Gingival Depigmentation Using Diode 980 nm and Erbium-YAG 2940 nm Lasers: A Split-Mouth Clinical Comparative Study

Aim of the Study. This study aimed to compare the effectiveness of diode laser (980 nm) and erbium-YAG laser (2940 nm) for gum depigmentation. Background. Gingival hyperpigmentation, “black gum,” refers to black discrete single or multiple pigments on the gingiva. Several factors may play a role in gingival hyperpigmentation ranging from physiologic pigmentation to manifestations of systemic diseases. Several techniques have been used for gingival depigmentation to lighten its color. Methods. Fifteen patients exhibiting nonsmoking melanin hyperpigmentation, with the mean age of 28.6 ± 7.8 years, were recruited. The facial gingiva of the anterior teeth and premolars of each jaw was divided into two halves. The right or left side of each jaw quadrant randomly received either diode laser operating at 980 nm wavelength or erbium-YAG laser at 2940 nm. Parameters such as degree of gingival depigmentation, bleeding, pain, patient satisfaction, and wound healing were assessed and compared between the two techniques. The subjects were followed up to six months for melanin pigmentation recurrence. Results. Both techniques were efficient for gingival depigmentation. Nevertheless, bleeding during surgery was statistically higher for Er:YAG laser technique as compared to diode laser. Wound healing showed statistically nonsignificant differences between the two lasers, although Er:YAG seems to give better outcomes than the diode. The patients were satisfied with both laser techniques during and after gingival depigmentation. However, the pain score was higher for Er:YAG laser than for diode laser. Conclusion. This study demonstrated that both lasers’ techniques are efficient for gingival depigmentation. However, diode laser seems to show less painful experience and relatively better bleeding control.

SURGICAL MANAGEMENT OF DEPIGMENTATION IN HYPERPIGMENTATION WITH SCRAPPING METHOD USING SURGICAL SCALPEL

Introduction:The color of healthy gingiva is often influenced by melanin pigmentation as an abnormal deposition of melanocytes located in basal and suprabasal cells. Gingival hyperpigmentation that exceeds normal causes a variety of physiological and pathological conditions. Gingival depigmentation is a periodontal surgical procedure to remove or reduce gingival hyperpigmentation by various techniques to improve aesthetics. The procedures include the use of chemicals such as 90% phenol, diamond drill abrasion, gingivectomy, soft tissue autograft, partial thickness flap, cryosurgery and laser. Case: A 19-year-old male patient came to periodontist office, after an examination he had Smoker's melanosis hyperpigmentation in the upper anterior region. Case Management: The patient was given depigmentation surgery using the scrapping method using a scalpel No. 15c.Discussion: Surgical management of gingival depigmentation with scrapping provides good esthetic results. Conclusion: It is necessary to take a proper history and adequate examination and be wise in determining the various surgical methods of depigmentation.

Vitiligo and tumor response in a patient with amelanotic melanoma undergoing nivolumab treatment

Vitiligo, an acquired depigmenting disorder of the skin that reacts against normal melanocytes, sometimes occurs as an immune-related adverse event in the treatment of melanoma with immune checkpoint inhibitors. It has been known that the occurrence of vitiligo is associated with a favorable therapeutic response in patients with melanoma, but it is not yet clear whether the association also applies to amelanotic melanoma, a minor subtype of melanoma with little or no melanin pigmentation. We report a patient with amelanotic melanoma of the esophagus who responded well to nivolumab treatment. Shortly after the tumor response, vitiligo was found on the patient’s forearms. This case suggests that the occurrence of vitiligo is associated with a favorable response to nivolumab treatment for amelanotic melanoma.

Fractional carbon dioxide laser, platelet –rich plasma and narrow band ultraviolet B in the treatment of Vitiligo (A prospective randomized comparative trial)

Vitiligo is a disease that causes the loss of skin color in patches due to loss of melanin pigmentation of specific areas of the skin. Although several hypotheses have been proposed, the leading theory is still the auto-immune etiology linked to specific genetic mutations. Vitiligo can also be associated with several autoimmune diseases. There is no curative treatment for vitiligo but, several treatment modalities are considered. Topical therapies like steroids and Calcineurin inhibitors are of popular use in clinical settings also, steroids can be administered systemically in vitiligo patients. Physical therapies as fractionated CO2 (Fr: CO2) laser and Narrowband-UV (NBUV) phototherapy represent a gold standard in treatment in clinical practice. Moreover, intralesional therapies are emerging, one of which is autologous platelet-rich plasma injection. Aim of the study This study aimed to evaluate and compare the efficacy and safety of Fr: CO2 laser, PRP, combined Fr: CO2 laser and PRP, combined Fr: CO2 laser and NB-UVB, combined Fr: CO2 laser, PRP and NB-UVB in the treatment of vitiligo as well as reporting the side effects. Patients and methods This study included 20 vitiligo patients with at least 6 patches of stable vitiligo (120 patches), the patches were divided into six groups according to the treatment modality. Assessment of treatment response was done through patient satisfaction score and Vitiligo analysis by computer-assisted grid (VACAG). Results Regarding surface area reduction in included patients, fractional CO2 laser achieved the best results followed by triple combination therapy (CO2 with PRP and NB-UVB), the least response was with CO2 with PRP treatment. Patient satisfaction in the current study had a different outcome, PRP treated patients exhibited the highest satisfaction scores while triple combination treated group showed the least satisfaction scores.

Phenotypic Plasticity of Common Wasps in an Industrially Polluted Environment in Southwestern Finland

Insects vary in the degree of their adaptability to environmental contamination. Determining the responses with phenotypic plasticity in ecologically important species in polluted environments will ease further conservation and control actions. Here, we investigated morphological characteristics such as body size, body mass, and color of the common wasp Vespula vulgaris in an industrially polluted environment, considering different levels of metal pollution, and we studied the localization of contaminants in the guts of wasps. We revealed some differences in morphological characteristics and melanization of wasps collected in habitats with high, moderate, and low levels of pollution. The results indicated that V. vulgaris from highly polluted environments had reduced melanin pigmentation on the face but increased melanin pigmentation on the 2nd tergite of the abdomen. In addition, with transmission electron microscopy (TEM) and energy dispersive X-ray analysis (EDX), we found metal particles from the midgut of wasps originating from the polluted environment. Most of the particles were encapsulated with melanin pigment. This finding confirmed that in wasps, ingested metal particles are accumulated in guts and covered by melanin layers. Our data suggest that wasps can tolerate metal contamination but respond phenotypically with modification of their size, coloration, and probably with the directions of the melanin investments (immunity or coloration). Thus, in industrially polluted areas, wasps might probably survive by engaging phenotypic plasticity with no significant or visible impact on the population.

Functional Characterization of Melanin Decolorizing Extracellular Peroxidase of Bjerkandera adusta

Melanin pigmentation in the human skin results from complicated cellular mechanisms that remain to be entirely understood. Uneven melanin pigmentation has been counteracted by inhibiting synthesis or transfer of melanin in the skin. Recently, an enzymatic approach has been proposed, wherein the melanin in the skin is decolorized using lignin peroxidase. However, not many enzymes are available for decolorizing melanin; the most studied one is lignin peroxidase derived from a lignin degrading fungus, Phanerochaete chrysosporium. Our current study reveals that versatile peroxidase from Bjerkandera adusta can decolorize synthetic melanin. Melanin decolorization was found to be dependent on veratryl alcohol and hydrogen peroxide, but not on Mn2+. The degree of decolorization reached over 40% in 10 min at 37 °C and a pH of 4.5. Optimized storage conditions were slightly different from those for the reaction; crude enzyme preparation was the most stable at 25 °C at pH 5.5. Since the enzyme rapidly lost its activity at 50 °C, stabilizers were screened. As a result, glycerol, a major component in several cosmetic formulations, was found to be a promising excipient. Our results suggest that B. adusta versatile peroxidase can be considered for future cosmetic applications aimed at melanin decolorization.

Comparative Evaluation of Treatment Outcome of Gingival Depigmentation by Surgical Scalpel, Laser and Cryosurgery Techniques for the Management of Gingival Hyperpigmentation – A Randomized Clinical Trial Conducted in the Institute of Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Hingna

BACKGROUND Aesthetic concerns have plagued humans for ages, but now modern technology and science have presented us with various options to treat these concerns. One such aspect is gingival depigmentation which as a dentist, we often come across. A randomized controlled clinical trial was conducted to compare and evaluate the techniques of gingival depigmentation for the management of gingival hyperpigmentation. METHODS A total of 45 patients with gingival pigmentation were randomly allocated into 3 groups: Surgical scalpel (N = 15), Cryosurgery (N = 15) and 810nm Diode Laser (N = 15). Melanin pigmentation index (MPI), visual analogue scale (VAS), wound healing index (WHI) and colour intensity index were evaluated for all the groups at baseline, immediate postoperative, 1 week, 1 and 3 months postoperatively. Statistical analysis was done for the data obtained to test the significance between the variables. P value < 0.05 was considered significant. RESULTS MPI scores from baseline to the postoperative intervals were effective in the management of gingival hyperpigmentation without any statistically significant difference. Faster healing was noted with surgical scalpel than cryosurgery. VAS scores were higher for the surgical scalpel group and lower for the other groups. The colour intensity index, an increase in the red colour value and decrease in the blue colour value was indicative of effectiveness of all the three techniques in the management of gingival hyperpigmentation. CONCLUSIONS It can be concluded that all the three techniques are effective in the management of gingival hyperpigmentation. KEY WORDS Gingival Hyperpigmentation, Aesthetic, Cryosurgery, Surgical Scalpel, Laser

Diabetes and Oral Health: Summary of Current Scientific Evidence for Why Transdisciplinary Collaboration Is Needed

This Perspective provides a brief summary of the scientific evidence for the often two-way links between hyperglycemia, including manifest diabetes mellitus (DM), and oral health. It delivers in a nutshell examples of current scientific evidence for the following oral manifestations of hyperglycemia, along with any available evidence for effect in the opposite direction: periodontal diseases, caries/periapical periodontitis, tooth loss, peri-implantitis, dry mouth (xerostomia/hyposalivation), dysbiosis in the oral microbiome, candidiasis, taste disturbances, burning mouth syndrome, cancer, traumatic ulcers, infections of oral wounds, delayed wound healing, melanin pigmentation, fissured tongue, benign migratory glossitis (geographic tongue), temporomandibular disorders, and osteonecrosis of the jaw. Evidence for effects on quality of life will also be reported. This condensed overview delivers the rationale and sets the stage for the urgent need for delivery of oral and general health care in patient-centered transdisciplinary collaboration for early detection and management of both hyperglycemia and oral diseases to improve quality of life.

Er,Cr:YSGG 2780 nm Laser Treatment of Lip Melanin Hyperpigmentation

Background. In the current research, Er,Cr:YSGG laser been used in ablative mode to peel the pigmentation, and many sessions were done to completely remove the melanin pigmentations. Materials and Methods. 85 patients were selected and Er,Cr : YSGG laser with 2780 nm wavelength in ablative mode (iPlus, Biolase, USA) was used to treat patients with dark lip melanin pigmentation, using gold handpiece and MZ 10 tip (diameter of 1 mm), and the parameters were set as follows: energy density 28.7 J/cm2, frequency 30 Hz, water cooling 100%, and air cooling 60%. Results. The vast majority of the patients (82.4%) had mild adverse effects after the lip depigmentation and 74.1% of patients reported complete improvement of the lip with a high satisfaction rate (84.7%) during the follow-up period with a low level of relapse. Conclusion. Er,Cr:YSGG 2670 nm is an effective tool to achieve excellent esthetic results in the treatment of lip melanin pigmentation; it is very well tolerated by patients with minimal adverse effects.