Gingival Pigmentation Clinical Trial
Official title:
Clinical Comparison of the Effect of Non-eugenol Containing Periodontal Pack With and Without Platelet Rich Fibrin on Post-operative Pain and Wound Healing After Surgical Gingival Depigmentation: A Randomized Clinical Trial
In an era where less than ideal esthetics is not accepted, the request for esthetic
procedures is widely sought after. Melanin, a brown pigment, is the most common natural
pigment contributing to endogenous pigmentation of gingiva. It is a non-hemoglobin-derived
pigment formed by cells called melaonocytes
Dental cosmetic procedures including gingival depigmentation among the young generation are
vastly becoming popular due to the public advertising of what the "ideal smile" should be.
This means that brown/ pigmented gingiva is not esthetically accepted by modern standards.
Numerous techniques for depigmentation were developed including surgical abrasion, lasers,
chemicals and thermal techniques.
The use of post-operative non-eugenol containing periodontal packs acts as a mechanical
barrier for coverage of the denuded area which prevents bleeding and promotes healing by
preventing trauma to the area.
Platelet Rich Fibrin (PRF) is a form of concentrated suspension of growth factors that
promote healing and tissue regeneration. Its use in the medical and dental fields is
expanding during the recent year.
Gingival depigmentation procedures especially bur abrasion and scalpel surgical techniques
require the use of post-operative periodontal pack. The periodontal pack protects the
surgical site from surface trauma, stops the post-operative bleeding and infection as well as
stabilizing the blood clot and accelerate healing.
However, a review article discussed the adverse effects of periodontal pack as it may cause
plaque induced inflammation, patient discomfort due to difficulty in eating and irritation of
the tissues. In the article, there were clinical trials that advocated that wound healing
could occur without the need of periodontal pack if the surgical wound was kept clean alone
indicating that the pack does not affect the wound healing.
This gave rise to idea to use a material that has been proven to accelerate wound healing and
decrease the patient discomfort to be placed under the periodontal pack which would be used
only as a protective barrier.
Several studies tested platelet rich concentrates as adjunctive methods under periodontal
packs verses periodontal packs alone after surgical abrasion of gingival depigmentation. They
found that there was a clinical, histological and statistical difference between the groups
favoring the platelet concentrate groups.
Using PRF which is a second generation platelet concentrate first developed by Choukroun et
al in 2001 used as a membrane could provide accelerated wound healing properties which would
accelerate ginigival re-epithelization . Using a periodontal pack is conventionally used
which will provide a mechanical barrier to protect the wound from any stimulus.
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