30 July 2021

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How to remove metal or amalgam gingival tattoos: a new minimally invasive approach

Lara Figini

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The blue-gray pigmentation in gingival tissue, called metal or amalgam tattoo, has been found in 3.3% of adults in the United States and is caused by the inadvertent  deposition of metal particles, contained in prostheses and dental materials, at the level of the gum adjacent to teeth undergoing dental treatment. The pigmented areas vary from very small spots to large areas that can extend over several teeth and cause  serious esthetic problems. Despite awareness about this phenomenon for many years, treatment methods are yet to be established, because of difficulties associated with treatment procedures and the lack of suitable instruments. The traditional treatment is resective plastic surgery of the pigmented gingiva, combined or not with connective tissue grafts and free gingival grafts, however invasive treatments, often complex, not always decisive, as well as being associated with risks or complications, including gingival recessions and defects. post-surgical. 

Materials and methods
In a study, published on the Journal of Esthetic and Restorative Dentistry, June 2021, the authors presented a series of cases in which they illustrated a new minimally invasive technique for removing metallic tattoos using laser (Er: YAG). Clinical data were retrospectively collected from 18 patients who had undergone Er: YAG laser treatment to remove metal tattoos. Minimally invasive gingival ablation was performed using an Er: YAG laser directly on the pigmented area, thanks to which the metal debris inside the connective tissue, causing the pigmentation, was exposed and carefully removed. An operating microscope was employed to identify metal debris, and to conduct accurate irradiation minimizing the risk of injury, thus making the treatment minimally invasive. Postoperative gingival color and morphology were then assessed, and patient-reported postoperative pain was analyzed using the visual analog scale. 

Results
The metallic tattoos of all patients included in the study were completely and safely removed. Remarkable cosmetic improvements and valid wound healing were achieved with almost no pain or postoperative complications. 

Conclusions
From the data of this study, which must be confirmed in other similar studies, it can be concluded that the therapy for the removal of metal or amalgam tattoos that involves the use of the Er: YAG laser is effective and safe, is associated with positive results and has a feedback of aesthetic satisfaction from patients. 

Clinical implications
This new technique is much simpler and less invasive than conventional periodontal plastic surgery and may be more reliable with regards to aesthetic gingival improvements as it is associated with favorable wound healing with reduced chair time and postoperative pain. 

For additional information: A novel minimally-invasive approach for metal tattoo removal with Er: YAG laser