“Gingival tissue constitutes the macroelement of dentofacial esthetics along with face, lip, and teeth.Gingiva participates in the harmony of smile with its pigmentation playing a crucial role. Pigmentation of gingiva is considered to be unaesthetic by patients, and it may have a psychological impact on them. This impact is aggravated in patients with “gummy smile” or excessive gingival display while smiling (high smile line).
Gingival hyperpigmentation can be defined as a darker gingival color beyond what is normally expected. Pigmentation is contributed by-products of the physiological process such as melanin, melanoid, carotene, oxyhemoglobin, reduced hemoglobin, bilirubin and iron and/or pathological diseases, and conditions. Melanin pigmentation results from melanin granules which are produced by melanoblasts. Furthermore, environmental risk factors such as tobacco smoking contribute to the gingival hyperpigmentation in both active and passive form. Ethnicity and age also influence the color of gingiva and has no sexual predilection.”
Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124824/
The present case demonstrates the use of diamond burs used on a high speed handpiece to carefully remove the superficial layer of epithelium to expose the underlying connective tissue..
The denunded connective tissue then heals by secondary intention. Bleeding during the procedure is controlled by using gauze soaked in local anaesthetic solution with 1:80000 Adrenaline concentration.
The patient was discharged once bleeding was under control. Although literature suggests that a perio pack be given, no post operative placement of periodontal dressing was done for this patient.
The patient was put on a 3 day course of Augmentin 625, 3 day course of a paracetemol-brufen combination , Chlorhexidine Mouthrinses as well as a Chlorhexidine-Lignocaine Gel for topical application for 1 week.
The patient reported no pain or discomfort after the procedure.
Her follow up showed uneventful healing with excellent resolution of her gingival pigmentation.
The biggest drawback of this technique is the bleeding associated with the procedure and the need for excellent control of the bur to prevent accidental trauma to tooth structures, buccal mucosa, as well as unwanted removal of excess tissue leading to contact with the bone.
The advantages include the need for no additional equipment such as lasers, cryosurgery unit etc , ease of therapy , readily available instruments in a dental setting thus making it a highly cost effective technique.
Initial presentation of smile showing significant high smile line and melanin pigmentation of the tissues..
Intra Oral presentation..showing the clear extent of the pigmentation of the marginal attached tissues..
A course diamond bur is used to abrade the tissues carefully. Here a high speed handpiece was used. One can also consider the use of a low speed handpiece for greater control during the procedure..
after initial analyses, some areas of pigmentation was noted to have been missed, these areas were further abraded..
Intra Oral healing at just 10 days..
The smile change at 10 days.. showing a pleasing outcome..
Share on:
