2012 b2 Dentistry - Journal of IMAB · / J of IMAB. 2014, vol. 20, issue 1/ 487 SUMMARY:...
3
/ J of IMAB. 2014, vol. 20, issue 1/ http://www.journal-imab-bg.org 487 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 la- ser than liquid nitrogen in case of gingival depigmentation. That’s 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 (-196º C).Laser assisted gingival depigmentation is a single step pro- cedure, 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, depigmen- tation 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 pigmenta- tion within the oral cavity. Melanin is a natural brown pig- ment, produced by melanocytes that reside in the basal layer of the epithelium. Chemically, melanin is a high – molecu- lar weight dye that is insoluble in water and most organic sol- vents. Melanin is formed only in the cytoplasm of melanin- forming cells or the melanocytes. These are dendritic cells found at the epidermal – dermal junction of the skin, mu- cous membranes, in the leptomeninges of the central nerv- ous system and in the retina of the eye. [1] The degree of pig- mentation depends on variety of factors, especially the ac- tivity 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 mostly. Depigmentation is a procedure of removing or reduc- ing 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 ab- lation [2] and cryosurgical procedure of tissue destruction by fast freezing with liquid nitrogen (- 196º 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 - 81ºC and applied to the pigmented gingiva for 10 sec (Pic. 2). [1] Gingiva- thawed 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 re- sults. Rapid freezing is leading to denaturation of proteins and cell death. There is no need of using a periodontal dress- ing 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 diffi- cult 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 didn’t feel any pain during or post- operatively.Mild itching was common during the first week. The esthetic results were pleasing and healing was unevent- ful. Gingiva showed fast epithilization with a healthy appear- ance (Pic. 6). DEPIGMENTATION OF GINGIVA Genoveva Balcheva, Miglena Balcheva Department of Conservative dentistry and oral pathology, Faculty of Dental Medicine, Medical University-Varna, Bulgaria Bulgaria Journal of IMAB - Annual Proceeding (Scientific Papers) 2014, vol. 20, issue 1 ISSN: 1312-773X (Online) http://dx.doi.org/10.5272/jimab.2014201.487
-
Upload
truonglien -
Category
Documents
-
view
220 -
download
0
Transcript of 2012 b2 Dentistry - Journal of IMAB · / J of IMAB. 2014, vol. 20, issue 1/ 487 SUMMARY:...
/ J of IMAB. 2014, vol. 20, issue 1/ http://www.journal-imab-bg.org 487
SUMMARY:Hyperactivity of melanocytes is the reason for dark
colour of gingiva, which is absolutely benign condition withonly esthetic disadvantage, for people with gummysmilemostly. Depigmentation is a procedure of removing orreducing of gingival hyperpigmentation. The purpose of theresearch is to investigate the advantage of using Er:YAG la-ser than liquid nitrogen in case of gingival depigmentation.That’s why two alternative methods are used: laser ablationwith an Er:YAG laser and cryosurgical procedure of tissuedestruction by fast freezing with liquid nitrogen (-196ºC).Laser assisted gingival depigmentation is a single step pro-cedure, with fast healing process. There is difficult controlof penetration and risk for excessive tissue destruction afterprolonged freezing in the cryosurgical procedure.
Key words: Er:YAG laser, liquid nitrogen, depigmen-tation
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 mainpigments, responsible for the normal physiologic pigmenta-tion within the oral cavity. Melanin is a natural brown pig-ment, produced by melanocytes that reside in the basal layerof the epithelium. Chemically, melanin is a high – molecu-lar weight dye that is insoluble in water and most organic sol-vents. Melanin is formed only in the cytoplasm of melanin-forming cells or the melanocytes. These are dendritic cellsfound at the epidermal – dermal junction of the skin, mu-cous membranes, in the leptomeninges of the central nerv-ous system and in the retina of the eye. [1] The degree of pig-mentation depends on variety of factors, especially the ac-tivity of the melanocytes.
The degree of gingival pigmentation of the gingiva andskin is reciprocally related. Fair-skinned individuals are verylikely to have non-pigmented gingiva, but in darker skinnedpersons, the chance of having pigmented gingiva is extremelyhigh. The highest rate of gingival pigmentation is observedin the area of the incisors.
Within the oral cavity, the melanin is found in thegingiva, hard palate, mucosa and tongue. Its appearance maybe: diffuse, solid or irregular shaped, with different shadesof colour: from light brown to black.
Hyperactivity of the melanocytes is the reason for darkcolour of gingiva, which is absolutely benign condition withonly esthetic disadvantage, for people with gummy smile
mostly. Depigmentation is a procedure of removing or reduc-ing of gingival hyperpigmentation. Possible ways of doingit are: surgical, by lasers, cryosurgery, bur abrasion andelectro-cautery. Each technique has its own advantages andinadequacies.
METHODS:We are observing two alternative methods: laser ab-
lation [2] and cryosurgical procedure of tissue destruction byfast freezing with liquid nitrogen (- 196º C). [3]
RESULTS:Case 1: A 24 years old male patient, with melanin
hyperpigmentation in the area of lower incisors (Pic. 1). Weused gas expansion cryoprobe, cooled to - 81ºC and appliedto the pigmented gingiva for 10 sec (Pic. 2). [1] Gingiva-thawed spontaneously within 1 minute and necrosis becomeapparent within 1 week. Keratinization was complete within3 - 4 weeks (Pic. 3). This procedure does not require the useof local anesthesia and has shown to produce excellent re-sults. Rapid freezing is leading to denaturation of proteinsand cell death. There is no need of using a periodontal dress-ing in this procedure. The removal of the pigments cannotbe evaluated immediately, it requires a second procedure inabout 5 days, during which the residual pigmentation shouldbe removed. The big disadvantage is that the liquid nitrogenevaporates too fast.
Cryotherapy procedure requires a special container forstorage of liquid nitrogen. The depth of penetration is diffi-cult to control and prolonged freezing can cause excessivetissue destruction.
The accidental contact of the liquid nitrogen can alsocause injury of the skin and other contact areas.
Case 2: A 27 years old female patient, with dark skinand black hair, active smoker. The examination showed acutegingival inflammation (Pic. 4), but the X – ray proved lackof pathological changes in the bone structure.
Depigmentation was completed by an Er: YAG laserablation, 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 HzThe patient didn’t feel any pain during or post-
operatively.Mild itching was common during the first week.The esthetic results were pleasing and healing was unevent-ful. Gingiva showed fast epithilization with a healthy appear-ance (Pic. 6).
DEPIGMENTATION OF GINGIVA
Genoveva Balcheva, Miglena BalchevaDepartment of Conservative dentistry and oral pathology, Faculty of DentalMedicine, Medical University-Varna, Bulgaria Bulgaria
Journal of IMAB - Annual Proceeding (Scientific Papers) 2014, vol. 20, issue 1ISSN: 1312-773X (Online)
http://dx.doi.org/10.5272/jimab.2014201.487
488 http://www.journal-imab-bg.org / J of IMAB. 2014, vol. 20, issue 1/
CONCLUSIONS:Laser assisted gingival depigmentation is a single step
procedure, with fast healing process and sterilization andwithout necessity of using periodontal dressing.
Cryosurgical procedure of depigmentation is compli-
cated by the necessity of providing special containers for liq-uid nitrogen saving and the requirement for fast (20 – 30 sec)application. There is also difficult control of penetration andrisk for excessive tissue destruction after prolonged freezing.
Picture 1. Gingival hyperpigmentation.
Picture 5. Gingival view after laser ablation.
Picture 6. Gingival view – 1 week after laserprocedure.
Picture 2. Cryosurgical procedure.
Picture 3. Gingival view – 3 weeks after cryosurgicalprocedure.
Picture 4. Gingival hyperpigmentation.
/ J of IMAB. 2014, vol. 20, issue 1/ http://www.journal-imab-bg.org 489
1. Karydis A, Bland P, Shiloah J.Management of oral melanin pigmenta-tion. J Tenn Dent Assoc. 2012 Fall-Win-ter;92(2):10-5. [PubMed]
2. Rosa DS, Aranha AC, EduardoCde P, Aoki A. Esthetic treatment ofgingival melanin hyperpigmentationwith Er:YAG laser: short-term clinicalobservations and patient follow-up. JPeriodontol. 2007 Oct;78(10):2018-25.
REFERENCES:
Address for correspondence:D-r Genoveva BalchevaFDM, MU-Varna“Tzar Osvoboditel” Boul., No 84, off. 6239002, Varna, Bulgaria; Tel.: +359 888 511 132E-mail: [email protected];
[PubMed] [CrossRef]3. Tal H, Landsberg J, Kozlovsky A.
Cryosurgical depigmentation of thegingiva. A case report. J ClinPeriodontol. 1987 Nov; 14(10):614-7.[PubMed] [CrossRef]
4. Lee KM, Lee DY, Shin SI, KwonYH, Chung JH, Herr Y. A comparisonof different gingival depigmentationtechniques: ablation by erbium: yttrium-
aluminum-garnet laser and abrasion byrotary instruments. J Periodontal Im-plant Sci. 2011 Aug;41(4):201-7.[PubMed] [CrossRef]
5. Azzeh MM. Treatment of gingivalhyperpigmentation by erbium-doped:yttrium, aluminum, and garnetlaser for esthetic purposes. JPeriodontol. 2007 Jan;78(1):177-84.[PubMed] [CrossRef]
