Depigmentation

A smile expresses a feeling of joy, success, sensuality, affection and courtesy, and reveals self confidence and kindness. The harmony of the smile is determined not only by the shape, the position and the color of the teeth but also by the gingival tissues. Gingival health and appearance are essential components of an attractive smile. Gingival pigmentation results from melanin granules, which are produced by melanoblasts. The degree of pigmentation depends on melanoblastic activity. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of 'black gums' are common particularly in patients having a very high smile line (gummy smile). For depigmentation of gingiva different treatment modalities have been reported like- Bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery and laser. In the present case series bur abrasion, scraping, partial thickness flap (epithelial excision) cryotherapy and electrosurgery have been tried for depigmentation, which are simple, effective and yield good results, along with good patient satisfaction.The normal color of the gum tissue (gingiva) is pink, but excess deposits of melanin (melanin gingival hyperpigmentation) can create what seem to be black spots or patches on the gums, creating an aesthetic or cosmetic problem. Discolouration may also be caused by long term use of certain medications.A clinical assessment is carried out to customize the treatment to the patients needs, and the procedure itself can involve surgical, chemical, or laser ablation techniques.

The gingiva is most commonly affected intraoral tissue responsible for an unpleasant appearance. Melanin pigmentation often occurs in the gingiva as a result of an abnormal deposition of melanin. This pigmentation may be seen across all the races and at any age and it is without gender predilection. It is generally agreed that pigmented areas are present only when melanin granules synthesized by melanocytes are transferred to the keratinocytes.

Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of black guns are common particularly in patients having a very high smile line (gummy smile).

The smile lines can be analyzed according to the following classification -

Class 1 . Very high smile line -more than 2 mm of the marginal gingiva visible or more than 2 rnm apical to the cemento-enamel junction visible for the reduced but healthy periodontium. This could be gimmry smile.

Class2 . High smile line - between 0 and 2 rnm of marginal gingiva visible or between 0 and 2 mm apical to the cemento-enamel junction visible for the reduced but healthy periodontium.

Class3 . Average smile line- only gingival embrasures visible.

Class4 . Low smile line- gingival embrasures and cemento-enamel junction not visible.

Demand for depigmentation is usually made for esthetic reasons, particularly in patients having a very high or high smile line. However there is not much information in the literature about depigmentation of gingiva. Elimination of these melanotic areas through surgery [7], [8], lasers, cryosurgery through use of a gas expansion system, bur abrasion, scrapping and electrocautery have been reported.