A 22-year-old nonsmoking patient of brown race was referred to the department of oral medicine and surgery at the University Dental Clinic of Monastir, with a chief complaint of a “dark-color upper gum.” He reported noticing darkening of the gums 10 years ago. The lesion was asymptomatic and has remained stable since then. He had no significant personal history and denied taking any medication or other substances that may have caused this pigmentation.\nIn clinical examination, periodontal tissues were healthy, but bilateral melanin pigmentation was present, associated with a fractured upper central incisor. A pigmentation index as mentioned by Kumar et al. [] was used to determine the level of pigmentation, and the score was diagnosed as “3” (diffuse brown to black pigmentation, marginal, and attached) ().\nAt first sight, the diagnoses evoked by this oral pigmentation of melanin were gingival pigmentation of exogenous origin (drugs, tobacco, metals,…), racial pigmentation, and Addison's disease. However, given the diffuse, bilateral appearance of these pigmentations which are not of recent appearance, the absence of smoking history or drug use, the patient's race, and the absence of systemic involvement, a final diagnosis of physiological gingival pigmentation (ethnic/racial) was established.\nFollowing the patient's request, a laser depigmentation procedure was planned after obtaining the patient's consent.\nA semiconductor diode surgical laser unit (Elexxion pico 808 nm diode laser, Elexxion AG, Singen, Germany) was used for the procedure; it is a digitally pulsed diode laser with a frequency of 20,000 Hz, a peak power of 5 W, and a pulse width of 26 microseconds. With this setting, the laser beam is “on” the tissue for only 26 microseconds which makes around one-third of the total cycle. The rest of the time is to allow the tissue to cool down. The semiconductor diode laser was operated in a contact method using a 400 nm flexible fiber optic handpiece.\nSpecial eyeglasses were worn by the patient and the staff to fulfill the Food and Drug Administration laser safety rules. After a local infiltration of anesthesia, the properly initiated tip of the diode laser was angled at an external bevel of 45 degrees. The melanin-pigmented gum was resected by circular movement of the fiber with a slight contact on the tissue, avoiding teeth structures.\nThis technique was performed on the entire pigmented anterosuperior attached gingiva for the deepithelialization procedure. Saline-soaked gauze was used to remove epithelial remnant. This procedure was repeated until the desired depth of tissue removal was reached, combined with a labial frenectomy (). The treatment time was two minutes compared to the ablative technique time up to 30 minutes in an area of first molar to first molar.\nAnalgesics and 0.2% chlorhexidine mouthwash were prescribed.\nThe patient did not report any postoperative pain, swelling, or other complications at the first and subsequent visits. It should be noted that a greyish-white fibrin layer completely covers the “laser wound” 6 hours after the operation (), which should not be misinterpreted as secondary infection. Four months later, the patient had no symptoms or signs of gingival melanin pigmentation ().
A 32-year-old female who requested cosmetic therapy for "black gum" in the anterior part of the mandibular gingiva visited the Department of Periodontology, School of Dentistry, Kyung Hee University. There were no contributory medical problems. Melanin hyperpigmentation was found on the labial surface of the mandibular arches and maxillary lateral incisor. Compared with case 1, pigmentation showed more focal pigmented lesions ().\nThe same depigmentation techniques were applied: the Er:YAG laser on the right side and mechanical depigmentation of rotary round bur on the left side. Since the patient had focal pigmentation, depigmentation was conducted on both the maxilla and mandible area simultaneously. Due to the patient's thin gingival biotype and careless laser application, case 2 showed exposure of underlying bone around the incisal area on the right side of the mandible ().\nAt 1 week, the gingiva showed gradual epithelization, but was in an immature state. The laser surgery area showed redness and unfavorable healing with an appearance of necrosis. On the other hand, on the left side where the high speed rotary was applied, almost complete re-epithelization was observed (). After 2 weeks, epithelization was completed except in the right mandibular area (). A linear cleft was observed in the right mandibular area until 3 weeks. The wound healing was almost completed, but slight redness still remained at 4 weeks after surgery. However, the patient was satisfied with the significant improvement in color. Gingival recession and loss of papilla were not observed at 4 weeks after surgery ().