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 23-year-old male patient complaining of heavily pigmented gums [] visited department of Periodontics, Institute of Dental Studies and Technologies, Modinagar. On examination, the patient was otherwise healthy but had a deeply pigmented gingiva. Pigmentation was unsightly and hence laser depigmentation procedures were planned. The procedure was explained verbally to the patient and the consent was obtained.\nPatient and operating staff wore special diode-laser protective eye glasses. Highly reflective instruments or instruments with mirrored surfaces were avoided as there could be reflection of the laser beam. A semiconductor diode surgical laser unit (Sunny Gold; Mikro Scientific Instrument Pvt Ltd., India, wavelength 980 nm, power 2-4 W) was used for depigmentation of the maxillary and mandibular anterior gingiva up to the second premolar on both right and left sides. The semiconductor diode laser was emitted in gated-pulsed mode, and was operated in a contact method using a flexible fiber optic handpiece. The Laser settings used were: fluence between 5 and 15 J/cm2, pulse length between 20 and 50 ms, spot diameter of 2 mm and thermal relaxation times of 0.15 to 0.20 milliseconds. No topical or local anesthesia was given to patients. Laser ablation started from the mucogingival junction toward the free gingival margin, including papillae. The motion of ablation was circular with overlapping circles. High attention was taken to avoid passing the laser beam on teeth structures and over mucosa. During the procedure, laser ablated the gingival epithelial surface little by little to reach the pigments without causing any bleeding which was beneficial for clear visualization. [] To enhance visualization, normal saline-soaked cotton or gauze was used to remove epithelial remnant.\nThe ablation of the gingiva was completed within 20-25 minutes on the maxilla and mandible. Laser ablation of pigmented epithelium immediately produced a melanin pigment-free surface without any carbonization. The wound looked fresh with no bleeding []. There was no need to apply a periodontal dressing. Patient was instructed to avoid smoking and eating of hot and spicy foods for the first 24 hours and was discharged from dental office to perform normal daily activity. Healing was good at 1 month with pink color comparable to nearby non-treated area, resulting in a significant improvement in aesthetic appearance []. No infection or significant postoperative complications such as pain or bleeding were encountered. Fifteen months follow-up showed no signs of recurrence of pigmentaion.