Comparative Evaluation of Clinical Efficacy of Diode LASER and Cryosurgery for Gingival Pigmentation: A Split-Mouth Randomized Clinical Study

ABSTRACT Objective: To compare and evaluate the clinical efficacy of diode laser and cryosurgery for treating melanin pigmentation of gingiva. Material and Methods: A total of twenty-five subjects with physiological gingival pigmentation on the facial aspect of both maxillary and mandibular anterior arches (50 sites), both male and female, with an average age ranging from 18-35 years, participated in the study. The sites were randomly divided into Group I: depigmentation by Laser and Group II: depigmentation by Cryosurgery. The following parameters were assessed for the evaluation of treatment results: Melanin Oral Pigmentation Index (PI), Visual Analogue Scale (VAS) for pain evaluation and Healing index (HI). The data collected was statistically evaluated. Results: On intergroup comparison, there was no statistical difference in the score from baseline (p>0.05); however, a statistically significant difference was seen at the end of 1 year (p<0.05). Moreover, 57-60% of arches showed recurrence of pigmentation in the laser group whereas; only 12.7-17% recurrence was seen in the cryosurgery group at the end of the first year. Conclusion: Treatment of gingival hyperpigmentation with laser and cryosurgery shows a marked improvement of gingival pigmentation in both groups, but the cryosurgery depigmentation sites showed more sustainability.

Tratamiento de la melanosis gingival y evaluación de la repigmentación melánica: reevaluación clínica al cabo de 2 años / Treatment of gingival melanosis and assessment of melanin repigmentation. Clinical evaluation after 2 years

La encía hiperpigmentada es un problema estético en algunos pacientes, particularmente si la pigmentación es en la zona facial de la encía y es visible durante la sonrisa y el habla del paciente. Objetivo El propósito de este estudio fue evaluar el grado de repigmentación melánica de melanosis gingivales tratadas con la combinación del uso del bisturí y la gingivoabrasión. Material y método Se incluyó a 6 pacientes con diagnóstico de pigmentación melánica fisiológica al nivel de la encía del maxilar, y que por necesidad estética se planificó la retirada del pigmento (depigmentación) con el bisturí y medios rotatorios, se evaluaron los parámetros de: intensidad de la pigmentación (IP) y el índice gingival de pigmentación. Resultados Con un promedio de 18 meses +/- 4,5 meses de postoperatorio 2 casos tuvieron una repigmentación de IP leve y 4 casos un IP ausente, los 6 casos mostraron un índice gingival de pigmentación de ausente después del postoperatorio. Conclusión La eliminación de manchas melánicas combinando el uso del bisturí y la abrasión es una técnica efectiva y posee un bajo índice de repigmentación al cabo de 18 meses de control.

Hyperpigmentation of the gingiva is an aesthetic problem in some patients, particularly if the pigment is in the facial area of the gum and is visible during smiling and speaking. Objective The purpose of this study was to evaluate the degree of repigmentation of gingival melanosis treated with the combination of using the scalpel and gingival abrasion. Material and method Six patients were evaluated with a diagnosis of physiological melanin pigmentation at the gingiva of the maxilla, and for aesthetic reasons needed the pigment removed (depigmentation) with a scalpel and a rotary abrasive. The parameters evaluated were the intensity of pigmentation index (PI) and gingival pigmentation index (GPI). Results After a mean of 18months +/- 4.5 months after the procedure, 2 patients had a mild repigmentation, and 4 cases with an absence of IP, and all 6 cases showed an PGI of zero in the postoperative period. Conclusion The removal of melanin spots combining the use of the scalpel and abrasion is an effective technique, and has a low rate of repigmentation after 18 months follow-up.

Tratamento da hipercromia cutânea idiopática da região orbital com Erbium Laser: uma avaliação retrospectiva / Treatment of idiopathic cutaneous hyperchromia of the orbital region (ICHOR) with Erbium Laser: a retrospective assessment

Introdução: a hipercromia cutânea idiopática da região orbital dá um aspecto cansado à face. Sua etiologia ainda não é bem entendida. Causas primárias incluem hiperpigmentação da derme, por depósitos de melanina, ou pela vascularização superficial visível através da pele palpebral inferior. Causas secundárias são associadas com doenças sistêmicas e autoimunes. As opções de tratamento são muito vastas, com o laser sendo relativamente recente. Objetivos: o objetivodesteestudo é avaliar os resultados, a longo prazo, com o uso do Er:YAG(erbium) laser, nadiminuiçãodahiperpigmentação periorbital. Métodos: dez pacientes, incluindo oito mulheres e dois homens, foram submetidos ao tratamento da região periorbital usando Erbum:YAG laser, entre 2003 e 2006. Os pacientes foram avaliados comA e B períodos após o procedimento. Os critérios de avaliação incluíram a redução da pigmentação periorbital e a satisfação do paciente. Resultados: o tratamento com Er:YAG laser mostrou redução da hipercromia periorbital efetiva, com significativa melhora precoce e tardia, além da manutenção dos resultados, durante o período de avaliação, com satisfação dos pacientes. Discussão: a ablação com o Er:YAG laser mostrou-se efetiva na redução da hipercromia idiopática periorbital, com resultados duradouros. Complicações menores e raras incluíram hiperpigmentação transitória, pigmentação residual e leve hipocromia, em alguns casos.

Introduction: idiopathic Cutaneous Hypercromia of the Orbital Region (HCIRO),give a sad, tired aspect to face. Its etiopathology is to date still not well understood. Primary causes include hyperpigmentation from dermal deposits of melanin, or from superficial vascularization that is visible through the lower palpebral skin. Secondary causes are associated with systemic and autoimmune disorders. Treatment for HCIRO varies greatly, with laser treatment being relatively recent. Objectives: theobjective of this study was to clinically evaluate the long-term results of treatment using the Er:YAG (erbium)laser to diminish idiopathic periorbital hyperpigmentation. Methods: ten patients, eight females and two males underwent treatment of the periorbital region using ablative Erbium: YAG laser treatment between 2003 and 2006. The patients were evaluated at 2 and 6 month and 2-5 years post-procedure. The evaluation criteria included clinical reduction of periorbital pigmentation and patient satisfaction. Results: the treatment with Er:YAG laser, reduction of idiopathic periorbital hyperchromia was effective at early and long-term evaluation points, with the results being maintained during the period of evaluation with good patient satisfaction. Discussion: ablative treatment with Er:YAG laser was found to be effective in reduction of idiopathic periorbital hyperchromia, with a long-lasting result. Complications were minorandrare, and included mild hyperpigmentation, residual pigment, and hipopigmentation.

Management of gingival hyperpigmentation by surgical abrasion - report of three cases

Esthetics has become a significant aspect of dentistry and clinicians are faced with achieving acceptable gingival esthetics as well as addressing biologic and functional problems. The color of the gingiva plays an important role in overall esthetics but the principles and the techniques of the management of the problems associated with gingival melanin pigmentation are still not fully established. A method of de-epithelialization of the pigmented or discolored areas of the gingiva using a surgical diamond bur is documented. The technique is relatively simple and versatile and requires minimum time and effort. If repigmentation occurs, the procedure can be done repeatedly in the same area without limitation or causing any permanent damage. Three cases of gingival hyperpigmentation treated by the surgical abrasion technique are described here. After eighteen months follow up, none of the cases showed any recurrence of the pigmentation

Três diferentes técnicas cirúrgicas empregadas no clareamento gengival / Three different techniques used in the gingival depigmentation

A hiperpigmentaçäo gengival pode causar problemas estéticos, especialmente em pacientes com sorriso gengival. O presente trabalho apresenta três diferentes técnicas cirúrgicas periodontais que podem ser empregadas no clareamento gengival. Os resultados, obtidos de dois a três meses após as intervençöes cirúrgicas, demonstraram um tecido gengival saudável, firme e com uma coloraçäo rosada. A recorrência da pigmentaçäo näo foi observada em nenhum dos casos apresentados

ND: Yag Laser Treatment for Gingival Hyperpigmentation

Hyperpigmentation due to abnormal deposition of melanin often occurs in the gingiva, producing unsighty dark coloured areas ranging from light blue to black. In the present study we investigated the clinical effectiveness and patients' acceptability of Nd: YAG Laser treatment for the elimination of hyperpigmented areas of the gingiva. Twelve patients complaining of dark localized areas in their labial mucosa and gingiva of upper and lower jaws were included in this study. They were eight females and four males, their ages ranged from 16- 35 years with an average of 25 years. The patients were systemically free from any other diseases and had no other areas of hyperpigmentations. Most of the patients [11 patients] required only one treatment session to remove the melanotic lesions satisfactorily. The patients were seen after one and two weeks. Five patients [41.7%] had a good response after one week, while seven patients [58.3%] had a very good response after two weeks. Only one patient representing [8.3%] had a bad result and required a second treatment session after 2 weeks. Most of the patients had no post-operative discomfort including pain, oedema and disfigurement. Restoration of their gingiva was optimal giving satisfactory esthetic results. In conclusion we consider the Nd: YA G laser as an important mean to remove melanotic lesions of gingiva and it is well tolerated by the patients

Nova técnica cirúrgica para corrigir hiperpigmentaçäo das pálpebras (olheiras) / New surgical technique for correction of hyperpigmentation of the eyelids (dark eyelids)

O autor descreve metodologia cirúrgica para corrigir hiperpigmentaçäo das pálpebras, popularmente denominadas olheiras. Ainda que a causa e fisiopatologia näo seja conhecida a ressecçäo de extensa área de pela da pálpebra inferior confere muita reduçäo da coloraçäo configurando bom aspecto estético. Ele emprega sua técnica preconizada para corrigir deformidades outras da pálpebra, pois a simples aproximaçäo das bordas cutâneas da ferida já promove a correçäo do espaço entre os dois segmentos musculares. A excelência dos resultados assegura indicaçäo da técnica em diversificadas patologias. Na clínica do autor a cirurgia é realizada em mais de 75 por cento dos casos de blefaroplastias inferiores