[Gingival depigmentation for aesthetic purposes using erbium:YAG laser: rationale and technique]

Melanin, carotene and hemoglobin are the most common natural pigments contributing to the normal color of the gums. Although physiologic and ethnic melanin pigmentation is not a medical problem, complains about "black gums" are common. Gingival depigmentation has been carried out using surgical, chemical, electrosurgical and cryosurgical procedures. Recently, Laser Ablation has been recognized as one of the most effective, pleasant and reliable techniques. Effective depigmentation of the gingival requires removal of all or most of the melanocytes from the basal layer of the gingival epithelium. Using non-specific radiation means ablation of all the epithelial cell layers, as well as connective tissue rete pegs, leaving behind only remnants of the epithelial rete ridges. CO2, Nd:YAG and Erbium:YAG lasers, meeting most of these requirements and being available in the dental office, seems to be the lasers of choice for this procedure. Five patients (3 F; 2 M) who were referred to the TAUSDM for cosmetic therapy of "black gums" were treated using Erbium-YAG laser. The laser beam was set up at 850 mj/10 pulses per second producing peak power of 2.13 kwand peak power density of 30.43 kw/sq/cm. The beam was defocused to produce a 3 mm diameter circle, thus reducing the beam penetration while increasing the treated surface. Using the "brush" technique, 800-2,000 pulses were required per patient, with an average of 500-1,100 pulses per 1 sq.cm, depending on the thickness of the epithelium and the intensity of the pigmentation. Treatment required only topical anesthesia. Healing was uneventful and required no supportive therapy. Three months follow up has shown no repigmentation in any of the patients. Patients' evaluation analysis showed that the results were pleasing; no pain was experienced during lasing as well as during healing. Two patients were interupted by the lasing burning smell, which may be reduced or eliminated by operating a power suction during the procedure.