A 21-year-old female patient reported to the Department of Conservative Dentistry and Endodontics with the complaint of discoloration in upper front teeth []. History of the patient revealed the presence of yellowish brown and white patches on teeth since childhood. Clinical examination showed the presence of dark yellow patches in maxillary central incisors and white patches on the facial surface of all teeth. Careful exploration of teeth revealed intact and smooth enamel surfaces. Several treatment options suggested to the patient were microabrasion, microabrasion along with bleaching, and direct or indirect veneers. Patient declined any procedure that included preparation of her intact tooth surfaces. After discussion, it was agreed to use enamel microabrasion followed by bleaching to improve the appearance of her teeth. The maxillary canines and incisors to be treated were first cleaned with pumice and water slurry. Petroleum jelly was applied around the cervical portion of the teeth to prevent leakage of the hydrochloric acid or damage to the gingiva. The teeth were then isolated using rubber dam. Freshly prepared solution of 11% hydrochloric acid was applied using cotton pellet on the discolored area followed by application of coarse composite contouring discs (Super Snap, Shofu Inc., Japan) at low speed for 10 seconds per tooth []. Same procedure was repeated 3 times at the same visit, which resulted in lightening of the dark areas to a great extent []. White spots were still evident on the labial surfaces of teeth. Thereafter, the remaining acid was rinsed from the teeth by use of gentle air water pressure and a high-volume aspirator. All teeth were finished using fine and extra fine grit abrasive discs (Super Snap). After finishing, the bleaching agent (XX-White™, DENT’N Co., France) was applied over the labial surfaces of isolated teeth, followed by light activation using a bleaching light (Flexi Light whitening system, DENT’N Co., France) for 4 minutes []. Bleaching procedure was repeated one more time for 8 minutes. The bleaching agent was removed by means of moist cotton followed by rinsing with air water spray. Lightening of the teeth shade was noted and rubber dam was removed. All the treated teeth were polished using fine polisher (Compo Site, Shofu Inc, Japan) to obtain high luster. High gloss finish obtained after fine polishing, camouflaged white spots as well as remaining dark areas on the enamel surface []. The patient was informed regarding the likelihood of developing dentinal hypersensitivity, which would subside in a few days. The patient was prescribed the calcium sodium phosphosilicate-containing desensitizing tooth paste (Vantej™, Dr. Reddy's Laboratories Ltd., India) for 3 weeks and then discharged. At 1 month follow-up, the results were stable and the patient did not complain of any symptoms related to dentinal hypersensitivity [].
A 32-year-old female who requested cosmetic therapy for "black gum" in the anterior part of the mandibular gingiva visited the Department of Periodontology, School of Dentistry, Kyung Hee University. There were no contributory medical problems. Melanin hyperpigmentation was found on the labial surface of the mandibular arches and maxillary lateral incisor. Compared with case 1, pigmentation showed more focal pigmented lesions ().\nThe same depigmentation techniques were applied: the Er:YAG laser on the right side and mechanical depigmentation of rotary round bur on the left side. Since the patient had focal pigmentation, depigmentation was conducted on both the maxilla and mandible area simultaneously. Due to the patient's thin gingival biotype and careless laser application, case 2 showed exposure of underlying bone around the incisal area on the right side of the mandible ().\nAt 1 week, the gingiva showed gradual epithelization, but was in an immature state. The laser surgery area showed redness and unfavorable healing with an appearance of necrosis. On the other hand, on the left side where the high speed rotary was applied, almost complete re-epithelization was observed (). After 2 weeks, epithelization was completed except in the right mandibular area (). A linear cleft was observed in the right mandibular area until 3 weeks. The wound healing was almost completed, but slight redness still remained at 4 weeks after surgery. However, the patient was satisfied with the significant improvement in color. Gingival recession and loss of papilla were not observed at 4 weeks after surgery ().