A Minimally Invasive Technique for the Management of Physiologic Gingival Melanin Hyperpigmentation: A Case Series.

An attractive smile enhances an individual's self-confidence. The overall harmony of a smile can be attributed to the interplay of the teeth's shape, color, and position along with the gingival tissue. Gingival pigmentation is observed across all human races, exhibiting variations from one race to another. Typically, gingival hyperpigmentation results from the abnormal buildup of melanin in the gingival tissue, imparting a dark appearance on the gums. Various procedures, collectively known as gingival depigmentation, are employed to address gingival hyperpigmentation. While the initial outcomes of depigmentation procedures are often promising, one common issue associated with them is the potential for re-pigmentation. This article aims to evaluate the clinical effectiveness and patient-reported outcomes of intraepidermal (oral mesotherapy) vitamin C injection for nonsurgical management of physiologic gingival melanin hyperpigmentation.

Assessment of clinical efficacy of 445 nm Diode laser as an adjunct to Kirkland flap surgery in the management of periodontitis - a split mouth randomized clinical trial.

Aim of this study is to assess the clinical efficacy of 445 nm Diode laser as an adjunct to Kirkland flap surgery in management of periodontitis. Type of study is a Split mouth clinical trial in which a total of 13 patients were recruited based on specific inclusion and exclusion criteria. In each participant, random allocation of selected sites into test and control in contralateral quadrants was done. Clinical parameters such as probing depth and clinical attachment loss was measured in control and test sites using occlusal stents. Flap surgery was carried out 6 weeks after phase I therapy and the selected contralateral sites with a probing depth of > 5mm were subjected to surgical therapy. In a test quadrant, 445 nm diode laser with a power of 0.8 W, CW mode, 320 µm fiber, in non-contact mode was used as an adjunct to flap surgery. Primary outcome variable assessed was change in PPD between baseline, pre-operative, 1-, 3- and 6-months post-surgery. Secondary outcomes variables assessed were Clinical attachment loss at baseline, pre-operative, 1, 3 and 6 months, visual analog scale at days 3 and 7 and patient satisfaction index at day 7 post surgery. Surgery for the second site (Test/control) in the contralateral quadrants was performed 1 week after the first surgery. A higher reduction in probing depth and gain in CAL was observed in test site at 1, 3 and 6 months follow up amongst all the included participants. VAS score was lower at the test site as compared to the control sites. PSI scores were similar in both the sites. The adjunctive use of 445nm diode laser to surgical periodontal therapy contributed to improved short term clinical outcomes as assessed at the end of 6 months post- surgery. VAS score indicative of post -surgical discomfort were also lower for the laser treated sites. Hence adjunctive use of laser (445 nm wavelength) can be recommended for achieving more predictable clinical outcomes.

Erbium lasers in non-surgical periodontal therapy: an umbrella review and evidence gap map analysis.

The literature on the efficacy of erbium lasers for nonsurgical periodontal therapy is inconsistent. The objective of the umbrella review was to collate the information available in the systematic reviews to provide a comprehensive synthesis of clinical and patient reported outcomes following the use of erbium lasers for non-surgical periodontal therapy. An electronic database search was carried out, and systematic reviews/meta-analyses which assessed the efficacy of erbium lasers as monotherapy or as an adjunct to scaling and root planing were included. The methodological quality and reporting quality of the included studies were assessed. 15 Systematic reviews/meta-analyses were obtained after title, abstract, and full text search. The meta-analyses data revealed a clinical attachment level gain, reduction in probing pocket depth at 1 and 3-month follow-up, and no additional benefit at ≥ 6-month follow-up in the erbium laser group. The evidence gap map revealed lack of clinical outcome data at > 6-month follow-up and dearth in studies assessing patient reported outcome measures and adverse events. Erbium lasers may provide short-term clinical benefits, and further studies with standardized laser parameters evaluating long-term follow-up, patient-reported outcome measures, and adverse events are needed.

A clinical and histological evaluation of platelet-rich fibrin and CGF for root coverage procedure using coronally advanced flap: A split-mouth design.

The management of gingival recession associated with esthetic concerns and root hypersensitivity is challenging and its sequelae are based on the assessment of etiological factors and the degree of tissue involvement. Procedures using pedicle flaps, free soft-tissue grafts, combination of pedicle flaps with grafts, barrier membranes, and the use of platelet concentrates are all effective for this purpose. The use of the second-generation platelet concentrate, platelet rich fibrin (PRF) has been widely used. Lately, concentrated growth factor (CGF) has evolved as a promising regenerative material, wherein it also acts as a scaffold and accelerates wound healing due to its dense fibrin meshwork. A 21-year-old male patient presented with bilateral multiple gingival recessions due to faulty tooth brushing. Coronally advanced flap with Zuchelli's technique was planned as a treatment modality. Platelet concentrates PRF and CGF were placed bilaterally during the procedure, and the outcome of the treatment was compared. The percentage of root coverage was clinically evaluated, and histological evaluation was also done to assess the density of fibrin meshwork in the platelet concentrates. Nearly 100% of root coverage was achieved with both PRF and CGF membrane 3 months postoperatively. However, CGF showed satisfactory wound healing by the 10th-day postoperatively compared to PRF. As CGF operates on varying centrifugation to separate cells in the venous blood, thereby resulting in fibrin-rich blocks that are much larger, denser, and richer in growth factors as also shown histologically.

Treatment of gingival recession by coronally advanced flap in conjunction with platelet-rich fibrin or resin-modified glass-ionomer restoration: A clinical study.

AIMS: The aim of this study is to compare the outcome of coronally advanced flap (CAF) along with the use of platelet-rich fibrin (PRF) versus CAF in conjunction with a resin-modified glass-ionomer cement (RmGIC) for the management of Millers Class I and Class II gingival recession coupled with noncarious cervical lesions (NCCLs). MATERIALS AND METHODS: Single and multiple Miller's Class I and Class II gingival recessions were chosen for the study. Twenty participants with total of 78 sites associated with NCCL bilaterally in the anterior and premolar region of maxilla were selected. Thirty-nine sites were treated with CAF and PRF and the remaining 39 sites were treated with CAF and RmGIC. Clinical parameters such as probing pocket depth, relative gingival recession, relative clinical attachment level, NCCL height, NCCL width, width of keratinized tissue, and keratinized tissue thickness were measured at baseline, 90th, and 180th day in both the groups. The presence or absence of dentin sensitivity (DS) was determined at baseline and 180th day. RESULTS: Both the groups showed optimal root coverage, with statistical significant difference in thickness of keratinized gingiva in Group I when compared to Group II from baseline to 90th day and from baseline to 180th day and also from 90th to 180th day. On comparing the DS between Group I and Group II from baseline to 180th day, Group II showed greater reduction in dentinal hypersensitivity as compared to Group I. CONCLUSION: The use of PRF along with CAF showed increased thickness of the keratinized tissue and the utilization of RmGIC resulted in decreased DS. Hence, the combination of CAF and PRF or CAF and RmGIC could provide a better treatment option in the management of gingival recession that is of esthetic concern.