Gingival hyperpigmentation is caused by excessive deposition of melanin in the basal and suprabasal cell layers of the epithelium. Although melanin pigmentation of the gingiva is completely benign, cosmetic concerns are common, particularly in patients having a very high smile line (gummy smile). Various depigmentation techniques have been employed, such as scalpel surgery, gingivectomy, gingivectomy with free gingival autografting, cryosurgery, electrosurgery, chemical agents such as 90% phenol and 95% alcohol, abrasion with diamond burs, Nd:YAG laser, semiconductor diode laser, and CO2 laser. The present case report describes simple and effective depigmentation technique using semiconductor diode laser surgery – for gingival depigmentation, which have produced good results with patient satisfaction.

Introduction: Free gingival grafting is one of the most common techniques used to increase the dimensions of keratinized tissue (KT). The palatal donor sites heal with secondary intention, require a longer time, and cause discomfort to patients. This case series describes the use of platelet‐rich fibrin (PRF) membrane as a palatal bandage to cover donor sites. To the best of the authors’ knowledge, this is the first report that describes the use of PRF membrane as a palatal bandage. Case Series: Five patients requiring augmentation of KT are described in this case series. The palatal donor sites of four of these patients were covered with PRF membranes as a palatal bandage. The donor site of the fifth patient was allowed to heal in a conventional way without PRF membrane to evaluate the difference in healing. The healing was evaluated visually by hydrogen peroxide test at days 12, 13, 18, 19, 24, 25, 30, and 31. Palatal donor sites covered with PRF membranes demonstrated considerably faster healing compared with the site not covered by PRF membrane. Conclusions: The superior healing observed at the PRF membrane sites supports its use in accelerating soft‐tissue healing. PRF membrane as a palatal bandage is an efficacious approach to protect the raw wound area of a palatal donor site to reduce healing time and patient discomfort.

Background:Aggressive periodontitis is a characterized by rapid attachment loss, bone destruction and familial aggregation. Platelet-rich plasma (PRP) has been proposed to promote regeneration of the lost periodontal tissues. The aim of this study was to evaluate and compare the efficacy of PRP combined with hydroxyapatite (HA) graft in the treatment of intra-bony defects in localized aggressive periodontitis (L-AgP) patients.Materials and Methods:Ten L-AgP patients having bilateral intra-bony defect ≥2 mm and probing depth (PD) ≥6 mm were randomly treated either with the PRP/HA graft or HA graft alone. The clinical (plaque control record, bleeding on probing index, PD, and relative attachment level [RAL]), and radiographic parameters (size of the bone defect) were recorded pre- and post-operatively at 3, 6, and 12 months.Results:After 12 months, for both maxillary and mandibular arches, the mean PD decrease was significantly more (P < 0.05) for the test group than the control group (3.2 mm vs. 1.9 mm and 3.6 mm vs. 1.9 mm, respectively). Furthermore, the mean RAL decrease in both maxillary and mandibular arches was significantly more (P < 0.05) for the test group than the control group (3.0 mm vs. 1.2 mm and 3.1 mm vs. 1.4 mm, respectively). Radiographically, the test group showed significantly more defect fill as compared with the control group.Conclusion:Both treatments provided significant improvements in clinical and radiographic parameters in a 12-month postoperative period. PRP/HA group presented superior results regarding PD reduction, clinical attachment gain and radiographic bone fill than HA group.

Introduction: Gingival recession presents with destruction of both soft and hard tissues and can cause major functional and esthetic problems. Treatment of gingival recession especially multiple recession defects presents a challenge because several recession defects must be treated at a single surgical session to minimize patient discomfort. New materials and techniques are being developed these days to obtain predictable root coverage. This article describes the use of vestibular incision subperiosteal tunnel access (VISTA) technique in combination with platelet rich fibrin (PRF) membrane in the treatment of gingival recession defects. This is probably the first article that describes the use of PRF membrane reinforced VISTA technique.Case Presentation: Four patients with multiple gingival recessions were selected for this case series. VISTA technique allowed coronal repositioning of gingival margin, which was then stabilized by coronally anchored suturing technique. PRF membrane was inserted inside the subperiosteal tunnel and vertical incision was sutured. Patients were kept under observation for 6 months.Conclusion: This use of PRF membrane along with VISTA technique allows clinician to successfully treat multiple recession defects.

Introduction:Demand for cosmetic therapy of gingival melanin pigmentation is common. Re-pigmentation after gingival depigmentation is an important point. The aim of this study is to evaluate the effect of surgical scraping and electrosurgery on postoperative pain, healing and recurrence of pigmentation.Materials and Methods:Fifteen patients with esthetic concern related to black gums were selected and treated by surgical scraping with respect to right quadrant and electrosurgery with respect to left quadrant. Patients were recalled post-operatively to evaluate healing and recurrence of pigmentation. Each patient was asked to complete the Visual Analogue Scale (VAS) index cards 2 and 24 hours postoperatively.Results:In the initial post-operative period, VAS index cards showed that the discomfort and pain level associated with electrosurgery was significantly higher than conventional scalpel surgery (P < 0.05). Clinically delayed healing was observed in the electrosurgically treated site. Electrosurgery showed better results as compared to epithelial excision for recurrence of pigments. At the end of 15 months, 7 sites in the scalpel excision group showed recurrence, whereas only 4 site showed recurrence in the electrosurgically treated group.Conclusion:The methods used here produced desired results and above all, the patients were satisfied with the outcome. Increased pain level and clinically delayed healing was associated with electrosurgery as compared to scalpel surgery, whereas repigmentation occurred more frequently in scalpel-treated sites.