Ascorbic Acid Versus Diode Laser in the Treatment of Gingival Hyperpigmentation
Condition: Gingival Hyperpigmentaion
MeSH terms: Hyperpigmentation
Study type: Interventional
Phase: Phase 4

Summary: 
      Vitamin C affect the melanocytes function not the number while diode laser cause melanocytes
      destruction. Although diode laser and vitamin C have proved their effectiveness in
      depigmentation in previous studies, there are no published studies compared the effect of
      diode laser and vitamin C on melanocytes and melanosomes clinically and histologically.
    

Detailed description: 
      Cosmetic dentistry is usually centered on aesthetic restorative procedures but it may also
      involve the appearance of the gingiva, especially when it is located in the anterior labial
      region. Oral pigmentation may be physiological or pathological in nature. Better esthetics
      results of depigmentation were achieved with diode laser than conventional scalpel and with
      rotary abrasion, also diode laser is effective and safe in removal of gingival
      hyperpigmentation and repigmentation doesn't occur.When choosing a depigmenting agent, it is
      important to differentiate between substances that are toxic to the melanocyte and substances
      that interrupt the key steps of melanogenesis. Vit. C interacts with copper ions at the
      tyrosinase-active site and inhibits action of the enzyme tyrosinase, thereby decreasing the
      melanin formation.

      This randomized comparative clinical study was conducted on ten patients attending the
      outpatient clinic of the Oral Medicine and Periodontology department, Faculty of Dentistry,
      Ain Shams University and seeking treatment for their gingival hyperpigmentation for esthetic
      reason.

      The study was conducted after receiving an ethical clearance from the Research Ethics
      Committee of Ain Shams University, Faculty of Dentistry; that the study follows the ethical
      guidelines of research. The patients clearly understood the purpose of this study and signed
      an informed consent.

      According to the study results, vit C treated patients showed no or little repigmentation
      after six months post treatment. Conversely, diode laser treated patients showed significant
      recurrence of gingival pigmentation after six months post treatment. These could be
      attributed to the blocking effect of vitamin C on the existing melanocytes to form new
      melanoseomes, however diode laser cause removal of the existing melanocytes that may cause
      formation of new melanocytes (migrating from neighboring melanocytes from the adjacent area
      of the gingiva) with the ability of forming new melanosomes and causing repigmentation.
      Histopathological assessment revealed that both treatment modalities caused significant
      reduction in MAF after six months post treatment.
    

Intervention name(s): Ascorbic Acid 500 MG; diode laser
Intervention type(s): Drug; Device
Intervention description(s): ascorbic acid is vitamin that can cause gingival depigmentation; diode laser is soft tissue laser case photothermolysis of melanoctes
Intervention MeSH terms: Ascorbic Acid
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: treating of gingival hyperpigmentation by two different methods
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: ascorbic acid; diode laser; gingival hyperpigmentation