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      Gingival Depigmentation Using Diode 980 nm and Erbium-YAG 2940 nm Lasers: A Split-Mouth Clinical Comparative Study

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      1 , 2 , 3 , 4 ,
      International Journal of Dentistry
      Hindawi

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          Abstract

          Background

          Gingival hyperpigmentation, “black gum,” refers to black discrete single or multiple pigments on the gingiva. Several factors may play a role in gingival hyperpigmentation ranging from physiologic pigmentation to manifestations of systemic diseases. Several techniques have been used for gingival depigmentation to lighten its color.

          Methods

          Fifteen patients exhibiting nonsmoking melanin hyperpigmentation, with the mean age of 28.6 ± 7.8 years, were recruited. The facial gingiva of the anterior teeth and premolars of each jaw was divided into two halves. The right or left side of each jaw quadrant randomly received either diode laser operating at 980 nm wavelength or erbium-YAG laser at 2940 nm. Parameters such as degree of gingival depigmentation, bleeding, pain, patient satisfaction, and wound healing were assessed and compared between the two techniques. The subjects were followed up to six months for melanin pigmentation recurrence.

          Results

          Both techniques were efficient for gingival depigmentation. Nevertheless, bleeding during surgery was statistically higher for Er:YAG laser technique as compared to diode laser. Wound healing showed statistically nonsignificant differences between the two lasers, although Er:YAG seems to give better outcomes than the diode. The patients were satisfied with both laser techniques during and after gingival depigmentation. However, the pain score was higher for Er:YAG laser than for diode laser.

          Conclusion

          This study demonstrated that both lasers' techniques are efficient for gingival depigmentation. However, diode laser seems to show less painful experience and relatively better bleeding control.

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          Most cited references33

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          Is Open Access

          Melanin: the biophysiology of oral melanocytes and physiological oral pigmentation

          The presence of melanocytes in the oral epithelium is a well-established fact, but their physiological functions are not well defined. Melanin provides protection from environmental stressors such as ultraviolet radiation and reactive oxygen species; and melanocytes function as stress-sensors having the capacity both to react to and to produce a variety of microenvironmental cytokines and growth factors, modulating immune, inflammatory and antibacterial responses. Melanocytes also act as neuroendocrine cells producing local neurotransmitters including acetylcholine, catecholamines and opioids, and hormones of the melanocortin system such as proopiomelanocortin, adrenocorticotropic hormone and α-melanocyte stimulating hormone, that participate in intracellular and in intercellular signalling pathways, thus contributing to tissue homeostasis. There is a wide range of normal variation in melanin pigmentation of the oral mucosa. In general, darker skinned persons more frequently have oral melanin pigmentation than light-skinned persons. Variations in oral physiological pigmentation are genetically determined unless associated with some underlying disease. In this article, we discuss some aspects of the biophysiology of oral melanocytes, of the functions of melanin, and of physiological oral pigmentation.
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            Measurement of pain using the visual numeric scale.

            We introduce the English-language Visual Numeric Scale (VNS) for self-reported pain and examine its psychometric properties; we compare the VNS to the better known Visual Analog Scale (VAS). We developed the VNS, which combines strong visual cues with an 11-point numeric rating scale. The VNS was administered to 2 sets of subjects with arthritis or chronic disease (N = 175, N = 192, respectively) and responses were examined. To compare the VNS to the VAS, we administered both scales to all subjects and used correlations to compare them to each other and to health distress and overall general health scores. A subset of respondents enrolled in an arthritis self-management program were given the VNS 4 months later, and change scores were used to test the sensitivity of the VNS. The VNS had means of 5.4 and 5.6 in the 2 samples, with distributions across the range of possible values. The VNS correlated well with the VAS (r = 0.85) and correlated slightly better than the VAS with the 2 independent health measures. The VNS was more likely to be completed than the VAS and there were fewer coding errors with the VNS. The VNS showed a significant (effect size 0.28) positive change for participants in a self-management course. The VNS appeared to be a valid measure. It was as successful as the VAS in measuring the underlying pain variable. It was easier to administer and code than the VAS, and was sensitive to change in pain.
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              Treatment of gingival hyperpigmentation for esthetic purposes by Nd:YAG laser: report of 4 cases.

              Gingival hyperpigmentation may cause esthetic problems and embarrassment, especially in patients with a gummy smile. This report presents the use of the Nd:YAG laser for gingival depigmentation. Four cases, 3 females and 1 male, ages between 24 to 28 years old, presented with the same chief complaint of unesthetic gingiva caused by melanin hyperpigmentation. The Nd:YAG laser was set at 6 watts, 60 millijoules per pulse, and 100 pulses per second. The procedures were performed with contact mode in all pigmented areas by using a handpiece with a 320 microm diameter fiber optic. Ablation of the gingival hyperpigmented areas were accomplished without any bleeding complications or significant postoperative pain. Three to 4 weeks after the procedures, the hyperpigmented gingiva appeared healthy, pink, and firm. No recurrence of hyperpigmentation had been found in 11 to 13 months of follow-up. However, in delicate areas such as the marginal gingiva, the Nd:YAG laser should be used cautiously.
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                Author and article information

                Contributors
                Journal
                Int J Dent
                Int J Dent
                ijd
                International Journal of Dentistry
                Hindawi
                1687-8728
                1687-8736
                2021
                28 December 2021
                : 2021
                : 9424793
                Affiliations
                1Royal Clinic, Corniche Alqawasim, Ras Alkhaimah, UAE
                2College of Dental Medicine, Gulf Medical University, Ajman, UAE
                3College of Dentistry, Suez Canal University, Ismailia, Egypt
                4Oral Medicine, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
                Author notes

                Academic Editor: Stefano Pagano

                Author information
                https://orcid.org/0000-0001-8099-5076
                Article
                10.1155/2021/9424793
                8727139
                34992657
                7f837430-d95d-4d53-96d0-58f1083746d1
                Copyright © 2021 Zaid Kamel Jnaid Harb et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 September 2021
                : 22 November 2021
                : 14 December 2021
                Categories
                Research Article

                Dentistry
                Dentistry

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