Microneedling with Vitamin C, Soft-tissue Laser and Scalpel Technique in the Management of Gingival Pigmentation: A Prospective Interventional Study

Abstract

Introduction: Gingival hyperpigmentation is a common aesthetic concern caused by excessive melanin deposition in the gingival epithelium. Various treatment modalities have been proposed for depigmentation, including conventional scalpel surgery, soft-tissue lasers, and newer minimally invasive approaches such as microneedling with topical agents. Microneedling combined with vitamin C has recently gained attention for its potential to enhance drug delivery, promote healing, and reduce recurrence. Aim: To comparatively evaluate the clinical efficacy of gingival depigmentation using microneedling with a derma pen and topical vitamin C, soft-tissue laser and the conventional scalpel technique. Materials and Methods: The present prospective interventional study was conducted in the Department of Periodontics and Oral Implantology at Santosh Dental College and Hospital, Ghaziabad, Uttar Pradesh, India, from October 2024 to November 2025, with follow-up assessments at 24 hours, one week, one month and six months. Eleven systemically healthy patients, predominantly females, aged 18-40 years with physiologic gingival hyperpigmentation participated in the study. Of 23 patients screened, 33 hyperpigmented gingival sites in these 11 patients were included and randomly allocated to three groups: Group 1 (conventional scalpel technique), Group 2 (soft-tissue laser), and Group 3 (microneedling with derma pen and topical vitamin C). Clinical parameters-Dummett Oral Pigmentation Index (DOPI), Takashi’s Oral Pigmentation Index (TOPI), Visual Analogue Scale (VAS) for pain, and Wound Healing Index (WHI)- were recorded at baseline, 24 hours, one week, and six months, as applicable to each parameter. Intergroup comparisons were performed using one-way Analysis of Variance (ANOVA), and intragroup comparisons across time were performed using the paired t-test. Results: All three techniques produced a significant reduction in gingival pigmentation from baseline (DOPI and TOPI, p<0.001 within each group), with pigmentation scores falling to near zero in all groups by one month. By six months, however, a significant intergroup difference emerged for DOPI (p=0.013), with pigment recurrence in the scalpel (0.909±0.944) and laser (0.727±0.786) groups, whereas the microneedling group maintained a complete absence of pigmentation (0.000±0.000). Postoperative pain at 24 hours (VAS) was significantly higher after scalpel surgery (3.636±0.924) than after microneedling (1.364±0.505) or laser (0.273±0.467; p<0.001). Wound healing at one week was most favourable in the microneedling group (1.000±0.000, uneventful in all cases) compared with laser (1.545±0.522) and scalpel (1.818±0.405; p<0.001). Conclusion: Microneedling with derma pen and topical vitamin C achieved depigmentation outcomes comparable to laser and scalpel techniques, with the least postoperative discomfort, the most uneventful early wound healing, and the greatest resistance to pigment recurrence at six months-supporting its use as a minimally invasive alternative for gingival depigmentation.