Gingival Depigmentation Technique using Bur Abrasion {Step Wise}

When we talk about gingival depigmentation it all comes to "Smile". Most of your patients will come to you with a complain of blackish gums.They will say "My gums are black and they don't look good please do some treatment"  people are concerned about their smile. So what to do ? how to reduce the black discoloration of the gums?  
There are many techniques - Laser, scalpel surgery,Bur abrasion, epithelial excision, electrocautery, cryotherapy.

• Here we will discuss a technique which can be performed in a regular dental set up and does not require higher equipment,You don't have to be a Periodontist to do this surgery you can do this if you are a dental graduate,Bur abrasion is relatively easy and safe and it can be easily repeated if there is any residual pigmented area. 

Before Treatment

After Bur Abrasion

Initial Healing

The Process-


Step 1- 

• When patient arrives and show concern about the blackish gums tell them this condition can be treated and you can reduce the blackish color of their gums, Show your confidence in treatment (remember patient buys confidence in you) tell them about benefits of improved looks and improved confidence.  
• If patient shows interest, inform them about the treatment procedure and possible results.Show them before and after photographs of your successful cases ( If you don't have photos then "right click & save" the pics given in this article and use them)
• Once patient gets ready for the treatment take proper medical and family history,Do all the necessary blood investigations and rule out any contraindications for surgery,
• Take written consent this is very important I ask all the young dentist to take written consent before any kind of surgery, this will be very helpful if you are subjected to malpractice claims. 

Step 2

• Materials used- Lignocaine with adrenaline in the ratio 1:100000 by weight. Gauze pieces, A high speed hand piece with round diamond bur, hand piece should be sterilized before the treatment and you should use a new bur not the bur you are using for endo or operative purpose.

Step 3

• [Prepare the patient] Surgery is usually required from premolar to premolar region of maxillary anterior. If patient wants the treatment for both arch then involve mandibular arch too.Now anesthetize the area with local infiltration.

Step 4

• Start Deepithelization by removing the epithelium of the gingiva with help of round diamond bur, just touch the revolving bur on the surface of pigmented gingiva and move the bur with feather light strokes, don't keep the bur at one place for long time it may result in thermal trauma and permanent harm to underlying tissue.
• There is no need of pressure in this procedure just touch the bur to superficial part of epithelium and remove it upto connective tissue care must be taken not to harm underlying periostium.   
• Use round bur of biggest size because small bur will produce small pits rather then surface abrasion. 
• Controle the bleeding and check for any pigmented area and remove it to prevent relaps. Epithelium should be removed upto connective tissue/"Lamina proprria".
• Bleeding Control- It can be done by applying pressure by a gauze piece on the denuded epithelium Soak the  gauze piece in Adrenaline containing Local anesthetic.
• Caution- Removal of gingival melanin pigmentation should be performed cautiously and the adjacent teeth should be protected, since inappropriate application may cause gingival recession, damage to underlying periosteum and bone, delayed wound healing, as well as loss of enamel.    

Step 5- 

• Apply a surgical dressing like 'Co -pack' for few days and prescribe Chlorhexidine mouthwash for 1 week.

Step 6 -

•  Recall after 1 weeks and check for the status and any healing problems.