Successful Use of the Er,Cr:YSGG Laser for Gingival Depigmentation

The color of the gingiva is determined by the degree of vascularization, epithelial thickness, and the number of melanin pigments within the epithelium. Melanin pigmentation is caused by abnormal or increased deposition of melanin by active melanocytes located mainly in the basal and supra-basal cell layers of the oral epithelium. Oral melanin pigmentation occurs most frequently in the gingiva, known as gingival hyperpigmentation (GHP), which is a common esthetical concern with variable etiologic factors. Clinically, GHP reveals asymptomatic, well-defined, generalized or localized, light-to-dark brown macules of variable sizes. Gingival depigmentation (GD) is a procedure used to remove or reduce excessive pigmentation using several therapeutic approaches, which include surgical, chemical, electrosurgical, and cryosurgical procedures. Many clinicians prefer to use laser ablations such as CO₂, diode, Er:YAG, and Er,Cr:YSGG, which can be utilized safely and effectively without postoperative discomfort. Er,Cr:YSGG with a 2780 nm wavelength has an ablative mechanism of action with high water absorption. Herein, we present a case of a 16-year-old girl with a darkly pigmented gingiva. Clinical examination revealed generalized physiologic pigmentation in the maxillary and mandibular anterior gingiva. Treatment was carried out by using an Er,Cr:YSGG laser including a wavelength of 2780 nm, a frequency of 50 Hz, 2.5 W, 10-20% water, and 20-40% air, employing the MZ8 tip in contact mode localized only on pigmentated areas. The ablated regions healed almost completely in two weeks without pain or discomfort, and the color was comparable to the normal gingiva. In the six-month follow-up, the patient was seen with full satisfaction. GD by the Er,Cr:YSGG laser was found to be a safe and efficient approach.