COMPARATIVE EVALUATION OF GINGIVAL DEPIGMENTATION USING SCALPEL/ ELECTROCAUTERY/ DIAMOND BUR/ DIODE LASER. A CASE REPORT
At a Glance
Section titled âAt a Glanceâ| Metadata | Details |
|---|---|
| Publication Date | 2020-11-15 |
| Journal | GLOBAL JOURNAL FOR RESEARCH ANALYSIS |
| Authors | Priyanka Agarwal, Mudda Jayashree, P. Veena, Desai Shrikar, Ansari T. Sobia |
| Institutions | Kamineni Institute of Dental Sciences |
| Citations | 1 |
| Analysis | Full AI Review Included |
Executive Summary
Section titled âExecutive SummaryâThis study provides a comparative technical evaluation of four distinct methods for gingival depigmentation, focusing on material interaction (tissue response) and procedural efficiency for an engineering audience.
- Objective: To compare the efficacy, healing profile, and recurrence rates of Scalpel, Electrocautery, Diamond Bur, and Diode Laser techniques on melanin hyperpigmented gingiva in a split-mouth design.
- Performance Metrics: Scalpel surgery and Diode Laser (980 nm) demonstrated superior outcomes, characterized by uneventful healing and minimal post-operative pain in the immediate 1-month period.
- Thermal Management Failure: Electrocautery resulted in delayed healing and scar formation (persisting up to 1 month), indicating localized excessive heat accumulation and undesired tissue destruction.
- Mechanical Abrasion Risk: Diamond Bur abrasion led to delayed healing, persistent granulation tissue, and increased redness, highlighting the sensitivity of tissue to uncontrolled mechanical force and friction-induced thermal trauma.
- Laser Mechanism: The Diode Laser (980 nm, gated pulsed mode) achieved ablation via cellular rupture and vaporization, offering a bloodless field, short treatment time, and minimal damage to surrounding tissue, making it a highly controlled thermal process.
- Economic vs. Technical Trade-off: While Scalpel surgery is the most economical and simple, the Diode Laser offers superior control and hemostasis, though requiring expensive, sophisticated equipment.
- Long-Term Stability: All four techniques showed comparable results regarding complete healing and zero recurrence of pigmentation after the 3-month follow-up period.
Technical Specifications
Section titled âTechnical Specificationsâ| Parameter | Value | Unit | Context |
|---|---|---|---|
| Diode Laser Wavelength | 980 | nm | Used for soft tissue ablation (depigmentation) |
| Diode Laser Operating Mode | Gated Pulsed | N/A | Energy delivery method for minimizing thermal spread |
| Scalpel Blade Specification | #15 | N/A | Conventional surgical tool (Bard-Parker handle) |
| Electrocautery Tool Type | Loop Electrode | N/A | Used for deepithelizing the gingiva |
| Pigmentation Scoring Index | 3 | N/A | Dummett: Gupta Oral Pigmentation Index (diffused hyperpigmentation) |
| Post-Op Antibiotic (Amoxicillin) | 500 | mg | Thrice daily dosage for 5 days |
| Post-Op Rinse (Chlorhexidine) | 12 | hourly | Frequency of use for 1 week |
| Healing Assessment Intervals | 1 week, 1 month, 3 months | N/A | Follow-up schedule for pain and healing |
| Recurrence Observation | 3 | months | Time point where no recurrence was observed across all sites |
Key Methodologies
Section titled âKey MethodologiesâThe study utilized a split-mouth design on an 18-year-old male patient, applying four distinct depigmentation techniques across different quadrants of the maxillary and mandibular anterior gingiva.
- Patient Preparation: Local anesthesia was infiltrated from the first premolar to the first premolar in both arches. Written consent and routine oral hygiene procedures were completed prior to surgery.
- Scalpel Technique (Conventional Ablation):
- A #15 blade was used with a scrapping technique to remove the pigmented epithelial layer and a thin layer of underlying connective tissue.
- Hemorrhage was controlled using sterile gauze soaked in local anesthetic agent.
- Electrocautery Technique (Controlled Thermal Destruction):
- A loop electrode was used for deepithelizing the maxillary anterior gingiva (21-24).
- Applied using light brushing strokes, ensuring the tip remained in motion to prevent excessive heat build-up and subsequent tissue necrosis.
- Diode Laser Technique (Precision Photothermal Ablation):
- A 980 nm diode laser was applied using the Sieve method (gated pulsed mode).
- The fiberoptic tip was kept in contact with the pigmented area, moving horizontally to remove the epithelial lining.
- The area was wiped with saline-soaked gauze, and the procedure was repeated until no pigment remained.
- Diamond Bur Technique (Mechanical Abrasion):
- A revolving diamond bur was used with feather light strokes (14-11).
- Crucially, no pressure was applied, and the bur was not held in one place for prolonged periods to mitigate thermal trauma and permanent harm to underlying tissue.
- Post-Operative Management: All surgical areas were covered with a periodontal dressing pack. Patients received standard post-operative instructions, antibiotics (Amoxicillin), analgesics (Ibuprofen with paracetamol), and Chlorhexidine mouthwash.
Commercial Applications
Section titled âCommercial ApplicationsâThe technologies and findings presented have direct relevance to precision surgical tools and material interaction studies in biomedical engineering.
- Aesthetic and Periodontal Surgery: Direct application in cosmetic dentistry for treating gingival hyperpigmentation, utilizing advanced energy delivery systems (lasers) for improved patient outcomes.
- Precision Soft Tissue Ablation: The use of 980 nm Diode Lasers demonstrates effective, controlled tissue removal with minimal collateral damage, applicable to micro-surgery and endoscopic procedures requiring high hemostasis.
- Biomaterial Tool Design: Provides comparative data on tissue response to different energy sources (mechanical, thermal, photonic), informing the design and optimization of surgical instruments (e.g., bur materials, electrocautery tip geometry, laser delivery systems).
- Thermal Management in Surgery: The negative results from Electrocautery and Diamond Bur highlight critical engineering requirements for heat dissipation and controlled energy delivery in surgical tools to prevent iatrogenic tissue destruction.
- Medical Device Economics: The comparison provides a cost-benefit analysis framework, contrasting the low cost/high skill requirement of scalpel surgery with the high capital cost/high precision of diode laser systems.
View Original Abstract
Introduction: Gingival pigmentation which is caused by deposition of melanin pigment is a major esthetic concern for many people. A case is reported in which an evaluation of 4 popular depigmentation procedures carried . Methodology: Patients associated with gingival hyperpigmentation in 4 quadrants based on Dummetts scoring criteria were included. Healing and recurrence were assessed following depigmentation carried out by scalpel, bur, electrosurgery and laser. The outcome of procedures were assessed at 1 week, 1 month and 3 months. Results: Healing following Scalpel and laser were better than bur and electro surgery. Post-operative pain was less with the use of scalpel and laser. Discussion: In this case report, it was found that the time taken to carry out all the 4 procedures were nearly the same. Both scalpel surgery and laser led to uneventful healing and minimal post-operative pain when compared to abrasion by burs and electro surgery in the immediate post-surgical period of 1 week to 1 month. Conclusions: Better treatment outcomes were observed with the scalpel and laser techniques.