Comparative Evaluation of Gingival Depigmentation Using Scalpel, Diode Laser, Vitamin C, and Bur Abrasion Techniques: A Case Series
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Abstract
Background: Gingival hyperpigmentation is a common physiological condition caused by excessive melanin deposition within the basal and suprabasal layers of the gingival epithelium. Although benign, excessive pigmentation often presents an esthetic concern, particularly in patients with a high smile line. Various surgical and non-surgical techniques have been introduced to eliminate gingival pigmentation, each possessing distinct advantages and limitations.
Objective: To compare the clinical outcomes of four gingival depigmentation techniques—scalpel surgery, diode laser, vitamin C injection, and bur abrasion—with respect to pain, healing, and esthetic outcome.
Methods: Patients presenting with moderate to severe gingival pigmentation (Dummett Oral Pigmentation Index ≥3) underwent gingival depigmentation using one of the four treatment modalities. Clinical evaluation included postoperative pain using the Visual Analog Scale (VAS), wound healing using the Modified Healing Index described by Landry et al., and assessment of gingival pigmentation using the Dummett Oral Pigmentation Index.
Results: The scalpel technique demonstrated rapid healing, excellent esthetic outcome, and remained the most economical approach, although intraoperative bleeding was comparatively greater. The diode laser provided a relatively bloodless surgical field with minimal postoperative discomfort but was associated with a burning odor during treatment and slower healing. Bur abrasion achieved satisfactory depigmentation but required meticulous technique because of the risk of thermal injury. Vitamin C injection produced the least satisfactory depigmentation among the evaluated techniques.
Conclusion: Scalpel surgery remains a reliable and cost-effective technique for gingival depigmentation. Diode laser offers superior patient comfort and hemostasis, whereas bur abrasion serves as an acceptable alternative. Vitamin C injection demonstrated limited clinical effectiveness for moderate to severe gingival pigmentation.
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