Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
Hillside Dental Clinic, Kanagawa, Japan.
J Prosthodont Res. 2022 Apr 27;66(2):346-352. doi: 10.2186/jpr.JPR_D_21_00045. Epub 2021 Sep 18.
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.
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.
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.
本文介绍了一种新的微创治疗方法，即铒：钇铝石榴石激光微孔手术（EL-MIKS），可在不引起牙龈变形和退缩的情况下，去除毗邻义齿的牙龈内的金属或汞合金纹身。我们旨在评估 EL-MIKS 去除金属纹身的临床疗效，并介绍其长期治疗结果。
EL-MIKS 手术包括几个步骤，均在显微镜下进行。首先，在金属色素沉着的中心用铒：钇铝石榴石激光制备微孔（直径 1-2 毫米）。在深层面蒸发结缔组织，金属碎屑沉积于此。其次，在可触及范围内，改变照射角度，以不同方向的照射来消融金属碎片和变色的结缔组织，而不扩大微孔。最后，在组织蒸发产生的空间充满血液后，用散焦激光照射对微通道入口处的血凝块表面进行热凝固。单个微孔无法成功去除的色素可以通过在距每个先前创建的孔 3 毫米或更远的距离处形成新的微孔来进行处理。每隔 4 周进行几次治疗，每次治疗间隔 4 周，即可完成大面积的去色素化，术后无牙龈退缩。
EL-MIKS 是一种新型的去色素技术，与传统牙周整形手术相比，它可以通过更简单、更容易和创伤更小的手术成功去除牙龈内大面积的金属纹身。成功实现了美学修复，术后牙龈轮廓无改变。
