Gingival depigmentation by erbium:YAG laser: clinical observations and patient responses

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, complaints about "black gums" are common. Gingival depigmentation has been carried out using non-surgical and surgical procedures. Recently, laser ablation has been recognized as a most effective, pleasant and reliable technique.

The study included 10 patients who requested cosmetic therapy for melanin pigmented gums. Treatment was carried out using an erbium:YAG laser. The laser beam was set at 500 mJ/10 pulses/second. The beam was defocused to produce a 3 mm diameter circle, thus reducing the beam penetration to 2 to 4 microm/pulse while increasing the treated surface. The "brush" technique was applied until the gingival surface appeared clinically free of pigmentation. Patients were observed for 6 months. Each patient filled out a personal evaluation questionnaire for clinical analysis.

Between 500 to 1,100 pulses/cm2 were recorded and a total of 800 to 2,200 pulses were required per patient, depending on the epithelium thickness and pigmentation. Treatment required only topical anesthesia. Healing was uneventful and required no supportive therapy. None of the patients experienced severe pain during or post-operatively. Mild pain or itching was common during the first week. Treatment was reported as generally pleasant. Follow-up during the 6 months showed no recurrences.

Depigmentation of gingival melanin pigmentation by erbium:YAG laser radiation in a defocused mode was a safe and effective procedure. The esthetic results were pleasing and healing was uneventful. Since the erbium:YAG laser is available in the dental office, it seems to be the laser of choice for this procedure.