Gingival Melanin Depigmentation Using Pulsed 450 nm Diode Laser: A Split-Mouth Randomized Clinical Trial Comparing Ablative Versus Non-Ablative Techniques.

Introduction: Diode laser irradiation has recently shown promising results for treatment of gingival pigmentation. This study sought to compare the efficacy of 2 diode laser irradiation protocols for treatment of gingival pigmentations, namely the conventional method and the sieve method. Methods: In this split-mouth clinical trial, 15 patients with gingival pigmentation were selected and their pigmentation intensity was determined using Dummett's oral pigmentation index (DOPI) in different dental regions. Diode laser (980 nm wavelength and 2 W power) was irradiated through a stipple pattern (sieve method) and conventionally in the other side of the mouth. Level of pain and satisfaction with the outcome (both patient and periodontist) were measured using a 0-10 visual analog scale (VAS) for both methods. Patients were followed up at 2 weeks, one month and 3 months. Pigmentation levels were compared using repeated measures of analysis of variance (ANOVA). The difference in level of pain and satisfaction between the 2 groups was analyzed by sample t test and general estimate equation model. Results: No significant differences were found regarding the reduction of pigmentation scores and pain and scores between the 2 groups. The difference in satisfaction with the results at the three time points was significant in both conventional and sieve methods in patients (P = 0.001) and periodontists (P = 0.015). Conclusion: Diode laser irradiation in both methods successfully eliminated gingival pigmentations. The sieve method was comparable to conventional technique, offering no additional advantage.

Gingival hyper-pigmentation is an esthetics problem in patients with excessive gingival display. Laser ablation has been suggested recently as the most effective, pleasant, and reliable technique for gingival depigmentation compared to blade surgery. The present study aimed to identify and compare the effectiveness of two types of lasers, Er:YAG laser-2940nm and Diode laser-980nm, in gingival depigmentation in the maxilla and mandible. 20 participants, 16 males, and 4 females, whose ages ranged between 18 and 35years, were recruited using simplified random sampling. Oral pigmentation was measured at pre- and two postoperative follow-ups, 1month, and 6months, according to the oral pigmentation index. Furthermore, the study assessed postoperative intensity of pain using the Visual Analogue Scale, bleeding and healing process in both groups. There was a significant decrease in the oral pigmentation index scores, 1month (0.90±0.64) and 6months (1.55±0.60) after the operation (P<.001). No significant differences were detected between the two study groups regarding the mean ranking on the oral pigmentation index pre-operatively (P=.547), 1month after the operation (P=.154), and 6months after the operation (P=.831). The Er:YAG laser and Diode laser both significantly reduced gingival pigmentation with no significant differences between the effectiveness of the two types of laser in treating gingival hyper-pigmentation.

Surgical methods of gingival depigmentation can be challenging, particularly if the gingival phenotype is thin due to the risk of gingival recession and bone exposure. Thus, exploring alternative, non-surgical, minimally invasive treatment modalities is warranted. In dermatology, vitamin C is extensively used for depigmentation and microneedling for collagen induction, with limited literature about its usage for improving gingival esthetics. The present preliminary case study aims to explore the synergistic use of vitamin C mesotherapy with microneedling for the esthetic management of physiologic melanin gingival hyperpigmentation. Eleven arches from six patients having anterior physiologic melanin hyperpigmentation were recruited. Microneedling was done with a lancet, followed by intra-epidermal administration of 1.5-2mL of vitamin C in pigmented gingiva (once weekly/four sessions). Dummett oral pigmentation index (DOPI), gingival pigmentation index (GPI), pigmented surface area (PSA), and gingival luminescence (L*) were assessed at baseline and follow-up visits of 1 week, 1 month, and 3 months. Gingival thickness (GT) was recorded at baseline and 3 months. Pain, itching, and gingival color were also assessed. A significant reduction (p < 0.05) in mean DOPI, GPI, and PSA was observed from baseline to 3 months, while L* and GT increased significantly within that timeframe. Patients reported an improvement in gingival color at 1 and 3 months. Low pain and itching scores were obtained post-treatment. Vitamin C mesotherapy with microneedling is a newer, minimally invasive approach that can effectively reduce gingival melanin pigmentation intensity and extent, and can potentially increase the gingival thickness. Vitamin C mesotherapy (intra-epidermal injection) is an effective and minimally invasive treatment modality for gingival depigmentation. The adjunctive use of microneedling with vitamin C mesotherapy can potentially increase gingival thickness non-surgically. Non-surgical methods for gingival depigmentation can be chosen as an alternative to surgical methods for esthetic management of physiologic melanin hyperpigmentation in cases with thin gingival phenotype. Patients seek treatment for hyperpigmented gingiva caused by increased melanin to improve the smile esthetics. Conventional surgical methods for gingival depigmentation, however, are challenging to perform in areas of thin gingiva as there is an increased risk of gingival damage and bone exposure. Thus, exploring alternative, non-surgical, minimally invasive options will be advantageous. In dermatology, vitamin C is a popular agent for treating skin hyperpigmentation, and microneedling is a technique used for collagen induction. This preliminary case study synergistically used local vitamin C injections (mesotherapy) in gingiva with microneedling to manage gingival hyperpigmentation in eleven arches from six patients. Microneedling was done with a lancet, following which 1.5-2 mL of vitamin C was injected intra-epidermally in pigmented gingiva (once weekly for four sessions). From baseline to three months, a significant reduction in melanin pigmentation intensity and extent was observed as assessed by clinical and photographic parameters. Gingival thickness increased significantly within that timeframe. Patients reported favorable outcomes with improved gingival color with low pain and itching scores. Vitamin C mesotherapy with microneedling is a newer, minimally invasive, effective, non-surgical treatment modality for achieving gingival depigmentation and improving gingival thickness. The results need further validation in future studies with large sample sizes and long-term follow-up.

ObjectiveThis research compares the clinical outcomes of gingival depigmentation procedures with conventional scalpel, ceramic trimmer bur, and diode laser techniques.Materials and methodsTwenty-four individuals with physiologic gingival hyperpigmentation received random allocation to one of three treatment groups: scalpel, ceramic bur, or diode laser. Pain score, operation time, bleeding index, degree of epithelialization, wound healing, Dummett-Gupta Oral Pigmentation Index (DOPI), and Takashi Index score changes were all investigated at different time points.ResultsAt 12-h follow-up, significant variations in pain scores were seen between the laser and scalpel groups (p = 0.003) but not between the laser and ceramic bur groups. The diode laser group completed the procedure significantly quicker than the scalpel and ceramic bur groups (p = 0.004 and p = 0.001, respectively). The ceramic trimmer bur and diode laser groups showed significantly less bleeding tendency than the scalpel group. Wound healing and the degree of epithelialization were similar in all groups. DOPI and Takashi indices significantly decreased compared to baseline in all groups, with no significant difference recorded between all groups.ConclusionWhile diode lasers are a safe and effective treatment option for gingival hyperpigmentation, providing optimal aesthetics with reduced discomfort to patients, a ceramic trimmer bur can also be used as a simple and affordable alternative to a laser in gingival depigmentation procedures.Clinical relevanceGingival hyperpigmentation is a major aesthetic issue for many individuals. Laser and ceramic trimmer bur treatments produce equivalent aesthetic outcomes for gingival hyperpigmentation.

Purpose: The goal of this study is to compare the scalpel and diode laser methods for treating gingival hyperpigmentation in terms of postoperative discomfort and wound healing. Materials &amp; Methods: Sixteen systemically healthy individuals diagnosed with light or moderate gingival hyperpigmentation were enrolled for this study. Patients were randomly assigned to one of two treatment groups: scalpel or laser. Dummett’s oral pigmentation index was recorded at baseline. Early wound healing and post-operative discomfort were evaluated on the 7th day by using the VAS form. Comparisons between the groups were tested using the Mann-Whitney U test and P-value &lt; 0.05 was considered significant. Results: Total epithelization was observed in the laser group, whereas the epithelization was incomplete in the scalpel group at the end of the observation period. The pain perception on the first two days after the surgery was significantly higher in the scalpel group than in the laser group. (p=0,002 and p=0,038, respectively). No significant differences were found between the fourth- and seventh-day when surgical techniques were compared regarding pain perception (p&gt;0,05). Similarly, pain perceptions of female and male individuals showed no significant difference (p&gt;0,05). Conclusion: In the treatment of gingival hyperpigmentation, both surgical techniques were clinically successful. Although the treatment process was long, according to the results of our study, the laser technique is superior to the scalpel method in terms of patient comfort. The choice of the method may vary depending on the available equipment and the clinician’s preference or request of the patient.

Aim This study aims to compare the effectiveness of the two modes of 940 nm diode lasers on gingival depigmentation. Methods Twenty patients (11 females and 9 males) participated in this study; they were free of any systemic or local condition and randomly assembled into two groups: continuous wave (CW) and pulsed groups, in contact modes. The diode laser was of 940 nm wavelength and 1-2 W irradiation power for the two modes in all cases. A single session of irradiation was applied to the facial gingivae of the upper and lower anterior segments. Photographs were taken preoperatively and postoperatively for all patients, and a questionnaire and follow-up were carried out for the next four weeks and after three years. Results The intraoperative duration of both modes was considerably short, with a short chair time subsequently. A statistically significant decrease in the intensity of pain, discomfort, and bleeding (p ≤ 0.05) was noticed during the first week of follow-up within each group. Nonetheless, the two groups showed a close pattern of decline with no statistically significant differences between them. It was also clear that pain and discomfort were strongly correlated with each other within each group, and the correlation was statistically significant. On the other hand, carbonization was minimal in a few cases treated with CW mode but still not statistically significant. Finally, although the gingival pigmentation index (GPI) differences were not statistically significant between the two groups, they were significant within each group. Conclusions The diode laser (940 nm) offered an effective and safe modality, providing an optimal aesthetic result that can meet patient satisfaction with minimal pain, bleeding, discomfort, intraoperative time, and the possibility of recurrence in the treatment of gingival hyperpigmentation.

Introduction: Gingival hyperpigmentation is a common aesthetic concern that often requires treatment to achieve a pleasing smile. While various methods for depigmentation have been described in the literature, the scalpel method is widely advocated. Laser technology, particularly diode lasers, has emerged as a preferred treatment option due to their unique properties. Aim: To compare the efficacy of two different diode wavelengths, namely Denlase and Bluelase lasers, in terms of pain intensity, aesthetic appraisal, and the rate of repigmentation. Materials and Methods: This split-mouth randomised clinical trial was conducted in the Department of Periodontics at Vishnu Dental College, Bhimavarm, Andhra Pradesh, India. over a period of one year with follow-up. A total of 16 patients were included, and the right and left quadrants (both maxilla and mandible) were randomly assigned to either the Denlase or Bluelase group using the coin toss method. Depigmentation using diode lasers at 810 nm and 470 nm wavelengths was carried out in the respective groups. Pain perception, aesthetic appraisal, and recurrence of pigmentation were evaluated at 1, 3, 6, 9 months, and one year. The data were analysed using Friedman’s analysis and the Mann-Whitney U-test. Results: A total of 16 subjects, with a mean age of 27.64±7.64 years and of both genders, were included in the study. Statistically significant differences (p=0.001) were reported in pain perception, aesthetic appraisal, and the rate of repigmentation at 1, 3, 6, 9 months, and one year, respectively. Intergroup comparison revealed an increase in the mean amount of repigmentation at three months in the Denlase group, indicating a recurrence of pigmentation after three months. Conclusion: The Bluelase diode laser (470 nm) demonstrated superior results compared to the Denlase diode laser (810 nm) in terms of pain intensity, aesthetic appraisal, and repigmentation.

Background & Objective:Skin complexion and oral aesthetics significantly influence facial harmony and smile attractiveness. This study aimed to explore the relationship between skin tone, gingival pigmentation, and tooth shade to achieve natural and aesthetically pleasing dental outcomes.Methods:This cross-sectional observational study was conducted at the Dental Clinic Complex of King Faisal University, Al-Ahsa from September 2024 to January 2025. A total of 261 participants of both genders, with good oral health and healthy central incisors for shade selection, were included. Skin complexion was assessed using the Revlon (Revlon Foundation Makeup Shade Guide, USA), while gingival pigmentation with the Dummett-Gupta Oral Pigmentation Index, and tooth shade using the Vita Easyshade® V (Bad Säckingen, Germany). Data analysis was performed using SPSS (Version 20.0, SPSS Inc., Chicago), with chi-square, Spearman’s correlation, and linear regression tests. A p-value ≤0.05 was considered significant.Results:Most participants were male (65.5%). Shade A was the most common tooth shade (62.1%), followed by shade B (30.3%). Medium skin tone (51.0%) was predominant, with dark (28.0%) and fair (21.0%) tones following. The majority had no gingival pigmentation (66.7%). A significant association was found between skin complexion and tooth shade (p = 0.018), with a weak positive correlation (ρ = 0.146, p = 0.019). No significant associations were observed with gingival pigmentation or smile satisfaction.Conclusions:Fair-skinned participants tended to have lighter tooth shades, whereas those with medium and dark skin tones had relatively darker shades. However, gingival pigmentation and smile satisfaction showed no significant correlation with skin complexion.

Introduction: Pigmentation is associated with the production of melanin by melanocytes, which is a physiological state in the body. It makes an unpleasant appearance especially for those who have high aesthetic demand. Among different methods, lasers have many advantages in dentistry. Evaluation of gingival pigmentation treatment efficacy using 980 nm diode laser is the purpose of this study. Material and Methods: 24 patients were qualified for inclusion in the study. Depigmentation was performed using a diode laser. The size of the pigmentation was measured by AutoCAD software before the intervention, 1, 3, and 6 months after the intervention in each patient. Data were analyzed using SPSS software (v.22), Paired t-test, Smirnov-Kolmogorov, and Friedman tests. Results: The results demonstrated that the area and circumstance of the pigmentation significantly reduced after laser therapy. Also, repigmentation rate evaluation demonstrated that the rate has not changed in the first, third, and sixth months of follow up periods. Conclusion: The outcomes demonstrated that 980 nm diode laser is effective in treating gingival pigmentation as well as restoring beauty and comfort to the patient.

BackgroundThe ceramic soft tissue trimming bur (CeraTip™) was initially introduced for use in gingivoplasty but has recently been used for gingival depigmentation. The aim of this study is to compare the efficacy of depigmentation between the novel CeraTip™ and the gold-standard surgical scalpel technique.MethodsEight healthy, nonsmokers with moderate to severe gingival hyperpigmentation in both arches were randomly assigned for CeraTip™ depigmentation in one arch as the test group (TG) and scalpel depigmentation in the opposite arch as the control group (CG). Pigmentation indices were used to assess clinical performance. Treatment time, pain level, and esthetic satisfaction were the parameters of patient experience. The assessments were performed at baseline, one week, one month, and three months.ResultsAt all assessment visits, pigmentation intensity represented by the Dummet oral pigmentation index (DOPI), and pigmentation distribution represented by the Hedin melanin index (MI), were significantly lower than those at baseline (p < 0.001) in both groups. When comparing the two groups, Scalpel depigmentation had better initial clinical outcomes, while CeraTip™ had less visible repigmentation, pain scores, treatment time, and greater esthetic satisfaction. However, none of the differences were statistically significant.ConclusionBoth techniques successfully removed gingival hyperpigmentation with comparable clinical performance. The patients preferred CeraTip™ depigmentation.Trial registrationThe study protocol was registered on 11/09/2023 on the www.clinicaltrials.gov database (NCT06031116) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASU-Rec012124).

Background: Gingival pigmentation not only has an impact on aesthetics but also causes negative psychological effects. Gingival pigmentation is the coloring of the gingiva due to a variety of lesions and disorders caused by various endogenous and exogenous causes. Smoker’s melanosis refers to the pigmentation of the oral mucosa that occurs as a result of tobacco consumption. Gingival depigmentation is a periodontal plastic surgery process that uses a variety of procedures to eliminate hyperpigmentation, including scalpel, cryosurgery, electrosurgery, laser and others. Objective: To describe surgical procedures that maintain both cosmetic and functional requirements. Case Report: A 21-year-old man presented with complaints of inflammatory gingival enlargement and Smoker’s pigmentation of the maxillary and mandibular gingival melanosis. Surgical therapy was used to improve the appearance of the patient and avoid plaque retention. Conclusion: The scalpel approach is one of the most cost-effective methods, requiring only a basic armamentarium. It is highly recommended considering the limitations of equipment and that scalpel wounds heal more quickly than those treated with other techniques. Keywords: smoker’s melanosis, depigmentation, surgical scalpel technique, periodontal plastic surgery

Rhinophyma results in nasal deformity, which may lead to significant distress, embarrassment, social isolation, and low self-esteem. Fractional carbon dioxide (CO2) laser treatment is a simple, noninvasive, outpatient procedure with a low complication rate that has proved useful in rhinophyma treatment. The aim of this study was to assess the impact of fractional ablative CO2 laser treatment on self-esteem in patients with rhinophyma. Twelve patients with rhinophyma, between 50 and 80 years of age, received 4 monthly treatment sessions with a fractional ablative CO2 laser. The laser parameters were chosen based on the severity of the condition of each patient. Patient satisfaction was assessed through a study-specific questionnaire administered 1 month after treatment. Self-esteem was assessed by the Rosenberg Self-Esteem (RSE) Scale, which was administered before treatment, and at 1, 6, and 12 months after treatment. A decrease in RSE scores was observed in the post-treatment period, indicating an improvement in self-esteem among patients. All patients were satisfied with the aesthetic results and would recommend the treatment to a friend. Fractional ablative CO2 laser treatment is associated with high levels of rhinophyma patient satisfaction, and significant improvements in self-esteem.

Background: Elimination of gingival pigmentation is a common demand in dental cosmetic. Various methods have been reported in clinical practice. However, simplicity and safety of the technique and maintenance of the results is often a challenge. The aim of this study is to evaluate the clinical effect, patient satisfaction and recurrence rate of pigmentation following surgical scraping technique for gingival depigmentation.Subjects and Methods: This time series prospective clinical study included 15 healthy non-smoker patients seeking gingival depigmentation for esthetic reason. The patients’ sex and age were recorded. Then pigmented gingiva of the whole arch was scraped using Kirkland periodontal knife until the entire visible pigmentation was removed. Dummett-Gupta Oral Pigmentation Index (DOI) was recorded at baseline, 1 month, and 6 months. Patients’ satisfaction and frequency of re-pigmentation were also evaluated.Results: The mean DOI decreased significantly from 2.53 (0.52) at baseline to 0.60 (0.51) after 1 month and the 6 month score was 0.93 (0.59). By the end of 1 month the percentage of cases that showed any sign of pigmentation recurrence was 13.3% and 33.3% by the end of 6 months, 10 patients (66.6%) had persistence results and no cases returned to baseline score. (86.7%) experienced no pain during the surgical procedure and only (33.3%) had severe pain at the day of surgery and all patients were pain free in the first week. (80%) reported marked cosmetic changes by the end of 1st week and 6 months.Conclusion: The surgical scarping gingival depigmentation technique produced desired and persistence clinical results up to 6 months and all patients were satisfied with the procedure and cosmetic outcomes.

Ablative fractional laser treatment is considered the gold standard for skin rejuvenation. In order to understand how fractional laser works to rejuvenate skin, we performed microarray profiling on skin biopsies to identify temporal and dose-response changes in gene expression following fractional laser treatment. The backs of 14 women were treated with ablative fractional laser (Fraxel®) and 4 mm punch biopsies were collected from an untreated site and at the treated sites 1, 3, 7, 14, 21 and 28 days after the single treatment. In addition, in order to understand the effect that multiple fractional laser treatments have on skin rejuvenation, several sites were treated sequentially with either 1, 2, 3, or 4 treatments (with 28 days between treatments) followed by the collection of 4 mm punch biopsies. RNA was extracted from the biopsies, analyzed using Affymetrix U219 chips and gene expression was compared between untreated and treated sites. We observed dramatic changes in gene expression as early as 1 day after fractional laser treatment with changes remaining elevated even after 1 month. Analysis of individual genes demonstrated significant and time related changes in inflammatory, epidermal, and dermal genes, with dermal genes linked to extracellular matrix formation changing at later time points following fractional laser treatment. When comparing the age-related changes in skin gene expression to those induced by fractional laser, it was observed that fractional laser treatment reverses many of the changes in the aging gene expression. Finally, multiple fractional laser treatments, which cover different regions of a treatment area, resulted in a sustained or increased dermal remodeling response, with many genes either differentially regulated or continuously upregulated, supporting previous observations that maximal skin rejuvenation requires multiple fractional laser treatments. In conclusion, fractional laser treatment of human skin activates a number of biological processes involved in wound healing and tissue regeneration.

Background: Melanin pigmentation of the gingiva produces an unpleasant and unesthetic appearance to an individual especially if they have excessive gingival display. The present study aims to compare the two different depigmentation techniques to achieve gingival depigmentation. Materials and methods: A total number of 10 patients with 56 sites for depigmentation were recruited for the study. The patients were equally divided into groups, i.e., group I scalpel treatment and group II laser treatment. The gingival pigmentation was analysed using Dummett’s Oral Pigmentation score before and after the treatment. Additionally, the clinical parameters such as gingival index (GI) and plaque index (PI) were assessed. The above-mentioned parameters were assessed at the baseline, 3-months and 6-months post-operative period. Also, to evaluate the post-operative discomfort, Visual Analog Scale (VAS) was also employed. Result: In both groups, a statistically significant difference in pigmentation score was observed. Furthermore, group II displayed a lower VAS score and a decrease in post-operative pain, including bleeding, redness, and burning. Following both operations, no discernible changes in pigmentation were observed between the three and six-month follow-up. Conclusion: Both, the scalpel and laser depigmentation techniques offer better clinical outcomes in terms of reduction in pigmentation. Laser technique offers improved post-operative comfort for the patients. Keywords: Depigmentation, Diode Laser, Melanin pigments, Scalpel