GINGIVAL DEPIGMENTATION TECHNIQUES

 

The gingiva is an important intraoral tissue which when affected particularly by pigmentation is mainly responsible for the unpleasant appearance. The gingival melanin pigmentation occurs in all races in variable amount caused by melanin granules. Gingival hyperpigmentation can be defined as a darker gingival color beyond what is normally expected. The degree of pigmentation varies from person to person. Excessive gingival pigmentation may be a major esthetic concern for many patients.

VARIOUS DEPIGMENTATION TECHNIQUES:

1.     Chemical method: by using agents like alcohols, phenols, and ascorbic acid.

2.     Surgical method: it includes 5 techniques i.e.:

·        Conventional techniques : gingival abrasion, split thickness epithelial excision, scalpel surgical technique, free gingival grafting

·        Electrosurgery

·        Lasers

·        Cryosurgery

·        Radiosurgery

 

ASCORBIC ACID:

·        It inhibits the denuding of pigmented gingival epithelium by superficial abrasion using diamond burs in a low speed handpiece.

·        It downregulates dopaquinone formation which is a precursor in melanin synthesis, inhibiting melanin formation.

GINGIVAL ABRASION:

·        Inhibits the denuding of pigmented gingival epithelium by superficial abrasion using diamond burs in a low speed hand piece.

·        It is non-invasive and cost effective technique and does not require any specific instruments.

·        Drawbacks of this technique are it is technique sensitive, treatment duration is increased, and there is post treatment pain and a high recurrence rate.

SCALPEL SURGICAL TECHNIQUE:

·        It involves surgical excision of gingival epithelium using a scalpel and allowing the denuded connective tiisue to heal by secondary intention.

·        It is simple, most economical and convenient to perform.

·        Healing is faster.

·        It is associated with pain and post-operative discomfort and requires placement of periodontal dressing.

·        Thinner gingival biotype and narrow papillary areas are contraindicated in this technique.

FREE GINGIVAL GRAFTING:

·        In this an unpigmented free gingival graft autograft is harvested from the patient’s palate and is placed on the prepared recipient site.

·        It is technique sensitive and ghost like appearance of the treated site due to hypopigmentation are the drawbacks of this technique.

ELECTROSURGERY:

·        In this the heat generated by transmission of high frequency electrical energy to the tissues leads to either cutting or coagulation of tissue.

·        Repeated application can induce heat accumulation and undesired tissue destruction

·        There is less scar tissue formation.

LASERS:

·        Lasers exhibit enhanced hemostatic activity, good visibility at the surgical site and fewer post-operative complications.

·        It is effective and safe treatment modality.

·        Inappropriate application may damage gingiva and the underlying alveolar bone.

CRYOSURGERY:

·        This technique is most widely accepted method.

·        It involves freezing of gingiva with the application of different materials, i.e. cryogen.

·        The effect of cryogen on gingiva causes the epithelium to undergo cryonecrosis, which helps to eliminate gingival pigmentation.

·        It is a long term inexpensive method with rapid healing and low recurrence rate.

·        Post - operative swelling and difficulty in controlling the penetration depth constitute the disadvantages of the technique.

 

                                                            Dr. Anjusha Sharda