Palabras clave
Pigmentación oral; melanina; hiperpigmentación; encía. (DeCS).
Cómo citar
Melanosis gingival, una revisión de los criterios para el diagnóstico y tratamiento. (2019). Odontoestomatología, 21(33). https://odon.edu.uy/ojs/index.php/ode/article/view/268
Resumen
La encía hiperpigmentada es un problema estético para los pacientes debido a la exposición gingival al momento de sonreír. La principal pigmentación gingival ocurre de forma fisiológica principalmente como respuesta frente a los traumatismos, sustancias químicas y radiación ultravioleta. En el presente artículo se realizó una revisión bibliográfica sobre los criterios para el diagnóstico y tratamiento de la pigmentación gingival (melanosis). Se exploró los artículos de las bases de datos PubMed, EMBASE y SciELO desde el año 2005 (enero) hasta la actualidad (diciembre del 2018). Los criterios clínicos para su diagnóstico están basados en la severidad y extensión de las pigmentaciones sobre la encía marginal y adherida; de esta forma, la melanosis gingival es más común a nivel de la encía adherida con tonalidades que varían entre el castaño claro y castaño oscuro. Se concluye que todas las técnicas de depigmentación gingival son efectivas; las diferencias se encuentran en el costo, rapidez de cicatrización, confort y grado de dolor posoperatorio.
Referencias
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2. Selvig KA. Structure and function of the periodontium. Dent. Update. 1991; 18: 292–7.
3. Pavlic V, Brkic Z, Marin S, Cicmil S, Gojkov-Vukelic M, Aoki A. Gingival melanin depigmentation by Er:YAG laser: A literature review. J. Cosmet. Laser. Ther. 2018; 20(2): 85-90.
4. Dummett CO. Clinical observation on pigment variations in healthy oral tissues in the Negro. J. Dent. Res. 1945; 24: 7-13.
5. Tal H, Oegiesser D, Tal M. Gingival Despigmentation by Er bium: YAG La ser: Clinical Observations and Patient Responses. J. Periodontol. 2003; 74(11): 1660-7.
6. Roshna T, Nandakumar K. Anterior esthetic gingival depigmentation and crown lengthening: report of a case. J. Contemp. Dent. Pract. 2005; 6(3): 139-47.
7. Duarte A. Cirugía Periodontal Preprotésica y Estética. 1era ed. Bogotá: Santos Editora; 2004. 225p.
8. Huaman EV. Características clínicas de melanosis gingival en pacientes del curso de periodoncia de la escuela de Estomatología de la Universidad Nacional de Trujillo. [Tesis de bachiller]. [Trujillo]. Facultad de Estomatología, Universidad Nacional de Trujillo; 2013. 54p.
9. Ipek H, Kirtiloglu T, Diraman E, Acikgoz G. A comparison of gingival depigmentation by Er:YAG laser and Kirkland knife: osmotic pressure and visual analog scale. J. Cosmet. Laser. Ther. 2018:1-4.
10. Janiani P, Bhat PR, Trasad VA, Acharya AB, Thakur SL. Evaluation of the intensity of gingival melanin pigmentation at different age groups in the Indian population: An observational study. J. Indian. Soc. Pedod. Prev. Dent. 2018;36(4):329-33.
11. Tamizi M, Taheri M. Treatment of severe physiologic gingival pigmentation with free gingival autograft. Quintessence. Int. 1996; 27:555 8.
12. Dummett CO, Bolden TE. Post-surgical clinical repigmentation of the gingiva. Oral. Surg. Oral. Med. Oral. Pathol. 1963;16: 353-6.
13. Gupta G.The labial melanotic macule A review of 79 cases. Br. Dent. Dermatologyc. 1964; 136: 772-75.
14. Corteillini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(Suppl 20):S190–S198.
15. León SM, Faria H, Pérez L. Despigmentación gingival: Procedimiento quirúrgico. Reporte de un caso. Ciencia. odontológica. 2005; 2(2): 127- 32.
16. Rawal SY, Burrell R, Hamidi CS, Kalmar JR, Tatakis DN. Diffuse pigmentation of maxillary attached gingiva: four cases of the cultural practice of gingival tattoo. J. Periodontol. 2007;78 (1):170-6.
17. Abdo JM, Pérez ET, Bernal FS, Dzib JS. Síndrome de Peutz-Jeghers. Rev. Med. Hosp. Gen. Mex. 2005; 68 (2): 99-105
18. Kato T, Mizutani S, Takiuchi H, Sugiyama S, Hanioka T, Naito T. Gingival Pigmentation Affected by Smoking among Different Age Groups: A Quantitative Analysis of Gingival Pigmentation Using Clinical Oral Photographs. Int. J. Environ. Res. Public. Health. 2017;14(8). pii: E880. doi: 10.3390/ijerph14080880
19. Araki S, Murata K, Ushio K, Sakai R. Dose-response relationship between tobacco consumption and melanin pigmentation in the attached gingiva. Arch. Environ. Health. 1983; 38(6):375-8.
20. Axéll T, Hedin CA. Epidemiologic study of excessive oral melanin pigmentation with special reference to the influence of tobacco habits. Scand. J. Dent. Res. 1982;90 (6): 434-42.
21. Marakoğlu K, Gürsoy UK, Toker HC, Demirer S, Sezer RE, Marakoğlu I. Smoking status and smoke-related gingival melanin pigmentation in army recruitments. Mil. Med. 2007;172(1):110-3.
22. Hanioka T, Tanaka K, Ojima M, Yuuki K. Association of melanin pigmentation in the gingiva of children with parents who smoke. Pediatrics. 2005;116(2):e186-90.
23. Sridharan S, Ganiger K, Satyanarayana A, Rahul A, Shetty S.Effect of environmental tobacco smoke from smoker parents on gingival pigmentation in children and young adults: a cross-sectional study. J. Periodontol. 2011;82 (7):956-62.
24. Laimer J, Henn R, Helten T, Sprung S, Zelger B, Zelger B, Steiner R, Schnabl D, Offermanns V, Bruckmoser E, Huck CW. Amalgam tattoo versus melanocytic neoplasm - Differential diagnosis of dark pigmented oral mucosa lesions using infrared spectroscopy. PLoS. One. 2018;13(11):e0207026.
25. Chavés-Álvarez AJ, Rodríguez-Nevado IM, Argila-Fernández D, Monje-Gil F. Mácula hiperpigmentada en mucosa gingival. Actas. Dermosifiliogr. 2007; 98: 367-8.
26. Owens BM, Johnson WW; Schuman NJ. Oral amalgam pigmentations (tattoos): a retrospective study. Quintessence. Int. 1992; 23: 805-10.
27. Tavares TS, Meirelles DP, de Aguiar MCF, Caldeira PC. Pigmented lesions of the oral mucosa: A cross-sectional study of 458 histopathological specimens. Oral. Dis. 2018; 24(8):1484-91.
28. Hartman LC, Natiella JR, Meenaghan MA. The use of elemental microanalysis in verification of the composition of presumptive amalgam tattoo. J. Oral. Maxillofac. Surg. 1986; 44(8): 628-33.
29. Eley BM, Garrett JR. Tissue reactions to the separate implantation of individual constituent phases of dental amalgam, including assessment by energy dispersive X-ray microanalysis. Biomaterials. 1983; 4(2): 73-80.
30. Mohr W, Gorz E. Association of silver granules with elastic fibers in amalgam reaction of mouth mucosa. HNO. 2001; 49(6):454-7.
31. Hasegawa A, Okagi H. Removing melanogenous pigmentation using 90 percent phenol with 95 percent alcohol. Dent. Outlook. 1973;42: 673-6.
32. Tamizi M, Taheri M. Treatment of severe physiologic gingival pigmentation with free gingival autograft. Quintessence. Int. 1996; 27:555 8.
33. Bergamaschi O, Kon S, Doine AI, Ruben MP. Melanin repigmentation after gingivectomy: A 5-year clinical and transmission electron microscopic study in humans. Int. J. Periodontics. Restorative. Dent. 1993;13: 85-92
34. Pérez-Fernández A. Pigmentaciones melánicas gingivales. Tratamiento mediante mucoabrasión. Cirugía. Plástica. Ibero- Latinoamer. 1977; 3: 57-9.
35. Mesa FL, García MO, López LC, Aneiros CJ, O´Valle RF. Tratamiento de la melanosis gingival mediante mucoabrasión. Estudio inmunohistoquímico en un paciente con pigmentaciones melánicas múltiples. Periodoncia. 2001; 11 (5): 383-90.
36. Murthy MB, Kaur J, Das R.Treatment of gingival hyperpigmentation with rotary abrasive, scalpel, and laser techniques: A case series. J. Indian. Soc. Periodontol. 2012; 16(4): 614-9.
37. Englard S, Seifter S. The biochemical functions of ascorbic acid. Ann. Rev. Nutr. 1986; 6: 365-406.
38. Spencer P, Cobb CM, Wieliczka DM, et al. Change in temperature of subjacent bone during soft tissue laser ablation. J. Periodontol. 1998;69: 1278-82.
39. Goldstein A, White JM, Pick RM. Clinical applications of the Nd:YAG laser. In: Miserendino LJ, Pick RM, eds. Lasers in Dentistry. 1era ed. Chicago: Quintessence Company; 1995. 126p.
40. Hasegawa A, Okagi H. Removing melanogenous pigmentation using 90 percent phenol with 95 percent alcohol. Dent. Outlook. 1973; 42: 673-6.
41. Singh V, Bhat SG, Kumar S, Bhat M. Comparative Evaluation of Gingival Depigmentation by Diode Laser and Cryosurgery Using Tetrafluoroethane: 18-Month Follow-Up. Clin. Adv. Periodontics. 2012; 2: 129-34.
42. Shirazi AS, Moeintaghavi A, Khorakian F, Talebi M. Treatment of gingival physiologic pigmentation in adolescents by liquid nitrogen cryosurgery: 24-month follow-up. Int. J. Periodontics. Restorative. Dent. 2012; 32(4):e142-6.
43. Ahmed SK, George JP, Prabhuji ML, Lazarus F. Cryosurgical Treatment of Gingival Melanin Pigmentation —A 30-Month Follow-Up Case Report. Clin. Adv. Periodontics. 2012; 2:73-8.
44. Grados SP, Castro YR, Bravo FC. Consideraciones clínicas en el tratamiento quirúrgico periodontal. 1era ed. Caracas: AMOLCA; 2014. 165p.
45. Castro RY, Grados PS. Tratamiento de la melanosis gingival y evaluación de la repigmentación melánica. Reevaluación clínica al cabo de 2 años. Rev Clin Periodoncia Implantol Rehabil Oral. 2015; 8(2):139-43.
2. Selvig KA. Structure and function of the periodontium. Dent. Update. 1991; 18: 292–7.
3. Pavlic V, Brkic Z, Marin S, Cicmil S, Gojkov-Vukelic M, Aoki A. Gingival melanin depigmentation by Er:YAG laser: A literature review. J. Cosmet. Laser. Ther. 2018; 20(2): 85-90.
4. Dummett CO. Clinical observation on pigment variations in healthy oral tissues in the Negro. J. Dent. Res. 1945; 24: 7-13.
5. Tal H, Oegiesser D, Tal M. Gingival Despigmentation by Er bium: YAG La ser: Clinical Observations and Patient Responses. J. Periodontol. 2003; 74(11): 1660-7.
6. Roshna T, Nandakumar K. Anterior esthetic gingival depigmentation and crown lengthening: report of a case. J. Contemp. Dent. Pract. 2005; 6(3): 139-47.
7. Duarte A. Cirugía Periodontal Preprotésica y Estética. 1era ed. Bogotá: Santos Editora; 2004. 225p.
8. Huaman EV. Características clínicas de melanosis gingival en pacientes del curso de periodoncia de la escuela de Estomatología de la Universidad Nacional de Trujillo. [Tesis de bachiller]. [Trujillo]. Facultad de Estomatología, Universidad Nacional de Trujillo; 2013. 54p.
9. Ipek H, Kirtiloglu T, Diraman E, Acikgoz G. A comparison of gingival depigmentation by Er:YAG laser and Kirkland knife: osmotic pressure and visual analog scale. J. Cosmet. Laser. Ther. 2018:1-4.
10. Janiani P, Bhat PR, Trasad VA, Acharya AB, Thakur SL. Evaluation of the intensity of gingival melanin pigmentation at different age groups in the Indian population: An observational study. J. Indian. Soc. Pedod. Prev. Dent. 2018;36(4):329-33.
11. Tamizi M, Taheri M. Treatment of severe physiologic gingival pigmentation with free gingival autograft. Quintessence. Int. 1996; 27:555 8.
12. Dummett CO, Bolden TE. Post-surgical clinical repigmentation of the gingiva. Oral. Surg. Oral. Med. Oral. Pathol. 1963;16: 353-6.
13. Gupta G.The labial melanotic macule A review of 79 cases. Br. Dent. Dermatologyc. 1964; 136: 772-75.
14. Corteillini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(Suppl 20):S190–S198.
15. León SM, Faria H, Pérez L. Despigmentación gingival: Procedimiento quirúrgico. Reporte de un caso. Ciencia. odontológica. 2005; 2(2): 127- 32.
16. Rawal SY, Burrell R, Hamidi CS, Kalmar JR, Tatakis DN. Diffuse pigmentation of maxillary attached gingiva: four cases of the cultural practice of gingival tattoo. J. Periodontol. 2007;78 (1):170-6.
17. Abdo JM, Pérez ET, Bernal FS, Dzib JS. Síndrome de Peutz-Jeghers. Rev. Med. Hosp. Gen. Mex. 2005; 68 (2): 99-105
18. Kato T, Mizutani S, Takiuchi H, Sugiyama S, Hanioka T, Naito T. Gingival Pigmentation Affected by Smoking among Different Age Groups: A Quantitative Analysis of Gingival Pigmentation Using Clinical Oral Photographs. Int. J. Environ. Res. Public. Health. 2017;14(8). pii: E880. doi: 10.3390/ijerph14080880
19. Araki S, Murata K, Ushio K, Sakai R. Dose-response relationship between tobacco consumption and melanin pigmentation in the attached gingiva. Arch. Environ. Health. 1983; 38(6):375-8.
20. Axéll T, Hedin CA. Epidemiologic study of excessive oral melanin pigmentation with special reference to the influence of tobacco habits. Scand. J. Dent. Res. 1982;90 (6): 434-42.
21. Marakoğlu K, Gürsoy UK, Toker HC, Demirer S, Sezer RE, Marakoğlu I. Smoking status and smoke-related gingival melanin pigmentation in army recruitments. Mil. Med. 2007;172(1):110-3.
22. Hanioka T, Tanaka K, Ojima M, Yuuki K. Association of melanin pigmentation in the gingiva of children with parents who smoke. Pediatrics. 2005;116(2):e186-90.
23. Sridharan S, Ganiger K, Satyanarayana A, Rahul A, Shetty S.Effect of environmental tobacco smoke from smoker parents on gingival pigmentation in children and young adults: a cross-sectional study. J. Periodontol. 2011;82 (7):956-62.
24. Laimer J, Henn R, Helten T, Sprung S, Zelger B, Zelger B, Steiner R, Schnabl D, Offermanns V, Bruckmoser E, Huck CW. Amalgam tattoo versus melanocytic neoplasm - Differential diagnosis of dark pigmented oral mucosa lesions using infrared spectroscopy. PLoS. One. 2018;13(11):e0207026.
25. Chavés-Álvarez AJ, Rodríguez-Nevado IM, Argila-Fernández D, Monje-Gil F. Mácula hiperpigmentada en mucosa gingival. Actas. Dermosifiliogr. 2007; 98: 367-8.
26. Owens BM, Johnson WW; Schuman NJ. Oral amalgam pigmentations (tattoos): a retrospective study. Quintessence. Int. 1992; 23: 805-10.
27. Tavares TS, Meirelles DP, de Aguiar MCF, Caldeira PC. Pigmented lesions of the oral mucosa: A cross-sectional study of 458 histopathological specimens. Oral. Dis. 2018; 24(8):1484-91.
28. Hartman LC, Natiella JR, Meenaghan MA. The use of elemental microanalysis in verification of the composition of presumptive amalgam tattoo. J. Oral. Maxillofac. Surg. 1986; 44(8): 628-33.
29. Eley BM, Garrett JR. Tissue reactions to the separate implantation of individual constituent phases of dental amalgam, including assessment by energy dispersive X-ray microanalysis. Biomaterials. 1983; 4(2): 73-80.
30. Mohr W, Gorz E. Association of silver granules with elastic fibers in amalgam reaction of mouth mucosa. HNO. 2001; 49(6):454-7.
31. Hasegawa A, Okagi H. Removing melanogenous pigmentation using 90 percent phenol with 95 percent alcohol. Dent. Outlook. 1973;42: 673-6.
32. Tamizi M, Taheri M. Treatment of severe physiologic gingival pigmentation with free gingival autograft. Quintessence. Int. 1996; 27:555 8.
33. Bergamaschi O, Kon S, Doine AI, Ruben MP. Melanin repigmentation after gingivectomy: A 5-year clinical and transmission electron microscopic study in humans. Int. J. Periodontics. Restorative. Dent. 1993;13: 85-92
34. Pérez-Fernández A. Pigmentaciones melánicas gingivales. Tratamiento mediante mucoabrasión. Cirugía. Plástica. Ibero- Latinoamer. 1977; 3: 57-9.
35. Mesa FL, García MO, López LC, Aneiros CJ, O´Valle RF. Tratamiento de la melanosis gingival mediante mucoabrasión. Estudio inmunohistoquímico en un paciente con pigmentaciones melánicas múltiples. Periodoncia. 2001; 11 (5): 383-90.
36. Murthy MB, Kaur J, Das R.Treatment of gingival hyperpigmentation with rotary abrasive, scalpel, and laser techniques: A case series. J. Indian. Soc. Periodontol. 2012; 16(4): 614-9.
37. Englard S, Seifter S. The biochemical functions of ascorbic acid. Ann. Rev. Nutr. 1986; 6: 365-406.
38. Spencer P, Cobb CM, Wieliczka DM, et al. Change in temperature of subjacent bone during soft tissue laser ablation. J. Periodontol. 1998;69: 1278-82.
39. Goldstein A, White JM, Pick RM. Clinical applications of the Nd:YAG laser. In: Miserendino LJ, Pick RM, eds. Lasers in Dentistry. 1era ed. Chicago: Quintessence Company; 1995. 126p.
40. Hasegawa A, Okagi H. Removing melanogenous pigmentation using 90 percent phenol with 95 percent alcohol. Dent. Outlook. 1973; 42: 673-6.
41. Singh V, Bhat SG, Kumar S, Bhat M. Comparative Evaluation of Gingival Depigmentation by Diode Laser and Cryosurgery Using Tetrafluoroethane: 18-Month Follow-Up. Clin. Adv. Periodontics. 2012; 2: 129-34.
42. Shirazi AS, Moeintaghavi A, Khorakian F, Talebi M. Treatment of gingival physiologic pigmentation in adolescents by liquid nitrogen cryosurgery: 24-month follow-up. Int. J. Periodontics. Restorative. Dent. 2012; 32(4):e142-6.
43. Ahmed SK, George JP, Prabhuji ML, Lazarus F. Cryosurgical Treatment of Gingival Melanin Pigmentation —A 30-Month Follow-Up Case Report. Clin. Adv. Periodontics. 2012; 2:73-8.
44. Grados SP, Castro YR, Bravo FC. Consideraciones clínicas en el tratamiento quirúrgico periodontal. 1era ed. Caracas: AMOLCA; 2014. 165p.
45. Castro RY, Grados PS. Tratamiento de la melanosis gingival y evaluación de la repigmentación melánica. Reevaluación clínica al cabo de 2 años. Rev Clin Periodoncia Implantol Rehabil Oral. 2015; 8(2):139-43.