Dentaltown February 2020 - 79

G

ingival depigmentation, or gum bleaching, is an
aesthetic procedure to remove dark pigmentation,
most commonly from melanin, on the gingiva. Several
factors could stimulate the melanin and the intensity
of the pigmentation, including smoking, genetics,
heavy metals, metabolic syndromes, endocrine
disturbances and medications.

This natural pigmentation, which does
not pose any other issues other than aesthetics, is usually seen in the labial, anterior
region of the maxillary and the mandibular
arches. It's more often seen in women and
girls who have high smile lines (or "gummy
smiles") than in men or boys.
Several techniques can be used to
de-epithelize the areas of pigmentation,
including electrosurgery, cryotherapy, surgical
scraping and bur/diamond abrasion. These
procedures generally create a hemorrhagic
wound surface with irregular contours, which
results in melanin not completely being
identified and removed, which can lead to
minimal recurrence of pigmentation. There is
also an increase in postoperative complications
such as bleeding and discomfort.
A more effective method to reduce or
remove melanin is the dental laser. Today's
lasers can ablate melanocytes, which will
eliminate melanin production in the gingiva,
resulting in a more uniform and lighter
color of a pink gingiva (Fig. 1). Diode
lasers utilize pigment as their chromophore
(target), while erbium lasers such as the
Er,Cr:YSGG have a wavelength that can
be quickly absorbed in water to ablate and
photoacoustically remove epithelium and
the associated melanin.
Dental patients who present with high
lip lines and gummy smiles are asking
dental health professionals to remove the
black spots to return pink gingiva. For some
individuals, removal of the discoloration
enhances confidence and self-esteem. They
also desire a level of permanency. Because
of safety and effectiveness, laser gingiva

depigmentation is becoming the procedure
of choice for dentists to change their patients'
gingival appearance.

Case study
A 19-year-old patient from the West
Indies presented with a chief concern of: "I
don't like it. Whenever I smile, the dark spots
show, and it is just not attractive" (Fig. 2).
The considered treatment plan was the
removal of melanin pigmentation in both the
maxillary and mandibular anterior regions,
while the maxilla was of most concern. An
erbium laser (Er,Cr:YSGG) was to be used
through de-epithelial ablation of gingival
buccal epithelium.

Fig. 1: Before and after a typical case.

Fig. 2: Preoperative photo of case study patient.

by Samuel B. Low, DDS, MS, MEd
Dr. Samuel B. Low was
named vice president,
dental and clinical
affairs, and chief dental
officer of Biolase in
October 2016. Low is
professor emeritus,
University of Florida
College of Dentistry
and associate faculty
member of the Pankey Institute, with 30 years of
private practice experience in periodontics, lasers
and implant placement. He is also a diplomate
of the American Board of Periodontology and
past president of the American Academy of
Periodontology.
Low received his DDS and MS degrees from the
University of Texas at Houston. He also completed
his residency in periodontics at the University
of Texas at Houston, and received a Master of
Education from the University of Florida.

by Maia Berger, DDS, MS
Dr. Maia Berger is
a top practitioner
of cutting-edge
technologies for
advanced dentistry.
Having completed
her DDS from the
New York University
College of Dentistry
and a master's
course in dentistry from the Henry Schein Dental
Business Institute, her passion initially brought
her overseas to help people in developing
countries gain access to premium dental
health. She used this experience to create a
dental practice where she envisioned patients
receiving individualized, premium care in a
boutique setting. Coliseum Dental specializes
in laser and cosmetic dentistry and Berger has
also added state-of-the-art technologies such
as 3D scanning, cavity indicators and same-day
dentistry to the Coliseum Dental portfolio of
services to better serve her patients.
Dentaltown February 2020

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