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 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.