Clinical and patient-reported outcomes of microneedling with ascorbic acid versus scalpel technique for gingival depigmentation: A randomized clinical trial

OBJECTIVES: To compare gingival depigmentation achieved with microneedling and topical ascorbic acid (MN + AA) versus the conventional scalpel technique, along with evaluation of repigmentation and patient-reported outcomes (PROMs). Gingival thickness (GT) and dermal-gingival pigmentation associations were also explored. METHODS: Twenty-six participants with maxillary physiologic gingival hyperpigmentation were randomized (1:1) to scalpel or MN + AA using an automated microneedling pen. Gingival pigmentation was assessed clinically (Dummett-Gupta Oral Pigmentation Index [DOPI], Gingival Pigmentation Index [GPI]); photographically (Pigmented Surface Area [PSA], Lightness [L]), and using a melanin meter (Gingival Melanin Meter Score, GMMS) at baseline, 1, 3, and 6 months. Primary outcome was change in DOPI at 1 month. Gingival Thickness (GT) and Dermal Melanin Meter Scores (DMMS) were recorded. RESULTS: Twenty-three participants completed the study. The scalpel group showed greater reduction in DOPI, GPI, PSA, GMMS, and a greater increase in L at 1 month (P < 0.05). Incomplete depigmentation was observed at some gingival sites with MN + AA. Repigmentation occurred in both groups; DOPI and GMMS were significantly lower in scalpel group at 3 months, with the difference in DOPI persisting at 6 months. Pain, itching, and discomfort scores were modestly higher in the scalpel group, with significant for discomfort on day 3. Color improvement and satisfaction scores were high in both groups. GT increased significantly in the MN + AA at 6 months. DMMS and GMMS were not correlated at any timepoint. CONCLUSION: Both treatments significantly reduced gingival pigmentation at 1 month, with the scalpel technique showing lower pigmentation intensity at 6 months. Both treatments were well tolerated with favorable PROMs. CLINICAL TRIAL REGISTRATION NUMBER: CTRI/2024/05/066602 (ctri.nic.in).