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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) 24418367Lin/2014Data collected from 61 case reports and clinical studies (351 patients)Systematic review of non-randomized trials
Key resultsSystematic 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) 23291916Ribeiro/201411 patients with bilateral gingival hyperpigmentation requesting cosmetic therapyRandomized Controlled Trial
Key resultsIndependent 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]
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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: 11/15/2016spacer
E-mail agirre@livemail.uthscsa.edu
Author Aaron J. Agirre, DDS
Co-author(s) e-mail
Faculty mentor/Co-author Yong-Hee Patricia Chun, DDS, MS, PhD
Faculty mentor/Co-author e-mail ChunY@uthscsa.edu
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