Vitamin C mesotherapy versus diode laser for the esthetic management of physiologic gingival hyperpigmentation: a randomized clinical trial.

BACKGROUND: Physiologic gingival hyperpigmentation is a common esthetic concern that affects individuals of various ethnicities, and can have a significant impact on individual's self-confidence and overall quality of life. Thus, this study aimed to clinically assess the effectiveness of intra-mucosal injection of vitamin C versus 980 nm diode laser for the management of physiologic gingival hyperpigmentation. METHODS: Twenty-six healthy non-smoker individuals with physiologic gingival hyperpigmentation were randomly assigned to two groups. Group I received intra-mucosal injection of vitamin C (L-Ascorbic acid 1000 mg/5 ml), and group II was managed using diode laser (980 nm, 1.5 W, continuous wave mode). Clinical evaluation of pigmentation intensity and distribution was performed preoperatively, and at 1, 2 and 3 months postoperatively using two different color assessment indices; Dummett-Gupta Oral Pigmentation Index (DOPI), and Gingival Pigmentation Index (GPI). Additionally, the study assessed pain intensity and patients' satisfaction. RESULTS: Pigmentation scores decreased significantly between pre-operative visit and different follow-up visits for both treatment modalities (p < 0.0001*). When compared to the vitamin C mesotherapy group, the laser group demonstrated significantly lower gingival pigmentation scores (p < 0.0001*). However, both treatment modalities were equally satisfying for the patients. CONCLUSIONS: Vitamin C mesotherapy and diode laser are both effective in the management of physiologic gingival hyperpigmentation. While diode laser yields better and earlier results, vitamin C mesotherapy offers a cost-effective, safe and minimally invasive approach that is equally satisfying for the patients seeking esthetic enhancements. TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov (NCT05608057) on (01/11/2022).

Utilización de láser diodo en tejidos blandos: reporte de 3 casos / Use of diode laser in soft tissue: report of 3 cases

Existen diversas condiciones anatómicas o alteraciones mucogingivales que pueden afectar tanto el normal funcionamiento como la estética gingival de piezas dentarias e implantes dentales. Si bien los tratamientos de estas condiciones se han realizado tradicionalmente con bisturí, el desarrollo tecnológico ha permitido que actualmente se pueden realizar con láser. Existen diferentes tipos de láser, siendo el diodo uno de los más utilizados debido a su menor tamaño, portabilidad, fácil configuración y menor costo. El láser ha adquirido mayor popularidad en cirugías de tejido blando dado sus múltiples beneficios: menor tiempo operatorio, control del sangrado y de la hemostasia, reducción de la cantidad de anestesia, posibilidad de no requerir suturas y minimización del dolor e inflamación postquirúrgica. El propósito de este trabajo es presentar la resolución de tres casos clínicos a los cuales se les realizaron los procedimientos de frenectomía labial, remoción de melanosis gingival y resección de fibroma irritativo mediante el uso de láser diodo. Para desarrollar todos los procedimientos se utilizó un equipo de láser diodo de 940 nm (Biolase®, USA) con una potencia que varió entre 2 y 2.5 W en modo continuo utilizando una pieza quirúrgica con una punta de 300 µm (E 3-4), la que fue activada antes de empezar. Posterior a la cirugía se bioestimuló para disminuir el dolor y edema postoperatorio utilizando la punta de dolor a 4 W por 30 segundos a una distancia de 1 cm directo en la zona intervenida a todos los casos. La conclusión arroja que en todos los casos, el láser de diodo permitió un resultado exitoso. El procedimiento fue seguro, la técnica fue sencilla y de tiempo clínico reducido. El postoperatorio ocurrió con ausencia de dolor o molestias, generando una mayor satisfacción del paciente. Cabe señalar que la técnica depende de la habilidad del profesional que la realiza.

There are various anatomical conditions or mucogingival alterations that can affect the normal functioning and the gingival aesthetics of teeth and dental implants. Although the treatments of these conditions have been traditionally performed with a scalpel, technological development has allowed that they can be now performed with lasers. There are different types of lasers, being the diode one of the most used due to its smaller size, portability, easy configuration, and lower cost. The laser has become more popular in soft tissue surgeries due to its multiple benefits: shorter operating time, control of bleeding and hemostasis, reduction in the amount of anesthesia, possibility of not requiring sutures, and minimization of post-surgical pain and inflammation. The purpose of this work is to present the resolution of three clinical cases which underwent labial frenectomy procedures, removal of gingival melanosis and resection of irritative fibroma using diode laser. To develop all the procedures, a 940 nm diode laser equipment (Biolase®, USA) was used with a power that varied between 2 and 2.5 W in continuous mode, using a 300 µm tip (E 3-4), which was activated before starting. After surgery, biostimulation was carried out to reduce postoperative pain and edema using the pain tip at 4 W for 30 seconds at a distance of 1 cm directly in the operated area in all cases. In all cases, the diode laser allowed a successful result. The procedure was safe, the technique was simple, and the clinical time was short. The postoperative period occurred with the absence of pain or discomfort, generating greater patient satisfaction. It should be noted that the technique depends on the skill of the professional who performs it.

Comparison of Nd:YAG Laser and Surgical Stripping for Treatment of Gingival Hyperpigmentation: A Clinical Trial.

OBJECTIVE: The objective of this study is to evaluate and compare surgical stripping and neodymium-doped: yttrium, aluminum garnet (Nd:YAG) laser techniques for gingival depigmentation and to evaluate their effect on repigmentation. BACKGROUND DATA: Gingival depigmentation is often associated with repigmentation. Recurrence of pigmentation differs according to different treatment modalities. MATERIALS AND METHODS: In this study, 40 maxillary sites from 20 patients presenting bilateral melanin gingival hyperpigmentation were selected. Contralateral quadrants in the maxilla were randomly assigned to receive Nd:YAG laser at 3 W, 30 mJ per pulse, with contact mode, and with a handpiece with a 300 µm diameter optic fiber and surgical stripping. Plaque index, Dummett Oral Pigmentation Index (DOPI), Hedin melanin index, size of pigmented area, time interval and extent of repigmentation, time taken for each of the procedures, assessment of pain, intraoperative bleeding index, and patient preference were compared from baseline to 6 months. RESULTS: Comparison between Nd:YAG laser and surgical stripping group for plaque index, DOPI, Hedin index, size of pigmented area, time interval, and extent of repigmentation, at 6 months was statistically nonsignificant. Intergroup comparison for time taken, pain, and patient preference was statistically significant. Intragroup comparison for Nd:YAG laser and surgical stripping at 6 months for DOPI, Hedin index, and size of pigmented area was statistically significant. CONCLUSIONS: From the present study it can be concluded that Nd:YAG laser can be used as an alternative technique for gingival depigmentation. However, surgical stripping continues to remain as a cost-effective procedure.

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.

Cytological assessment of healing palatal donor site wounds and grafted gingival wounds after application of ozonated oil: an eighteen-month randomized controlled clinical trial.

OBJECTIVE: The present study was undertaken to assess the therapeutic effects of topical ozonated oil on early healing of free gingival graft surgical sites. STUDY DESIGN: Twenty subjects were entered into this triple-blinded, randomized, placebo-controlled clinical trial, designed to evaluate the efficacy of ozonated oil on free gingival graft surgical wounds. Subjects were assigned to either the ozone group, in which ozonated oil was applied to the surgical wound, or the control group, in which non-ozonated oil was used as a control. Patients were postoperatively evaluated by cytological analysis. Cytological analysis consisted of the keratinisation and superficial cell indices measured at baseline, after 24 h, on the 3rd, 7th, 14th and 21st day and 2, 3, 8 and 18 months postoperatively. RESULTS: Cytological results showed that there was a significant (p < 0.001) improvement in epithelial healing by the 7th, 14th and 21st day and 2, 3 and 8 months postoperatively in the ozone group compared to the control group. CONCLUSION: The present study showed significant improvement in epithelial healing and gingival health after topical application of ozone-treated plant oil to gingival surgical sites.

[Gingival depigmentation for aesthetic purposes using erbium:YAG laser: rationale and technique].

Melanin, carotene and hemoglobin are the most common natural pigments contributing to the normal color of the gums. Although physiologic and ethnic melanin pigmentation is not a medical problem, complains about "black gums" are common. Gingival depigmentation has been carried out using surgical, chemical, electrosurgical and cryosurgical procedures. Recently, Laser Ablation has been recognized as one of the most effective, pleasant and reliable techniques. Effective depigmentation of the gingival requires removal of all or most of the melanocytes from the basal layer of the gingival epithelium. Using non-specific radiation means ablation of all the epithelial cell layers, as well as connective tissue rete pegs, leaving behind only remnants of the epithelial rete ridges. CO2, Nd:YAG and Erbium:YAG lasers, meeting most of these requirements and being available in the dental office, seems to be the lasers of choice for this procedure. Five patients (3 F; 2 M) who were referred to the TAUSDM for cosmetic therapy of "black gums" were treated using Erbium-YAG laser. The laser beam was set up at 850 mj/10 pulses per second producing peak power of 2.13 kwand peak power density of 30.43 kw/sq/cm. The beam was defocused to produce a 3 mm diameter circle, thus reducing the beam penetration while increasing the treated surface. Using the "brush" technique, 800-2,000 pulses were required per patient, with an average of 500-1,100 pulses per 1 sq.cm, depending on the thickness of the epithelium and the intensity of the pigmentation. Treatment required only topical anesthesia. Healing was uneventful and required no supportive therapy. Three months follow up has shown no repigmentation in any of the patients. Patients' evaluation analysis showed that the results were pleasing; no pain was experienced during lasing as well as during healing. Two patients were interupted by the lasing burning smell, which may be reduced or eliminated by operating a power suction during the procedure.

Case reports of epulis treated by CO2 laser without anesthesia.

This study reports seven cases of epulis excised by the CO2 laser without anesthesia. The laser was used in a continuous wave mode at power setting of 2-4 W. All lesions were excised completely, and no patients felt pain during laser irradiation. The operation was successful without using surgical packs, and there was no postoperative discomfort. There has been no evidence of recurrence after operation.