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

Abstract

Background and Aim: Gingival hyperpigmentation is an esthetic problem. The aim of the present study was to identify most effective treatment modality for managing generalized physiological gingival pigmentation. Materials and Methods: A systematic review and meta-analysis were done (1919 to October 2018) using PubMed, CINHAL, Dental and Oral Science, and manual searches. Twenty-five articles were finally reviewed. Only human clinical trials were considered with physiological gingival pigmentation treated with different depigmentation methods and compared with surgical stripping. The outcome was the achievement of gingival depigmentation and its recurrence. RevMan software was used for data analysis. Results: Of 26,132 articles, 25 met the inclusion criteria. Seventeen were randomized control trials and 8 were nonrandomized control trials. Most of the studies were on laser. The control group was scalpel surgery. Majority of studies showed no difference in compared treatment modality. A meta-analysis compared laser ablation with surgical stripping revealed a nonsignificance difference regarding recurrence ( P = 0.75) and depigmentation ( P = 0.23) and a statistically significant difference regarding postoperative pain favoring laser ablation ( P ≤ 0.05). Conclusions: Surgical stripping has been the conventional treatment of choice, but our review showed that new techniques are equally effective or even better. Laser especially diode laser was the most frequently used technique and showed better esthetic outcomes, less pain, faster healing, and patients' preference and satisfaction after treatment. However, laser showed more regimentation at 6-month evaluation. More good quality randomized controlled trials with different depigmentation methods are needed to draw strong conclusions.

Applications of diode laser in periodontal therapy clinical guidelines and tips

“…Bhat et al compared the tissue response post gingivectomy with scalpel or diode laser and observed that the soft tissue margins are more stable after laser excision whereas creeping was observed at 2 months post scalpel excision [14]. Gul et al [15] in their systematic review and meta-analysis observed that diode laser resulted in better aesthetic outcomes after gingival depigmentation and was the modality of preference in terms of patient comfort and satisfaction as compared to other techniques. Jacob et al [16] in their split mouth study found that operative ease was better and recurrence was lower in patients where diode laser was used for depigmentation.…”

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

“…Additionally, they present smaller rates of melanic repigmentation over time compared to other lasers [ 2 , 7 ]. The majority of soft-tissue procedures performed with diode lasers have output power between 2.5 and 1.5 W, continuous wave, with fiber activation, and these parameters create adequate power to cut tissue, with the fiber always placed directly on the tissue surface (contact mode) [ 8 ]. On the other hand, the usage of pulsed mode in diode lasers is possible, even though they can lead to gingival fenestrations and bone exposure, caused by the lack of control over temperature rise in gingival tissue [ 9 , 10 ].…”

A Concise Review of Gingival Depigmentation Techniques and Re-Pigmentation

“…This technique is slower than spray technique. (10) Disadvantages: (15) Diode laser: This laser is a solid-state semiconductor that utilizes light energy from electric energy. Flexible quartz fiber optic hand piece can be used.…”