So sánh kết quả điều trị nhiễm sắc nướu bằng laser diode 940 nm và laser Er,Cr:YSGG 2780 nm: thử nghiệm lâm sàng ngẫu nhiên chia nửa miệng

Abstract

Gingival pigmentation caused by excessive melanin deposition is an increasingly common esthetic concern, and laser ablation is currently regarded as the preferred treatment modality; however, direct comparative evidence between diode and Er,Cr:YSGG lasers in Vietnamese patients remains scarce. Objectives: To compare the outcomes of gingival depigmentation performed with a 940 nm diode laser and a 2780 nm Er,Cr:YSGG laser. Materials and methods: A randomized controlled split-mouth clinical trial was conducted on 30 patients aged 18 years or older with bilateral diffuse gingival pigmentation attending the Dental Clinic of Can Tho University of Medicine and Pharmacy Hospital from March 2023 to May 2024. Each patient received both treatments simultaneously on randomly allocated contralateral sides, yielding 30 quadrant pairs per modality. Outcomes were assessed using the Dummett Oral Pigmentation Index (DOPI), the Hedin melanin classification, the Landry - Turnbull - Howley healing index, the visual analogue scale for pain and patient-reported satisfaction, at immediate post-treatment, day 1, day 7, 1 month and 3 months. Results: Both lasers produced a marked reduction in DOPI scores at every follow-up compared with baseline (p<0.001). At day 7, the reduction was significantly greater in the diode group (0.37 ± 0.49 versus 0.67 ± 0.55; p=0.029), whereas no significant difference was observed at the other time points (p>0.05). The diode group showed a lower rate of gingival swelling on day 1 (10.0% versus 33.3%; OR=4.50; 95% CI 1.1-18.5; p=0.028) and a higher rate of excellent healing at 3 months (83.3% versus 26.7%; p<0.001). Patient satisfaction regarding speech at one week, eating at one day and gingival colour at three months was consistently higher in the diode group (p<0.05). No severe complication occurred; bleeding and pain had resolved completely in all patients of both groups by day 7. Conclusions: Both lasers are safe and effective for gingival depigmentation. The 940 nm diode laser offers advantages in early healing, reduced swelling, stability of the depigmentation result and patient satisfaction, and may therefore be preferred.