http://dx.doi.org/10.5272/jimab.2014201.

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ISSN: 1312-773X (Online)

Journal of IMAB - Annual Proceeding (Scientific Papers) 2014, vol. 20, issue 1

DEPIGMENTATION OF GINGIVA
Genoveva Balcheva, Miglena Balcheva
Department of Conservative dentistry and oral pathology, Faculty of Dental
Medicine, Medical University-Varna, Bulgaria Bulgaria

SUMMARY:
Hyperactivity of melanocytes is the reason for dark
colour of gingiva, which is absolutely benign condition with
only esthetic disadvantage, for people with gummy
smilemostly. Depigmentation is a procedure of removing or
reducing of gingival hyperpigmentation. The purpose of the
research is to investigate the advantage of using Er:YAG laser than liquid nitrogen in case of gingival depigmentation.
Thats why two alternative methods are used: laser ablation
with an Er:YAG laser and cryosurgical procedure of tissue
destruction by fast freezing with liquid nitrogen (-196
C).Laser assisted gingival depigmentation is a single step procedure, with fast healing process. There is difficult control
of penetration and risk for excessive tissue destruction after
prolonged freezing in the cryosurgical procedure.
Key words: Er:YAG laser, liquid nitrogen, depigmentation
INTRODUCTION:
The colour of gingiva depends on several factors:
number and size of blood vessels, thickness of the epithelium,
level of keratinization, quantity of pigments.
Melanin, carotene and oxyhaemoglobin are the main
pigments, responsible for the normal physiologic pigmentation within the oral cavity. Melanin is a natural brown pigment, produced by melanocytes that reside in the basal layer
of the epithelium. Chemically, melanin is a high molecular weight dye that is insoluble in water and most organic solvents. Melanin is formed only in the cytoplasm of melaninforming cells or the melanocytes. These are dendritic cells
found at the epidermal dermal junction of the skin, mucous membranes, in the leptomeninges of the central nervous system and in the retina of the eye. [1] The degree of pigmentation depends on variety of factors, especially the activity of the melanocytes.
The degree of gingival pigmentation of the gingiva and
skin is reciprocally related. Fair-skinned individuals are very
likely to have non-pigmented gingiva, but in darker skinned
persons, the chance of having pigmented gingiva is extremely
high. The highest rate of gingival pigmentation is observed
in the area of the incisors.
Within the oral cavity, the melanin is found in the
gingiva, hard palate, mucosa and tongue. Its appearance may
be: diffuse, solid or irregular shaped, with different shades
of colour: from light brown to black.
Hyperactivity of the melanocytes is the reason for dark
colour of gingiva, which is absolutely benign condition with
only esthetic disadvantage, for people with gummy smile

/ J of IMAB. 2014, vol. 20, issue 1/

mostly. Depigmentation is a procedure of removing or reducing of gingival hyperpigmentation. Possible ways of doing
it are: surgical, by lasers, cryosurgery, bur abrasion and
electro-cautery. Each technique has its own advantages and
inadequacies.
METHODS:
We are observing two alternative methods: laser ablation [2] and cryosurgical procedure of tissue destruction by
fast freezing with liquid nitrogen (- 196 C). [3]
RESULTS:
Case 1: A 24 years old male patient, with melanin
hyperpigmentation in the area of lower incisors (Pic. 1). We
used gas expansion cryoprobe, cooled to - 81C and applied
to the pigmented gingiva for 10 sec (Pic. 2). [1] Gingivathawed spontaneously within 1 minute and necrosis become
apparent within 1 week. Keratinization was complete within
3 - 4 weeks (Pic. 3). This procedure does not require the use
of local anesthesia and has shown to produce excellent results. Rapid freezing is leading to denaturation of proteins
and cell death. There is no need of using a periodontal dressing in this procedure. The removal of the pigments cannot
be evaluated immediately, it requires a second procedure in
about 5 days, during which the residual pigmentation should
be removed. The big disadvantage is that the liquid nitrogen
evaporates too fast.
Cryotherapy procedure requires a special container for
storage of liquid nitrogen. The depth of penetration is difficult to control and prolonged freezing can cause excessive
tissue destruction.
The accidental contact of the liquid nitrogen can also
cause injury of the skin and other contact areas.
Case 2: A 27 years old female patient, with dark skin
and black hair, active smoker. The examination showed acute
gingival inflammation (Pic. 4), but the X ray proved lack
of pathological changes in the bone structure.
Depigmentation was completed by an Er: YAG laser
ablation, after using contact anesthesia (Pic. 5).
Parameters of the irradiation. [4, 5]:
- Distance 7-9 mm (non contact, defocused mode)
- Water cooling
- Energy 300 mJ
- Frequency 15-17 Hz
The patient didnt feel any pain during or postoperatively.Mild itching was common during the first week.
The esthetic results were pleasing and healing was uneventful. Gingiva showed fast epithilization with a healthy appearance (Pic. 6).

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CONCLUSIONS:
Laser assisted gingival depigmentation is a single step
procedure, with fast healing process and sterilization and
without necessity of using periodontal dressing.
Cryosurgical procedure of depigmentation is compli-

Picture 1. Gingival hyperpigmentation.

Picture 4. Gingival hyperpigmentation.

Picture 2. Cryosurgical procedure.

Picture 5. Gingival view after laser ablation.

Picture 3. Gingival view 3 weeks after cryosurgical

procedure.

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cated by the necessity of providing special containers for liquid nitrogen saving and the requirement for fast (20 30 sec)
application. There is also difficult control of penetration and
risk for excessive tissue destruction after prolonged freezing.

Picture 6. Gingival view 1 week after laser

procedure.

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/ J of IMAB. 2014, vol. 20, issue 1/

REFERENCES:
1. Karydis A, Bland P, Shiloah J.
Management of oral melanin pigmentation. J Tenn Dent Assoc. 2012 Fall-Winter;92(2):10-5. [PubMed]
2. Rosa DS, Aranha AC, Eduardo
Cde P, Aoki A. Esthetic treatment of
gingival melanin hyperpigmentation
with Er:YAG laser: short-term clinical
observations and patient follow-up. J
Periodontol. 2007 Oct;78(10):2018-25.

[PubMed] [CrossRef]
3. Tal H, Landsberg J, Kozlovsky A.
Cryosurgical depigmentation of the
gingiva. A case report. J Clin
Periodontol. 1987 Nov; 14(10):614-7.
[PubMed] [CrossRef]
4. Lee KM, Lee DY, Shin SI, Kwon
YH, Chung JH, Herr Y. A comparison
of different gingival depigmentation
techniques: ablation by erbium: yttrium-

aluminum-garnet laser and abrasion by

rotary instruments. J Periodontal Implant Sci. 2011 Aug;41(4):201-7.
[PubMed] [CrossRef]
5. Azzeh MM. Treatment of gingival
hyperpigmentation by erbiumdoped:yttrium, aluminum, and garnet
laser for esthetic purposes. J
Periodontol. 2007 Jan;78(1):177-84.
[PubMed] [CrossRef]

Address for correspondence:

D-r Genoveva Balcheva
FDM, MU-Varna
Tzar Osvoboditel Boul., No 84, off. 623
9002, Varna, Bulgaria; Tel.: +359 888 511 132
E-mail: dr.Balcheva@gmail.com;
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