Split mouth de-epithelization techniques for gingival depigmentation: A case series and review of literature

Abstract

Gingival melanin pigmentation occurs in all races of mankind. Although clinical melanin pigmentation does neither present itself as a medical problem nor a disease entity, it is a major esthetic concern for many people, especially Asians. Esthetic gingival depigmentation procedures can be performed in such patients with excellent results. This case series presents a split mouth de-epithelization procedure using popular surgical techniques such as scalpel, bur abrasion or electrosurgery. These techniques were successfully used to treat gingival hyperpigmentation. Although we found that electrosurgery increased the efficacy of our work, giving a cleaner and neater work field, it required a lot of precision. In contrast, scalpel de-epithelization was easy and technique-friendly, giving excellent results and patient satisfaction. However, the cases are being followed-up to study the factors affecting the rate and length of time required for repigmentation and to study the repigmentation patterns. This case series also reviews the advantages and disadvantages of various techniques available for depigmentation, and reiterates that the scalpel technique still serves as a gold standard for depigmentation.

Efficacy of Different Techniques of Gingival Depigmentation: A Comparative Evaluation with a Case Report

“…Also, it has been reported that electrosurgery requires more expertise than scalpel surgery. 11 Here again, the results were in contrast to the present study, where dissection of the partial thickness flap by scalpel required more surgical expertize as compared to electrosurgery. 12 Electrosurgery, however, has the disadvantage that prolonged or repeated application of current to tissue induces heat accumulation and undesired tissue destruction.…”

Efficacy of Conventional Laser Irradiation Versus a New Method for Gingival Depigmentation (Sieve Method): A Clinical Trial

“…24 Due to unaesthetic appearance, patients often demand depigmentation treatments. Pigmented layers may be removed by scalpel surgery, bur abrasion, 18 cryosurgery, 25 electrosurgery, laser therapy [26][27][28] and chemical agents such as 90% phenol and 95% alcohol. Pigmented gingiva can also be covered by a free gingival graft 29 or acellular dermal matrix allografts.…”

Quadrant Wise Comparison of Four Different Treatment Modalities for the Management of Hyperpigmented Gingiva: A Quotidian Evaluatorycase Report.

“…It was reported that electrosurgery required a lot of precision but increased the efficacy of work, giving a cleaner and neater work field. Scalpel de-epithelialization was reported to be easier and gave profound results and patient satisfaction 13 . However, no study compared these four methods in one patient as done in the present case report.…”

“…These include instant sterilization of surgical site, reduced bacteremia, less mechanical trauma, minimal post-operative scarring, swelling and post-operative pain. In a case series by Pradeep et al, split mouth de-epithelialization procedure using a scalpel, bur abrasion and electrosurgery were successfully used to treat gingival hyperpigmentation 13 . It was reported that electrosurgery required a lot of precision but increased the efficacy of work, giving a cleaner and neater work field.…”