Most effective method for the management of physiologic gingival hyperpigmentation: A systematic review and meta-analysis

Efficacy of different gingival graft de-epithelialization methods: A parallel-group randomized clinical trial

OBJECTIVES

The clinical outcomes of either extra-oral (eo) or intra-oral (io) de-epithelialized connective tissue graft (DE-CTG) techniques to the recipient site have not been fully elucidated yet. There is an ongoing debate regarding the possible complications caused by incomplete elimination of the epithelial layer. The aim of this study is to compare clinical effectiveness and de-epithelialization efficacy of ioDE-CTG and eoDE-CTG in recession treatment.

MATERIALS AND METHODS

Forty patients, with a single gingival recession, were treated with coronally advanced flap combined with eo- or ioDE-CTG. Data consisted of surgical chair-time, recipient site periodontal and patient-based variables. To evaluate the efficacy of de-epithelialization, histological analyses were also performed via graft imprints.

RESULTS

There was no significant inter-group difference in terms of treatment outcomes. Aesthetic results were also similar for both groups. While chair-time was significantly shorter in the ioDE group, less epithelial remnants were showed with eoDE technique.

CONCLUSIONS

Similar clinical outcomes were obtained with eo- and ioDE-CTG. While ioDE is less effective in removing the epithelial layer, no long-term complications due to the epithelial residues were detected. Both techniques can be recommended in recession treatment.

CLINICAL RELEVANCE

This study demonstrates that extraoral and intraoral de-epithelialized connective tissue grafts in root coverage procedures led to similar clinical results without any further events. The study protocol was registered at ClinicalTrials.gov (NCT05494294).

Microneedling Technique With Topical Vitamin C for Gingival Depigmentation Enhancing Gingival Aesthetics: A Longitudinal Study

Introduction As the focus on dental aesthetics intensifies, contemporary cosmetic dentistry seeks to establish an equilibrium between teeth and gums. Gingival hyperpigmentation, resulting from excessive melanin accumulation, can impact individuals regardless of age or gender and frequently gives rise to aesthetic apprehensions. Microneedling combined with topical vitamin C is a promising new method for improving gum appearance, particularly for reducing gingival hyperpigmentation caused by excess melanin. Microneedling is less expensive, more versatile, and promotes faster healing than traditional procedures like lasers or surgery. Materials and methods A study with 10 participants at the Karnavati School of Dentistry demonstrated significant pigmentation reduction. A paste was made with powdered ascorbic acid and a liquid ampule solution and applied with a Derma Pen (Dr. Pen Ultima A1, C Cube Advanced Technologies, India), which is a rechargeable pen-like instrument with 24-36 adjustable needles (0.25 mm to 2 mm) and five-speed settings. The gadget enables multi-directional treatment, and its disposable needle tips assure clean use with several patients. Results A significant decrease in melanin pigmentation was observed across all age groups, but anatomical challenges, such as irregular gingival contours, hampered results in some cases. Conclusion Microneedling is a safe and effective option for improving gingival aesthetics. As the technique evolves, it has the potential for broader applications.

Comparison of Various Minimally Invasive Techniques for the Management of Gingival Hyperpigmentation: A Case Report

Gingival hyperpigmentation is a condition wherein there is excessive deposition of melanin pigment, which is produced by the melanocytes of the gingiva. Gingival depigmentation is a periodontal surgical procedure whereby the pigmentation is removed or reduced by various surgical techniques that are associated with significant postoperative pain, bleeding, and recurrence. Laser ablation has been recognized as one of the minimally invasive, effective, comfortable, and reliable techniques for gingival depigmentation. The use of lasers has several advantages such as high patient compliance, short healing period, no or very slight pain, and hemorrhage. On the contrary, mesotherapy is a minimally invasive technique that uses fine-gauge needles to locally administer modest amounts of Vitamin C to the mesoderm layer to achieve cosmetic goals. Recently, some case studies have shown that ascorbic acid (Vitamin C) can be used in the management of gingival pigmentation. The objective of this case report is to compare the clinical efficacy of these two techniques for gingival depigmentation and to arrive at an effective minimally invasive alternative for gingival depigmentation.

Blue laser-assisted depigmentation of gingiva using non-ablative technique

Diode lasers are one of the most widely used modalities in soft tissue dental surgery. Recent advancements have expanded the clinically useful emission spectrum of diode lasers to include the blue light region, corresponding to wavelengths such as 445 and 450 nm. The melanin present in hyperpigmented gingiva acts as a chromophore and absorbs laser energy, thus facilitating the denaturing of melanin-containing cells in the gingiva. This paper presents a case of ethnicity-related gingival hyperpigmentation that was successfully treated using a 445 nm blue wavelength soft tissue diode laser by non-ablative technique. The treated area showed no recurrence of pigmentation up to 9 months postoperatively.

Injectable platelet rich fibrin effect on laser depigmented gingiva: a clinical randomized controlled split mouth trial with histological assessment

OBJECTIVE

To determine whether intra-mucosal injection of injectable platelet-rich fibrin (i-PRF) can promote healing after Diode Laser Gingival Depigmentation (DLGD).

METHODOLOGY

A total of 20 arch sites of hyperpigmented gingiva of 10 patients underwent DLGD. For each patient, two arch sites were randomly assigned for either intra-mucosal injection of i-PRF (G1-i-PRF) (n=10 sites) or no treatment (G2-Control): (n=10 sites). Wound Healing Score (WHS), patient satisfaction, and Pigmentation Index (DOPI) were measured at 1 week and 1 and 3 months postoperatively. Histological assessment of tissue specimens was performed at baseline and 1 week.

RESULTS

The percentage change in WHS at 1 week was significantly higher in G1 (58.34±15.43) compared to G2 (37.50±11.79). At day 1, 50% of patients in G1 were pain free compared with 75% in G2, who had mild pain. Mean DOPI decreased significantly at 3 months in both groups (P-value <0.001), without significant differences between groups. G1 specimens showed significantly higher epithelial thickness (P-value <0.001), as well as a higher number of blood vessels and less percentage of inflammatory cells.

CONCLUSIONS

i-PRF demonstrated better clinical and histological healing potential and less patient discomfort compared to sites without treatment after DLGD. Registered at https://clinicaltrials.gov/ as (NCT05283668).

Comparison of the Diode Laser Wavelengths 445 nm and 810 nm in Gingival Depigmentation - A Clinical Evaluation

Introduction: Nowadays, esthetic appearance plays an important role in the field of dentistry. Discolorations and pigmentations of the gingiva reduce the appearance of a healthy-looking smile. On this occasion, the use of lasers shows a promising approach for a fast and non-aggressive treatment in this field. Different laser wavelengths are being used for gingival depigmentation this clinical study aimed to investigate the effect of the novel laser wavelength (445 nm) in this field and compare it with an 810 nm diode laser. Methods: Two diode laser wavelengths (445 nm and 810 nm) were used for depigmentation. The laser output power chosen was 1 W. An optical fiber with a diameter of 400 µm was used. 21 patients with pigmented gingiva were selected. Depigmentation was carried out in a split-mouth design for a direct comparison of the clinical effect. Outcomes were documented by photograph after one month and six months of follow-up. Results: For each wavelength, 21 volunteers evaluated 21 clinical cases of depigmentation, which means that 441 comparisons were carried out in total regarding the color change from brownish to pinkish. A 100% clarification was achieved for 445 nm. In the 810 nm group, the color change in 44 of 441 cases (10%) could not be clearly identified. No statistically significant difference in pain experience was reported for both laser treatments. Conclusion: The clinical evaluation showed that within the limitations of this study, most of the clinical outcome parameters were highly acceptable by the patients due to mild pain and discomfort for both laser systems.

Vitamin C mesotherapy versus diode laser for the esthetic management of physiologic gingival hyperpigmentation: a randomized clinical trial

BACKGROUND

Physiologic gingival hyperpigmentation is a common esthetic concern that affects individuals of various ethnicities, and can have a significant impact on individual's self-confidence and overall quality of life. Thus, this study aimed to clinically assess the effectiveness of intra-mucosal injection of vitamin C versus 980 nm diode laser for the management of physiologic gingival hyperpigmentation.

METHODS

Twenty-six healthy non-smoker individuals with physiologic gingival hyperpigmentation were randomly assigned to two groups. Group I received intra-mucosal injection of vitamin C (L-Ascorbic acid 1000 mg/5 ml), and group II was managed using diode laser (980 nm, 1.5 W, continuous wave mode). Clinical evaluation of pigmentation intensity and distribution was performed preoperatively, and at 1, 2 and 3 months postoperatively using two different color assessment indices; Dummett-Gupta Oral Pigmentation Index (DOPI), and Gingival Pigmentation Index (GPI). Additionally, the study assessed pain intensity and patients' satisfaction.

RESULTS

Pigmentation scores decreased significantly between pre-operative visit and different follow-up visits for both treatment modalities (p < 0.0001*). When compared to the vitamin C mesotherapy group, the laser group demonstrated significantly lower gingival pigmentation scores (p < 0.0001*). However, both treatment modalities were equally satisfying for the patients.

CONCLUSIONS

Vitamin C mesotherapy and diode laser are both effective in the management of physiologic gingival hyperpigmentation. While diode laser yields better and earlier results, vitamin C mesotherapy offers a cost-effective, safe and minimally invasive approach that is equally satisfying for the patients seeking esthetic enhancements.

TRIAL REGISTRATION

The study was registered on ClinicalTrials.gov (NCT05608057) on (01/11/2022).

A Comparative Histological Study of Gingival Depigmentation by 808 and 445 nm Diode Lasers

Introduction: Using lasers in melanin depigmentation is one of the main fields of interest for dental practitioners and patients. However, it is important to know what would happen inside the tissue and how the cells would interact inside the tissue with a laser. Methods: In this study, we used both wavelengths of 445 nm and 808 nm on sheep gingiva to find out the effects and side effects of these diode lasers while using them for gingival depigmentation. Results: After microscopic evaluation, we concluded that 808 nm and 445 nm lasers with a power of 1 W are safe enough to use in the depigmentation of gingiva, and both lasers are highly effective in melanin pigments which are located in basal membrane. Conclusion: The 445 nm blue laser produced a less thermal effect, which means it is safer to be used in gingival hyperpigmentation than a diode laser.

Efficacy and Risks of Different Treatments for Oral Hyperpigmentation: A Systematic Review and Network Meta-Analysis

BACKGROUND

Oral-pigmented lesions have raised aesthetic concerns, leading to multiple depigmentation techniques. This systematic review and network meta-analysis aimed to assess the efficacy of different treatments for oral hyperpigmentation.

METHODS

A computerized search was conducted on Science Direct, Medline via PubMed, Scopus, and Web of Science using the relevant keywords. English-language studies published between 2013 and 2023 that focused on patients with oral pigmented lesions subjected to different treatment modalities, such as laser or surgical intervention, were compared to determine their efficacy and safety profile. Data were analyzed using R software, applying frequentist models.

RESULTS

A total of 27 studies were included. In contrast to the CO2 laser, Er: YAG laser was linked to a higher risk of bleeding (RR = 2.73, p < 0.01), whereas the diode laser had the most favorable score in minimizing bleeding index (P-score = 0.86). In terms of lower risk and postoperative pain score (RR = 0.01, p < 0.01), the Er,Cr:YSGG laser had the most favorable result (P-score = 1.00). The Er: YAG laser demonstrated the highest probability of preventing recurrence (RR = 0.28, p < 0.01), followed by the diode laser (RR = 0.42, p < 0.01).

CONCLUSIONS

The choice of treatment for oral pigmentation should be based on individual patient needs and the desired outcomes. The Er: YAG laser seems highly effective in preventing pigment recurrence, the diode laser emerges as a top contender in managing bleeding risks, and the Er,Cr:YSGG laser is particularly efficacious in managing postoperative pain.

Q-switched ruby laser is safe and effective in treating primary gingival hyperpigmentation

BACKGROUND

Physiologic gingival hyperpigmentation (PGH) is a benign condition that results from increased melanin production and is prevalent among darker skin individuals. Although the use of lasers for PGH has gained popularity in recent years, the lasers being used are mostly ablative, and act through a non-selective tissue damage mechanism.

AIMS

The objective of this study was to evaluate the use of a non-ablative 694-nm Q-switched ruby laser (QSRL) for the depigmentation of PGH.

METHODS

A retrospective single-center study of patients diagnosed with PGH and treated with a QSRL Between March 2019 and November 2020.

RESULTS

Four patients were treated with QSRL for 1-3 sessions, until complete depigmentation was achieved. The average follow-up was 11 months (range 7-18 months) with no patient exhibiting re-pigmentation. Adverse events included mild local tenderness and transient erosions in two patients.

CONCLUSION

The 694-nm QSRL is a novel and promising safe and effective method for treating PGH with the advantages of being a non-ablative modality that minimizes tissue damage and optimizes the outcome.

Comparison of Er,Cr:YSGG laser and diode laser in the treatment of gingival melanin pigmentation: a randomized clinical trial

This investigation has aimed to compare the efficiency of clinical depigmentation and repigmentation rate of erbium chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) and diode lasers during a 1-year follow-up and to evaluate patient satisfaction. Twenty-two participants were divided into Er,Cr:YSGG laser and diode laser groups using computer-aided randomization. Dummett Oral Pigmentation Index (DOPI) and photographic assessment with ImageJ Software version 10.2 were performed at the preoperative period and postoperative 1st month, 6th month, and 12th month. Moreover, the study assessed intra- and postoperative intensities of pain and postoperative patient aesthetic satisfaction using the Visual Analog Scale in both groups. The median values of DOPI did not differ statistically between the groups according to time (p > 0.05). In the Er,Cr:YSGG group, the extension of repigmentation was less as compared to the diode group at 1-year follow-up (p = 0.045). In the Er,Cr:YSGG group, the patients felt less intraoperative pain and discomfort compared to the diode group (p = 0.007). No significant differences were found between the two groups in terms of patient aesthetic satisfaction at the 1st and 12th months. The findings indicate that diode and Er,Cr:YSGG lasers can be used safely in depigmentation treatment, while the Er,Cr:YSGG laser has been shown to have superiorities in pain management and patient comfort parameters. Clinical Trial No.: NCT05304624.

Gingival Pigmentation Removal With a High-Power Diode Laser in Non-contact Mode: A Proposed Technique With Two Years of Follow-Up

This case report describes the efficacy and advantages of using a high-power diode laser in non-contact mode to remove racial melanin pigmentation from the oral mucosa in an aesthetically sensible area to reduce thermal damage and promote better postoperative results. In the presented case, the lesion was removed under local anesthesia in a single session using high-power diode equipment with circular movements over the lesion (10 seconds maximum for each irradiation cycle, with 30 seconds for thermal relaxation, for a total of two cycles), maintaining an average distance of 2-3 mm from the target tissue without fiber activation (continuous wave, 2 W, delivered by quartz fiber with 300 µ). The patient did not report immediate postoperative pain; however, analgesic use was recorded during the first day after the surgical procedure. The biological response and cosmetic results were satisfactory, with proper lesion removal and adequate cicatrization observed during a two-year follow-up period, without complications or compromise of periodontal tissue esthetics.

Gingival Melanin Depigmentation Using a Diode 808-nm Laser: A Case Series

Introduction: Gingival hyperpigmentation is caused by an increase in the amount of melanin production or the number of melanocytes in the epithelium, which can impair smile esthetics. The current study aimed to report the experience of using a diode laser for gingival depigmentation of three different patients. Case Presentation: Three adult patients are presented with hyperpigmentation in labial gingivae of both jaws. The depigmentation was done using a diode laser at a wavelength of 808 nm, fiber diameter of 300 μm, and power of 1 W and in continuous mode. All three patients showed proper resolution of hyperpigmented areas in short- and long-term follow-up sessions. However, degrees of recurrence were noticeable in two cases. Conclusion: The 808-nm diode laser can be utilized safely and efficiently in gingival depigmentation, resulting in an acceptable cosmetic outcome.

Despigmentación gingival mediante mucoabrasion en el sector anterior. Reporte de caso

La melanosis gingival una alteración frecuente que causa disconformidad en la sonrisa de los pacientes. Existen múltiples tratamientos que ofrecen resultados favorables y con poca o nula recidiva. El propósito de los presentes casos clínicos fue evaluar los resultados que ofrece la técnica de mucoabrasión en la remoción de manchas melánicas en el sector anterior. Los casos incluyeron a dos pacientes se sexo femenino, sin enfermedades sistémicas, las cuales al examen clínico presentaban manchas melánicas. El primer caso presentó pigmentaciones en el maxilar superior, mientras que el segundo caso presentó pigmentaciones en ambos maxilares. Se combinó la remoción de las manchas con el uso de bisturí y medios rotarios. Se logró eliminar las manchas melánicas en su totalidad en ambos casos con una técnica completa, sin la necesidad de equipos de alto costo y no se observó recidiva al cabo de 6 meses. La técnica de mucoabrasión fue efectiva para tratar la melanosis gingival resaltando que es de fácil manejo, de corto tiempo operatorio, cicatrización rápida, con un posoperatorio aceptable para el paciente y de costos económicos.