Novel flapless esthetic procedure for the elimination of extended gingival metal tattoos adjacent to prosthetic teeth: Er:YAG laser micro-keyhole surgery

Abstract

Purpose: This article describes a novel, minimally invasive procedure called Er:YAG laser micro-keyhole surgery (EL-MIKS) that removes metal or amalgam tattoos in the gingiva adjacent to prosthetic teeth without gingival deformity and recession. We aimed to evaluate the clinical efficacy of EL-MIKS for removing metal tattoos and present its long-term treatment outcomes. Methods: The EL-MIKS procedure consists of several steps that are all performed under a microscope. First, a micro-keyhole (1-2 mm diameter) was prepared using an Er:YAG laser in the center of the metal pigmentation. The connective tissue was evaporated in the deep layer, where metal debris was deposited. Second, within the accessible range, the irradiation angle was changed in various directions to ablate the metal pieces and discolored connective tissue without enlarging the keyhole. Finally, after blood filled the space created by the tissue evaporation, the surface of the blood clot at the entrance of the micro-keyhole was thermally coagulated with defocus laser irradiation. Pigmentation that could not be successfully removed from a single micro-keyhole was treated by forming new micro-keyholes at a distance of 3 mm or more from each previously created hole. Depigmentation over an extended area was completed over a few sessions every 4 weeks without gingival recession after surgery. Conclusions: EL-MIKS, a novel depigmentation technique, was able to successfully remove an extended area of metal tattoos in the gingiva using a simpler, easier, and less invasive procedure than conventional periodontal plastic surgery. Esthetic restoration was successfully achieved without postoperative alteration of the gingival contour.

Influence of Reactive Oxygen Species on Wound Healing and Tissue Regeneration in Periodontal and Peri-Implant Tissues in Diabetic Patients

“…Because of the antioxidant properties of EMD, as mentioned above [ 56 ], EMD may also have potential benefits for periodontal tissue regeneration therapy in periodontal patients with type 2 DM. Mizutani et al reported that minimally invasive surgery combined with EMD resulted in significant clinical attachment gain and bone filling at comparable levels in the type 2 DM and non-DM groups [ 87 ]. Although various factors may have contributed to these results, the anti-inflammatory and antioxidant effects of EMD may have influenced the periodontal tissues of DM patients, which may be associated with delayed healing after surgery.…”

High-power xenon lamp-pumped Er:YAP pulse laser operated in free-running and acousto-optical Q-switching modes

“…It is well known that 2.7-3 µm lasers located at the strong absorption peak of water and the atmospheric transparency window in the range of some special wavelengths have potential applications in laser surgery, remote sensing, gas monitoring, detection, spectroscopy measurement, and material processing, etc. [1][2][3] Moreover, they can also be used as pump sources to obtain longer wavelength mid-infrared lasers, such as Fe 2+ -and Dy 3+ -doped lasers and optical parameter oscillator (OPO) lasers. [4][5][6][7] Especially for Q-switched lasers with pulse durations of ns level, which possess much advantages in the field of laser surgery and OPO due to their narrow pulse widths and high peak power.…”