Application of an Er: YAG laser to Remove Gingival Melanin Hyperpigmentation

Treatment procedure and clinical evaluation

Abstract

This case report presents the application of a high pulse rate Er: YAG laser to remove gingivalmelanin hyperpigmentation. A 19-year-old female complained of an esthetic problem caused by gingivalmelanin pigmentation. The patient desired improvement of gingival color by laser treatment. Themelanin-pigmented gingiva of the maxilla was divided into three sections, and each section was treated at onevisit. In total, three Er: YAG laser treatments were given. The Er: YAG laser irradiation was performed at theoutput energy of 27-47mJ/pulse (panel setting 42-72mJ/pulse) and 20-30Hz, with water spray in a contactmode using an 80-degree curved contact tip. At the first and second treatments, the irradiation was performedwith only topical anesthesia. At the third treatment, the irradiation was performed under local anesthesia byinjection, with microscopic observation. The wound healing was basically evaluated immediately, and at 1, 2, and 4 weeks, and at 3 and 6 months, after the irradiation. The visual analog scale (VAS) was used to evaluatethe pain level experienced by the patient. Ablation of the hyperpigmented epithelial tissue of gingiva waseasily achieved, without prominent bleeding complications. The use of water spray provided a clear operationfield. The microscopic monitoring during laser irradiation was of great advantage for complete removal ofslightly remaining melanin pigmentation. The irradiated site showed no major thermal damage, such aswhitish coagulation or carbonization. The patient perceived slight to moderate pain, such as irritation orcontact pain, until 3 days after treatment. At one week, the gingiva had recovered an almost normalappearance, with a healthy pink appearance, although the gingiva was immature and thin and at two weeks, the gingiva showed complete healing, with normal thickness. Healing delay, complications, or side effectswere not observed during this observation period. Slight recurrence of the melanin pigmentation was observed after six months. The results of the present clinical study suggest that the removal of gingival melanin pigmentation can be performed safely and effectively by high pulse rate Er: YAG laser irradiation.