Comparison of Er-YAG Laser, Air Polishing, and Surgical Excision for Gingival Hyperpigmentation

Physiologic gingival hyperpigmentation is a common esthetic condition caused by excessive melanin deposition within the gingival epithelium. Several treatment approaches have been proposed to eliminate gingival pigmentation, including conventional surgical techniques, laser applications, and minimally invasive air polishing systems. Although conventional surgical excision and laser therapy are widely used, alternative approaches that may reduce postoperative discomfort while maintaining comparable clinical outcomes remain of clinical interest.

The purpose of this randomized controlled clinical trial was to compare the clinical effectiveness and patient-related outcomes of four different treatment modalities for gingival hyperpigmentation: Er:YAG laser treatment, air polishing with erythritol powder, air polishing with sodium bicarbonate powder, and conventional surgical excision.

Eligible participants diagnosed with physiologic gingival melanin hyperpigmentation were randomly allocated into four parallel treatment groups. Clinical pigmentation changes were assessed using standardized clinical photographs, pigmentation index scoring systems, digital color analysis, and quantitative color measurements during baseline and follow-up examinations over a three-month period. Secondary evaluations included postoperative discomfort assessment and patient satisfaction measurements.

The study was designed to evaluate whether minimally invasive air polishing approaches could achieve clinical outcomes comparable to established treatment methods while providing improved patient comfort during the healing period.

Inclusion criteria

• Individuals aged between 18 and 50 years
• Systemically healthy individuals
• Presence of physiologic gingival hyperpigmentation in the anterior maxillary or mandibular gingiva
• Individuals seeking esthetic treatment for gingival pigmentation
• Presence of adequate oral hygiene and periodontal health before treatment
• Willingness to participate in the study and provide written informed consent
• Agreement to attend all follow-up visits during the study period

Exclusion criteria

• Presence of systemic diseases or conditions that may affect wound healing
• Smoking or use of tobacco products
• Pregnancy or lactation
• History of periodontal therapy or gingival depigmentation treatment in the study area
• Presence of active periodontal disease or gingival inflammation at baseline
• Use of medications affecting gingival tissues or wound healing
• Individuals with non-physiologic oral pigmentation associated with systemic disorders, medication use, or syndromic conditions
• Inability or unwillingness to comply with study protocol and follow-up visits