Evaluation & Comparison of Gingival Depigmentation Using Conventional Scalpel Technique and Diode Laser – A Clinical Study

Abstract

Background: Gingival melanin pigmentation is a common physiologic finding that may present as dark discoloration of the gingiva. Although it does not represent a pathological condition, it can be an esthetic concern for individuals, particularly those with a high smile line or excessive gingival display. Various techniques have been proposed for the management of gingival hyperpigmentation, among which the conventional scalpel technique and diode laser therapy are frequently used. The scalpel technique has long been considered the gold standard because of its simplicity and cost-effectiveness, whereas diode lasers have gained popularity due to advantages such as improved haemostasis, precision, and patient comfort. In view of these considerations, a comparative evaluation of these two treatment modalities becomes clinically relevant.
Objective: The present study was undertaken to evaluate and compare gingival depigmentation performed using the conventional scalpel technique and diode laser with respect to pigmentation reduction, wound healing, and patient-related outcomes.
Materials and Methodology: The study was conducted on 20 patients aged between 18 and 35 years who presented with gingival melanin pigmentation and reported to the Department of Periodontology and Implantology, Sri Siddhartha Dental College and Hospital, Tumkur. A randomized split-mouth design was employed in which each patient received both treatment modalities. One site was treated using the conventional scalpel technique (Group A), while the contralateral site was managed using a diode laser (Group B). Gingival pigmentation was evaluated using the Dummett–Gupta Oral Pigmentation Index (DOPI). Wound healing was assessed using the Wound Healing Index (WHI), and patient response was recorded using the Visual Analog Scale (VAS) for pain along with a questionnaire evaluating discomfort and esthetic satisfaction. Clinical assessments were carried out preoperatively and postoperatively at 1 week, 1 month, 3 months, and 6 months. Statistical analysis was performed using the Wilcoxon signed-rank test for intergroup comparisons and the Friedman test for intragroup comparisons.
Results: Both treatment modalities resulted in a noticeable reduction in gingival pigmentation. Baseline pigmentation scores were comparable between the two groups. At all postoperative evaluation periods, the diode laser group demonstrated lower pigmentation scores compared with the scalpel group, and the difference was statistically significant. Wound healing progressed satisfactorily in both groups, with no significant difference between the techniques. Patients treated with the diode laser generally reported less postoperative pain and discomfort. The overall esthetic outcome was favourable in both groups, with most patients expressing complete satisfaction with the treatment results.
Conclusion:
Within the limitations of the present study, both the conventional scalpel technique and diode laser were found to be effective methods for gingival depigmentation. The diode laser showed advantages in terms of reduced postoperative discomfort and improved patient experience. However, the scalpel technique remains a dependable and economical approach for the management of gingival hyperpigmentation.