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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 117-119

Laser versus electrocautery: A split-mouth study to evaluate depigmentation


Department of Periodontology, Army Dental Centre Research and Referral, New Delhi, India

Date of Web Publication2-May-2018

Correspondence Address:
Dr. Arnav Mukherji
15/202, Heritage Apartments, On DBP Rd., Yelahanka, Bengaluru - 560 064, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_77_1

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  Abstract 


Oral melanin pigmentation is considered to be multifactorial, which can be physiological or pathological and can be caused by a variety of local and/or systemic factors. Improved esthetics is the first and foremost indication for depigmentation. The selection of the technique should be based on clinical expertise and individuals' preferences, which give better results. This is a case report on comparative evaluation between electrocautery and laser for depigmentation.

Keywords: Depigmentation, electrocautery, laser


How to cite this article:
Mukherji A. Laser versus electrocautery: A split-mouth study to evaluate depigmentation. Int J Health Allied Sci 2018;7:117-9

How to cite this URL:
Mukherji A. Laser versus electrocautery: A split-mouth study to evaluate depigmentation. Int J Health Allied Sci [serial online] 2018 [cited 2019 Jul 20];7:117-9. Available from: http://www.ijhas.in/text.asp?2018/7/2/117/231695




  Introduction Top


Asmile is curving or parting of lips in pleased or amused expression. Among humans, smiling is an expression denoting happiness, pleasure, sociability, joy, or amusement. Smiling is a means of communication throughout the world. Oral pigmentation may be physiological or pathological in nature.[1] It may represent a localized anomaly of limited significance or the presentation of potentially life-threatening multisystem disease.[2] Pigmented lesions are commonly found in the mouth. Such lesions represent a variety of clinical entities, ranging from physiologic changes (e.g., racial pigmentation) to manifestations of systemic illness (e.g., Addison' s disease) and malignant neoplasms (e.g., melanoma and Kaposi's sarcoma).[3] Gingival pigmentation is presented as a diffuse deep purplish discoloration or as irregularly shaped brown and light brown or black patches, striae, or strands. It results from melanin granules, which are produced by melanoblasts. Melanin, a nonhemoglobin-derived brown pigment, is the most common of the endogenous pigments and is produced by melanocytes present in the basal and suprabasal cell layers of the epithelium.[4] Although melanin pigmentation is not a medical disorder, patients may complain that their black gums are unesthetic. Several procedures have been developed for depigmentation of gingiva, for example, epithelial abrasion, free gingival graft, gingivectomy, cryosurgery, acellular dermal matrix allograft, electrosurgery, and laser surgery.[5]

The present split-mouth case report describes two different techniques for gingival depigmentation.


  Case Report Top


A 18-year-old young girl, daughter of a serving officer complaining of pigmented gums and unaesthetic smile, visited our department [Figure 1]. The medical history was noncontributory. Intraoral examination revealed gingival pigmentation. No inflammation was evident. The patient underwent thorough scaling and was given oral hygiene instructions. Gingival depigmentation was planned from lower second premolar of third quadrant to second premolar of fourth quadrant. Hematological investigation was carried out to rule out any contraindication for surgery. Under topical anesthetic spray, local anesthesia was infiltrated in the mandibular left quadrant from the central incisor to the second premolar and vice versa in the right quadrant. A loop electrode was used for depigmentation of gingiva in the fourth quadrant [Figure 2]. It was used in light brushing strokes. The tip was kept in motion all the time to avoid heat buildup on the tissues and destruction of the tissues. Melanin pigments were removed completely in the lower right quadrant. A semiconductor diode laser unit (Biolase Technology) was used for depigmentation in the mandibular left quadrant [Figure 3]. Motion of ablation was in the form of brushing strokes. The remaining ablated tissues were removed using saline dipped gauze. Complete depigmentation was carried out. Safety glasses were worn by the clinician, the assistant, and the patient during the procedure. Coe pack was applied on both the sides. Postoperative instructions were given to the patient. The patient was put on analgesics for 3 days and recalled after 10 days for review. Coe pack was removed after 10 days. Complete healing and considerable improvement in esthetics was observed in the operated area [Figure 4] and [Figure 5]. Review after 3 months showed no signs of re-pigmentation [Figure 6].
Figure 1: Melanin pigments present in the lower quadrant

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Figure 2: Depigmentation in the fourth quadrant using electrocautery

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Figure 3: Depigmentation in the third quadrant using laser

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Figure 4: Uneventful healing in the fourth quadrant after 10 days

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Figure 5: Uneventful healing in the third quadrant after 10 days

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Figure 6: Postoperative view after 3 months showing no re-pigmentation

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  Discussion Top


Hyperpigmented gingiva often leads many at times and forces the patient to seek esthetic treatment. Many treatment modalities such as simple scalpel technique to advanced lasers have been addressed in the literature. According to Dummett (1960), the degree of pigmentation relates with the mechanical, chemical, and physical stimuli. Oringer (1975) has explained the superior efficacy of electrosurgery as compared to scalpel on the basis of his exploding cell theory. According to this theory, it is predicted that the electrical energy leads to molecular disintegration of melanin cells present in basal and suprabasal layers of the operated and the surrounding sites. Thus, electrosurgery has a strong influence on retarding migration of melanin cells from the locally situated cells. Electrosurgery, however, causes prolonged or repeated application of current to tissue which induces the accumulation of heat and undesired tissue destruction. Thus, one should avoid contact with periosteum or alveolar bone and vital teeth.[6],[7]

Semiconductor diode laser is emitted in continuous wave or gated pulse mode and is operated in contact method using flexible fiber optic delivery system. Laser light is poorly absorbed in water but highly absorbed in hemoglobin and other pigments. Since electrocautery basically does not interact with hard tissues, laser is indicated for cutting, coagulation, and debridement of gingiva. The diode laser exhibits thermal effects using the hot tip effect caused by heat accumulation at the end of the fiber and produces thick coagulation layer on the treated surface.[8]

Moritz et al. showed in a study the bactericidal effect of laser. It creates locally sterile conditions resulting in the reduction of bacteremia concomitant with the procedure.[9]

In the present case, two techniques were selected for depigmentation, which included electrosurgery and laser therapy. Following the surgical procedure, patients were recalled after 3-month postoperatively to evaluate the recurrence of melanin pigments. The patient showed complete healing within the 10-day period and also the patient had better compliance, less pain, and no signs of bleeding.

Both the techniques showed successful results with good patient satisfaction, and there was no recurrence at 3-month period. Using electrocautery can cause tissue destruction since there are chances of heat accumulation. However, the laser has superior qualities of soft-tissue ablation and hemostasis. Hence, it is more effective when compared with electrocautery.[10]


  Conclusion Top


Both electrocautery and laser therapy showed excellent results. However laser had better patient satisfaction 3-month postoperatively. These two modalities have the advantage of the bloodless field during surgery. Both the techniques did not show any postoperative complications as well.

Acknowledgment

The authors would like to acknowledge Col (Retd.) M.K. Mukherji, Mrs. S Mukherji and Dr. Siddharth Mukherji for their valuable help.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ciçek Y, Ertaş U. The normal and pathological pigmentation of oral mucous membrane: A review. J Contemp Dent Pract 2003;4:76-86.  Back to cited text no. 1
    
2.
Dummett CO. Oral pigmentation. First symposium of oral pigmentation. J Periodontol 1960;31:356.  Back to cited text no. 2
    
3.
Shafer WG, Hine MK, Levy BM. Text Book of Oral Pathology. Philadelphia: W.B. Saunders Co.; 1984. p. 89-136.  Back to cited text no. 3
    
4.
Javali M, Tapashetti R, Deshmukh J. Esthetic management of gingival hyperpigmentation: Report of two cases. Int J Dent Clin 2011;3:115-6.  Back to cited text no. 4
    
5.
Lee KM, Lee DY, Shin SI, Kwon YH, Chung JH, Herr Y, et al. Acomparison of different gingival depigmentation techniques: Ablation by erbium: yttrium-aluminum-garnet laser and abrasion by rotary instruments. J Periodontal Implant Sci 2011;41:201-7.  Back to cited text no. 5
    
6.
Kaushik N, Srivastava N, Kaushik M, Gaurav V. Efficacy of different techniques of gingival depigmentation: A comparative evaluation with a case report. Int J Laser Dent 2013;3:68-72.  Back to cited text no. 6
    
7.
Shah SS. Surgical esthetic correction for gingival pigmentation: Case series. J Interdiscip Dent 2012;2:195-200.  Back to cited text no. 7
    
8.
The Academy of Laser Dentistry Featured Wavelength: Diode- The Diode Laser in Dentistry (Academy Report). Vol. 8. Wavelengths; 2000. p. 13.  Back to cited text no. 8
    
9.
Moritz A, Schoop U, Strassl M, Wintner E. Laser in endodontics. In: Moritz A, editor. Oral Laser Application. Berlin: Quintessenz; 2006. p. 100.  Back to cited text no. 9
    
10.
Elavarasu S, Thangavelu A, Alex S. Comparative evaluation of depigmentation techniques in split-mouth design with electrocautery and laser. J Pharm Bioallied Sci 2015;7:S786-90.  Back to cited text no. 10
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