Minimally invasive non-surgical locally injected vitamin C versus the conventional surgical depigmentation in treatment of gingival hyperpigmentation of the anterior esthetic zone: A prospective comparative study

Abstract

Summary: Objective: The purpose of the current study is to evaluate the efficacy of intra-epidermal vitamin C injection in comparison to the conventional surgical technique in order to manage patients with gingival hyperpigmentation. Design: Thirty patients were enrolled seeking for gingival depigmentation with mild to severe hyperpigmented gingival tissues. Clinical evaluation was performed pre and post-operatively. Double evaluation of the depigmenting effect was performed using two different color assessment indices (Takashi and Kumar indices). The pain and itching grades were reported using VAS scale. Results: at baseline and 9 months, there was no statistical significant difference between both groups in index 1 and 2. At one month, statistical significant difference was reported in index 1 (p value = 0.003) and index 2 (p value = 0.002). Regarding pain score, statistical significant reduction in scores starting from day 1 (0.004), day 2 (0.0001) to 7 days (0.0015). Both surgical and non-surgical techniques revealed nearly equivalent results. Although non-surgical technique is less traumatic, it has several disadvantages such as time consumption - at least four weeks to achieve homogenous gingival color and needs tactile sensation. In addition, critical zones for injection have to be avoided. Conclusions: The current study examines the points of strength and weakness of both techniques in depth. The surgical technique is considered as the gold standard for management of gingival hyperpigmentation. The usage of vitamin C injection for depigmentation showed comparative results in comparison to the conventional technique. Furthermore, the usage of vitamin C could provide a long term stability of the gingival color if used after the surgical procedure. Finally, we suggest that using both techniques has to be pre-determined according to the clinical examination and the patient's desire. Further researches are recommended to study the efficacy of using booster doses for long term color stability. Keywords: Vitamin C, Intra-epidermal injection, Ascorbic acid, Gingival hyperpigmentation, Surgical depigmentation