
• Majority of the available literature is comprised case reports.
• Hence, authors recommend the conduct of randomized controlled
longitudinal studies to identify the efficiency and effectiveness of
available techniques.

115.  Clinical Periodontology – Carranza , 10th edition
 Burket’s Oral Medicine – 11th Editon
 Cawsons Essentials of Oral Pathology and Oral Medicine – 7th Edition
 Verma S, Gohil M, Rathwa V. Gingival depigmentation. Indian J Clin Pract
2013;23:801e3.
 Dummett CO, Barrens G. Pigmentation of oral tissues: a review of literature.
J Periodontol 1967;38:360e78
 Kumar S, Bhat GS, Bhat KM. Development in techniques for gingival
depigmentation an update. Indian J Dent 2012;3(4):213e21.
 Dummett, Clifton O.: Normal and abnormal pigmentations of the oral
mucosae. Dermat. Dig., 5:41-9, Jan., 1966
 Dummett, C. O.: A classification of oral pigmentations.Mil. Med., 127:837,
Oct., 1962.
 Hirschfeld I, Hirschfeld L. Oral pigmentation and method of removing it. Oral
Surg Oral Med Oral Path 1951;4:1012.
 Bergamaschi O, Kon S, Doine AI, Ruben MP. Melanin repigmentation after
gingivectomy: A 5-year clinical and transmission electron microscopic study in
humans. Int J Periodontics Restorative Dent 1993;13:85-92.

116.  Patil KP, Joshi V, Waghmode V, Kanakdande V. Gingival depigmentation: A split
mouth comparative study between scalpel and cryosurgery. Contemp Clin Dent
2015;6:S97-S101.
 Dhafer S. Alasmari-An insight into gingival depigmentation techniques: The pros
and cons:International Journal of Health Sciences:Vol. 12, Issue 5 (September -
October 2018)
 Raaman AR, Pratebha B, Jananni M, Saravanakumar R. Comparison of efficacy
of depigmentation of gingiva in terms of ImageJ intensity values and surface
area of repigmentation using scalpel and diode laser. Int J Oral Health Sci
2016;6:59-64.
 Diana Mostafa and Shaden M. Alotaibi:A Successful Esthetic Approach of
Gingival Depigmentation Using Microneedling Technique and Ascorbic Acid
(Vitamin C) Hindawi Case Reports in Dentistry,Volume 2022, Article ID
3655543
 Mahajan G, Kaur H, Jain S, Kaur N, Sehgal NK, Gautam A. To compare the
gingival melanin repigmentation after diode laser application and surgical
removal. J Indian Soc Periodontol 2017;21:112-8
 Mandal S, Bose S, Choudhuri P, et al. Esthetic correction of gingival
pigmentation using different techniquescase reports. J. Evolution Med. Dent. Sci.
2020;9(13):1102-1105,
 Çiçek Y. The Normal and Pathological Pigmentation of Oral Mucous Membrane:
A Review. J Contemp Dent Pract 2003 August