Comparative Evaluation of Microsurgery vs Conventional Surgical Technique of Gingival Depigmentation on Pink Aesthetics and Patient-Related Outcomes: A Case Series.

Introduction: Over the decades many non-surgical as well as surgical techniques have been developed to remove melanin-induced hyper-pigmentation of gingival tissue with comparable efficacies. Nowadays, minimally traumatising the surgical field and gaining maximum outputs with help of microsurgical instruments has attained a level of utmost importance in any surgical procedure. This case series is therefore aimed at determining the clinical, aesthetic and patient-related outcomes of gingival depigmentation performed using microsurgery vs conventional surgical technique.
Methods: Five patients with gingival melanin pigmentation participated in this case series. Depigmentation was performed using a conventional approach by #15 blade through unaided vision in one segment and using keratome and magnification loupes through a microsurgical approach in the other segment. Variations in Dummett Oral Pigmentation Index (DOPI), Hedin Melanin Index (HMI), clinical parameters such as bleeding, redness, swelling, wound healing, gingival colour, gingival morphology, periodontal parameters, patient-related outcome measures (PROMs) such as post-operative pain perception/discomfort on a visual analog scale (VAS), and patient’s preference/ aesthetic satisfaction were considered for each patient at 24 hours, 1 week, 1 month, 3 months, and 6 months.
Results: All the reported cases demonstrated significant improvement in clinical parameters at the end of 6 months follow-up (p<0.05). Better improvements in clinical parameters were observed in the segments treated with microsurgical technique at 24 hrs, 1 week, and 1 month. Three out of five patients reported less post-operative discomfort (at 24 hours and 1 week) after the microsurgical approach. Higher DOPI (2.1±0.7) and HMI (1.8±0.7) scores reflecting reoccurrence were observed at the end of 6 months in two cases treated with conventional technique. No difference between the treatment modalities was found in relation to overall aesthetic satisfaction of the patient.
Conclusions: A microsurgical approach for gingival depigmentation is associated with retaining the clinical outcomes longer than conventional approach. Post-operative pain is reported to be less using microsurgery, but aesthetic outcomes are similar.