Comparative evaluation of gingival depigmentation using diode laser and microneedling with Vitamin C mesotherapy: A randomized clinical trial.

A beautiful smiles is established by the harmonious relationship between the teeth and gingiva, i.e., the pink and white aesthetics. Gingival colour play a pivotal role in aesthetics, especially in patients with gummy smile. Gingival colour is governed by various factors such as, ethnicity, pregnancy, smoking, and drug intake.The gingival pigmentation is formed by melanoblasts, interlacing melanin granules between cells at the base of the gingival epithelium. The pigmentation degree differs depending on the melanoblastic interactions of each individual.

Various validated procedures for gingival depigmentation (GD) include bur abrasion, scalpel scraping, cryotherapy, electrosurgery, and laser treatments.3 These methods are resective in nature ie entail the removal of the epithelial layer along with the underlying connective tissue to promote the regeneration of a new gingival epithelium devoid of melanin. More recently, non-resective methods such as non-ablative laser depigmentation, transepithelial depigmentation, and vitamin C–based mesotherapy have gained popularity.

A study by Miao  et al (2019) have shown that vitamin C inhibits tyrosinase activity in melanocytes by intracellular acidification. As tyrosinase is essential for the conversion of L-tyrosine to L dopa (a rate limiting step), its inhibition results in down regulation of melaninogenesis.

Microneedling (MN) is a repetitive puncture technique recognized as a form of percutaneous collagen induction therapy. This process facilitates the penetration of topical medications across the stratum corneum layer.

Diode laser ablation has been recognized as one of the most effective, comfortable and reliable techniques for gingival depigmentation.

Objectives: To compare laser depigmentation using diode laser with microneedling technique  in combination with vitamin C mesotherapy in the treatment of gingival pigmentation.