Using Platelet-Rich Fibrin to Remove Graphite Tattoos May Yield Excellent Long-Term Result

TL;DR

A case report shows that using platelet-rich fibrin to treat a graphite tattoo on the gums led to excellent long-term results with no recurrence.

Contribution

A novel use of platelet-rich fibrin for covering exposed bone after removing a deep-seated graphite tattoo is presented.

Findings

Surgical removal of the pigmented tissue combined with PRF membrane coverage resulted in satisfactory healing.

Creeping attachment was observed at 8 weeks, with no recurrence after 13 years.

The PRF membrane provided structural support and facilitated tissue regeneration.

Abstract

Graphite tattoos are rarely reported because they are mainly caused by an accidental injury or habits during childhood that cause a pencil to penetrate the oral mucosa. Unlike other pigmentations, it stains layers that are deeper than the subepithelial and mucosal layers, and in most cases, it takes the form of a grayish black macule. This case report describes depigmentation with the denudation technique that was followed by a novel approach of using platelet-rich fibrin to cover exposed bone. A 41-year-old male patient presented with an aesthetic complaint from a grayish black staining on the labial gingiva near the maxillary central and lateral incisors. The lesion was diagnosed as a graphite tattoo due to the patient's history of sticking his gum with pencils when he was young. The entire pigmented gingiva was surgically removed and covered with two layers of PRF membrane to protect the exposed bone surface and provide an extracellular matrix for migration of gingival fibroblasts. Healing patterns were observed at 1, 2, 4, and 8 weeks, and satisfactory clinical and aesthetic results were obtained. Creeping attachment was observed at 8 years postop, and there was no recurrence for a long-term period of 13 years.

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