ORIGINAL ARTICLE Comparison of gingival depigmentation with Er,Cr:YSGG laser and surgical stripping, a 12-month follow-up Leila Gholami 1 & Somayeh Ansari Moghaddam 2 & Mohammad Ayoub Rigi Ladiz 2 & Zohreh Molai Manesh 3 & Hadi Hashemzehi 4 & Alireza Fallah 5 & Norbert Gutknecht 6 Received: 18 August 2017 / Accepted: 1 April 2018 # Springer-Verlag London Ltd., part of Springer Nature 2018 Abstract Gingival melanin hyperpigmentation is an esthetic concern for many individuals. In this study, we compared the standard surgical removal method with two different Er,Cr:YSGG laser settings in order to find the best treatment method. In 33 dental arches, the following three treatment groups were comparatively evaluated: (1) surgical stripping, (2) removal with laser setting 1 (4.5 W, 50 Hz, 100% water, 80% air, 60 μs, 800 μm Tip; MZ8), and (3) laser setting 2 (2.5 W, 50 Hz, 20% water, 40% air, 700 μs, 800 μm Tip; MZ8). We comparatively evaluated pain, patient satisfaction and wound healing, treatment time, and the amount of bleeding. Re- pigmentation was evaluated after 1 and 12 months by Hedin and Dummet pigmentation scores. Laser setting 1 had the best results regarding pain and patient satisfaction, although not statistically significant (P > 0.05). Wound healing results were better using lasers compared to surgical stripping (P < 0.05). Laser setting 1 was a faster procedure with mild amounts of bleeding. The least amount of bleeding was seen with laser setting 2. After 1 month, only two cases of the laser setting 2-treated areas showed an isolated pigmented area in the papilla; at 12 months, the mean Hedin indexes were still less than 2 and mean Dummett index less than 1 in all treatment techniques, with the lowest scores seen in the laser setting 1 sites. Based on our results, Er,Cr:YSGG laser can be more convenient for gingival depigmentation compared to surgical blade. Although not statistically significant, laser setting 1 with shorter pulse duration and higher water spray showed better overall results. However, laser setting 2, with longer pulse duration and less water spray, resulted in better coagulative effects and can be used to control bleeding wherever necessary in clinical practice. Keywords Laser . Wound healing . Surgical blade . Gingival depigmentation Introduction Health and appearance of gingival tissues influence the attrac- tiveness of a smile. Gingival color is one of these factors that is determined by the number and size of underlying blood ves- sels, epithelial thickness, degree of keratinization, and residing pigments within the gingiva. Melanin, carotene, reduced he- moglobin, and oxyhemoglobin are the main pigments found in the oral mucosa [1, 2]. Melanin is a brown pigment synthe- sized in the cytoplasm of melanocytes. After activation of melanocytes by factors like stress hormones, sunlight, etc., chemical messengers like melanocyte stimulating hormone are produced. Melanocytes are then induced to create melanin-containing granules called melanosomes. This pro- cess occurs when the enzyme tyrosinaseconverts tyrosine into a molecule named dehydroxyphenylalanine (DOPA). Tyrosinase also changes DOPA into a secondary chemical dopaquinone. After a series of reactions, dopaquinone is con- verted into either dark melanin (eumelanin) or light melanin (pheo-melanin). Melanin is then transferred to keratinocyte cells of skin and oral epithelium [3]. Excessive melanin depo- sition in the basal and suprabasal cell layers of the gingival epithelium creates pigmented areas in gums [4]. We normally consider this kind of hyperpigmentation of the gingiva a * Hadi Hashemzehi Hashemzehi@gmail.com 1 Department of Periodontology, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran 2 Oral and Dental research center, Department of Periodontology, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran 3 Dentist, Oral and Dental research center, Zahedan University of Medical Sciences, Zahedan, Iran 4 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran 5 Laser Dental Center, Aachen, Germany 6 Department of Conservative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen, Aachen, Germany Lasers in Medical Science https://doi.org/10.1007/s10103-018-2501-1