Laser-Assisted Depigmentation—An Introspection of the Science, Techniques, and Perceptions

Abstract

Background: Gingival hyperpigmentation is a major concern for a significant number of patients, as a relevant aesthetic or cosmetic need. Oral melanin pigmentation is considered to be multifactorial and could be related to physiological or even pathological reasons and can be the consequence of a variety of local or systemic factors. This pigmentation varies individually across races or age groups and is without any gender predilection. Evidence gleaned from literature is presented from case–control studies and from the authors’ own research work in prospective, split-mouth, double-blinded, clinical trials comparing treatment modalities in effecting depigmentation. Methods: A systematic review of published articles, using suitable assay criteria, was carried out to formulate a consensus on laser-assisted modalities. A total of 295 published sources were subject to critical analysis and resulted in six papers that were subject to data scrutiny. Additionally, evidence is presented on clinical protocols and treatment outcomes. Results: Analysis of randomized clinical studies identified the use of two laser wavelength groups—near infrared diode and erbium group of mid-infrared lasers. Several areas of analysis were examined, and inconsistent degrees of significance were obtained to establish which laser group was optimal and if they were any better than scalpel depigmentation. Conclusion: A definitive conclusion is wanting as studies with scientific and standardized protocols of evaluation are yet to provide a take on comparative assessments between different techniques of depigmentation.

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

“…Another described option for melanotic pigmentation management is the use of diode lasers in non-contact mode. The "non-contact" technique with diode lasers without fiber activation is not described in the majority of randomized clinical trials and lacks standardization and evidence with prolonged follow-ups [3].…”

Comparison of Diode Laser and Conventional Method in Treatment of Gingival Melanin Hyperpigmentation

“…According to some researchers, this was the result of thermal damage to tissues by the diode laser 28 . Nevertheless, reduced postoperative pain is the remarkable benefit of the diode laser to the scalpel in early phase wound healing 29 .…”

The Use of Lasers in Dental Materials: A Review

“…Lasers are used in most areas of clinical dentistry and their use is steadily increasing. Their application includes caries detection, caries removal, dental cavity preparation, dentine hypersensitivity management, tooth bleaching, photodynamic therapy, excisional biopsy, aphthous ulcers management, frenectomy, vestibuloplasty, removal of irritation fibroma, removal of hyperplastic tissues, haemangioma, exposure of impacted teeth, gingivectomy and gingivoplasty, apicoectomy, an adjunct to endodontic treatment [ 19 ], gingival melanin hyperpigmentation removal [ 20 , 21 , 22 ], non-surgical periodontal treatment of untreated periodontitis [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ] and treatment of peri-implant diseases [ 31 , 32 , 33 ]. In terms of endodontic treatment, lasers are used for post-chemomechanical preparation to reduce the remaining bacterial load either by direct irradiation of the canal walls or by laser assisted irrigation via erbium laser group.…”

“…In terms of endodontic treatment, lasers are used for post-chemomechanical preparation to reduce the remaining bacterial load either by direct irradiation of the canal walls or by laser assisted irrigation via erbium laser group. In terms of gingival melanin hyperpigmentation removal, a recent systematic review identified the use of two laser wavelength groups-near infrared diode and erbium group of mid-infrared lasers and failed to draw conclusions on the optimal laser group [ 22 ].…”