Novel flapless esthetic procedure for the elimination of extended gingival metal tattoos adjacent to prosthetic teeth: Er:YAG laser micro-keyhole surgery
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- Mizutani Koji
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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- Mikami Risako
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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- Tsukui Akira
- Hillside Dental Clinic, Kanagawa, Japan
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- Nagai Shigeyuki
- Nagai Dental Clinic, Tokyo, Japan
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- Pavlic Verica
- Department of Periodontology and Oral Medicine, Medical Faculty University of Banjaluka, Bosnia and Herzegovina Department of Periodontology and Oral Medicine, Institute of Dentistry, Banja Luka, Bosnia and Herzegovina
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- Komada Wataru
- Fixed Prosthodontics, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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- Iwata Takanori
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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- Aoki Akira
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Abstract
<p>Purpose: This article describes a novel, minimally invasive procedure called Er:YAG laser micro-keyhole surgery (EL-MIKS) that removes metal or amalgam tattoos in the gingiva adjacent to prosthetic teeth without gingival deformity and recession. We aimed to evaluate the clinical efficacy of EL-MIKS for removing metal tattoos and present its long-term treatment outcomes.</p><p>Methods: The EL-MIKS procedure consists of several steps that are all performed under a microscope. First, a micro-keyhole (1-2 mm diameter) was prepared using an Er:YAG laser in the center of the metal pigmentation. The connective tissue was evaporated in the deep layer, where metal debris was deposited. Second, within the accessible range, the irradiation angle was changed in various directions to ablate the metal pieces and discolored connective tissue without enlarging the keyhole. Finally, after blood filled the space created by the tissue evaporation, the surface of the blood clot at the entrance of the micro-keyhole was thermally coagulated with defocus laser irradiation. Pigmentation that could not be successfully removed from a single micro-keyhole was treated by forming new micro-keyholes at a distance of 3 mm or more from each previously created hole. Depigmentation over an extended area was completed over a few sessions every 4 weeks without gingival recession after surgery.</p><p>Conclusion: EL-MIKS, a novel depigmentation technique, was able to successfully remove an extended area of metal tattoos in the gingiva using a simpler, easier, and less invasive procedure than conventional periodontal plastic surgery. Esthetic restoration was successfully achieved without postoperative alteration of the gingival contour.</p>
Journal
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- Journal of Prosthodontic Research
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Journal of Prosthodontic Research 66 (2), 346-352, 2022
Japan Prosthodontic Society