Development in techniques for gingival depigmentation – An update

Abstract

Dental esthetic needs of patients are increasing with a greater demand on pleasing look. This demand gets fulfilled not only by having healthy set of dentition but also esthetically improved gingival component. Gingival melanin pigmentation is one of the factors which determine the smile of an individual. Based on the available literature gingival melanin pigmentation can vary depending on whether it is physiological or pathological. Its esthetic importance depends on the skin complexion of the patient and is one of the most important factors for determining the treatment for gingival melanin pigmentation. It is necessary to select an appropriate technique for treating unaesthetic gingival melanin pigmentation of patients and the treatment should cause minimal discomfort and should be effective for a longer period of time. Treatment of gingival melanin pigmentation can be done using scalpel, chemical agents, abrasion, grafts, electro surgery, cryosurgery or lasers. Recent reports on treatment of gingival melanin pigmentation using cryosurgery and lasers show results in terms of ease of use, acceptance and patient comfort to be far superior to other techniques. This literature review is done to classify and explore the recent treatments and future procedures available for depigmentation.

Introduction

Melanin is non-hemoglobin derived brown pigment, most common of the endogenous pigments. It is a derivative of tyrosine and is synthesized in the Melanocytes. The Melanocytes are embryologically derived from neural crest ectoderm. In the human fetus it enters the epidermis and presumably the oral epithelium from the eleventh week onwards.¹ Once in the epithelium these cells constitute a self-producing population normally situated within the basal layer of the fully developed human epidermis, although they have been observed supra basally in human oral epithelium.²

Melanin is a powerful cation chelator and may act as a free radical sink.³ It is used commercially as a component of photoprotective creams, although mainly for its free radical scavenging rather than its light absorption properties. The pigment is also a potential target for anti-melanoma therapy.⁴

Gingival melanin pigmentation does not usually present as a medical problem, but patients may complain that their black gums are unaesthetic. This problem aggravates in patients with a “gummy smile” or excessive gingival display while smiling or talking.5, 6, 7 Cryosurgery and lasers being the newer and recent applications, these are considered to be more acceptable not only by the clinicians but also by the patients than other traditional methods.