Comparison of Er-YAG Laser, Air Polishing, and Surgical Excision for Gingival Hyperpigmentation

This randomized controlled clinical trial aimed to compare the effectiveness of different treatment approaches for physiologic gingival hyperpigmentation. Participants with gingival melanin pigmentation were randomly assigned to one of four treatment groups: Er:YAG laser treatment, air polishing with erythritol powder, air polishing with sodium bicarbonate powder, or conventional surgical excision. Clinical outcomes were evaluated using pigmentation index scores, digital image analysis, and color measurements at baseline and follow-up visits. Patient-centered outcomes, including postoperative discomfort and satisfaction, were also assessed. The study sought to determine whether air polishing techniques could provide clinical outcomes comparable to conventional treatment approaches while improving patient comfort and satisfaction.

Inclusion Criteria: * Individuals aged between 18 and 50 years * Systemically healthy individuals * Presence of physiologic gingival hyperpigmentation in the anterior maxillary or mandibular gingiva * Individuals seeking esthetic treatment for gingival pigmentation * Presence of adequate oral hygiene and periodontal health before treatment * Willingness to participate in the study and provide written informed consent * Agreement to attend all follow-up visits during the study period Exclusion Criteria: * Presence of systemic diseases or conditions that may affect wound healing * Smoking or use of tobacco products * Pregnancy or lactation * History of periodontal therapy or gingival depigmentation treatment in the study area * Presence of active periodontal disease or gingival inflammation at baseline * Use of medications affecting gingival tissues or wound healing * Individuals with non-physiologic oral pigmentation associated with systemic disorders, medication use, or syndromic conditions * Inability or unwillingness to comply with study protocol and follow-up visits