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Gingival depigmentation with diode and Er,Cr:YSGG laser: evaluating re-pigmentation rate and patient perceptions



To evaluate the efficiency of depigmentation, patient perceptions, and the recurrence rates of physiological gingival pigments during a 2-year follow-up after ablative depigmentation using two laser wavelengths: diode 940 nm and Er,Cr:YSGG 2780 nm.

Materials and methods

Sixty patients exhibiting physiological melanin hyperpigmentation in the buccal maxillary gingiva were randomly divided into two equal groups treated with an Er,Cr:YSGG laser at 2780 nm, and a 940 nm diode laser, respectively. The depigmentation procedure essentially involves the ablation of epithelial tissue exhibiting melanin pigmentation. The intensity and extensity indices of gingival pigments were evaluated at baseline, 1 month, 1 year, and 2 years.


At all time points following depigmentation treatment, oral pigmentation index (OPI) and melanin pigmentation index (MPI) scores were less significantly (p <0.05) compared to the baseline in both groups. Treatment was significantly faster with Er,Cr:YSGG laser and required no anesthesia, with faster healing and less postoperative discomfort after 1-week of treatment, compared to the diode laser treatment (p <0.001). The re-pigmentation intensity and extensity were higher significantly in the Er,Cr:YSGG group than in the diode group at 1 year and 2 years (p <0.05).


Both lasers efficiently removed gingival pigments with comparable clinical outcomes and overall positive patient experience. Diode laser treatment exhibited better long-term stability of gingival color, with a lower incidence of re-pigmentation.

Clinical relevance

The color of the gingiva plays an important role in the esthetics of oral soft tissues and the overall ideal smile. Laser-assisted gingival depigmentation is an effective, comfortable, and reliable technique with good esthetical outcomes. The rate of re-pigmentation was affected by the laser wavelength and the technique used.

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  1. Iplus Waterlase, Biolase, Irvine, CA, USA.

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  3. Ubistesin™ 1/200,000, 3M ESPE AG, Germany.


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The authors wish to thank Josep Arnabat-Domínguez, Kenneth Luk, and Sana Farista for their expertise and contribution as external examiners throughout all aspects of the study.

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Authors and Affiliations



Walid Altayeb and Georgios E. Romanos substantially contributed to the conception and design of the study. Walid Altayeb was involved in clinical procedures and data collection. Ahmed Abdullah was involved in the statistical data analysis. Omar Hamadah, MHD Bahaa Aldin Alhaffar, and Walid Altayeb were involved in drafting the manuscript. All authors have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Georgios E. Romanos and Omar Hamadah critically revised the article for important intellectual content and gave final approval on the version to be submitted.

Corresponding author

Correspondence to Walid Altayeb.

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Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies involving animals performed by any of the authors. Informed consent was obtained from all individual participants involved in the study.

Competing interests

The authors declare no competing interests.

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A randomized controlled trial to evaluate the effectiveness of two types of intraoral lasers in treating gingival hyperpigmentation and the rate of re-pigmentation.

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Altayeb, W., Hamadah, O., Alhaffar, B.A. et al. Gingival depigmentation with diode and Er,Cr:YSGG laser: evaluating re-pigmentation rate and patient perceptions. Clin Oral Invest 25, 5351–5361 (2021).

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  • Ablation
  • Esthetic
  • Gingival hyperpigmentation
  • Laser
  • Melanin