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VOLUME 21 , ISSUE 10 ( October, 2020 ) > List of Articles


Comparative Evaluation of Gingival Depigmentation by Scalpel, Electrosurgery, and Laser: A 14 Months’ Follow-up Study

Swaminathan Rajendran, Lakshmi Priya Sridhar

Citation Information : Rajendran S, Sridhar LP. Comparative Evaluation of Gingival Depigmentation by Scalpel, Electrosurgery, and Laser: A 14 Months’ Follow-up Study. J Contemp Dent Pract 2020; 21 (10):1159-1164.

DOI: 10.5005/jp-journals-10024-2934

License: CC BY-NC 4.0

Published Online: 01-12-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Aim and objective: The aim of the study was to compare three different techniques using scalpel, electrosurgery, and laser for gingival depigmentation in terms of pain, discomfort, duration of procedure, wound healing, and repigmentation. Materials and methods: Thirty patients in the age range of 24–38 years were briefed about the surgical procedure and an informed consent was obtained and they were randomly allocated into three groups of 10 individuals (5 males and 5 females) each: those undergoing depigmentation with scalpel (group I), electrosurgery (group II), and diode lasers (Biolase) (group III). Individuals of all three groups were asked to describe the level of pain and discomfort by using the visual analog scale (VAS) 2 hours, 24 hours, and 1 week postoperatively. Further, the groups were compared based on duration of procedure, wound healing, and repigmentation at the end of 14 months. Results: All the groups showed a decrease in the pain levels, which was statistically highly significant 1 week postoperatively when compared 24 hours postoperatively. There was a statistically significant difference in the pain levels between the scalpel, electrosurgery, and lasers groups after 24 hours (p < 0.001), with the lasers group demonstrating significantly less pain and discomfort. There was significant difference between the groups with respect to the duration of procedure, with less mean time for completion of the procedure observed for group III. Furthermore, less time for wound healing was observed in group III as compared to other groups. Total 8 out 10 patients in group I, 7 out of 10 patients in group II, and 2 out of 10 patients in group III showed repigmentation at the end of 14 months. Conclusion: The rising concern for esthetic demand of an individual requires the removal of hyperpigmented gingival areas to create a confident and pleasing smile, which could be easily attained by using laser. Clinical significance: Laser is an effective and fast tool that causes less pain, discomfort, faster healing, and delayed repigmentation compared with scalpel or electrosurgery for gingival depigmentation.

  1. Goodlin R. Cosmetic dentistry-gingival aesthetics–a critical factor in smile design. Oral Health 2003;93:10–28.
  2. Chu SJ, Tan JH, Stappert CF, et al. Gingival zenith positions and levels of the maxillary anterior dentition. J Esthet Restor Dent 2009;21(2):113–120. DOI: 10.1111/j.1708-8240.2009.00242.x.
  3. Rufenacht CR. Principles of esthetic integration. Quintessence Publishing Company; 2000.
  4. Hassell TM. Tissues and cells of the periodontium. Periodontol 2000 1993;3(1):9–38. DOI: 10.1111/j.1600-0757.1993.tb00230.x.
  5. Granstein RD, Sober AJ. Drug- and heavy metal-induced hyperpigmentation. J Am Acad Dermatol 1981;5(1):1–18. DOI: 10.1016/s0190-9622(81)70072-0.
  6. Rakhewar PS, Patil HP, Thorat M. Identification of gingival pigmentation patterns and its correlation with skin color, gender and gingival phenotype in an Indian population. Indian J Multidiscip Dent 2016;6(2):87–92. DOI: 10.4103/2229-6360.197763.
  7. Martini FH, Timmons MJ. Human Anatomy. Upper Saddle River, New Jersey: Prentice Hall Pub. Co.; 1995. p. 88–93.
  8. Farnoosh AA. Treatment of gingival pigmentation and discoloration for esthetic purposes. Int J Periodont Restorat Dent 1990;10(4): 312–319.
  9. Ponnaiyan D, Jegadeesan V, Perumal G, et al. Correlating skin color with gingival pigmentation patterns in South Indians - a cross sectional study. Oral Health Dent Manag 2014;13(1):132–136.
  10. Hoexter DL. Periodontal aesthetics to enhance a smile. Dent Today 1999;18(5):78–81.
  11. Lee K-M, Lee D-Y. A comparison of different gingival depigmentation techniques: ablation by erbium:yttrium-aluminum-garnet laser and abrasion by rotary instruments. J Periodontal Implant Sci 2011;41(4):201–207. DOI: 10.5051/jpis.2011.41.4.201.
  12. Kaushik N, Srivastava N, Kaushik M, et al. Efficacy of different techniques of gingival depigmentation; a comparative evaluation with a case report. Int J Laser Dent 2013;3(2):68–72. DOI: 10.5005/jp-journals-10022-1040.
  13. Patil KP, Joshi V, Waghmode V, et al. Gingival depigmentation: a split mouth comparative study between scalpel and cryosurgery. Contemp Clin Dent 2015;6(Suppl 1):S97–S101. DOI: 10.4103/0976-237X.152964.
  14. Kaarthikeyan G, Jayakumar ND, Padmalatha O, et al. Pain assessment using a visual analog scale in patients undergoing gingival depigmentation by scalpel and 970 nm diode laser surgery. J Laser Dent 2012;20:20–23.
  15. Azzeh MM. Treatment of gingival hyperpigmentation by erbium-doped: yttrium, aluminum, and garnet laser for esthetic purposes. J Periodontol 2007;78(1):177–184. DOI: 10.1902/jop.2007.060167.
  16. Sagar G, Rajesh N, Kumar T, et al. Comparative evaluation of two surgical techniques using conventional scalpel method and diode laser for treatment outcome of depigmentation: 6 months follow-up study. J Dent Lasers 2016;10(1):2–9. DOI: 10.4103/0976-2868.184600.
  17. Claffey N, Shanley D. Relationship of gingival thickness and bleeding to loss of probing attachment in shallow sites following nonsurgical periodontal therapy. J Clin Periodontol 1986;13(7):654–657. DOI: 10.1111/j.1600-051x.1986.tb00861.x.
  18. Greene JG, Vermillion JR. The simplified oral hygiene index. 1964;68((1):7–13.
  19. Dummett CO, Sakumura JS, Barens G. The relationship of facial skin complexion to oral mucosa pigmentation and tooth color. J Prosthet Dent 1980;43(4):392–396. DOI: 10.1016/0022-3913(80)90207-3.
  20. Gupta G, Kumar A, Khatri M, et al. Comparison of two different depigmentation techniques for treatment of hyperpigmented gingiva. J Indian Soc Periodontol 2014;18(6):705–709. DOI: 10.4103/0972-124X.147404.
  21. Malkoc S, Buyukyilmaz T, Gelgor I, et al. Mucosal wound healing is impaired by examination stress. Psychosom Med 1998;60:362–365.
  22. Bhusari BM, Kasat S. Comparison between scalpel technique and electrosurgery for depigmentation: a case series. J Indian Soc Periodontol 2011;15(4):402–405. DOI: 10.4103/0972-124X.92580.
  23. Eslamian L, Borzabadi-Farahani A, Edini HZ, et al. The analgesic effect of benzocaine mucoadhesive patches on orthodontic pain caused by elastomeric separators, a preliminary study. Acta Odontol Scand 2013;71(5):1168–1173. DOI: 10.3109/00016357.2012.757358.
  24. Eslamian L, Borzabadi-Farahani A, Hassanzadeh-Azhiri A, et al. The effect of 810 nm low-level laser therapy on pain caused by orthodontic elastomeric separators. Lasers Med Sci 2014;29(2): 559–564. DOI: 10.1007/s10103-012-1258-1.
  25. Tipton WW, Garrick JG, Riggins RS. Healing of electrosurgical and scalpel wounds in rabbits. J Bone Joint Surg Am 1975;57(3):377–379. DOI: 10.2106/00004623-197557030-00016.
  26. Manivannan N, Ahathya RS, Rajaram PC. Scalpel versus electrosurgery: comparison of gingival perfusion status using ultrasound Doppler flowmetry. J Pharm Bioallied Sci 2013;5(Suppl 2):S154–S159. DOI: 10.4103/0975-7406.114317.
  27. Atsawasuwan P, Greethong K, Nimmanon V. Treatment of gingival hyperpigmentation for esthetic purposes by Nd: YAG laser: report of 4 cases. J Periodontol 2000;71(2):315–321. DOI: 10.1902/jop.2000.71.2.315.
  28. Lomke MA. Clinical applications of dental lasers. Gen Dent 2009;57(1):47–59.
  29. Ohshiro T, Calderhead RG. Development of low reactive-level laser therapy and its present status. J Clin Laser Med Surg 1991;9(4):267–275. DOI: 10.1089/clm.1991.9.267.
  30. Wigdor HA, Walsh JT Jr, Featherstone JD, et al. Lasers in dentistry. Lasers Surg Med 1995;16(2):103–133. DOI: 10.1002/lsm.1900160202.
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