Split mouth de-epithelization techniques for gingival depigmentation: A case series and review of literature

Abstract

Gingival melanin pigmentation occurs in all races of mankind. Although clinical melanin pigmentation does neither present itself as a medical problem nor a disease entity, it is a major esthetic concern for many people, especially Asians. Esthetic gingival depigmentation procedures can be performed in such patients with excellent results. This case series presents a split mouth de-epithelization procedure using popular surgical techniques such as scalpel, bur abrasion or electrosurgery. These techniques were successfully used to treat gingival hyperpigmentation. Although we found that electrosurgery increased the efficacy of our work, giving a cleaner and neater work field, it required a lot of precision. In contrast, scalpel de-epithelization was easy and technique-friendly, giving excellent results and patient satisfaction. However, the cases are being followed-up to study the factors affecting the rate and length of time required for repigmentation and to study the repigmentation patterns. This case series also reviews the advantages and disadvantages of various techniques available for depigmentation, and reiterates that the scalpel technique still serves as a gold standard for depigmentation.

Keywords: Bur abrasion; depigmentation; electrosurgery; gingiva; melanin; physiological pigmentation; scalpel technique.

Figure 1

Baseline (Left to right). Patient 1: 20 years male (Weinman score 10) Patient 2: 25-years-old male (Weinman score 7), 12 weeks post-treatment after scalpel de-epithelization Patient 3: 20 years female (Weinman score 10) Patient 4: 22 years female (Weinman score 10) Patient 5: 21 years male (Weinman score 10) Patient 6: 19 years male (Weinman score 10)

Figure 2

Patient 2 – Bur abrasion (II quadrant) on the contralateral side after scalpel de-epithelization (I quadrant, not shown)

Figure 3

Patient 3 – Scalpel de-epithelization procedure (I quadrant)

Figure 4

Patient 4 – A single sitting scalpel de-epithelization with frenectomy (upper arch)

Figure 5

Patient 5 – Diamond bur abrasion (I quadrant)

Figure 6

Patient 6 – Scalpel de-epithelization (I quadrant)

Figure 7

Patient 6 – Needle electrode used to give incisoin, mesial incision was given with a scalpel to avoid demarkation between the contralateral side

Figure 8

Patient 6 – Outline of the incision using needle electrode

Figure 9

Patient 6 – Ball electrodes of different diameters used for coagulation

Figure 10

Patient 6 – Arrow showing fenestration between the canine and the premolar region

Figure 11

Patient 6: 1 week post-treatment, mild inflammation in the caninepremolar region

Figure 12

Patient 1: 8 weeks post-operative following scalpel de-epithelization (I quadrant)

Figure 13

Post-treatment Patient 1 – 22 weeks post-operative (post-op) following scalpel technique (I quadrant) and 2 weeks post-op following diamond bur abrasion (II quadrant) Patient 2: 24 weeks post-op after scalpel de-epithelization (I quadrant) and 12 week post-op after bur abrasion (II quadrant) Patient 3: 22 weeks post-treatment after scalpel de-epithelization (I quadranat) Patient 4: 20 weeks post-operative after scalpel de-epithelization and frenectomy (upper arch) Patient 5: 2 weeks post-treatment after bur abrasion (I quadrant) Patient 6: As Figure 13

Figure 14

Patient 6: 3week post-op after scalpel de-epithelization (I quadrant) and 12 days post-electrosurgery (II quadrant)