A 27-year-old Caucasian female was referred to the Stomatology and Dental Medicine Department (CESPU) of the Centro Hospitalar de São João, Pólo de Valongo, Oporto, Portugal. Her chief complaint was of a “dark-colour lower gum” and she made the request for rapid cosmetic therapy. She reported noticing darkening of the teeth and gums for over two years, mainly in the mandible. No symptoms and no significant personal or family history were present. The patient denied taking any medication or any other dark pigmentation in other locations. Her blood pressure was within the normal range of values. She had stopped smoking a year before the consultation, although she had smoked 30 cigarettes per day for more than 10 years. On oral examination two black-brown macules measuring 1 × 1 cm were detected in the vestibular attached lower gingiva (). There was no lymphadenopathy or salivary gland abnormalities detected. Previous incisional biopsy to rule out any malignancy and blood investigations (complete full blood count and general biochemistry, including cortisol and ACTH serum levels) showed no abnormalities or potential causes. A diagnosis of smoker's melanosis was given based on the smoking history and the absence of any abnormalities seen in previous investigations. After explaining the benign character of the pigmentation, the patient requested the elimination of the pigmentation by aesthetic reasons due to professional work issues. A CO2 laser vaporization for gingival depigmentation was proposed. The vaporization of the pigmentation was performed under local anaesthesia (2% lidocaine with 1 : 100,000 epinephrine) with CO2 laser (10600 nm) (DEKA Smart US20D, Florence, Italy), with angulated mirror, focus spot of 1 mm, pulsed mode (50 Hz), 4.5 W of output power, power density of 573.25 W/cm2, and fluence of 11.46 J/cm2 (). During this procedure, safety precautions were in place to protect the operator, assistant, and patient. With this laser procedure, the secondary-intention healing of the surgical wound was reached without any dressing (). Paracetamol (1 g every 12 hours) was prescribed for two days to be taken only if she developed painful symptoms. After 3 weeks, wound healing was completed uneventfully without any melanin pigmentation (). She did not report any postoperative pain, swelling, or other complications. After two years of follow-up, the patient had no symptoms or signs of gingival melanin pigmentation.
A 27-year-old male who had a chief complaint of unesthetic melanin pigmentation in the anterior part of the maxillary and mandibular gingiva visited the Department of Periodontology, School of Dentistry, Kyung Hee University. There was no remarkable medical history, but he had been smoking a pack of cigarettes per day on average for the last 10 years. Diffused melanin hyperpigmentation was found on the labial surface of both the maxillary and mandibular arches ().\nFor the comparison of the two techniques, melanin pigmentation was removed bilaterally: on the right side Er:YAG laser therapy was used, while on the other side the epithelium was mechanically removed with a rotary round bur.