Removal of an Amalgam Tattoo Using a Subepithelial Connective Tissue Graft and Laser Deepithelialization

Background: A 56‐year‐old female presented for periodontal treatment with a large amalgam tattoo located in alveolar mucosa on the facial aspect of her maxillary central incisors. The lesion had been present for 42 years since having endodontic surgery at teeth #8 and #9 after a traumatic childhood incident. Methods: A two‐stage surgical approach was used to eliminate the lesion, beginning with a subepithelial connective tissue graft to increase tissue thickness subjacent to the amalgam tattoo. After 6 weeks of healing, the overlying pigmented tissue was removed using laser surgery to expose the underlying grafted connective tissue. Results: After 2 months of healing following laser surgery, the amalgam pigmentation was completely removed, with good color match and an increased width of keratinized tissue at the surgical site. Conclusion: A relatively large amalgam tattoo in the esthetic zone can be adequately removed by a two‐stage procedure using grafted palatal connective tissue and laser deepithelialization.