A Comparison of 940 nm Diode Laser and Cryosurgery With Liquid Nitrogen in the Treatment of Gingival Physiologic Hyperpigmentation Using Split Mouth Technique: 12 Months Follow Up
Journal of Lasers in Medical Sciences,
Vol. 10 No. 2 (2019),
25 February 2019
,
Page 131-138
Abstract
Introduction: Gingival hyperpigmentation is excessive deposition of melanin pigments in the epithelium of gingiva which affects facial esthetics. Various surgical methods for gingival depigmentation have been used to treat the darkened color of pigmented gingiva. This study compared the use of 940 nm diode laser and liquid nitrogen cryosurgery in the treatment of gingival physiologic hyperpigmentation in terms of gingival depigmentation, postoperative pain, healing duration, pigmentation recurrence, and patients’ satisfaction.
Methods: Fifteen systemically healthy patients (11 females and 4 males; 17-35 years of age) with bilateral gingival physiologic hyperpigmentation were enrolled in this split-mouth randomized study. Maxillary anterior labial gingiva of each patient was divided into left and right halves, and each half was randomly depigmented by either laser or cryosurgery. Patients were given questionnaires to evaluate the procedures and were followed up in 3, 7, 10, 17 and 21 days postoperatively for the assessment of gingival healing and 1, 3, 6 and 12 months after the treatments to detect any sign of pigmentation recurrence.
Results: The severity of post-op pain measured by visual analogue scale (VAS) was mild to average and showed no significant difference between the 2 modalities (P > 0.05). There was no considerable swelling or hemorrhage after the treatment procedures and the healing duration was significantly shorter in laser (P < 0.05). The degree of pigmentation in all gingival sites treated by laser reached and remained at zero until the last follow up (1 year) and reached zero in 9 out of 15 cryosurgery-treated sites. All patients were completely satisfied with the laser, and 9 out of 15 were completely satisfied with cryosurgery. No pigmentation recurrence was observed during any follow-up periods.
Conclusion: Removal of gingival physiologic hyperpigmentation by laser therapy and cryotherapy was effective and safe. The efficiency of the laser was better than cryotherapy.
- Hyperpigmentation
- Gingiva
- Cryosurgery
- Diode Laser
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References
Abdel Moneim RA, El Deeb M, Rabea AA. Gingival pigmentation (cause, treatment and histological preview). Fut Dent J. 2017;3(1):1-7. doi:10.1016/j.fdj.2017.04.002
Glick M. Burket’s Oral Medicine. 12th ed. USA: People’s Medical Publishing House; 2015.
Sabrinath B, Sivapathasundharam B, Ghosh G, Dhivya. Pigmentation. Indian J Dent Adv. 2009;1(1):38-45.
Farahmand AH, Moghareh Abed A, Mansouri Y. Clinical Application of Er.YAG Laser and Cryosurgery in Gingival Depigmentation. World J Dent. 2014;5(2):102-8.
Özcan M, Işler SC, Bozkaya S, Özcan G. Complication after cryosurgery treatment for gingival melanin pigmentation: a case report. Clinic Adv Periodontics. 2015;5(1):56-60. doi:10.1902/cap.2013.120124
Agarwal N, Bhowmick D, Sinha A, Mishra A, Shukla S, Singh D. Depigmentation of gingiva using semiconductor diode laser: a clinical case report. J Pak Dent Assoc. 2014;23(3):126-30.
Azma E, Safavi N. Diode laser application in soft tissue oral surgery. J Lasers Med Sci. 2013;4(4):206-211.
Lin YH, Tu YK, Lu C, et al. Systematic Review of treatment modalities for gingival depigmentation: a random-effects poisson regression analysis. J Esthet Restor Dent. 2014;26(3):162-178. doi:10.1111/jerd.12087
Bakutra G, Shankarapillai R, Mathur L, Manohar B. Comparative evaluation of diode laser ablation and surgical stripping technique for gingival depigmentation: a clinical and immunohistochemical study. Int J Health Sci. 2017;11(2):51-58.
Rao PVN, Penmetsa GS, Dwarakanath CD. Gingival depigmentation by cryosurgery and laser application - a comparative clinical study. Br J Med Med Res. 2015;5(11):1403-1412. doi:10.9734/BJMMR/2015/12870
Ribeiro FV, Cavaller CP, Casarin RC, et al. Esthetic treatment of gingival hyperpigmentation with Nd:YAG laser or scalpel technique: a 6 month RCT of patient and professional assessment. Lasers Med Sci. 2014;29(2):537- 544. doi:10.1007/s10103-012-1254-5
Lagdive S, Doshi Y, Marawar PP. Management of gingival hyperpigmentation using surgical blade and diode laser therapy: a comparative study. J Oral Laser Appl. 2009;9(1):41-7. doi:10.4103/0974-2077.91256
Murthy MB, Kaur J, Das R. Treatment of gingival hyperpigmentation with rotary abrasive, scalpel, and laser techniques: a case series. J Indian Soc Periodontol. 2012;16(4):614-619.
Singh V, Giliyar SB, Kumar S, Bhat M. Comparative evaluation of gingival depigmentation by diode laser and cryosurgery using tetrafluoroethane:18-month follow-up. Clin Adv Periodontics. 2012;2(3):129-34. doi:10.1902/ cap.2012.110008
Patil KP, Joshi V, Waghmode V, Kanakdande V. Gingival depigmentation: A split mouth comparative study between scalpel and Cryosurgery. Contemp Clin Dent. 2015;6(1):97- 101. doi:10.4103/0976-237X.152964
Kaya GS, Yavuz GY, Sümbüllü MA, Dayı E. A comparison of diode laser and Er:YAG lasers in the treatment of gingival melanin pigmentation. Int J Health Sci. 2012;113(3):293- 299. doi:10.1016/j.tripleo.2011.03.005
Rahmati S, Darijani M, Nourelahi M. Comparison of surgical blade and cryosurgery with liquid nitrogen techniques in treatment of physiologic gingival pigmentation: short term results. J Dent Shiraz. 2014;15(4):161-166.
Azzeh MM. Treatment of Gingival hyperpigmentation by erbium-doped:yttrium, aluminum, and garnet laser for esthetic purposes. J Periodontol. 2007;78(1):177-184. doi:10.1902/jop.2007.060167
Shirazi ARS, Taghavi AM, Khorakian F. Treatment of gingival physiologic pigmentation in adolescent using cryosurgery technique with liquid nitrogen: one year follow up. J Mashhad Dent Sch. 2010;33(4):331-342.
Hagan JF Jr, Coleman WL, Foy JM, et al. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793-797.
Sharon E, Azaz B, Ulmansky M. Vaporization of melanin in oral tissues and skin with a carbon dioxide laser: a canine study. J Oral Maxillofac Surg. 2000;58(12):1387-1393. doi:10.1053/joms.2000.18272
Esen E, Haytac MC, Oz IA, Erdog˘an O, Karsli ED. Gingival melanin pigmentation and its treatment with the CO2 laser. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98(5):522-527.
Atsawasuwan P, Greethong K, Nimmanon V. Treatment of gingival hyperpigmentation for esthetic purposes by Nd:YAG laser: report of 4 cases. J Periodontol. 2000;71(2):315-21.
Berk G, Atici K, Berk N. Treatment of gingival pigmentation with Er, Cr:YSGG laser. J Oral Laser Appl. 2005;5(4):249- 53.
Thangavelu A, Elavarasu S, Jayapalan P. Pink esthetics in periodontics - gingival depigmentation: a case series. J Pharm Bioallied Sci. 2012;4(2):186-190.
Govila V, Gulati M, Govila S. Diode laser applications in periodontics. Indian J Dent Sci. 2011;3(5):64-67.
Saygun I, Karacay S, Serdar M, Ural AU, Sencimen M, Kurtis B. Effects of laser irradiation on the release of basic fibroblast growth factor (bFGF), insulin like growth factor-1 (IGF-1), and receptor of IGF-1 (IGFBP3) from gingival fibroblasts. Lasers Med Sci. 2008;23(2):211-5. doi:10.1016/S107921040400160X
Yu W, Naim JO, Lanzafame RJ. The effect of laser irradiation on the release of bFGF from 3T3 fibroblasts. Photochem Photobiol. 1994;59(2):167-170.
Ozturan S, Ususmez A. Case report: asethetic treatment of gingival hyperpigmentation by Er:YAG laser. J Laser Health Acad. 2013;2013(1):1-3.
Darbandi A, Shahbaz NA. Effect of cryotherapy on physiologic pigmentation of oral mucosa: a preliminary study. J Dent Tehran Univ Med Sci. 2004;1(2):49-52.
Talebi M, Farmanbar N, Abolfazli S, Shirazi AS. Management of physiological hyperpigmentation of oral mucosa by cryosurgical treatment: a case report. J Dent Res Dent Clin Dent Prospects. 2012;6(4):148-151. doi:10.5681/ joddd.2012.030
Soliman MM, Al Thomali Y, Al Shammrani A, El Gazaerly H. The use of soft tissue diode laser in the treatment of oral hyper pigmentation. Int J Health Sci. 2014;8(2):133-140.
Doshi Y, Khandge N, Byakod G, Patil P. Management of gingival pigmentation with diode laser: is it a predictive tool? Int J Laser Dent. 2012;2(1):29-32.
Jha N, Ryu JJ, Wahab R, Al-Khedhairy AA, Choi EH, Kaushik NK. Treatment of oral hyperpigmentation and gummy smile using lasers and role of plasma as a novel treatment technique in dentistry: an introductory review. Oncotarget. 2017;8(12):20496-20509. doi:10.18632/ oncotarget.14887
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