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melanin , a brown pigment , is the most common natural pigment contributing to endogenous pigmentation of gingiva and the gingiva is also the most predominant site of pigmentation on the mucosa .
melanin pigmentation is the result of melanin granules produced by melanoblasts intertwined between epithelial cells at the basal layer of gingival epithelium .
gingival hyperpigmentation is seen as a genetic trait in some populations irrespective of age and gender ; hence it is termed physiologic or racial gingival pigmentation .
the degree of pigmentation varies from one individual to another which is mainly dictated by the melanoblastic activity .
melanin pigmentation of gingiva is symmetric and persistent and it does not alter normal gingival architecture .
melanosis of gingiva is frequently encountered among dark - skinned ethnic groups , as well as in medical conditions such as addison 's syndrome , peutz - jegher 's syndrome , and von recklinghausen 's disease ( neurofibromatosis ) .
earlier studies have shown that no significant difference exists in the density of distribution of melanocytes between light - skinned , dark - skinned , and black individuals .
however , melanocytes of dark - skinned and black individuals are uniformly highly reactive than in light - skinned individuals .
demand for cosmetic therapy is made , especially by fair - skinned people with moderate or severe gingival pigmentation .
gingival depigmentation is a periodontal plastic surgical procedure whereby the gingival hyperpigmentation is removed or reduced by various techniques .
one of the first and still popular techniques to be employed is the surgical removal of undesirable pigmentation using scalpels .
the procedure essentially involves surgical removal of gingival epithelium along with a layer of the underlying connective tissue and allowing the denuded connective tissue to heal by secondary intention .
scalpel techniquegingival abrasion technique using diamond burcombination of both the scalpel and bur 
  gingival abrasion technique using diamond bur combination of both the scalpel and bur we have used the scalpel technique in the following cases .
surgical gingival de - epithelization can be performed by the following techniques . 
 scalpel techniquegingival abrasion technique using diamond burcombination of both the scalpel and bur 
  gingival abrasion technique using diamond bur combination of both the scalpel and bur we have used the scalpel technique in the following cases .
a healthy 21-year - old male patient reported to the department of periodontology , yerala dental college , with the chief complaint of  blackish gums  which esthetically interfered with his smile [ figure 1 ] .
the patient requested for any cosmetic therapy which would eventually enhance the esthetics on smiling .
the patient 's history revealed that the blackish discoloration of gingiva was present since birth suggestive of physiologic melanin pigmentation .
on intraoral examination , generalized diffused blackish pigmentation of gingiva was observed on the labial surface of both maxillary and mandibular arches ; however it was healthy and completely free of any inflammation .
case 1 considering the patient 's concern , a surgical gingival de - epithelization procedure was planned using electrosurgery unit for the right side and scalpel technique for the left side of the maxillary arch . for the scalpel technique , following the administration of a local anesthetic solution ,
care was taken that excessive tissue was not removed thereby avoiding any bone exposure [ figure 2 ] .
de - epithelisation using scalpel techique similarly epithelial excision was done on the right side with the electrosurgery unit using the loop electrode [ figure 3 ] .
again care was taken not to expose the bone on the attached gingiva and not to remove excessive tissue on the marginal gingiva thereby disturbing the gingival harmony [ figure 4 ] .
de - epithelisation using the electrosurgery unit immediately after the surgery the surgical area was covered with a periodontal pack and postoperative instructions were given .
the gingiva appeared pink , healthy , and firm giving a normal appearance [ figure 5 ] .
post - operative view after 7 days a 24-year - old female patient [ figures 6 and 7 ] and a 19-year - old male patient [ figures 8and 9 ] reported with similar findings and underwent the same procedure pre - operative view  case 2 post - operative view 
case 2 pre - operative view case 3 post - operative view case 3 patients were recalled after 7 days and the following was recorded : 
 healing  absence of pain , bleeding , and infectionpostoperative pain and itching if anyinflammation and color changethe mcgill pain questionnaire 
  healing  absence of pain , bleeding , and infection postoperative pain and itching if any inflammation and color change the mcgill pain questionnaire the mcgill pain questionnaire :
a healthy 21-year - old male patient reported to the department of periodontology , yerala dental college , with the chief complaint of  blackish gums  which esthetically interfered with his smile [ figure 1 ] .
the patient requested for any cosmetic therapy which would eventually enhance the esthetics on smiling .
the patient 's history revealed that the blackish discoloration of gingiva was present since birth suggestive of physiologic melanin pigmentation .
on intraoral examination , generalized diffused blackish pigmentation of gingiva was observed on the labial surface of both maxillary and mandibular arches ; however it was healthy and completely free of any inflammation .
case 1 considering the patient 's concern , a surgical gingival de - epithelization procedure was planned using electrosurgery unit for the right side and scalpel technique for the left side of the maxillary arch . for the scalpel technique , following the administration of a local anesthetic solution ,
care was taken that excessive tissue was not removed thereby avoiding any bone exposure [ figure 2 ] .
de - epithelisation using scalpel techique similarly epithelial excision was done on the right side with the electrosurgery unit using the loop electrode [ figure 3 ] .
again care was taken not to expose the bone on the attached gingiva and not to remove excessive tissue on the marginal gingiva thereby disturbing the gingival harmony [ figure 4 ] .
de - epithelisation using the electrosurgery unit immediately after the surgery the surgical area was covered with a periodontal pack and postoperative instructions were given .
the gingiva appeared pink , healthy , and firm giving a normal appearance [ figure 5 ] .
a 24-year - old female patient [ figures 6 and 7 ] and a 19-year - old male patient [ figures 8and 9 ] reported with similar findings and underwent the same procedure pre - operative view  case 2 post - operative view 
case 2 pre - operative view case 3 post - operative view case 3 patients were recalled after 7 days and the following was recorded : 
 healing  absence of pain , bleeding , and infectionpostoperative pain and itching if anyinflammation and color changethe mcgill pain questionnaire 
  healing  absence of pain , bleeding , and infection postoperative pain and itching if any inflammation and color change the mcgill pain questionnaire the mcgill pain questionnaire :
the degree of vascularization , the thickness of the keratinized layer , and the amount of the pigment containing cells will determine the color of the gingiva .
there are few studies published so far regarding clinical methods of treatment of pigmented gingiva .
the techniques that were tried in the past to treat gingival pigmentation include chemical cauterization , gingivectomy , scalpel scraping procedure , and abrasion of gingiva .
the recent techniques of gingival depigmentation in practice are cryotherapy , free gingival autograft , and laser therapy and these have achieved satisfactory results .
the use of the scalpel technique for the depigmentation is most economical compared to other techniques , which require more advanced armamentarium .
however , scalpel surgery causes unpleasant bleeding during and after the operation , and it is necessary to cover the surgical site with periodontal dressing for 710 days .
electrosurgery has its own limitations in that its repeated and prolonged use induces heat accumulation and undesired tissue destruction .
we found the scalpel and abrasion technique relatively simple and versatile and it required minimum time and effort .
though the initial result of the depigmentation surgery is highly encouraging , repigmentation is a common problem .
different studies show variation in the timing for early repigmentation . to return to the full clinical baseline repigmentation it takes about 1.53 years
. this variation may be due to the different techniques performed or due to the patient 's race .
thus , the gingival depigmentation procedure , if performed primarily for cosmetic reason , will not be of permanent value , because pigmentation tends to return to baseline values . in future , even if gingival repigmentation occurs in this patient , the same procedure could be repeated in the same region .
therefore , the scalpel surgical technique and gingival abrasion technique are highly recommended in consideration of the equipment constraints in developing countries .
it is simple , easy to perform , cost effective , and above all provides minimum discomfort to the patient and esthetically pleasing results .
a beautiful smile definitely enhances the personality of an individual and reveals self - confidence . 
 the harmony of the smile is determined not only by the shape , position , and color of the teeth but also by the gingival tissues . 
 gingival pigmentation results from melanin granules which are produced by melanoblasts . 
 although melanin pigmentation of the gingiva is a completely benign condition and does not pose any medical problem , complaints of  black gums  are common particularly in patients having a very high smile line . 
 the different treatment modalities that have been reported for depigmentation are bur abrasion , partial thickness flap , cryotherapy , electrosurgery , and lasers . in this paper 
 we have compared the results of electrosurgery and scalpel technique , i.e. , partial thickness flap .