A Randomized Comparative Clinical Study to Evaluate the Longevity of Esthetic Results of Gingival Melanin Depigmentation Treatment Using Different Laser Wavelengths (Diode, CO2, and Er:YAG).
Namour, Samir; El Mobadder, Marwan; Namour, Mélanieet al.
2020 • In Photobiomodulation, Photomedicine, and Laser Surgery, 38 (3), p. 167 - 173
[en] Background: Gingival melanin hyperpigmentation is due to excessive deposition of melanin granules. The duration of pigmentation reappearance after treatment using different laser wavelengths remains controversial. Objective: The study aims to assess the longevity of gingival depigmentation (GD) and the consistency in esthetic results as three laser wavelengths (Er:YAG laser, CO2 laser, and diode laser, 980 nm) were used in two different groups (smokers and nonsmokers). This is attained by comparing the periods of time in each group before pigmentation reappearance. Methods: Seventy-two subjects were divided into daily smokers (S) and nonsmokers. Subjects underwent a randomized GD with: Erbium laser (Er), CO2 laser (CO2), and Diode laser (Diode). The subjects were divided into six groups: S and nonsmokers were treated with three different wavelengths. Irradiation was performed until there was no visible pigmentation. For qualitative measurement, Hedin Melanin Index (HMI) was used, before treatment, after 2 weeks, and until 60 months. Pigmentation reappearance of degree 1 or above of the HMI was noted. Descriptive statistics were also calculated. Results: HMI showed a 0 in all groups after 14 days of treatment. The time before pigmentation rebound was: Diode > CO2 > S-Diode > S-CO2 > Er > S-Er. The first signs of relapse shown among all groups were seen in the group S-Er group. The longest time before rebound was observed with the Diode group for the nonsmoker. Conclusions: Diode laser provides the longest-term stability in treatment. Smoking negatively affects the longevity of GD. Er laser gives the shortest time before the reappearance of gingival pigmentation.
Research Center/Unit :
d‐BRU - Dental Biomaterials Research Unit - ULiège [BE]
Disciplines :
Dentistry & oral medicine
Author, co-author :
Namour, Samir ; Université de Liège - ULiège > Département des sciences dentaires
El Mobadder, Marwan; Department of Dental Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
Namour, Mélanie ; Université de Liège - ULiège > Dental biomaterials research unit (d-BRU)
Namour, Amaury; Department of Dental Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
Rompen, Eric ; Université de Liège - ULiège > Département des sciences dentaires > Chirurgie bucco-dentaire et parodontologie
Maalouf, Elie; Faculty of Dentistry, Lebanese University, Hadath, Beirut, Lebanon
Brugnera Junior, Aldo; National Institute of Science and Technology-IFSC-USP, São Paulo, Brazil
Brugnera, Ana Paula; Department of Dental Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
Vescovi, Paolo; Unit of Oral Pathology and Medicine and Laser-Assisted Oral Surgery, Department of ENT/Dental/Ophthalmological and Cervico-Facial Sciences, Faculty of Medicine and Surgery, University of Parma, Parma, Italy
Zeinoun, Toni; Faculty of Dentistry, Lebanese University, Hadath, Beirut, Lebanon
Language :
English
Title :
A Randomized Comparative Clinical Study to Evaluate the Longevity of Esthetic Results of Gingival Melanin Depigmentation Treatment Using Different Laser Wavelengths (Diode, CO2, and Er:YAG).
Publication date :
March 2020
Journal title :
Photobiomodulation, Photomedicine, and Laser Surgery
Hegde R, Padhye A, Sumanth S, Jain AS, Thukral N. Comparison of surgical stripping; erbium-doped: yttrium, aluminum, and garnet laser; and carbon dioxide laser techniques for gingival depigmentation: a clinical and histologic study. J Periodontol 2013;84:738-748.
Ishii S, Aoki A, Kawashima Y, Watanabe H, Ishikawa I. Application of an Er:YAG laser to remove gingival mela-nin hyperpigmentation-treatment procedure and clinical evaluation. J Jpn Soc Laser Dent 2002;13:89-96.
Feller L, Masilana A, Khammissa RA, Altini M, Jadwat Y, Lemmer J.Melanin: the biophysiology oforalmelanocytes and physiological oral pigmentation. Head Face Med 2014;10:8.
Kato T, Mizutani S, Takiuchi H, Sugiyama S, Hanioka T, Naito T. Gingival pigmentation affected by smoking among different age groups: a quantitative analysis of gingival pigmentation using clinical oral photographs. Int J Environ Res Public Health 2017;14:880.
Zarone F, Leone R, Ferrari M, Sorrentino R. Treatment concept for a patient with a high smile line and gingival pigmentation: a case report. Int J Periodontics Restorative Dent 2017;37:e142-e148.
El Mobadder M, Farhat F, El Mobadder W, Nammour S. Photobiomodulation therapy in the treatment of oral mucositis, dysgeusia and oral dryness as side-effects of head and neck radiotherapy in a cancer patient: a case report. Dent J (Basel) 2018;6:64.
Azzeh MM. Treatment of gingival hyperpigmentation by erbium-doped: yttrium, aluminum, and garnet laser for esthetic purposes. J Periodontol 2007;78:177-184.
Bakhshi M, Rahmani S, Rahmani A. Lasers in esthetic treatment of gingival melanin hyperpigmentation: a review article. Lasers Med Sci 2015;30:2195-2203.
Perveen A, Molardi C, Fornaini C. Applications of laser welding in dentistry: a state-of-the-art review. Micromachines 2018;9:209.
Belikov AV, Skrypnik AV. Soft tissue cutting efficiency by 980 nm laser with carbon-, erbium-, and titanium-doped optothermal fiber converters. Lasers Surg Med 2019;51: 185-200.
Grover HS, Dadlani H, Bhardwaj A, Yadav A, Lal S. Evaluation of patient response and recurrence of pigmentation following gingival depigmentation using laser and scalpel technique: a clinical study. J Indian Soc Periodontol 2014;18:586.
Alasmari DS. An insight into gingival depigmentation techniques: the pros and cons. Int J Health Sci (Qassim) 2018;12:84.
Pavlic V, Brkic Z, Marin S, Cicmil S, Gojkov-Vukelic M, Aoki A. Gingival melanin depigmentation by Er:YAG laser: a literature review. J Cosmet Laser Ther 2018;20:85-90.
Mojahedi SM, Bakhshi M, Babaei S, Mehdipour A, Asayesh H. Effect of 810 nm diode laser on physiologic gingival pigmentation. Laser Ther 2018:27:99-104.
Verma SK, Maheshwari S, Singh RK, Chaudhari PK. Laser in dentistry: an innovative tool in modern dental practice. Natl J Maxillofac Surg 2012;3:124.
Pang P, Sebastiano Andreana DDS, Aoki A, et al. Laser energy in oral soft tissue applications. J Laser Dent 2007; 15:78-86.
Hale GM, Querry MR. Optical constants of water in the 200-nm to 200-lm wavelength region. Appl Opt 1973;12: 555-563.
Cheong WF, Prahl SA, Welch AJ. A review of the optical properties of biological tissues. IEEE J Quantum Electron 1990;26:2166-2185.
Tsai CL, Chen JC, Wang WJ. Near-infrared absorption property of biological soft tissue constituents. J Med Biol Eng 2001;21:7-14.
Ansari MA, Erfanzadeh M, Mohajerani E. Mechanisms of laser-tissue interaction: II. Tissue thermal properties. J Lasers Med Sci 2013;4:99.
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;58:1387-1393.
Suter VGA, Altermatt HJ, Bornstein MM. A randomized controlled trial comparing surgical excisional biopsies using CO(2) laser, Er:YAG laser and scalpel. Int J Oral Maxillofac Surg 2020 Jan;49:99-106.
Seker BK. Treatment of gingival melanin hyperpigmentation with Er, Cr:YSGG laser: short-term follow-up of patient. J Cosmet Laser Ther 2018;20:148-151.
Suragimath G, Lohana MH, Varma S. A split mouth randomized clinical comparative study to evaluate the efficacy of gingival depigmentation procedure using conventional scalpel technique or diode laser. J Lasers Med Sci 2016;7: 227-232.
El Shenawy HM, Nasry SA, Zaky AA, Quriba MA. Treatment of gingival hyperpigmentation by diode laser for esthetical purposes. Open Access Maced J Med Sci 2015;3: 447.
Wise RJ, Chen CY, Kim DM. Treatment of physiologic gingival pigmentation with surgical blade: a 25-year follow-up. Int J Periodontics Restorative Dent 2018;38: 45-48.
Tamizí M, Taheri M. Treatment of severe physiologic gingival pigmentation with free gingival autograft. Quintessence Int 1996;27:555-558.
Patel KA, Patil SS, Agrawal C, Patel AP, Kalaria J. Gingival depigmentation: case series. Int J Appl Dent Sci 2015; 1:37-39.
Kathariya R, Pradeep AR. Split mouth de-epithelization techniques for gingival depigmentation: a case series and review of literature. J Indian Soc Periodontol 2011;15:161-168.
Ahmed SK, George JP, Prabhuji MLV, Lazarus F. Cryosurgical treatment of gingival melanin pigmentation-a 30-month follow-up case report. Clin Adv Periodontics 2012; 2:73-78.
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;16:614.
Narayankar SD, Deshpande NC, Dave DH, Thakkar DJ. Comparative evaluation of gingival depigmentation by tetrafluroethane cryosurgery and surgical scalpel technique. A randomized clinical study. Contemp Clin Dent 2017;8:90.
Sedeh SA, Badihi S, Esfahaniyan V. Comparison of recurrent rate of gingival pigmentation after treatment by liquid nitrogen and cryoprob in 18 months follows-up. Dent Res J 2014;11:592.
Thangavelu A, Elavarasu S, Jayapalan P. Pink esthetics in periodontics-gingival depigmentation: a case series. J Pharm Bioallied Sci 2012;4(Suppl 2):S186.
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 (Qassim) 2014;8:133.
Kaya GSx, Yavuz GY, Sümbüllü MA, Dayi E. A comparison of diode laser and Er:YAG lasers in the treatment of gingival melanin pigmentation. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:293-299.
Salahi Alasbahi R, Hamadah O. A comparative clinical study between the efficacy of Nd:YAG laser and diode laser in the management of physiologic gingival melanin pigmentation. Oral Surg 2018;11:282-290.
Ozbayrak S, Dumlu A, Ercalik-Yalcinkaya S. Treatment of melanin-pigmented gingiva and oral mucosa by CO2 laser. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 2000;90:14-15.
Esen E, Haytac MC, Oz IA, Erdogan O, Karsli ED. Gingival melanin pigmentation and its treatment with the CO2 laser. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 2004;98:522-527.
Nakamura Y, Hossain M, Hirayama K, Matsumoto K. A clinical study on the removal of gingival melanin pigmentation with the CO2 laser. Lasers Surg Med 1999;25: 140-147.
Basha MI, Hegde RV, Sumanth S, Sayyed S, Tiwari A, Muglikar S. Comparison of ND:YAG laser and surgical stripping for treatment of gingival hyperpigmentation: a clinical trial. Photomed Laser Surg 2015;33:424-436.
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;29:537-544.
Tal H, Oelgiessr D, Tal M. Gingival depigmentation for aesthetic purposes using erbium:YAG laser: rationale and technique. Refuat Hapeh Vehashinayim (1993) 2002;19: 25-32.
Kishore A, Kathariya R, Deshmukh V, Vaze S, Khalia N, Dandgaval R. Effectiveness of Er:YAG and CO2 lasers in the management of gingival melanin hyperpigmentation. Oral Health Dent Manag 2014;13:486-491.
Salahi Kumar S, Bhat GS, Bhat KM. Comparative evaluation of gingival depigmentation using tetrafluoroethane cryosurgery and gingival abrasion technique: two years follow up. J Clin Diagn Res 2013;7:389.
Hedin CA. Smokers' melanosis: occurrence and localization in the attached gingiva. Arch Dermatol 1977;113: 1533-1538.
Hedin CA, Axell T. Oral melanin pigmentation in 467 Thai and Malaysian people with special emphasis on smoker's melanosis. J Oral Pathol Med 1991;20:8-12.
Hedin CA, Pindborg JJ, Axéll T. Disappearance of smoker's melanosis after reducing smoking. J Oral Pathol Med 1993;22:228-230.
Hedin CA, Larsson A . The ultrastructure of the gingival epithelium in smokers' melanosis. J Periodontal Res 1984; 19:177-190.
Hanioka T, Tanaka K, Ojima M, Yuuki K. Association of melanin pigmentation in the gingiva of children with parents who smoke. Pediatrics 2005;116:e186-e190.
