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.
A 9-year-old boy was referred to the Department of Pediatric Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. The patient needed comprehensive dental treatment due to amelogenesis imperfecta. At the same time his parents requested to treat his gingival pigmentation. His oral examination revealed that his gingiva is deeply pigmented from the right second primary molar to the left second primary molar (). He had been checked by a physician previously and there were no pathologic disorders (e.g. Albright syndrome, trauma, hemachromatosis and racial pigmentation) in this case. Therefore, we started depigmentation therapy by cryosurgery technique.\nLiquid nitrogen was provided in the morning of treatment day by a consumer gas factory and was transferred to the dental facility. In order to transfer the liquid nitrogen, it had been saved in a two-layer flask (metallic inner layer and glassy outer layer).\nIn the first step isolation was instated by suction and cotton rolls; then hyperpigmentation areas were dried byair spray and 10% topical lidocaine gel was used to achieve anesthesia. During treatment, liquid nitrogen was poured into the glass mug and was rolled on the pigmentation area by cotton swabs (). After the gingiva blanched, the operation was started in another area; after 20 seconds this process was repeated. It is possible repeat this process three or four times for each area. The total time needed for this operation was 30 minutes. In order to record and analyze the results, five standard photos were taken in different positions. Standard high-quality images were taken at baseline and after one, three, six and twelve months (). All the photos were taken by a Canon digital camera (Ixus 800IS, Japan) in the same position, while the patient was sitting upright, and the distance between patient and camera was fixed to about 30 centimeters.\nMinimal reddish erythema was observed after cryosurgery. After one month the gingival color was ideal. No complications were observed during the follow-up. No recurrent lesions were observed in 12-month follow-up ().