Dark pigmentation of the gums, known as gingival hyperpigmentation, is commonly caused by increased melanin in the gingival tissues.
Several treatment options exist for gingival depigmentation, including scalpel surgery, electrosurgery, lasers, and bur abrasion. However, these techniques may involve bleeding, postoperative discomfort, or specialized equipment.
A clinical case report explored a simpler alternative: cryotherapy using liquid nitrogen to remove gingival pigmentation.
Case Details
The case involved a 21-year-old female patient who visited the Department of Periodontology at the School of Dental Sciences, Krishna Vishwa Vidyapeeth, Karad, India.
Patient Complaint
The patient reported black gums present since childhood.The pigmentation became more noticeable while smiling, creating an aesthetic concern.
Clinical Findings
Diffuse medium-brown pigmentation was observed in both the upper and lower gingiva, particularly in the anterior region. The pigmentation was diagnosed as physiologic gingival melanin pigmentation.
The patient had good oral hygiene and no relevant medical history.
After discussing different treatment options, the patient chose liquid nitrogen cryotherapy for gingival depigmentation.
Treatment Procedure
Before the procedure, oral prophylaxis was performed one week earlier to ensure good oral hygiene.
Steps of the Procedure
The pigmented gingival area was isolated with cotton rolls.A topical anesthetic spray (10% lidocaine) was applied to reduce discomfort. Liquid nitrogen was applied using a pre-cooled cotton swab.The swab was rolled over the pigmented area for approximately 30 seconds until tissue blanching occurred.
The cryotherapy caused freezing of the pigmented tissues, which leads to destruction of melanin-containing cells.
Immediately after treatment, the gingiva showed mild redness (erythema), which is a normal reaction.
Healing and Follow-Up
Healing occurred gradually through natural tissue regeneration.
Post-Treatment Observations
A whitish slough layer formed during early healing.The tissue healed completely within three to four weeks.There was no bleeding, infection, or scarring.The patient reported no pain, only mild discomfort.
Follow-Up Results
The patient was examined at different intervals:
- 1 month: Healthy pink gingiva with improved appearance
- 3 months: No recurrence of pigmentation
- 6 months: Stable results with no repigmentation
The patient was satisfied with the aesthetic outcome.
Why Cryotherapy Works
Liquid nitrogen has extremely low temperatures of around −196°C. When applied to tissue, it causes rapid freezing and destruction of pigmented cells.
Mechanism
- Freezing damages melanin-producing cells
- Tissue undergoes necrosis and sloughing
- New epithelium regenerates during healing
- Gingival color becomes lighter and more uniform
Clinical Significance
This case suggests that liquid nitrogen cryotherapy may be a safe and effective option for gingival depigmentation. Compared with surgical or laser techniques, it offers a simple method with minimal discomfort and good cosmetic results.
However, the authors emphasize that larger clinical studies and long-term trials are needed to confirm the long-term success and recurrence rates of this treatment.
Reference
Article Title:
Liquid Nitrogen as a Novel Treatment for Gingival Depigmentation: A Case Report
Authors:
Kamala K. A, S. Sankethguddad
Journal: Cureus
🔗 Full Case Report
https://www.cureus.com/articles/291185-liquid-nitrogen-as-a-novel-treatment-for-gingival-depigmentation-a-case-report
🔗 DOI Link
