Evaluation of Healing and Recurrence Following Gingival Depigmentation Procedure: A Comparison of Ceramic Bur, Diode Laser Techniques Single Blinded Split Mouth Randomized Control Trial

Abstract

Introduction: An ideal smile is assessed using eight key components, including lip line, smile arc, upper lip curvature, lateral negative space, symmetry, occlusal plane, dental, and gingival features. Additional factors like papilla size and soft tissue color and form also influence esthetic outcomes. Gingival hyperpigmentation is a benign darkening of the gums caused primarily by melanin accumulation. Thus, for aesthetic purposes, gingival depigmentation is done via various techniques. In this study we have compared the efficacy wound healing and recurrence of pigmentation followed by depigmentation using ceramic bur, diode laser and scalpel.

Methodology: A split-mouth, randomised clinical trial was conducted in 18 to 50 year olds. Rigorous inclusion and exclusion criteria were implemented, and participants were randomly assigned in 3 groups, Bur (Ceratip) depigmentation, Diode Laser depigmentation and traditional surgical (scapel) depigmentation. The Clinical assessment was done at baseline and after 2 week, 1 month,3 months,6 months and 9 months by indices such as, Dummet Oral Pigmentation Index (DOPI) and Takashi Index, 2005, Visual Analogue Scale (VAS), Healing Index (HI) by Landry et al, and Hydrogen Bubble test.

Results: The Bubble Test revealed that scalpel and ceramic bur groups had 100% tissue exposure, significantly higher than the laser group's 69.2% (p = 0.012). Pain scores were lower for scalpel and ceramic bur groups at 24 hours, with all groups pain-free by two weeks. Healing was rated "Excellent" for scalpel and bur patients, while only 69.2% of the laser group achieved this. Complete depigmentation was seen in scalpel and bur groups initially, but re-pigmentation occurred by three months (p = 0.001). The scalpel technique was cost-effective but required postoperative dressing due to bleeding.

Discussion: Diode laser and ceramic bur treatments yielded superior clinical outcomes, including pain resolution and faster healing, compared to scalpel use. While all groups healed completely by one month, pigmentation recurrence was higher in scalpel and diode laser groups by nine months.