This article is the winning entry of the DRDCA 2020 Article Contest (Second Position). Congratulations to the author Dr. Gulafsha M!
Co-authored by Dr Anuroopa P, Professor, RRDCH, Bangalore.
ABSTRACT
Gingival health and appearance are essential components of an attractive smile with gingival pigmentation playing a crucial role. Gingival hyperpigmentation is physiologic phenomenon resulting from deposition of melanin in basal and supra basal layer of epithelium. Gingival depigmentation involves removal of gingival hyperpigmentation through various techniques. In the present case series, gingival depigmentation was performed using 3 different techniques like scalpel, electrosurgery and diode laser and also post-operative pain score was measured by the Visual Analogue Scale.
INTRODUCTION
Esthetic dentistry strives to merge function and beauty with values and individual needs of every patient 1. A beautiful smile surely enhances individual’s self-confidence 2. Gingival health and appearance are essential components of an attractive smile, with gingival pigmentation playing crucial role 3,4.
Gingival hyperpigmentation can be defined as darker gingival color beyond what is normally expected 4. It is a physiologic phenomenon resulting from deposition of endogenous melanin by melanin granules of melanocytes in basal and supra basal layer of epithelium and transferred to basal cells where it is stored in form of melanosomes 3,5. Pigmentation is contributed by-products of physiological process such as melanin, melanoid, carotene, oxyhemoglobin, reduced hemoglobin, bilirubin and iron and/or pathological diseases, and conditions. Environmental risk factors such as tobacco smoking contribute to the gingival hyperpigmentation in both active and passive form. Ethnicity and age also influence the color of gingiva but it has no sexual predilection 4. Systemic conditions such as endocrine disturbances, Albright’s syndrome, malignant melanoma, Peutz Jeghar’s syndrome, trauma, and racial pigmentation are known cause of oral melanin pigmentation 3.
Gingival depigmentation can be defined as periodontal plastic surgical procedure whereby gingival hyperpigmentation is removed or reduced by various techniques. Depigmentation is a treatment of choice where esthetics is a concern 4.
In the present case series, gingival hyperpigmentation was treated by 3 different techniques like scalpel, electrosurgery and diode laser and also post-operative pain score was measured by Visual Analogue Scale.
CASE SERIES
CASE 1:
A 20-year-old male patient visited the Department of Periodontology in a private dental college and hospital, Bangalore with chief complaint of heavily pigmented gums. Oral examination revealed, DOPI score* was 3 and Class 2- high smile line (Liebart and Deruelle 2004**) that revealed deeply pigmented gingiva from canine to canine (Figure 1).
Surgical procedure: Surgical depigmentation with scalpel was planned. Routine oral hygiene procedures were carried out and oral hygiene instructions were given. Local anesthesia was infiltrated in maxillary anterior region. Using number 15 B.P blade, scrapping of pigmented epithelium until mucogingival junction was carried out, leaving connective tissue intact (Figure 2a, 2b). A periodontal dressing (Coe-Pak) was placed on surgical wound area for 1 week (Figure 3). Patient was kept on analgesics for 5 days and was advised to use 0.12% chlorhexidine gluconate mouthwash for 2 weeks postoperatively.
Post-operative evaluation: Wound healing was uneventful without any discomfort. 1 month postoperative examination showed well-epithelialized gingiva, which was pink in color and pleasant (Figure 4).
VAS score: Patient’s postoperative self-assessment report showed VAS score of 4 at 24 hr, score 2 at 72 hr and no pain at 1 week post operatively indicating that patient experienced moderate pain at 24 hr and slight pain at 72 hr and absolutely no pain at 1-week post operatively.
CASE 2:
A 20-year-old male patient visited Department of Periodontology in a private dental college and hospital, Bangalore with chief complaint of heavily pigmented gums. Oral examination revealed, DOPI score* was 3 and Class 3- average smile line (Liebart and Deruelle 2004**) that revealed deeply pigmented gingiva from canine to canine in mandible (Figure 5).
Surgical procedure: Depigmentation procedure was planned using electrocautery. Under local anaesthesia using electro cautery (Art- E1 110V Electrosurgery Dental Vet cutting unit), loop electrode was used in light brushing strokes and tip was kept in motion all the time to avoid excessive heat buildup and destruction of tissues for gingival depigmentation (Figure 6). Finally, Coe-pak was placed for 1 week over wound area (Figure 7) and oral hygiene instructions were given.
Post-operative evaluation: Wound healing was uneventful without any discomfort. Pigmentation was absent in newly formed epithelium, with gingiva appearing pale pink in color after 1 month .
VAS score: Patient reported VAS score of 2 at 24 hr, score 0 at 72 hr and 1 week post operatively indicating that patient experienced mild pain at 24 hr and no pain at 72 hr and 1-week post operatively.
CASE 3:
A 25-year-old female patient visited Department of Periodontology in private dental college and hospital, Bangalore with chief complaint of dark gums and wanted to get it corrected for esthetic reason. Oral examination revealed, DOPI score* was 3 and Class 2-high smile line (Liebart and Deruelle 2004**) that revealed deeply pigmented gingiva from canine to canine in maxilla (Figure 9).
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