JOURNEY FROM BLACK TO PINK GUMS: MANAGEMENT OF MELANIN INDUCED PHYSIOLOGICAL GINGIVAL HYPER PIGMENTATION
AbstractSmile is an expression of happiness, self-confidence, kindness and beauty. Along with teeth and lips, gingiva is also a vital component of smile. Melanin induced gingival hyper pigmentation may appear un-aesthetic especially when it is associated with high smile line, upper anterior labial segment and is uneven in appearance. It affects individuals from all races. Generally, it is believed that melanin induced gingival hyper pigmentation is confined to individuals from dark races. But studies have shown that Iranian, Indian, Italian, Arabian, Greek. German, French, Japanese, Chinese, Jewish, Thai, Malaysian and other ethnic groups also display clinical gingival pigmentation.1 Gingival hyper pigmentation may result in psychological distress especially when the appearance is of utmost importance for the individuals. This article aims to focus on the physiology, clinical appearance and treatment options available for the melanin induced gingival hyper pigmentation along with the reported recurrence in the light of current literature.Keywords: Gingival Hyperpigmentation; Physiological pigmentation; Gums; Black gums
Tamizí M, Taheri M. Treatment of severe physiologic gingival pigmentation with free gingival antograft. Quintessence Int 1996;27(8):555–8.
Bolden TE. Histology of Oral Pigmentation. J Periodontol 1960;31(5):361–74.
Dummett CO, Gaida B. Pigmentation of the oral tissue: A review of the literature. J Periodontol 1967;38(5):369–78.
Aoki A, Sasaki KM, Watanabe H, Ishikawa I. Lasers in nonsurgical periodontal therapy. Periodontology 2000 2004;36:59–97.
Ishikawa I, Sasaki KM, Aoki A, Watanabe H. Effects of Er:YAG laser on periodontal therapy. J Int Acad Periodontol 2003;5(1):23–8.
Meredith P, Riesz J. Radiative relaxation quantum yields for synthetic eumelanin. Photochem Photobiol 2004;79(2):211–6.
Eid AH. Impact of melanin pigmentation on gingival inflammation- histopathological and biochemical analysis. Dent J 2012;58(2):1289–94.
Esen E, Haytac MC, Oz IA, Erdoğan O, Karsli ED. Gingival melanin pigmentation and its treatment with the CO2 laser. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98(5):522–27.
Nilima S, Vandana KL. Melanin: a scavenger in gingival inflammation. Ind J Dent Res 2011;22(1):38–43.
Patsakas A, Demetriou N, Angelopoulos A. Melanin pigmentation and inflammation in human gingiva. J Periodontol 1981;52(11):701–4.
Dummett CO. First symposium on oral pigmentation. J Periodontol 1960;31(5):345–85.
Merchant HW. Oral pigmentation associated with bronchogenic carcinoma. Oral Surg Oral Med Oral Pathol 1973;36(5):657–7.
Dummett CO, Barens G. Pigmentation of the oral tissues: a review of the literature. J Periodontol 1967;38(5):369–78.
Coleton SH. The use of lasers in periodontal therapy. Alpha Omegan 2008;101(4):181–7.
Rawal SY, Burrell R, Hamidi CS, Kalmar JR, Tatakis DN. Diffuse pigmentation of maxillary attached gingiva: four cases of the cultural practice of gingival tattoo. J Periodontol 2007;78(1):170–6.
Hirschfeld I, Hirschfeld L. Oral pigmentation and a method of removing it. Oral Surg Oral Med Oral Pathol 1951;4(8):1012–6.
Shimada Y, Tai H, Tanaka A, Ikezawa-Suzuki I, Takagi K, Yoshida Y, et al. Effects of ascorbic acid on gingival melanin pigmentation in vitro and in vivo. J Periodontol 2009;80(2):317–23.
Parwani S, Parwani R. Achieving better esthetics by gingival de-pigmentation: report othree cases with a review of the literature. J Mich Dent Assoc 2013;95(2):52–8,78.
Ribeiro FV, Cavaller CP, Casarin RC, Casati MZ, Cirano FR, Dutra-Correa M, et al. Esthetic treatment of gingival hyperpigmentation with Nd:YAG laser or scalpel technique: a 6-month RCT of patient and professional assessment. Lasers Med Sci 2014;29(2):537–44.
Hegde R, Padhye A, Sumanth S, Jain AS, Thukral N. Comparison of surgical stripping; erbium-doped:yttrium, aluminum, and garnet laser; and carbon dioxide laser techniques for gingival depigmentation: a clinical and histologic study. J Periodontol 2013;84(6):738–48.
Wilderman MM. Exposure of the bone in periodontal surgery. Dent Clin North Am 1964;8:23–36.
Santos A, Goumenos G, Pascual G. Management of Gingival Recession by the Use of an Acellular Dermal Graft Material: A 12-Case Series. J Periodontol 2005;76(11):1982–90.
Yeh CJ. Cryosurgical treatment of melanin-pigmented gingiva. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86(6):660–3.
Almas K, Sadig W. Surgical treatment of melanin-pigmented gingiva; an esthetic approach. Indian J Dent Res 2002;13(2):70–3.
Kumar S, Bhat GS, Bhat KM. Effectiveness of cryogen tetrfluoroethane on elimination of gingival epithelium and its clinical application in gingival depigmentation-histological findings and case series. J Clin Diagn Res 2013;7(12):3070–2.
Arikan F, Gürkan A. Cryosurgical treatment of gingival melanin pigmentation with tetrafluoroethane. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(4):452–7.
Atsawasuwan P, Greethong K, Nimmanon V. Treatment of gingival hyperpigmentation for esthetic purposes by Nd:YAG laser: report of 4 cases. J Periodontol 2000;71(2):315–21.
Gupta G. Management of gingival hyperpigmentation by semiconductor diode laser. J Cutan Aesthet Surg 2011;4(3):208–10.
Ko HJ, Park JW, Suh JY, Lee JM. Esthetic treatment of gingival melanin hyperpigmentation with a Nd:YAG laser and high speed rotary instrument: comparative case report. J Periodontal Implant Sci 2010;40(4):201–5.
Sherman JA, Gurkan A, Arikan F. Radiosurgery for gingival melanin depigmentation. Dent Today 2009;28(1):118,20–1.
Bergamaschi O, Kon S, Doine AI, Ruben MP. Melanin repigmentation after gingivectomy: a 5-year clinical and transmission electron microscopic study in humans. Int J Periodontics Restorative Dent 1993;13(1):85–92.
Simsek Kaya G, Yapici Yavuz G, Sumbullu MA, Dayi E. A comparison of diode laser and Er:YAG lasers in the treatment of gingival melanin pigmentation. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113(3):293–9.
Shirazi AS, Moeintaghavi A, Khorakian F, Talebi M. Treatment of gingival physiologic pigmentation in adolescents by liquid nitrogen cryosurgery: 24-month follow-up. Int J Periodontics Restorative Dent 2012;32(4):e142–6.
Kasagani SK, Nutalapati R, Mutthineni RB. Esthetic depigmentation of anterior gingiva. A case series. N Y State Dent J 2012;78(3):26–31.
Talebi M, Farmanbar N, Abolfazli S, Sarraf Shirazi A. Management of physiological hyperpigmentation of oral mucosa by cryosurgical treatment: a case report. J Dent Res Dent Clin Dent Prospects 2012;6(4):148–51.
Thangavelu A, Elavarasu S, Jayapalan P. Pink esthetics in periodontics - Gingival depigmentation: A case series. J Pharm Bioallied Sci 2012;4(Suppl 2):S186–90.
Murthy MB, Kaur J, Das R. Treatment of gingival hyperpigmentation with rotary abrasive, scalpel, and laser techniques: A case series. J Indian Soc Periodontol 2012;16(4):614–9.
Kathariya R, Pradeep AR. Split mouth de-epithelization techniques for gingival depigmentation: A case series and review of literature. J Indian Soc Periodontol 2011;15(2):161–8.
Bhusari BM, Kasat S. Comparison between scalpel technique and electrosurgery for depigmentation: A case series. J Indian Soc Periodontol 2011;15(4):402–5.
Lee KM, Lee DY, Shin SI, Kwon YH, Chung JH, Herr Y. A comparison of different gingival depigmentation techniques: ablation by erbium:yttrium-aluminum-garnet laser and abrasion by rotary instruments. J Periodontal Implant Sci 2011;41(4):201–7.
Azzeh MM. Treatment of gingival hyperpigmentation by erbium-doped:yttrium, aluminum, and garnet laser for esthetic purposes. J Periodontol 2007;78(1):177–84.
Rosa DS, Aranha AC, Eduardo Cde P, Aoki A. Esthetic treatment of gingival melanin hyperpigmentation with Er:YAG laser: short-term clinical observations and patient follow-up. J Periodontol 2007;78(10):2018–25.
Pontes AE, Pontes CC, Souza SL, Novaes AB Jr, Grisi MF, Taba M Jr. Evaluation of the efficacy of the acellular dermal matrix allograft with partial thickness flap in the elimination of gingival melanin pigmentation. A comparative clinical study with 12 months of follow-up. J Esthet Restor Dent 2006;18(3):135–43.
Roshna T, Nandakumar K. Anterior esthetic gingival depigmentation and crown lengthening: report of a case. J Contemp Dent Pract 2005;6(3):139–47.
Deepak P, Sunil S, Mishra R, Sheshadri. Treatment of gingival pigmentation: a case series. Indian J Dent Res 2005;16(4):171–6.
Tal H, Oegiesser D, Tal M. Gingival depigmentation by erbium:YAG laser: clinical observations and patient responses. J Periodontol 2003;74(11):1660–7.
Ozbayrak S, Dumlu A, Ercalik-Yalcinkaya S. Treatment of melanin-pigmented gingiva and oral mucosa by CO2 laser. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90(1):14–5.