Evaluation of gingival depigmentation using microneedling procedure with vitamin-c and electrosurgery: A split mouth randomized controlled trial.

The gingiva is a part of oral mucosa that covers the alveolar process of the jaws and surrounds the neck of the tooth.The color of healthy gingiva is coral pink. Gingival color changes due to the degree of keratinization ,vascularity, gingival epithelial thickness and pigmentation. Gingival pigmentation is maybe due to physiological or pathological factor which causes increased formation of melanin granules in melanocytes. Other causes for hyperpigmentation are genetics, drugs, and metals like bismuth, arsenic, mercury and lead. Lead pigmentation is due to perivascular precipitation of metallic sulfides in subepithelial connective tissue, endocrine disorders like Peutz-Jeghers syndrome and habits (smoking).Gingival pigmentation is more commonly seen in females than males. Dark skinned individuals will be having more melanin production in their body. Gingival depigmentation is a periodontal plastic procedure where removal of the epithelium layer along with connective tissue so that new gingival epithelium regenerates. Treatment options for gingival hyperpigmentation may be divided into two groups: techniques to eliminate the pigments and hide the pigments. Pigment elimination can be done surgically, non-surgically, or chemically. Scalpel surgery, laser ablation, cryosurgery, bur abrasion electrocautery, and radiosurgery are some of the most common surgical techniques. Chemical cauterization is the most common non-surgical method. Use of free gingival autograft operations and the acellular dermal matrix allograft are examples of masking gingival colors. Microneedling a novel non surgical procedure that necessitates puncturing the skin with sterilized microneedles on a regular basis. The needles pierce the skin and generate very tiny pores known as micro-conduits, these micro-injuries cause minor surface bleeding and initiation of a wound-healing pathway that includes inflammation, proliferation, and remodeling. Vitamin C is a water-soluble antioxidant referred to as ascorbic acid, is vital to the growth of strong bones, teeth, gums, ligaments, and blood vessels and is involved in important functions.Also, the anti-pigmentation properties of vitamin C are evident. It interacts with copper and inhibits the tyrosinase enzyme’s action, thus decreasing melanin formation. There are many articles providing various comparative studies with electrosurgery, but the comparison of different techniques with microneedling has not been done as per our knowledge. The rationale behind the study is to compare the efficacy of microneedling procedure with vitamin-c and electrosurgery for treating gingival pigmentation.