Achieving better esthetics by gingival de-pigmentation: report of three cases with a review of the literature.

A smile expresses a feeling of joy and success and also reveals self-confidence and kindness in an individual. A holistic smile is dictated not only by the shape, position and color of the teeth but also by the health of the gingival tissues. Gingival appearance is an important component of an attractive smile. Melonin, carotene and hemoglobin are the most common natural pigments contributing to the normal color of gingiva. Although physiologic and ethnic melanin pigmentation is not a medical problem, complaints about "black gums" are common. For de-pigmentation of gingiva, different treatment modalities have been reported such as bur abrasion, scraping with scalpel, partial thickness flap, gingivectomy, cryotherapy, electrosurgery, lasers, free gingival autografting, sub-epithelial connective tissue graft and combination techniques. In the present case reports, scalpel surgery and electrosurgery were performed for gingival de-pigmentation, which are simple and effective. The esthetic results were pleasing and healing was uneventful. Patients were satisfied with the outcome at three month follow-up as evidenced from their feedback.

Comparing the 810nm diode laser with conventional surgery in orthodontic soft tissue procedures.

AIM: To compare the use of the 810nm diode laser with conventional surgery in the management of soft tissue mucogingival problems associated with orthodontic treatment. METHODS: Orthodontic patients requiring different soft tissue surgical procedures were randomly assigned to receive conventional surgery or soft tissue diode laser, (wavelength 810 nm). MAIN OUTCOME MEASURES: Parameters documented include the type of anaesthesia used, intra and post operative pain, bleeding, the use of scalpel and sutures. The chi-squared test was used to test for significance at 95% confidence level. Probability values (p-values) less than 0.05 were regarded as significant. RESULTS: Only 2(16.7%) of the procedures carried out with the soft tissue laser required infiltration anaesthesia compared to 10 (90.9%) with conventional surgery and this was significant (P<0.001). Post operative pain was significantly reduced in all cases treated with the diode laser (P<0.001). There was also a significant difference (P<0.05) in post operative bleeding in all cases treated with the diode laser. No sutures were used in all soft tissue cases managed with the diode laser and this was significant (P<0.001). There was no statistically significant difference in treatment time in the use of the laser compared with conventional surgery. CONCLUSION: Orthodontic patients treated with the diode laser required less infiltration anaesthesia, had reduced bleeding during and after surgery, rapid postoperative haemostasis, elimination of the need for sutures and an improved postoperative comfort and healing.

Healing process and laser therapy in the superficial periodontium: a histological study.

AIM: To evaluate the efficiency of laser therapy in healing, regeneration and repair processes located in the superficial periodontium after gingivectomy procedures. MATERIALS AND METHODS: The study group consisted of 38 patients without any systemic diseases presenting with gingival hypertrophy developed exclusively within the clinical context of gingivitis and/or periodontitis. All patients were included in the study based on their informed consent. All patients required several surgical interventions at the level of the superficial periodontium. Subgroup 1 (17 patients) was treated only through gingivectomy procedures. For subgroup 2 (21 patients), the gingivectomy was associated with laser therapy, applied every day for seven days. Gingival mucosa fragments were taken on day 1 (curative gingivectomy) and on day 21 (clinical control and corrective gingivectomy), and routinely processed for the microscopic exam, using Hematoxylin-Eosin and special stains (trichrome Szekely and Periodic Acid-Schiff). RESULTS AND DISCUSSION: The comparison between the morphological pictures characterizing the healing process associated or not with laser therapy, allowed the identification of some features supporting the benefits of laser therapy. We believe that the decrease in the inflammatory infiltrate located in the lamina propria is the critical morphological trait for the control of a healing process as near to restitutio ad integrum as possible. The diminished number of lymphocytes and macrophages will implicitly determine a lower production of chemical mediators interfering with the sequences of the healing process. CONCLUSIONS: The morphological differences identified at the gingival epithelium level and subjacent lamina propria support the value of laser therapy, stimulating an improved healing of the damaged tissues.

Laser-assisted gingivectomy in pediatric patients: a novel alternative treatment.

Gingival enlargement is quite a common pathology in pediatric patients and may be inflammatory, noninflammatory, or a combination of both. Idiopathic gingival fibromatosis, although rare, is a slowly progressive benign enlargement that affects the marginal gingiva, attached gingival, and interdental papilla. The fibromatosis may potentially cover the exposed tooth surfaces, causing esthetic and functional problems. The treatment of gingival fibromatosis is essential because it causes difficulties with mastication, speech problems, mispositioning of teeth, esthetic effects, and psychological difficulties for the patient. Traditional gingivectomy procedures have been a challenge for dentists who confront issues of patient cooperation and discomfort. In the last decade, laser procedures in oral cavity had shown many optimum effects in both hard and soft tissue procedures. Laser soft-tissue surgery has been shown to be well accepted by children. The following case report describes a laser-assisted gingivectomy procedure performed on a 13-year-old female.

Therapeutic effect of topical ozonated oil on the epithelial healing of palatal wound sites: a planimetrical and cytological study.

AIM: To evaluate the effect of ozonated oil on palatal wounds. METHODS: Eighteen patients were randomized and allocated to either the ozone group (n = 8) or control (n = 10) group. Free gingival graft surgery was performed, and post-harvested palatal wounds were treated with either 2 mL ozonated oil or control oil daily for 1 week. A planimetrical analysis analyzed the digital image for the wound sizes and shape factor at baseline, at 24 h, and days 5, 7, 14, 21, and 28, postoperatively. A cytological analysis used the keratinization and superficial cell indices at baseline, 24 h, and days 3, 7, 14, and 21 and the second and third months, postoperatively. RESULTS: Planimetrical results showed a significant (P ≤ 0.05) improvement in wound size on days 5, 7, 14, 21, and 28, postoperatively, in the ozone group compared to the control group. Cytological results showed a significant (P ≤ 0.001) improvement in epithelial healing on days 7, 14, and 21, and the second and third months, postoperatively, after the application of ozonated oil compared to control oil. CONCLUSION: Our results showed significant improvement in wound size and epithelial healing after topical ozonated oil application compared to control oil on palatal wounds.

Laser-aided circumferential supracrestal fiberotomy and low-level laser therapy effects on relapse of rotated teeth in beagles.

OBJECTIVE: To investigate the effectiveness and periodontal side effects of laser circumferential supracrestal fiberotomy (CSF) and low-level laser therapy (LLLT) on orthodontically rotated teeth in beagles. MATERIALS AND METHODS: Eighteen mandibular incisors from nine dogs were divided into three groups by treatment (n = 6/group): A, orthodontic couple force application only (control); B, laser CSF following orthodontic couple force application; and C, LLLT following orthodontic couple force application. Both mandibular lateral incisors were rotated for 4 weeks, and the relapse tendency was observed for 4 weeks more without any retainers. The amount of relapse, sulcus depth, and gingival recession were measured at weeks 4 and 8. One-way analysis of variance (ANOVA) and Scheffé's post hoc test were used for data analysis. Tissue specimens were examined at week 8 under light microscopy after hematoxylin-eosin (H&E) and Masson's trichrome staining. RESULTS: The mean percentage of relapse was 41.29% in group A, 14.52% in group B, and 56.80% in group C (P < .001). Four weeks after laser CSF, the sulcus depth increased by 0.67 mm, but no gingival recession was observed. There was no significant difference between groups A and C in terms of sulcus depth and gingival recession. CONCLUSIONS: Laser CSF is an effective procedure to decrease relapse after tooth rotation, causing no apparent damage to the supporting periodontal structures, whereas LLLT on orthodontically rotated teeth without retainers appears to increase the relapse tendency.

Expression of heat shock proteins, Hsp70 and Hsp25, in the rat gingiva after irradiation with a CO2 laser in coagulation mode.

BACKGROUND AND OBJECTIVE: The therapeutic rationale of low-energy pulsed CO(2) laser coagulation mode has not been clarified yet. We conducted this study to characterize the effect of low-energy pulsed CO(2) laser coagulation mode irradiation of the rat gingiva in terms of the expression of heat shock proteins. MATERIAL AND METHODS: Laser irradiation was achieved with the parameters of 5 W, 600 mus pulse duration, and fluence of 326 J/cm(2). The gingiva dissected at different times after irradiation was processed for immunohistochemical examination of the expression of the heat shock proteins, Hsp70 and Hsp25. RESULTS: One hour after irradiation, the epithelial keratinocytes facing the laser wound exhibited an overexpression of Hsp70 in their nucleus. The connective tissue cells facing the laser wound, which included fibroblasts and capillary endothelial cells, showed de novo expression of Hsp70 at 3 h post-irradiation, the level of which peaked at 1 d and thereafter decreased. An enhanced and/or de novo expression of Hsp25 in the connective tissue cells facing the laser wound became evident at 3 h after irradiation, and after 1 d the Hsp25-expressing cells increased in number and spread over the wound as wound repair progressed. There was a temporospatial difference in the expression pattern between Hsp70 and Hsp25, with only a few cells appearing to co-express both heat shock proteins. CONCLUSION: The CO(2) laser treatment in coagulation mode produced the expression of heat shock proteins, and the findings suggest that while Hsp70 mainly conferred cell protection, Hsp25 was involved in the progress of wound repair as well as cell protection.

Lasers and pediatric dental care.

There are several types of lasers that will allow pediatric dentists to remove soft tissue (such as diode or Neodynium:Yttrium-Aluminum-Garnet (Nd:YAG) lasers) or remove both hard and soft tissue (such as the Erbium:YAG laser), in addition to photobiostimulation or therapeutic lasers that produce their healing benefits without producing heat. Lasers allow pediatric dentists to provide optimal care without many of the fear factors that result from conventional dental techniques. Lasers are extremely safe and effective when the user has a proper understanding of laser physics. Using lasers for caries removal, bone removal, and soft tissue treatment can reduce postoperative discomfort and infection and make it possible for dentists to provide safe, simple treatments.

Improved wound healing by low-level laser irradiation after gingivectomy operations: a controlled clinical pilot study.

AIM: Low-level laser therapy (LLLT) may induce morphological, molecular and cellular processes, which are involved in wound healing. The aim of this split-mouth controlled clinical trial was to assess the effects of LLLT on healing of gingiva after gingivectomy and gingivoplasty. MATERIAL AND METHODS: Twenty patients with inflammatory gingival hyperplasias on their symmetrical teeth were included in this study. After gingivectomy and gingivoplasty, a diode laser (588 nm) was randomly applied to one side of the operation area for 7 days. The surgical areas were disclosed by a solution (Mira-2-tones) to visualize the areas in which the epithelium is absent. Comparison of the surface areas on the LLLT-applied sites and controls were made with an image-analysing software. RESULTS: Despite the prolonged time needed for application, patients have tolerated LLLT well. While there were no statistically significant differences between the stained surface areas of the LLLT applied and the control sites immediately after the surgery, LLLT-applied sites had significantly lower stained areas compared with the controls on the post-operative third, seventh and 15th day (p<0.001 for each). CONCLUSIONS: Within the limitations of this study, the results indicated that LLLT may enhance epithelization and improve wound healing after gingivectomy and gingivoplasty operations.

Lasers and soft tissue treatments for the pediatric dental patient.

Historically, oral soft tissue surgery on infants and young children was completed in the operating room under a general anesthetic agent. Many children were referred to an oral surgeon and required a physician's physical examination and medical clearance for a hospital admission. potentially placed a child at risk during the use of a general anesthetic for an elective procedure, which may not have insurance benefits. Traditional methods of oral surgery using scalpels or electrosurgery may produce significant postoperative discomfort and require sutures and prolonged healing. Lasers provide a simple and safe in-office alternative for children while at the same time reducing the chances of infection, swelling, discomfort, and scaring.

Lasers and soft tissue: 'fixed' soft tissue surgery.

Within a general practice setting, there are few benign pathological conditions of the attached or keratinised gingival complex that are not amenable to simple surgical intervention. The majority of surgical procedures are adjunctive to the delivery of restorative dentistry. There is an understandable dogma worldwide towards the management of soft tissues as they interface with restorative procedures. Contemporary teaching, both at undergraduate and postgraduate level, would recognise the need for a period of wound healing and stability, based on scalpel-induced incisional therapy. The use of laser wavelengths, based on predictable evidence-based protocols, has re-defined the surgical management of keratinised mucosa that is bound to the underlying periosteum and bone. This can be seen as being of benefit to the clinician in determining the outcome, and the patient in achieving quality results.

Hospital periodontal surgery.

Phenytoin-induced gingival overgrowth is a recognized side effect in many cerebral palsy patients using diphenyl hydantoin for the control of seizures. Severe gingival overgrowth in these patients can affect normal masticatory function, lead to poor occlusal development, and compromise esthetics. This report addresses the complex nature of treating phenytoin-induced gingival overgrowth in a mentally retarded 20-year-old female patient. For this patient, full-mouth gingivectomy procedure was performed under general anesthesia in a single session. Post operative follow-up was uneventful. This article discusses major indications, contraindications, and protocols to be followed for periodontal surgical procedures done under general anesthesia.

Tratamiento estético integral del sector anterior de la boca / Comprehensive esthetic treatment of the anterior section of the mouth

Los diferentes elementos del rostro, ojos, nariz, labios, mentón, boca, etc., en forma aislada no determinan la belleza. La integración armónica de estos elementos son determinantes de la estética facial. Dentro de ellos, la boca juega un papel preponderante con una disposición, forma, tamaño y color de dientes adecuada, en relación con los márgenes gingivales y con los llamados puntos de referencia del rostro. El tener una agradable sonrisa y una buena apariencia en el momento de hablar, se ha convertido en una necesidad en la vida moderna, en el campo de las relaciones sociales, laborales y humanas en general. Se hace una revisión de las bases de la estética dental: 1) marco y puntos de referencia; 2) proporciones e idealismo; 3) simetría y 4) perspectiva e ilusión. Como parte de estas bases, se analizan los principios macro estéticos y micro estéticos. Finalmente, se presenta un caso clínico como aplicación de los fundamentos descritos

Infiltrated lidocaine 2% with epinephrine 1:80,000 causes more postoperative pain than lidocaine 2% after oral soft tissue surgery.

A controlled, randomized, double-blind, within-patient, crossover study was made with 50 patients (28 women and 22 men) of mean age 47 years (range, 32-69 years) who were subjected to identical bilateral gingivectomies. On one occasion, lidocaine 2% was infiltrated as the local anesthetic. On the other occasion, lidocaine 2% with epinephrine 1:80,000 was given. Postoperative pain intensity was recorded by the patients on a 100-mm visual analogue scale every hour during an 11-hour observation period. The mean pain intensity was numerically higher after lidocaine 2% at 0 hours and 1 hour postoperatively. Then the mean pain intensity after lidocaine 2% was lower than that after lidocaine 2% with epinephrine 1:80,000 throughout the remaining observation period. The difference in pain intensity was statistically significant (P < .05) at 2, 4, 5, 6, and 7 hours after surgery. Mean sum (SEM) pain intensity over the 11-hour observation period was lower (P = .03) after lidocaine 2%, 66.5 (13.4) mm than after lidocaine 2% with epinephrine 1:80,000, 92.6 (15.4) mm. The study shows that high epinephrine concentration (1:80,000) increases the postoperative pain after dental soft tissue surgery with mild pain.

Pigmentaciones gingivales / Gingival pigmentations

El color gingival en salud varia desde el rosa coral palido hasta el purpura, este esta determinado por su vascularidad, el grosor y queratinizacion epitelial y la intensidad en la melaninogenesis. El color establecido en normalidad puede aumentar en intensidad, disminuir, o bien presentar pigmentaciones. Las pigmentaciones y decoloraciones gingivales pueden tener un origen fisiologico o patologico y son causados por una gran cantidad de factores locales o sistemicos. Los problemas esteticos que originan las pigmentaciones en los tejidos orales y las implicancias sistemicas obligan al clinico a un adecuado diagnostico de estas y a una terapeutica de acuerdo con los requerimientos del paciente y con las actuales posibilidades.

Combined treatment approach to gingival overgrowth due to drug therapy.

A case of severe gingival overgrowth associated with combined drug therapy of cyclosporin A and nifedipine is reported. The frequently increased vascularity of the gingival tissues in such cases often causes problems with bleeding both during and after surgery. Acrylic suckdown splints have been used postoperatively to assist haemostasis; however, these can interfere with function and cause discomfort. This report describes a combined treatment approach using conventional gingivectomy and carbon dioxide laser for the removal of the hypertrophic soft tissue. The benefits of such combined treatment include reduced bleeding during surgery with consequent reduced operating time and rapid post-operative haemostasis, thus eliminating the need for a splint.

Multimodal treatment of drug-induced gingival hyperplasia in a kidney transplant patient.

Medical advances for treating organ diseases have resulted in thousands of organ transplants being performed each year. Every patient receiving a transplanted organ will also be placed on drugs that may induce gingival hyperplasia as a side effect. This article discusses the multiphasic approach to treating the disfiguring hyperplasia through chemical and mechanical plaque control, surgical removal of the tissue by lasers, and postsurgical rinses with folate.

Effect of folic acid on recurrence of phenytoin-induced gingival overgrowth following gingivectomy.

This study examined the effect of folic acid supplementation on the recurrence of phenytoin-induced gingival overgrowth following gingivectomy. 8 residents of an institution for the developmentally disabled were randomly assigned to a treatment (N = 4) or control (N = 4) group. Subjects in the treatment group received an oral supplementation of 5 mg of folic acid daily during the study; those in the control group did not. A gingivectomy with an external beveled incision made to the crest of the alveolus was completed by quadrants. The following data were obtained prior to gingivectomy, 2 weeks following the last quadrant of surgery, and at 3 and 6 months post-surgery: plaque and gingival index scores, red blood cell folic acid levels, free phenytoin blood levels, photographs, and impressions. % change in overgrowth was determined from cross-sectional area measurements made on dies obtained from bucco-lingual cuts on stone models. Differences across time between and within groups were tested by a two-factor repeated measure analysis of variance. The groups did not differ in plaque and gingival index scores or free phenytoin blood levels. The treatment group had significantly higher red blood cell folic acid levels (p less than or equal to 0.0001). Reduction in gingival overgrowth as a result of surgery was similar in both groups. Although the treatment group had significantly less recurrence of gingival overgrowth (p less than or equal to 0.05), the mean differences amounted to only 6-7% at 3 and 6 months.