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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 2  |  Issue : 3  |  Page : 223-225

Gingival depigmentation using scalpel


Department of Periodontology and Implantology, MGV's KBH Dental College and Hospital, Nashik, Maharashtra, India

Date of Web Publication6-Sep-2018

Correspondence Address:
Dr. Shreeprasad Vijay Wagle
Anand Nagar, Lashkarwadi, Jalgaon, Dapoli - 415 712, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_87_18

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  Abstract 


Smile shows the feeling of joy and success and reveals self-confidence and kindness. A good smile is not only caused due to shape, position, and color of the teeth but also by the gingival tissues. Melanin pigmentation of the gingiva is not a medical problem. Nowadays, complaints of dark gums are common, particularly in patients having high smile line. Hence, periodontists have to achieve a harmonious interrelationship of the pink gingiva and white teeth. For depigmentation of gingiva, different treatment modalities have been reported, such as bur abrasion, scraping, cryotherapy, electrosurgery, and laser. In the present case series, slicing and scraping technique was used which is simple, effective, and yield good results along with good patient satisfaction. Gingival depigmentation of a 19-year-old male patient was done under local anesthesia with combination of slicing and scraping technique using 15 no. Bard-Parker blade. Depigmentation with combination of slicing and scraping technique is simple, easy to perform, cost-effective, and causes less discomfort and is esthetically acceptable to the patient.

Keywords: Depigmentation, esthetics, melanin, periodontal dressing, repigmentation, scraping, slicing


How to cite this article:
Wagle SV, Agrawal AA, Sankhe R. Gingival depigmentation using scalpel. Biomed Biotechnol Res J 2018;2:223-5

How to cite this URL:
Wagle SV, Agrawal AA, Sankhe R. Gingival depigmentation using scalpel. Biomed Biotechnol Res J [serial online] 2018 [cited 2020 Apr 8];2:223-5. Available from: http://www.bmbtrj.org/text.asp?2018/2/3/223/240713




  Introduction Top


A smile is not only a method of communication but also a method of socialization. Harmony of smile is based on not only the color of teeth but also depends on the color of the gingival tissues. Any feeling of pleasure, happiness, laughter, or simply a greeting leads to a smile resulting in the exposure of teeth and gingiva. It could be an esthetic issue for some patients, especially when it is located in the anterior labial gingiva, is combined with a high smile line, and is not uniform in appearance.

Dummet (1960) proposed the following explanation for gingival pigmentation. The color of the healthy gingiva is variable ranging from a pale pink to a deep bluish-purple hue. Between these limits of normalcy is a large number of pigmentation which depends primarily upon (i) the intensity of melanogenesis, (ii) depth of epithelial cornification, and (iii) arrangement of gingival vascularity.

Moreover, color variation may not be uniform and may exist as unilateral, bilateral, mottled, macular, or blotched and may involve gingival papillae alone or extend throughout the gingiva onto other soft tissues.

Most pigmentation is caused by five primary pigments.

  • Melanin
  • Melanoid
  • Oxyhemoglobin
  • Reduced hemoglobin
  • Carotene
  • Others are caused by bilirubin and iron.


Alex A Farnoosh in 1990 said that melanin deposits mainly in basal and suprabasal cell layers of the epithelium. The degree of pigmentation is attributed to melanoblastic activity and density of melanophores in the gingiva.

Dummet proposed the Dummet Oral Pigmentation Index (DOPI) assessment: 1964

  • Score 0: Pink tissue (No clinical pigmentation)
  • Score 1: Mild light brown color (Mild clinical pigmentation)
  • Score 2: Medium brown or blue-black tissue (Heavy clinical pigmentation)
  • Score 3: Deep brown or blue-black tissue (Heavy clinical pigmentation).


Physiologic pigmentation

Etiology: Normal melanocyte activity

Clinical presentations are seen in all ages, symmetric distribution over many sites, gingiva most commonly, surface architecture, texture unchanged.


  Case Report Top


A 19-year-old male patient reported to the Department of Periodontology and Implantology, MGVs KBH Dental College and Hospital, Nashik, with a chief complaint of poor appearance due to dark-brown discoloration of the front gum region. The patient observed the same for the past 1 year.

On examination, lips were competent, with intraoral findings of melanin pigmentation seen at maxillary and mandibular anterior region from around premolar to premolar area. Melanin pigmentation was seen at attached gingiva including papillae. Angle's Class I occlusion was seen. Mild stains and calculus were observed.

Thus, it was decided to perform a gingival depigmentation procedure.

  • Treatment plan was


    • Complete oral prophylaxis
    • Follow-up on the 7th day after oral prophylaxis
    • Gingival depigmentation using scalpel.


Clinical procedure performed

  • Thorough oral prophylaxis was done
  • Follow-up on the 7th day after oral prophylaxis was taken, in that it is seen that the patient was maintaining the oral hygiene and papillae was normal and marginal gingiva was normal [Figure 1]
  • Blood investigations were performed, in that bleeding time, clotting time, and hemoglobin were checked. All the values were in the normal range
  • Depigmentation was done using 15 no. Bard-Parker blade with combination of slicing and scraping method under infiltration local anesthesia [Figure 2]
  • The procedure was started from distal of second premolar from both sides up to then midline [Figure 2]
  • Scraping was done first at papillae involved instead of attached gingiva
  • After completing the procedure, periodontal dressing was given, that is, Barricaid which is a light-cured periodontal dressing material [Figure 3]
  • The patient was recalled after 7 days for follow-up [Figure 4] and [Figure 5].
Figure 1: Preoperative hyperpigmented gingiva

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Figure 2: Before and after complete removal of pigmented layer using 15 no. Bard-Parker blade

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Figure 3: Application of periodontal dressing on raw wound surface. (Barricaid®)

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Figure 4: Seven days after gingival depigmentation

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Figure 5: Preoperative and 7 days after gingival depigmentation

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  Discussion Top


Esthetic is defined as “Appreciative of responsive to, what is pleasurable to the senses of beauty and culture.” Dental esthetics has become increasingly important in the practice of modern dentistry and is synonymous with a natural, harmonious appearance.[1],[2]

Oral pigmentation occurs in all races of man. There are no significant differences in oral pigmentation between males and females. The intensity and distribution of 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; however, as Dummet [3] suggested, the degree of pigmentation is partially related to mechanical, chemical, and physical stimulation.[4]

Melanin pigmentation is frequently caused by melanin deposition by active melanocytes located mainly in the basal and suprabasal layer of the oral epithelium [Table 1]. Pigmentations can be removed for esthetic reasons. Different treatment modalities have been used for this aim.[5] The selection of a technique for depigmentation of the gingiva should be based on clinical experience, patient's affordability, and individual preferences.
Table 1: Types of melanin

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The depigmentation procedure by scalpel technique is simple, easy to perform, noninvasive, and above all, cost-effective. According to Almas and Sadiq,[6] the scalpel wound heals faster than that in other techniques.

Pigment recurrence has been documented to occur following the surgical procedure, within 24 days to 8-year long period. A study by Perlmutter et al.[7] showed that gingival surgical procedures performed solely for cosmetic reasons offer no permanent results. Repigmentation refers to the clinical reappearance of melanin pigment following a period of clinical depigmentation. The mechanism suggested for the spontaneous repigmentation is that the melanocytes from the normal skin proliferate and migrate into the depigmented areas.[7]


  Conclusion Top


The depigmentation procedure was successful and the patient was satisfied with the result. Thus, we conclude that depigmentation of hyperpigmented gingiva using 15 no. Bard-Parker blade with combination of slicing and scraping technique is simple, easy to perform, cost-effective, and above all, it causes less discomfort and is esthetically acceptable to the patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Asopa V. Management of adverse tissue response to faulty pontic design – A case report. Int J Prosthet Dent 2013;4:26-30.  Back to cited text no. 1
    
2.
Lombardi RE. The principles of visual perception and their clinical application to denture esthetics. J Prosthet Dent 1973;29:358-82.  Back to cited text no. 2
    
3.
Dummet CO. First symposium on oral pigmentation. J Periodontol 1960;31:345-85.  Back to cited text no. 3
    
4.
Ciçek Y, Ertaş U. The normal and pathological pigmentation of oral mucous membrane: A review. J Contemp Dent Pract 2003;4:76-86.  Back to cited text no. 4
    
5.
Pontes AE, Pontes CC, Souza SL, Novaes AB Jr., Grisi MF, Taba M Jr., et al. Evaluation of the efficacy of the acellular dermal matrix allograft with partial thickness flap in the elimination of gingival melanin pigmentation. A comparative clinical study with 12 months of follow-up. J Esthet Restor Dent 2006;18:135-43.  Back to cited text no. 5
    
6.
Almas K, Sadig W. Surgical treatment of melanin-pigmented gingiva; an esthetic approach. Indian J Dent Res 2002;13:70-3.  Back to cited text no. 6
    
7.
Perlmutter S, Tal H. Repigmentation of the gingiva following surgical injury. J Periodontol 1986;57:48-50.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]



 

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