Top

Lasers in Dental Science

Published in:

01-09-2018 | Original Article

Surgical laser oral depigmentation procedure: an investigation on the optimum power settings using Er:YAG laser

Authors: Yasser Stas, Akram Hassan, Nor FaridMohd Noor, A. R. Samsudin, Ramizu Shaari

Published in: Lasers in Dental Science | Issue 3/2018

Abstract

Introduction

Gingiva hyperpigmentation is often a non-pathological problem, but clinically considered unaesthetic when the gingiva appears dark and purplish. Chemical peeling, surgery, and laser ablation are the available treatment options. Er:YAG laser is one of the common laser used in soft and hard tissue management. This study compared the Er:YAG different power settings and selected the best setting for gingival depigmentation.

Materials and methods

Two phases of studies were conducted, starting with ex-vivo animal tissue experimental phase followed by prospective human experimental phase. Twenty-four different power settings were applied for the gingival depigmentation of a recently slaughtered sheep’s head. The four best power settings applied to the human studies were selected based on the following parameters: histology, carbonization, speed, and operator controllability. Two and 4 J/cm² fluences and short pulse (SP) 0.3 ms and very long pulse (VLP) 1 ms pulse durations were chosen. Forty adult nonsmoker patients were randomly divided into four groups of 10 patients; one power setting was applied to each group followed by clinical and biological evaluation. Pain, bleeding, satisfaction, carbonization, speed of removal, and histological investigation parameters were tested. Ablated tissue specimens were sent for histological analysis.

Results

Four power settings proved safety, patient and dentist satisfaction, and efficiency in removing pigmentations. Regarding pain, satisfaction, and bleeding presented no statistical difference. Histological analysis showed a superficial damage in lamina propria. There was obvious effect of the peak power on the speed of depigmentation procedure.

Conclusion

The higher the peak power the higher work speed and the less carbonization, but it however provided less operator controllability. The reasonable parameter for all practicing dentists is using 2 J/cm² with very long pulse duration for laser depigmentation therapy.

Hirschfeld I, Hirschfeld L (1951) Oral pigmentation and a method of removing it. Oral Surg Oral Med Oral Pathol 4(8):1012–1016CrossRefPubMed

Dummett C, Bolden T (1963) Postsurgical clinical repigmentation of the cingivae. Oral Surg Oral Med Oral Pathol 16(3):353–365CrossRef

Sawabe M, Aoki A, Komaki M, Iwasaki K, Ogita M, Izumi Y (2015) Gingival tissue healing following Er: YAG laser ablation compared to electrosurgery in rats. Lasers Med Sci 30(2):875–883CrossRefPubMed

Romeo U, Libotte F, Palaia G, Del Vecchio A, Tenore G, Visca P, Nammour S, Polimeni A (2012) Histological in vitro evaluation of the effects of Er: YAG laser on oral soft tissues. Lasers Med Sci 27(4):749–753CrossRefPubMed

Abduljabbar T, Vohra F, Javed F, Akram Z (2017) Antimicrobial photodynamic therapy adjuvant to non-surgical periodontal therapy in patients with diabetes mellitus: a meta-analysis. Photodiagn Photodyn Ther 17:138–146CrossRef

Hibst R, Keller U (1989) Experimental studies of the application of the Er: YAG laser on dental hard substances: I. Measurement of the ablation rate. Lasers Surg Med 9(4):338–344CrossRefPubMed

Tal H, Oegiesser D, Tal M (2003) Gingival depigmentation by erbium: YAG laser: clinical observations and patient responses. J Periodontol 74(11):1660–1667CrossRefPubMed

Tal H, Oelgiessr D, Tal M (2002) Gingival depigmentation for aesthetic purposes using erbium: YAG laser: rationale and technique. Refuat Hapeh Vehashinayim (1993) 19(4):25–32, 69

Esen E, Haytac MC, Öz IA, Erdoğan Ö, Karsli ED (2004) Gingival melanin pigmentation and its treatment with the CO 2 laser. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98(5):522–527CrossRefPubMed

10.

Saladin KS, Miller L (1998) Anatomy & physiology. WCB/McGraw-Hill New York, NY

11.

Apel C, Franzen R, Meister J, Sarrafzadegan H, Thelen S, Gutknecht N (2002) Influence of the pulse duration of an Er: YAG laser system on the ablation threshold of dental enamel. Lasers Med Sci 17(4):253–257CrossRefPubMed

12.

Srinivasan M, Sedmak D, Jewell S (2002) Effect of fixatives and tissue processing on the content and integrity of nucleic acids. Am J Pathol 161(6):1961–1971CrossRefPubMedPubMedCentral

13.

Downie W, Leatham P, Rhind V, Wright V, Branco J, Anderson J (1978) Studies with pain rating scales. Ann Rheum Dis 37(4):378–381CrossRefPubMedPubMedCentral

14.

Trelles M, Verkruysse W, Segui J, Udaeta A (1993) Treatment of melanotic spots in the gingiva by argon laser. J Oral Maxillofac Surg 51(7):759–761CrossRefPubMed

15.

Hegde R, Padhye A, Sumanth S, Jain AS, Thukral N (2013) Comparison of surgical stripping; erbium-doped: yttrium, aluminum, and garnet laser; and carbon dioxide laser techniques for gingival depigmentation: a clinical and histologic study. J Periodontol 84(6):738–748CrossRefPubMed

16.

Nakamura Y, Funato A, Wakabayashi H, Matsumoto K (1992) A study on the removal of the melanin pigmentation of dog gingiva by CO₂ laser irradiation. J Clin Laser Med Surg 10(1). https://doi.org/10.1089/clm.1992.10.41

17.

Sharon E, Azaz B, Ulmansky M (2000) Vaporization of melanin in oral tissues and skin with a carbon dioxide laser: a canine study. J Oral Maxillofac Surg 58(12):1387–1393CrossRefPubMed

18.

Rosa DSA, Aranha ACC, de Paula Eduardo C, Aoki A (2007) Esthetic treatment of gingival melanin hyperpigmentation with Er: YAG laser: short-term clinical observations and patient follow-up. J Periodontol 78(10):2018–2025CrossRefPubMed

19.

Gutknecht N (2007) Proceedings of the 1st international workshop of evidence based dentistry on lasers in dentistry. Quintessence Publishing, IL

20.

Němec M, Koranda P, Jelínková H, Köhler O, Drlík P, Miyagi M, Shi Y-W, Matsuura Y (2005) Application of hollow glass waveguides in urological treatment. In: Optical fibers and sensors for medical applications V. Proceedings of SPIE 5691:183–191

21.

Suter VG, Altermatt HJ, Bornstein MM (2017) A randomized controlled clinical and histopathological trial comparing excisional biopsies of oral fibrous hyperplasias using CO2 and Er: YAG laser. Lasers Med Sci 32(3):573–581CrossRefPubMed

22.

Kan JY, Morimoto T, Rungcharassaeng K, Roe P, Smith DH (2010) Gingival biotype assessment in the esthetic zone: visual versus direct measurement. Int J Periodontics Restorative Dent 30(3):237–243

23.

Walsh JT, Cummings JP (1994) Effect of the dynamic optical properties of water on midinfrared laser ablation. Lasers Surg Med 15(3):295–305CrossRefPubMed

24.

Kaya GŞ, Yavuz GY, Sümbüllü MA, Dayı E (2012) A comparison of diode laser and Er: YAG lasers in the treatment of gingival melanin pigmentation. Oral Surg Oral Med Oral Pathol Oral Radiol 113(3):293–299CrossRef

25.

Parwani S, Parwani R (2013) Achieving better esthetics by gingival de-pigmentation: report of three cases with a review of the literature. J Mich Dent Assoc 95(2):52–58 78PubMed

26.

Kauvar A, Hruza G (2005) Principles and practices in cutaneous laser surgery. CRC Press Inc, Boca Raton

Title: Surgical laser oral depigmentation procedure: an investigation on the optimum power settings using Er:YAG laser
Authors: Yasser Stas
Akram Hassan
Nor FaridMohd Noor
A. R. Samsudin
Ramizu Shaari
Publication date: 01-09-2018
Publisher: Springer International Publishing
Published in: Lasers in Dental Science / Issue 3/2018
Electronic ISSN: 2367-2587
DOI: https://doi.org/10.1007/s41547-018-0037-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical laser oral depigmentation procedure: an investigation on the optimum power settings using Er:YAG laser

Abstract

Introduction

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2018

Erbium lasers in operative dentistry—a literature review

Effects of different Er,Cr:YSGG laser parameters on dentin shear bond strength and interface morphology: an in vitro study

Corrosion behavior of erbium chromium-doped yattrium-scandium-gallium-garnet (Er,Cr:YSGG 2780 nm) laser-treated titanium alloy used for dental applications at different pH conditions (in vitro study)

The effect of self-etching adhesive system associated with different energy densities of Nd:YAG laser on microtensile bond strength to dentin

Outcome of 940-nm diode laser-assisted endodontic treatment of teeth with apical periodontitis: a retrospective study of clinical cases

The effectiveness of different Er,Cr:YSGG laser settings in smear layer on osteotomy sites for dental implants