Academy of Laser Dentistry

was kept in constant motion. Care
was taken to avoid keeping the tip
in one place as this would lead to
excessive heat buildup and cause
damage to the underlying bone
(Figures 3b-3c). The area was then
irrigated with normal saline to
remove the tissue debris. The entire
procedure was completed in 30
minutes. The 3-month postoperative
examination revealed well-epithelialized,
pink gingiva with few
remnants of pigmentation (Figure
3d). Similar to the other cases, pain
measurements were performed.
DISCUSSION
Three cases were treated for
gingival hyperpigmentation using
laser, scalpel surgery, and electrocautery.
Pain levels were evaluated
using a Visual Analog Scale immediately
after the procedure and 1
week postoperatively. As can be
seen in Table 1, immediately after
the procedure, the VAS score for
the patient treated with the laser
was lower compared to patients
treated with scalpel surgery and
electrocautery, indicating the laser
procedure produced less pain and
discomfort. It can be theorized that
this may be due to protein coagulum
that is formed on the wound
surface, which may act as a biological
wound dressing 3 and seal the
ends of the sensory nerves. 4
In all three patients, healing
was uneventful. A white fibrin
slough was seen in Case 1 after 24
hours; this is a normal characteristic
of a laser wound during the
first several days of healing. In this
case, the “hot tip” of the diode laser
produced a relatively thick coagulation
layer on the treated surface.
Bleeding that occurred during
scalpel surgery was eliminated
when laser and electrocautery were
used. This can be attributed to the
property of lasers and electrocautery
instruments to coagulate
bleeding vessels and thereby assist
in providing a relatively dry
surgical field.
At the end of 6 months, all three
treatment modalities provided
satisfactory results in terms of
healing, repigmentation, and
patient satisfaction. Few patchy
areas of repigmentation were
observed in the cases treated with
electrosurgery and laser. This could
be due to deeper pigmentation in
these cases.
CONCLUSION
Within the limitations of this study,
the use of a diode laser is shown to
be a safe and effective treatment
modality to provide optimal
esthetics and enhanced comfort
with reduced discomfort to the
patients during the treatment for
gingival hyperpigmentation. A
longitudinal investigation of
similar treatments in a larger
patient population would be helpful
to confirm these findings.
AUTHOR BIOGRAPHY
Dr. Mihir Khakhar received his
BDS from the Maharashtra
University of Health Science,
Nashik, India in 2008 and is
currently pursuing his MDS in peri-
C A S E R E P O R T S
Table 1: Visual Analog Scale (VAS) Scores for All Three Cases
VAS Scores
Immediately Postoperative 1-Week Postoperative
Case 1 8 3
Case 2 15 4
Case 3 10 3
odontics at Saveetha University in
Chennai, India. He has been a delegate
at various national conferences
on periodontics, implant dentistry,
and general dentistry and has
received awards for poster and
paper presentations. He is also
working on a research project
related to the molecular pathogenesis
of periodontal diseases. He can
be contacted via e-mail at
mihirkhakhar@gmail.com.
Disclosure: Dr. Khakhar has no
commercial affiliations or conflicts of
interest.
REFERENCES
1. Volker JF, Kenney JA Jr. The physiology
and biochemistry of
pigmentation. J Periodontol
1960;31(5):346-355.
2. Dummett CO. Overview of normal
oral pigmentations. J Indiana Dent
Assoc 1980;59(3):13-18.
3. Fisher SE, Frame JW, Browne RM,
Tranter RMD. A comparative histological
study of wound healing
following CO2 laser and conventional
surgical excision of canine
buccal mucosa. Arch Oral Biol
1983;28(4):287-291.
4. Schuller DE. Use of the laser in the
oral cavity. Otolaryngol Clin North
Am 1990;23(1):31-42. nn
Khakhar, et al.
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
285