Melanin, a brown pigment, is the most common natural pigment contributing to endogenous pigmentation of gingival. Melanin pigmentation is the result of melanin granules produced by melanoblasts intertwined between epithelial cells at the basal layer of gingival epithelium. The degree of pigmentation varies from one individual to another which is mainly dictated by the melanoblastic activity.
Melanin pigmentation of the gingiva occurs in all races. Although clinically melanin pigmentation of the gingiva does not present any medical problems it can be an aesthetic concern for the patient. Demand for cosmetic therapy is made, especially by fair skinned people with moderate or severe gingival pigmentation.
Recently, laser ablation has been recognized as one of the most effective, comfortable and reliable techniques. Many laser systems such as Q-switched ruby laser, flash-lamp pumped-dye laser, argon laser, CO2 laser, Nd:YAG laser and Er:YAG laser have been used for dermal depigmentation.
Er,Cr:YSGG hydrokinetic system laser (Waterlase) with a wavelength of 2780nm, frequency of 20Hz, pulse energy between 0 and 300mJ has FDA (Federal Drug Administration, USA) approval for several soft tissue procedures such as gingivoplasty, gingivectomy, fibroma removal.
Treatment of gingival hyperpigmentation by Waterlase radiation in a defocused mode is a safe and effective procedure. Postoperative patient satisfaction in terms of aesthetics and pain is excellent.
The gingiva heales uneventfully and completely regenerates with no infection, pain, swelling, or scarring.
Repigmentation after gingival depigmentation is an important point of which clinicians should be aware. Reports of repigmentation after using a waterlase MD are quite limited and varied.
Gingival depigmentation has been carried out using surgical, electrosurgical and cryosurgical procedures. One of the first, and still popular, techniques to be employed was the surgical removal of undesirable pigmentation using scalpels. The procedure essentially involves surgical removal of gingival epithelium along with a layer of the underlying connective tissue and allowing the denuded connective tissue to heal by secondary intention. The new epithelium that forms is devoid of melanin pigmentation.