Abstract
Gingival hyperpigmentation is produced by excessive melanin deposit, generating a dark gum coloring. Although it does not constitute a health issue, in some cases it usually represents an aesthetic problem that can affect psychologically, for which there are currently several treatment alternatives such as: surgery with scalpel, laser therapy, abrasion, cryosurgery, electrosurgery, among others. The aim of this literature review was to analyze the available information about gingival melanosis and the therapeutics that can be applied to improve the appearance of patients with this condition. Articles in English and Spanish, published during the period 2000-2020 in the PubMed, Medline, Scielo, Cochrane and Lilacs databases, were reviewed. It was concluded that the selection of the technique will depend on each particular case, however, the laser is the most relevant.
References
Dummett C. Overview of normal oral pigmentations. J Indiana Dent Assoc. 1980; 59 (3): 13-8.
Grover H., Dadlani H., Bhardwaj A., Yadav A., Lal S. Evaluation of patient response and recurrence of pigmentation following gingival depigmentation using laser and scalpel technique: A clinical study. J Indian Soc Periodontol. 2014; 18 (5): 586-92.
Jha N., Ryu J.J., Wahab R., Al-Khedhairy A.A., Choi E.H., Kaushik N.K. Treatment of oral hyperpigmentation and gummy smile using lasers and role of plasma as a novel treatment technique in dentistry: An introductory review. Oncotarget. 2017; 8 (12): 20496-509.
Pavlic V., Brkic Z., Marin S., Cicmil S., Gojkov-Vukelic M, Aoki A. Gingival melanin depigmentation by Er:YAG laser: A literature review. J Cosmet Laser Ther [Internet]. 2018; 20 (2): 85-90. Available from: https://doi.org/10.1080/14764172.2017.1376092
Molano Valencia P.E., Quisoboni Eguizábal J.F., Yepes Ramírez B.I. Despigmentación gingival y cirugía de alargamiento coronal en erupción pasiva alterada tipo IA e IB en el mismo tiempo quirúrgico / Gingival Depigmentation and Crown Lengthening in IA- and IB-Type Altered Passive Eruption in the same Surgical Procedure. Univ Odontol. 2015; 34 (72): 91.
Narayankar S., Deshpande N., Dave D., Thakkar D. Comparative Evaluation of Gingival Depigmentation by Tetrafluroethane Cryosurgery and Surgical Scalpel Technique. A Randomized Clinical Study. Contemp Clin Dent. 2017; 8 (1): 90-5.
Bakhshi M., Rahmani S., Rahmani A. Lasers in esthetic treatment of gingival melanin hyperpigmentation: a review article. Lasers Med Sci. 2015; 30 (8): 2195-203.
Penmetsa G.S., Mopidevi A., Dwarakanath C.D., Raju M. Melanocyte Response Following Depigmentation by Cryosurgery and Mucosal Excision: A Comparative Clinical and Histopathological Study. Contemp Clin Dent. 2019; 10 (2): 214-9.
Cerman A.A., Training S.E. Atlas of Pigmentary Disorders. J Pigment Disord. 2016; 3 (1): 1-4.
Hertz R.S., Beckstead P.C. BW. Epithelial melanosis of the gingiva possibly resulting from the use of oral contraceptives. J Am Dent Assoc. 1980;100 (5): 713-21.
Abdel R., El Deeb M., Rabea A. Gingival pigmentation (cause, treatment and histological preview). Futur Dent J. 2017; 3 (1): 1-7.
Shirazi A.S., 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 [Internet]. 2012 [cited 2020 Jul 24]; 32 (4): e142-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22577644
Fernández G., Guzmán A., Vera I. Lesiones pigmentadas de la mucosa oral. Parte I. Dermatología Cosmética, Médica y Quirúrgica. 2015; 13 (2): 139-48.
Ponnaiyan D, Anusha J, Gomathy L. The correlation of skin color and gingival pigmentation patterns in a group of South Indians in Tamil Nadu, India. SRM J Res Dent Sci. 2013; 4 (2): 54.
Hassona Y., Sawair F., Al-karadsheh O., Scully C. Prevalence and clinical features of pigmented oral lesions. Int J Dermatol. 2016; 55 (9):1005-13.
Masilana A., Khammissa R.A.G., Lemmer J., Feller L. Physiological oral melanin pigmentation in a South African sample: A clinical study. J Investig Clin Dent. 2017; 8 (4).
Dummett C.O., Sakumura J.S., Barens G. The relationship of facial skin complexion to oral mucosa pigmentation and tooth color. J Prosthet Dent. 1980; 43 (4): 392-6.
Raposo A., Monsalves M.J., Aravena P., Sanhueza A. Prevalencia de lesiones de la mucosa oral en el hospital Hernán Henríquez Aravena de Temuco. Int J Morphol. 2011; 29 (2): 622-7.
Moret Y., Rivera H., Cartaya M. Prevalencia de lesiones en la mucosa bucal de pacientes diagnosticados en el Laboratorio Central de Histopatología Bucal Dr. Pedro Tinocco de la Facultad de Odontología de la Universidad Central de Venezuela, durante el período 1968-1987: resultados preli. Acta odontol venez [Internet]. 2007 [cited 2020 Aug 7]; 45 (2): 240-3. Available from: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0001-63652007000200021
Cury P.R., Porto L.P.A., Dos Santos J.N., Ribeiro L.S.F., De Aquino Xavier F.C., Figueiredo A.L., et al. Oral mucosal lesions in Indians from northeast Brazil. Med (United States). 2014; 93 (27): 1-6.
Gallegos D. Prevalencia de pigmentación melánica gingival en los pacientes mayores de 18 años de edad atendidos en la clínica odontológica de la UDLA en el período junio a noviembre del 2015. J Chem Inf Model [Internet]. 2016;75. Available from: http://dspace.udla.edu.ec/handle/33000/4896
Gladys Hernández. Prevalencia de pigmentaciones melánicas gingivales en los pobladores del caserio Carpa Huamantanga de Ferreñafe-2018. Perú: Universidad Señor de Sipán; 2019.
Raposo S., Pérez E. Melasnosis gingival en un paciente pediátrico: caso clínico y revisión de la literatura. Rev Eur Odontoestomatol [Internet]. 2015; 21 (1): 1-9. Available from: https://doi.org/10.1016/j.solener.2019.02.027%0Ahttps://www.golder.com/insights/block-caving-a-viable-alternative/%0A???
Reddy R., Ragul M., Nabeeh A-Q, Ravi K.S., Tikare S., Pasupuleti M.K. Clinical Effectiveness of Gingival Depigmentation Using Conventional Surgical Scrapping and Diode Laser Technique: A Quasi Experimental Study. Glob J Health Sci. 2016; 9 (3): 296-303.
Sheel V., Purwar P., Dixit J., Rai P. Ancillary role of vitamin C in pink aesthetics. BMJ Case Rep. 2015; 2015: 10-3.
Ribeiro F. V., Cavaller C.P., Casarin R.C.V., Casati M.Z., Cirano F.R., Dutra-Corrêa 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.
Taher Agha M., Polenik P. Laser Treatment for Melanin Gingival Pigmentations: A Comparison Study for 3 Laser Wavelengths 2780, 940, and 445 nm. Int J Dent. 2020; 2020 (3896386).
Feller L., Masilana A., Khammissa R.A.G., Altini M., Jadwat Y., Lemmer J. Melanin: The biophysiology of oral melanocytes and physiological oral pigmentation. Head Face Med. 2014; 10 (1): 1-7.
Kauzman A., Blanas N., Frcd C. Pigmented Lesions Of The Oral Cavity-Review And Differential Diagnosis. Chettinad Heal City Med J. 2013; 2 (2).
Meza I., Rodríguez J., Garza B., Martínez G. Tratamiento de pigmentaciones gingivales fisiológicas. Uso del dimetiléter y propano. Reporte de un caso. Rev Mex Periodontol. 2015; 6 (1): 16-20.
Shahna N., Suchetha A., Sapna N., Bm D. Gingival pigmentation : A review of literature. 2019; 5 (2): 83-91.
Multani S. Interrelationship of smoking, lip and gingival melanin pigmentation, and periodontal status. Addict Heal [Internet]. 2013; 5 (1-2): 57-65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24494159%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3905564
Gupta G., Kumar A., Khatri M., Puri K., Jain D., Bansal M. Comparison of two different depigmentation techniques for treatment of hyperpigmented gingiva. J Indian Soc Periodontol. 2014; 18 (6): 705-9.
Batra P., Daing A., Azam I., Miglani R., Bhardwaj A. Impact of altered gingival characteristics on smile esthetics: Laypersons’ perspectives by Q sort methodology. Am J Orthod Dentofac Orthop [Internet]. 2018; 154 (1): 82-90.e2. Available from: https://doi.org/10.1016/j.ajodo.2017.12.010
Silberberg N., Goldstein M., Smidt A. Exposición gingival excesiva: etiología, diagnóstico y modalidades de tratamiento. Quintessence Publicación Int Odontol. 2011; 24 (3): 133-42.
Kathariya R., Pradeep A.R. Split mouth de-epithelization techniques for gingival depigmentation: A case series and review of literature. J Indian Soc Periodontol. 2011; 15 (2): 161-8.
Falcón-Guerrero B. Melanosis gingival - Revisión a propósito de un caso. Kiru. 2014; 11 (2): 184-9.
Chandra G., Kumar M., Walavalkar N., Vandana K., Vardhan P. Evaluation of surgical scalpel versus semiconductor diode laser techniques in the management of gingival melanin hyperpigmentation: A split-mouth randomized clinical comparative study. J Indian Soc Periodontol [Internet]. 2020 Jan 1 [cited 2020 Aug 10]; 24 (1): 47-53. Available from: /pmc/articles/PMC6961452/?report=abstract
Yussif N.M., Abdel Rahman A.R., ElBarbary A. Minimally invasive non-surgical locally injected vitamin C versus the conventional surgical depigmentation in treatment of gingival hyperpigmentation of the anterior esthetic zone: A prospective comparative study. Clin Nutr Exp [Internet]. 2019;24:54–65. Available from: https://doi.org/10.1016/j.yclnex.2018.12.003
Kumar S., Satyanarayana D., Reddy V. Gingival depigmentation: comparison of two techniques. Indian J Dent Adv. 2012; 4 (1): 787-90.
Bhanu Murthy M., 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.
Suryavanshi P., Dhadse P., Bhongade L. Role of hypoxia in malignant transformation of oral submucous fibrosis. J Datta Meghe Inst Med Sci Univ. 2018; 13 (1): 38-43.
Elemek E. Gingival melanin depigmentation by 810 nm diode laser. Eur J Dent. 2017; 11 (4): 192-5.
Manaswini Eaturi, Krishnajaneya Reddy, Haritha Avula, Vijayalakshmi Bolla, Ashank mishra SK. Seasonal Variation of the Population of Ootheca mutabilis Sahlberg (Coleoptera: Chrysomelidae) on the Cowpea (Vigna unguiculata L.) in Adzopé, South of Côte d’Ivoire. Sch Acad J Biosci. 2017; 5 (6): 459-64.
Gholami L., Moghaddam S.A., Rigi Ladiz M.A., Molai Manesh Z., Hashemzehi H., Fallah A., et al. Comparison of gingival depigmentation with Er,Cr:YSGG laser and surgical stripping, a 12-month follow-up. Lasers Med Sci. 2018; 33 (8): 1647-56.
Esen E., Haytac M.C., Öz IA, Erdoǧan Ö., Karsli E.D. Gingival melanin pigmentation and its treatment with the CO 2 laser. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2004; 98 (5): 522-7.
Basha M.I., Hegde R.V., Sumanth S., Sayyed S., Tiwari A., Muglikar S. Comparison of Nd:YAG Laser and Surgical Stripping for Treatment of Gingival Hyperpigmentation: A Clinical Trial. Photomed Laser Surg. 2015; 33 (8): 424-36.
Castro Y., Grados S. Tratamiento de la melanosis gingival y evaluación de la repigmentación melánica. Reevaluación clínica al cabo de 2 años. Rev Clínica Periodoncia, Implantol y Rehabil Oral. 2015; 8 (2): 139-43.
Mesa F., García O., López C., Aneiros J., OValle F. Tratamiento dela melanosis gingival mediante mucoabrasión. Estudio inmunohistoquímico en un paciente con pigmentaciones melánicas múltiples. Periodoncia. 2001; 11 (5): 383-90.
Negi R., Gupta R., Dahiya P., Kumar M., Bansal V., Kaur Samlok J. Ceramic soft tissue trimming bur: A new tool for gingival depigmentation. J Oral Biol Craniofacial Res [Internet]. 2019; 9 (1): 14-8. Available from: https://doi.org/10.1016/j.jobcr.2018.07.002
Jokar L., Bayani M., Hamidi H., Keivan M., Azari-Marhabi S. A comparison of 940 nm diode laser and cryosurgery with liquid nitrogen in the treatment of gingival physiologic hyperpigmentation using split mouth technique: 12 months follow up. J Lasers Med Sci. 2019;10 (2): 131-8.
Kato T., Takiuchi H., Sugiyama S., Makino M., Noguchi S., Katayama-Ono T., et al. Measurement of reduced gingival melanosis after smoking cessation: A novel analysis of gingival pigmentation using clinical oral photographs. Int J Environ Res Public Health. 2016;13 (6).
Reinehr C.P.H., Peruzzo J., Cestari T. Flagellate hyperpigmentation. In: Hyperpigmentation [Internet]. CRC Press; 2017 [cited 2020 Sep 5]. p. 112–5. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482319/
Pontes A.N., Pontes C. Evaluation of the Efficacy of the Acellular Dermal Matrix Allograft with Partial Thickness Flap in the Elimination of Gingival Melanin Pigmentation . J Esthet Restor Dent 18135-143, 2006. 2006; 18 (3): 135-43.
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.
Alidaee M.R., Taheri A., Mansoori P., Ghodsi S.Z. Silver nitrate cautery in aphthous stomatitis: A randomized controlled trial. Br J Dermatol. 2005; 153 (3): 521-5.
Churata Quispe J., Correa Quispilaya E., Ríos Villasis K. Nitrato de plata y despigmentación gingival de manchas melánicas: un reporte de caso. Rev Estomatológica Hered. 2017; 27 (4): 242-6.
Vassoler F., Magro E.D., Magro A.K.-D., de-Lacerda R.R.P., Paranhos L.R., Santos P.L., et al. Gingival Melanin Depigmentation With Diode Laser-Case Report. Int J Odontostomatol. 2019; 13 (4): 481-5.