A Comparison Between the Efficacy of Scalpel and Laser Procedures for Treating Gingival Hyperpigmentation - A Case Report

At a Glance

Metadata	Details
Publication Date	2022-08-12
Journal	Cureus
Authors	Safiya Hassan, Prasad Dhadse, Pavan Bajaj, Chitrika Subhadarsanee
Institutions	Datta Meghe Institute of Medical Sciences
Citations	13
Analysis	Full AI Review Included

Technical Analysis and Documentation: Diamond for High-Power Medical Lasers

Executive Summary

This case report validates the superior clinical efficacy of diode laser technology over conventional surgical methods for gingival depigmentation, highlighting key advantages directly relevant to high-power laser system design:

Enhanced Surgical Quality: Laser treatment resulted in a completely bloodless surgical field, eliminating the need for postoperative periodontal packing (required by the scalpel method).
Improved Patient Outcomes: The laser-treated site demonstrated recovery without postoperative pain, bleeding, infection, or scarring, contrasting with three days of discomfort reported for the scalpel site.
Growing Market Demand: The successful application of diode lasers (980 nm cited) and other high-power systems (Nd:YAG, CO₂) in periodontal plastic surgery confirms the increasing demand for reliable, high-throughput medical laser systems.
Thermal Management Requirement: The continuous wave or high-repetition pulsed operation required for efficient tissue ablation necessitates advanced thermal management components, specifically high-purity Single Crystal Diamond (SCD) heat spreaders.
6CCVD Value Proposition: 6CCVD specializes in providing the high-thermal-conductivity SCD and large-area PCD materials required to manufacture robust, high-power diode laser arrays and optical windows, ensuring system longevity and performance stability.

Technical Specifications

The following table summarizes the key technical and clinical parameters extracted from the case report, focusing on the comparative performance metrics.

Parameter	Value	Unit	Context
Patient Age	23	Years	Female patient, physiological pigmentation
Treatment Modalities	Diode Laser, Scalpel	N/A	Split-mouth comparative study
Scalpel Type Used	#15	Blade	Conventional surgical method
Laser Type Used (Case)	Diode Laser	N/A	Left maxillary anterior quadrant
Common Diode Wavelengths (Cited)	980, 1064, 10600	nm	Diode, Nd:YAG, CO₂ lasers cited for depigmentation
Postoperative Pain (Scalpel)	3	Days	Required Diclofenac Sodium (NSAID)
Postoperative Pain (Laser)	None reported	N/A	Bloodless field, recovery without complications
Recurrence Rate	Zero	N/A	Observed throughout the follow-up period
Surgical Field Quality (Laser)	Bloodless	N/A	Coagulum acts as a physical wound dressing

Key Methodologies

The study employed a split-mouth randomized clinical comparative approach to evaluate the efficacy of two distinct surgical techniques for treating gingival hyperpigmentation:

Patient Selection: A 23-year-old female patient with physiological melanin pigmentation in the upper and lower jaws (wheatish complexion, non-smoker).
Anesthesia: Local infiltration using Lignocaine infusion with adrenaline.
Split-Mouth Design:
- Left Side: Treated using the Diode Laser technique (Laser Depigmentation).
- Right Side: Treated using the conventional surgical method (#15 Scalpel Blade Depigmentation).
Scalpel Procedure: Surgical elimination of the gingival epithelium and a thin connective tissue layer, followed by secondary intention healing.
Post-Surgical Management: Application of a tin foil stent (assessment) and a periodontal pack (uneventful healing) to the treated sites.
Follow-up and Assessment: Reevaluation at one week and one month post-surgery, focusing on healing, pain, bleeding, infection, and recurrence.

6CCVD Solutions & Capabilities

The successful deployment of high-power diode lasers in this clinical setting underscores the critical need for advanced thermal management components. 6CCVD provides the necessary MPCVD diamond materials that enable the high-performance, compact, and reliable laser systems demanded by the medical device industry.

Applicable Materials for Laser System Integration

High-power diode lasers (like the 980 nm system referenced) require materials with exceptional thermal conductivity (k) and low optical absorption to manage waste heat and maintain beam quality.

6CCVD Material	Application in Medical Lasers	Key Benefit
Thermal Grade SCD	High-Power Diode Laser Heat Spreaders (Substrates for GaAs/InP chips)	k > 2000 W/mK, ensuring maximum heat extraction and wavelength stability.
Optical Grade SCD	Laser Output Windows, Beam Splitters, ATR Prisms	Ultra-low absorption (below 10 cm^-1), high damage threshold, and broad spectral transparency (UV to Far-IR).
Optical Grade PCD	Large-Area Optical Components (up to 125mm diameter)	Cost-effective thermal management for large arrays or high-power CO₂ laser windows (10.6 µm).
Boron-Doped Diamond (BDD)	Electrochemical Sensors, Electrodes (for sterilization/disinfection systems)	Extreme chemical inertness and wide potential window for advanced sterilization protocols.

Customization Potential for OEM Laser Manufacturers

6CCVD’s in-house manufacturing capabilities are perfectly aligned with the stringent requirements of medical laser Original Equipment Manufacturers (OEMs) seeking to replicate or extend the performance demonstrated in this research:

Custom Dimensions: We supply SCD and PCD plates/wafers up to 125mm in diameter, ideal for scaling up high-density diode laser arrays.
Precision Thickness Control: SCD layers are available from 0.1 µm to 500 µm, allowing precise thermal resistance tuning for specific laser chip designs.
Ultra-Smooth Polishing: We offer SCD polishing to Ra < 1 nm for critical optical windows and heat spreader interfaces, minimizing thermal boundary resistance and optical scatter.
Advanced Metalization: 6CCVD provides internal metalization services (Au, Pt, Pd, Ti, W, Cu) for creating robust, low-resistance ohmic contacts and solderable surfaces on diamond heat sinks.

Engineering Support

The transition from conventional surgery to advanced laser techniques requires robust, reliable equipment. 6CCVD’s in-house PhD team specializes in diamond material science and thermal engineering. We can assist laser system developers with:

Thermal Modeling: Optimizing diamond heat spreader geometry and thickness for specific high-power diode laser stacks used in similar Periodontal Plastic Surgery projects.
Material Selection: Guidance on selecting the optimal diamond grade (SCD vs. PCD) based on required thermal conductivity, optical clarity, and cost targets.
Interface Engineering: Consultation on metalization schemes to ensure maximum thermal transfer efficiency between the laser chip and the diamond substrate.

For custom specifications or material consultation, visit 6ccvd.com or contact our engineering team directly. Global shipping (DDU default, DDP available) ensures timely delivery for critical projects worldwide.

View Original Abstract

Gingival hyperpigmentation is a hereditary feature in populations. Gingival pigmentation not only affects aesthetics but also has a negative psychological effect. For many people, gingival hyperpigmentation is a severe cosmetic problem. Although black gums are not a medical issue, many individuals find them unsightly. The pigmentation of gingiva contributes to the harmony of the smile in a significant way. A periodontal plastic surgery procedure called gingival depigmentation eliminates or reduces hyperpigmentation. Different treatment approaches for gingival depigmentation have been documented, such as scalpel, electrosurgery, diamond burs, chemical methods, cryosurgery, and lasers. According to studies, cryosurgery and lasers are the best procedures since they provide better aesthetic outcomes and low recurrence rates. The coordination of treatment plans and the choice technique are influenced by the patient’s skin tone, the degree of gingival pigmentation, the lip line, the upper lip curvature, aesthetic concern, and treatment expectations. This case report, which involves a 23-year-old female patient, provides a comparison between the efficacy of scalpel and laser procedures for treating gingival hyperpigmentation. The patient’s left side received diode laser treatment, while the right received scalpel treatment. Scalpel depigmentation caused the treated area to recover without incident. The benefits of laser depigmentation include a bloodless surgical field and recovery without complications. No postoperative pain, bleeding, infection, or scars were seen on the first and consequent visits. The recovery went smoothly. The patient was satisfied with the treatment modality, and the outcomes were outstanding, according to the patient. There was no re-pigmentation throughout the follow-up period. This split-mouth study will provide information regarding soft tissue healing using two different approaches in the same patient.

Tech Support

Original Source

DOI: https://doi.org/10.7759/cureus.27954

References

2017 - Gingival depigmentation by free gingival autograft: a case series [Crossref]
2005 - Treatment of gingival pigmentation with Er, Cr: Y.S.G.G. laser
1950 - Biochemistry of melanin formation [Crossref]
1960 - First symposium on oral pigmentation [Crossref]
2017 - Comparative evaluation of the effectiveness of surgical blade, electrosurgery, free gingival graft, and diode laser for the management of gingival hyperpigmentation [Crossref]
2005 - Anterior esthetic gingival depigmentation and crown lengthening: report of a case [Crossref]
2003 - The normal and pathological pigmentation of oral mucous membrane: a review
2012 - Treatment of gingival hyperpigmentation with rotary abrasive, scalpel, and laser techniques: a case series [Crossref]
2020 - Evaluation of surgical scalpel versus semiconductor diode laser techniques in the management of gingival melanin hyperpigmentation: a split-mouth randomized clinical comparative study [Crossref]
2016 - Gingival depigmentation using lasers: a literature review