- 期刊
牙齦色素沉著之治療：文獻回顧
Treatments of Gingival Pigmentation : A Literature Review
摘要
擁有美麗笑容的要素包含了牙齒的美觀以及牙齦的顏色，除了先天基因使黑色素活躍程度不同因此於膚色較深之人種較常有牙齦黑色素沉著現象外，牙齦的顏色表現也和基因缺陷、系統性疾病、不良習慣有關，牙齦黑色素沉著之治療分為非手術及手術治療。本文針對牙齦黑色素沉著之原因、治療方式以及長期追蹤進行相關的文獻回顧。文獻回顧結果顯示在術式的選擇上，去上皮方式中，雷射的效果較優，冷凍及電燒治療效果優於刀片去除和鑽針修磨，刀片去除和鑽針修磨主要受限於病人本身之牙齦表現型，若無法去除足夠厚度之牙齦組織，色素再沉著率會較高。而使用軟組織移植手術治療來覆蓋黑色素，長期觀察黑色素再沉著率較去上皮方式低，但病人術後較常有不適感，且目前文獻較少也缺乏較長期的追蹤。近期之文獻所探討的使用維生素C達到去除黑色素之方式，除了在市面上容易取得，也大幅減少病人術後不適感，但缺乏較多之文獻資料和長期觀察。因此，臨床上須根據病人的美觀需求、牙齦表現型以及經濟程度來選擇最適合的術式。
並列摘要
Having a perfect smile depends on the esthetic of teeth and gingiva. The factors influencing the color of gingiva include physiological etiology, race, genetic deficiencies, systemic diseases, and other exogenous factors. There are surgical and non-surgical treatments for gingival depigmentation. The aim of this literature review is to organize previous literature about the etiology and treatment of gingival depigmentation, and to compare the effect and the rate of re-pigmentation among different treatments. The result of this review demonstrates that in the de-epithelial methods, the effect of lasers on gingival pigmentation is better than cryosurgery, electrosurgery, scalpel surgery, and bur abrasion. Also, in scalpel surgery and bur abrasion technique, the outcomes were limited by the gingival phenotype if the eliminated tissue was not enough. In the methods used to mask the gingival pigmentation, autogenous gingival graft surgery revealed low re-pigmentation rate but with more discomfort after the operation. Recent studies investigated the effect of vitamin C. The procedures were convenient for patients since the products with vitamin C ingredients were available on the market. In addition, patients suffered less from post operational discomfort compared to other procedures. But this method still lacks comparative literatures and long term evidence. Clinically, the evaluation of gingival phenotype, patient's expectation, and patient's economic status are important before choosing the appropriate method.