Influence of gingival thickness on clinical outcomes following surgical scalpel depigmentation a prospective comparative clinical study

Abstract

Gingival hyperpigmentation is a frequent esthetic issue, but the impact of gingival thickness on outcomes of depigmentation procedures has not been studied extensively. This study aimed to investigate and compare the clinical outcomes of surgical scalpel depigmentation in patients with thick versus thin gingival tissue, as classified by the probe transparency method. In this prospective comparative clinical study, 40 patients with physiologic gingival melanin hyperpigmentation were recruited and classified into a thick gingiva group ( n = 20) or a thin gingiva group ( n = 20) through the probe transparency method. All patients were treated with surgical scalpel depigmentation. All patients were treated with surgical scalpel depigmentation. The primary outcome was postoperative pain assessed by VAS. Secondary outcomes included DOPI, Hedin Melanin Index, wound healing, bleeding time, and repigmentation, evaluated at baseline, one week, and three months postoperatively. Both groups showed significant reductions in DOPI and Hedin Melanin Index scores at one week and three months ( p < 0.001). The thin gingiva group reported significantly higher VAS pain scores at 24 h (4.65 ± 1.10 vs. 3.40 ± 0.92; p = 0.001) and one week (2.35 ± 0.95 vs. 1.20 ± 0.68; p = 0.030). No significant intergroup differences were found in wound healing or bleeding time. Repigmentation at three months was higher in the thin group (30%) than the thick group (15%), though not statistically significant ( p = 0.235). Surgical scalpel depigmentation effectively reduces gingival melanin hyperpigmentation regardless of gingival thickness. However, patients with thin gingival tissue may experience greater postoperative discomfort. A preliminary, non-statistically significant trend toward higher repigmentation was observed in the thin gingiva group; this exploratory finding requires confirmation in adequately powered studies with longer follow-up. These results should be interpreted within the constraints of the probe transparency classification method used.