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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 3  |  Issue : 1  |  Page : 29-32

Management of gingival hyperpigmentation


Department of Semiology and Clinics, Faculty of Dentistry, Federal University of Pelotas, Pelotas, Brazil

Date of Web Publication17-Jun-2016

Correspondence Address:
Dr. Josué Martos
Department of Semiology and Clinics, Faculty of Dentistry, University Federal of Pelotas, Goncalves Chaves Street 457, Pelotas, RS 96015-560
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5847.184258

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  Abstract 

The gingival melanin hyperpigmentation may represent an esthetic problem for some patients. Among the alternative treatments, the epithelial abrasion or scrapping is a simple and effective technique. The aim of this report is to present a clinical treatment of gingival melanin hyperpigmentation treated by the technique of epithelial scrapping. The result of the employed technique proved to be effective in the removal of melanin pigment, restoring the patient's esthetic, and self-esteem.

Keywords: Hyperpigmentation, periodontal surgery, treatment


How to cite this article:
Cruz LE, Martos J, Borges FB, Kochhann Lima EL. Management of gingival hyperpigmentation. Pigment Int 2016;3:29-32

How to cite this URL:
Cruz LE, Martos J, Borges FB, Kochhann Lima EL. Management of gingival hyperpigmentation. Pigment Int [serial online] 2016 [cited 2020 Feb 23];3:29-32. Available from: http://www.pigmentinternational.com/text.asp?2016/3/1/29/184258


  Introduction Top


The gingiva is considered normal and healthy has a pink color and it is firmly attached to the alveolar process and the cervical parts of the teeth. In light-skinned patients, the color of the gingiva is a slightly pink and in black individuals, the gingiva is frequently spotted with brown or is a fairly grayish brown as a result of the melanin in some epithelial cells.[1] The gingival hyperpigmentation is caused by an excessive deposition of melanin, mainly in the basal and suprabasal layers of the epithelium and is related to a series of local and systemic factors.[2],[3]

The gingival melanin hyperpigmentation does not represent pathology but a variation of normality and can become an esthetic problem suitable for treatment, especially for those individuals with high-smile line and clearer skin.[3] For removal of melanotic pigmentation, among the techniques most commonly employed are the epithelial abrasion [4],[5],[6] and gingivectomy.[6],[7] Other techniques such as cryotherapy and laser have been proposed for the removal of this gingival hyperpigmentation.[8],[9] The aim of this paper is to describe the treatment of gingival melanin hyperpigmentation by the use of the epithelial scrapping technique.


  Case Report Top


A 25-year-old female patient was referred to the dental clinic, reporting a visual discomfort with the appearance of the smile [Figure 1]. At the initial clinical examination and anamnesis, it was observed an excessive gingival hyperpigmentation in maxillary and mandibular arches [Figure 2] and [Figure 3]. The periodontal health of the patient was satisfactory, and radiographic examination revealed no abnormalities of the supporting tissues. The pattern of the gingival hyperpigmentation suggested that an epithelial surgical scraping or gingival peeling with a scalpel blade or Kirkland scalpel would be a reliable option for this case.
Figure 1: Initial view of the gingival pigmentation

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Figure 2: Buccal view of the maxillary arch pigmentation

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Figure 3: Scrapping of maxilar area with Kirkland scalpel

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During the presurgical appointments, the patient received preoperative information. After this, it was mapped the extension of the gingival hyperpigmentation to be removed. This procedure was performed in all gingival aspects, buccal, and proximal segment involving the premolars to premolars. The surgical procedure was divided into two phases: The first would be the intervention in the maxillary arch and the second stage surgery performed after 2 weeks in the mandibular arch.

From this point on antisepsis was performed with extra-oral iodine solution and intra-oral with a 2% chlorhexidine digluconate solution for subsequent regional block anesthesia. Immediately were initiating the scrapping procedures in the gingival surface of the maxilla. The periodontal surgical procedures were executed with a scalpel type Kirkland (Hu-Friedy Co., Chicago, IL, USA) at an inclination of 45°, scrapping, smoothing, and contouring the gingival tissue remaining [Figure 3],[Figure 4],[Figure 5],[Figure 6],[Figure 7] and a more refined approach was performed with the active part of a disposable scalpel blade 15C (Albion, Albion Surgicals Ltd., Sheffield, England).
Figure 4: Incisal view evidencing the thickness of gingival tissue removed

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Figure 5: Clinical aspect after scrapping the hyperpigmentation

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Figure 6: Buccal apect of the mandibular arch after scrappng (left side)

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Figure 7: Scrapping of mandibular area with Kirkland bisturi

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The surgical area was protected with surgical cement for 7 days. Orientation postsurgical was concluded with indication of the use of solution of chlorhexidine digluconate 0.12%. Postoperative period of 7 days showed favorable clinical aspect evidenced by the absence of bleeding besides a clinical appearance consistent with what had been planned [Figure 8]. The same result was obtained also after surgery in the mandibular arch. A follow-up evaluation was carried out in a period of 6 months after surgical periodontal procedure showing a good appearance [Figure 9].
Figure 8: Final aspect of the gingival coloration after 2-week of the periodontal procedures

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Figure 9: Esthetic result after 6-month follow-up

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  Discussion Top


Among the different techniques for the removal of the gingival hyperpigmentation proposed by the literature, epithelial abrasion seems to present certain advantages compared to the others.[4],[5],[6] The difference presented in this case report is the use of a Kirkland scalpel to initiate the procedure, associated with a disposable scalpel blade to an adequate refinement of the gingival scrapping. The technique is relatively simple, safe, requires no sophisticated equipment or materials, is minimally invasive, and the postoperative period is favorable.[3]

The result of this procedure is considered satisfactory and in some cases is definitive. However, repigmentation can occur between 6 months and 3 years, and additional procedures can be required for gingival color maintenance.[10]

The repigmentation after this treatment is an important point to be considered. The literature shows that repigmentation occurs with considerable low frequency while some authors, using different techniques, have not reported cases of re-pigmentation.[3],[10],[11] However, we should emphasize to the patient the possibility of repigmentation in future, and should consider the possibility of new surgical procedures. In the case presented the main cause of hyperpigmentation, i.e. Addison's disease, has not been precisely determined.

The use of periodontal surgical maneuvers when properly implemented, allow satisfactory cosmetic results, being simple, and economical techniques as well as preserving the integrity of the periodontal tissue volumetric compared to more invasive surgical procedures. We observed that the repair was satisfactory with no postoperative discomfort, infection or scarring. The result of the employed technique proved to be effective in the removal of melanin pigment, restoring the patient's esthetic, and self-esteem.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Melfi RC, Alley KE. Permar's Oral Embryology and Microscopic Anatomy: A Textbook for Students in Dental Hygiene. 10th ed. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 297.  Back to cited text no. 1
    
2.
Dummett CO. Dental health problems of the Negro population. J Am Dent Assoc 1960;61:308-14.  Back to cited text no. 2
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3.
Carvalho PF, Cury PR, Silva RC, Joly JC, Ciotti DL. Epithelial abrasion for the treatment of melanin gingival pigmentation: report of clinical cases. Rev Dent Press Periodontia Implantol 2008;2:47-57.  Back to cited text no. 3
    
4.
Farnoosh AA. Treatment of gingival pigmentation and discoloration for esthetic purposes. Int J Periodontics Restorative Dent 1990;10:312-9.  Back to cited text no. 4
    
5.
Perlmutter S, Tal H. Repigmentation of the gingiva following surgical injury. J Periodontol 1986;57:48-50.  Back to cited text no. 5
[PUBMED]    
6.
Silva MP, Sirotto TO, Ferrari DS, Queiroz AB, Duarte PM. Gingival peeling - presentation of two techniques. Rev Perionews 2009;3:119-23.  Back to cited text no. 6
    
7.
Bergamaschi O, Kon S, Doine AI, Ruben MP. Melanin repigmentation after gingivectomy: A 5-year clinical and transmission electron microscopic study in humans. Int J Periodontics Restorative Dent 1993;13:85-92.  Back to cited text no. 7
    
8.
Ishikawa I, Aoki A, Takasaki AA. Potential applications of Erbium: YAG laser in periodontics. J Periodontal Res 2004;39:275-85.  Back to cited text no. 8
    
9.
Yeh CJ. Cryosurgical treatment of melanin-pigmented gingiva. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:660-3.  Back to cited text no. 9
    
10.
Atsawasuwan P, Greethong K, Nimmanon V. Treatment of gingival hyperpigmentation for esthetic purposes by Nd: YAG laser: Report of 4 cases. J Periodontol 2000;71:315-21.  Back to cited text no. 10
    
11.
Yadav B, Ahuja T, Mittal M, Jain M, Khanna P. Surgical gingival depigmentation: A case report. Internet J Aesthet Antiaging Med 2012;3:1-4.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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