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Title |
Laser Treatment of Gingival Hyperpigmentation Is More Effective at Providing a Stable Outcome Compared to Treatment with Conventional Techniques |
Clinical Question |
For a patient with gingival hyperpigmentation, will treatment with a laser, as compared to conventional treatment (i.e., scalpel technique or bur abrasion), be effective in providing a stable outcome? |
Clinical Bottom Line |
Treatment of gingival hyperpigmentation with lasers is a viable alternative to conventional techniques and has shown stable, long-term results. Current data suggest that laser surgery is more effective at limiting re-pigmentation. Lasers also offer the benefits of reduced chair time and less post-operative discomfort. The initial cost of purchasing the unit may limit the wide scale use of lasers, due to the relatively low cost of utilizing conventional techniques. |
Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
#1) 24418367 | Lin/2014 | Data collected from 61 case reports and clinical studies (351 patients) | Systematic review of non-randomized trials | Key results | Systematic review showed that laser de-pigmentation had a pigmentation recurrence rate of 1.16% (95% CI 0.42-3.15) versus 8.89% (95% CI 2.52-32.08) when using bur abrasion, and 4.25% (95% CI 2.48-7.30) when using the scalpel technique. | #2) 23291916 | Ribeiro/2014 | 11 patients with bilateral gingival hyperpigmentation requesting cosmetic therapy | Randomized Controlled Trial | Key results | Independent of treatment modality, slight re-pigmentation was observed in 45% of patients within 6 months. The scalpel technique required statistically higher chair time than the laser technique; moreover, at 1 week, higher levels of pain were reported in this group (p<0.05). There were no differences in the patient’s perception of esthetic outcomes between the scalpel and laser groups. | |
Evidence Search |
("gingiva"[MeSH Terms] OR "gingiva"[All Fields] OR "gingival"[All Fields]) AND ("hyperpigmentation"[MeSH Terms] OR "hyperpigmentation"[All Fields]) AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND ("laser therapy"[MeSH Terms] OR ("laser"[All Fields] AND "therapy"[All Fields]) OR "laser therapy"[All Fields] OR ("laser"[All Fields] AND "surgery"[All Fields]) OR "laser surgery"[All Fields]) AND outcome[All Fields] |
Comments on
The Evidence |
Validity: The systematic review assessed the outcomes of 351 patients, with follow-up times of up to 5 years. Random-effects Poisson regression was used to analyze pigmentation recurrence. Conversely, the randomized controlled trial had a follow-up time of only 6 months, and 11 subjects.
Perspective: When considering the use of lasers, there are many types from which to choose, each with its own technical specifications (i.e., laser medium and wavelength). Clinicians should thoroughly familiarize themselves with laser mechanisms and techniques before utilizing this option. It is also important to note that all treatment modalities will invariably result in re-pigmentation, due to a variety of endogenous and exogenous factors. |
Applicability |
Clinicians may opt for conventional techniques based on convenience or lower operating costs. However, laser treatment has the benefits of reduced chair time and less post-operative discomfort for the patient. |
Specialty/Discipline |
(General Dentistry) (Periodontics) |
Keywords |
Gingival Hyperpigmentation, Laser
|
ID# |
3116 |
Date of submission: |
11/15/2016 |
E-mail |
agirre@livemail.uthscsa.edu |
Author |
Aaron J. Agirre, DDS |
Co-author(s) |
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Co-author(s) e-mail |
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Faculty mentor/Co-author |
Yong-Hee Patricia Chun, DDS, MS, PhD |
Faculty mentor/Co-author e-mail |
ChunY@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
None available | |
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