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 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.