Long-term Outcomes of Er: YAG Laser Microsurgery for Melanin Removal in Gingiva: A Case Report

Abstract

 Purpose: To describe the long-term outcomes of a case of severe gingival melanin removal using an erbium-doped yttrium aluminum garnet laser (Er: YAG) laser (Dentlite, HOYA ConBio) under the microscope.

 Methods: The patient provided informed consent prior to the presentation of this case report. A 29-year-old male, with a smoking habit of nearly 10 cigarettes per day, presented with a chief complaint of esthetic disorder in the mandibular anterior gingiva. Extensive melanin deposition was observed on the attached gingiva of the mandibular anterior teeth. Before the melanin removal procedure, he was first advised to quit smoking to prevent recurrence. Then, we planned gingival ablation of the melanin pigmentation area using an Er: YAG laser under a microscope.

 Results: The advice to quit smoking was successful. Local anesthesia was administered to the mandibular anterior teeth, and gingival ablation of melanin pigmentation sites was performed using the Er: YAG laser at 10-30 Hz and 80 mJ (panel display), using contact tips under water spray. By performing the microsurgery, the remaining subtle pigmented areas were easily visible, allowing for a more precise procedure. The magnified view facilitated careful tissue ablation in areas susceptible to postoperative gingival recession, such as the gingival margin and interdental papillary area. There was no obvious coagulation or carbonization on the laser-irradiated surface, and connective tissue exposure was observed after epithelial tissue ablation. Postoperative analgesia or antibacterial medication was not administered because invasion was minimal. Epithelialization was completed 7 days postoperatively. Melanin removal on the buccal side of the mandibular anterior teeth was divided into three sessions to complete the treatment. At 1 year and 6 months postoperatively, the improved gingival esthetics were well maintained. Mild to moderate recurrence was observed 16 years later.

 Conclusion: Minimally invasive removal of severe melanin pigmentation of the gingiva under a microscope using an Er: YAG laser resulted in a favorable healing outcome. This case suggests that microsurgical depigmentation using an Er: YAG laser could achieve and maintain medium-term sound outcomes for the treatment of gingival esthetic disorders.