A Comparison Between the Efficacy of Scalpel and Laser Procedures for Treating Gingival Hyperpigmentation - A Case Report
At a Glance
Section titled âAt a Glanceâ| Metadata | Details |
|---|---|
| Publication Date | 2022-08-12 |
| Journal | Cureus |
| Authors | Safiya Hassan, Prasad Dhadse, Pavan Bajaj, Chitrika Subhadarsanee |
| Institutions | Datta Meghe Institute of Medical Sciences |
| Citations | 13 |
| Analysis | Full AI Review Included |
Executive Summary
Section titled âExecutive SummaryâThis case report provides a comparative engineering assessment of two distinct methodsâsurgical stripping (scalpel) and diode laser ablationâfor treating gingival hyperpigmentation in a split-mouth study design.
- Objective: To compare the efficacy, healing profile, and patient comfort between conventional scalpel surgery and diode laser treatment for aesthetic gingival depigmentation.
- Scalpel Performance: The scalpel (#15 blade) technique is noted for being straightforward, affordable, and having a quick healing rate. However, it resulted in significant intra- and post-operative bleeding, required a periodontal pack, and caused patient discomfort for three days post-surgery.
- Laser Performance: Diode laser treatment provided a superior surgical environment, characterized by a bloodless field, immediate hemostasis, and recovery without complications (no post-operative pain, bleeding, or scars observed).
- Aesthetic Outcome: Both techniques achieved excellent aesthetic results, transforming the gingiva from pigmented to pink, firm, and healthy within one month.
- Recurrence Rate: Crucially, both the scalpel-treated and laser-treated sites showed equivalent long-term benefits with no observed re-pigmentation during the follow-up period.
- Cost vs. Comfort Trade-off: The choice involves a trade-off between the low cost and accessibility of the scalpel method versus the enhanced patient comfort, precision, and reduced post-operative care requirements offered by the specialized laser system.
Technical Specifications
Section titled âTechnical Specificationsâ| Parameter | Value | Unit | Context |
|---|---|---|---|
| Study Design | Split-Mouth | N/A | Comparison of two techniques in the same patient |
| Surgical Tool (Scalpel) | #15 | Blade | Used for surgical stripping (right maxillary quadrant) |
| Ablation Tool (Laser) | Diode Laser | N/A | Used for soft tissue ablation (left maxillary quadrant) |
| Common Laser Wavelengths (Ref. [10]) | 980, 1064, 10,600 | nm | Diode, Nd:YAG, CO2 lasers, respectively, used in depigmentation |
| Anesthesia Method | Local Infiltration | N/A | Lignocaine infusion with adrenaline |
| Post-operative Pain (Scalpel) | 3 | Days | Duration of patient discomfort requiring NSAIDs |
| Post-operative Bleeding (Laser) | None | N/A | Bloodless surgical field achieved via coagulation |
| Post-operative Dressing | Periodontal Pack | N/A | Applied to cover treated sites for 1 week |
| Post-operative Medication | Diclofenac Sodium | 2 times/day for 3 days | Nonsteroidal anti-inflammatory drug (NSAID) |
Key Methodologies
Section titled âKey MethodologiesâThe experiment followed a controlled split-mouth protocol to compare the two depigmentation techniques on the maxillary anterior aesthetic zone:
- Site Preparation: Hyperpigmented areas were clinically examined, marked using a template, and anesthetized via local infiltration (Lignocaine with adrenaline).
- Laser Ablation (Left Side): The diode laser was applied to the gingival epithelium. The mechanism relies on thermal energy absorption by melanin, leading to vaporization and ablation of the pigmented layer, resulting in a bloodless surgical field.
- Surgical Stripping (Right Side): A conventional #15 surgical blade was used to excise the gingival epithelium and a thin layer of underlying connective tissue. This method relies on secondary intention healing.
- Immediate Assessment: The treated areas were assessed using a tin foil stent. The scalpel site exhibited bleeding, while the laser site achieved immediate hemostasis due to coagulation.
- Post-operative Management: A periodontal pack was applied to cover the denuded surfaces on both sides to promote uneventful healing, particularly protecting the scalpel-treated site.
- Healing Monitoring: The patient received post-operative instructions and NSAIDs (Diclofenac sodium). The pack was removed after one week, and the sites were monitored for healing, discomfort, and recurrence at one month.
Commercial Applications
Section titled âCommercial ApplicationsâThis research directly impacts the development and selection criteria for equipment used in aesthetic periodontal surgery.
- Aesthetic Medical Device Manufacturing: Validation of diode laser technology (e.g., 980 nm systems) for soft tissue ablation, emphasizing features like precision, hemostasis, and minimal collateral damage.
- Surgical Tool Design: Informing the design of specialized surgical instruments and curettes optimized for minimal trauma during epithelial stripping procedures.
- Biomaterials Engineering: Development of advanced periodontal dressings and wound care materials that enhance secondary intention healing, reduce pain, and eliminate the need for frequent pack replacement.
- Clinical Protocol Development: Establishing evidence-based protocols for selecting depigmentation techniques based on clinical setting constraints (cost, equipment availability) versus patient priorities (comfort, recovery time).
- Dental Practice Management: Justification for the high capital investment required for laser systems based on improved patient satisfaction, reduced chair time for post-operative care, and superior immediate surgical outcomes (bloodless field).
View Original Abstract
Gingival hyperpigmentation is a hereditary feature in populations. Gingival pigmentation not only affects aesthetics but also has a negative psychological effect. For many people, gingival hyperpigmentation is a severe cosmetic problem. Although black gums are not a medical issue, many individuals find them unsightly. The pigmentation of gingiva contributes to the harmony of the smile in a significant way. A periodontal plastic surgery procedure called gingival depigmentation eliminates or reduces hyperpigmentation. Different treatment approaches for gingival depigmentation have been documented, such as scalpel, electrosurgery, diamond burs, chemical methods, cryosurgery, and lasers. According to studies, cryosurgery and lasers are the best procedures since they provide better aesthetic outcomes and low recurrence rates. The coordination of treatment plans and the choice technique are influenced by the patientâs skin tone, the degree of gingival pigmentation, the lip line, the upper lip curvature, aesthetic concern, and treatment expectations. This case report, which involves a 23-year-old female patient, provides a comparison between the efficacy of scalpel and laser procedures for treating gingival hyperpigmentation. The patientâs left side received diode laser treatment, while the right received scalpel treatment. Scalpel depigmentation caused the treated area to recover without incident. The benefits of laser depigmentation include a bloodless surgical field and recovery without complications. No postoperative pain, bleeding, infection, or scars were seen on the first and consequent visits. The recovery went smoothly. The patient was satisfied with the treatment modality, and the outcomes were outstanding, according to the patient. There was no re-pigmentation throughout the follow-up period. This split-mouth study will provide information regarding soft tissue healing using two different approaches in the same patient.
Tech Support
Section titled âTech SupportâOriginal Source
Section titled âOriginal SourceâReferences
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