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 This month's On The Chair is a very interesting case presentation of melanin hyperpigmentation of the gingiva. Dr.A.Kumarswamy highlights the intricacies of gingival pigmentation and explains how the case was surgically tackled. Beauty is indeed skin deepA Smile is not a mere curve of the lips. It is the extent of teeth and gums seen in the 'Smile Window'. The shape and size of teeth, the colour and shade of teeth, the extent of the gums displayed in relaxed lip position and in stretch. In other words, the right proportion of 'pink to white' is what is desired to be called as a presentable smile. The colour of the displayed gingiva is a major entity. Hyper pigmented marginal gingiva is a dampening factor in an otherwise acceptable smile window. 'Melanin' is an interesting component of the human skin. Philosophically speaking, those that have it in excess, want to shed it and those that do not have it in moderate quantities, long for it and find ways and means for acquiring a tan. But when we speak about the gingiva, this pigment is not desired at all, as normally would like to have a uniform pink gingiva.
If
the mouth is the stage, the central incisors the lead
characters, laterals the sidekicks, canines are potential
villians/vamps, then the gingiva is the backdrop. Excess
or deficiency of the backdrop could be another problem to
be tackled in the subsequent bulletins. |
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There have been various reasons for
pigmentation of gingiva, few have been documented but
still a lot needs to be studied into this enigma.
Depigmentation of marginal gingiva is what intrigued this
clinician and the demand (read desire) by the patient
propelled him to subject this span of gingiva to this
procedure. 
A split thickness flap
was reflected covering the span of teeth included in the
smile window, in this case from 1st premolar to 1st
premolar. The cervico-apical height of the flap depends
on the extent of pigmented layer. After a vertical
incision is given at the extreme end of the span, the
flap is carefully peeled away to leave behind the raw
denuded surface of the gingiva. It is the mucosal layer
which contains the pigmented layer and after healing by
secondary intention the ginigva displays a good uniform
layer of depigmented gingiva. 
Recurrence of
pigmentation in gingiva is a nagging problem. The results
of depigmentation are visually so appealing that the
patient and the clinician can get very euphoric. The
recurrence parameters like intensity, area of
pigmentation, time elapsed before re-pigmentation are all
to be considered, so that a predictable line of treatment
can be encountered. Aesthetic success combined with
surgical finessse is what de-pigmentation is all about.
If the gingiva displayed in the smile window, is an
important entity, then the color of the gingiva can be
altered to achieve acceptable qualities. 