Vitamin C mesotherapy with microneedling for gingival depigmentation: A case study.

Background: Surgical methods of gingival depigmentation can be challenging, particularly if the gingival phenotype is thin due to the risk of gingival recession and bone exposure. Thus, exploring alternative, non-surgical, minimally invasive treatment modalities is warranted. In dermatology, vitamin C is extensively used for depigmentation and microneedling for collagen induction, with limited literature about its usage for improving gingival esthetics. The present preliminary case study aims to explore the synergistic use of vitamin C mesotherapy with microneedling for the esthetic management of physiologic melanin gingival hyperpigmentation.

Methods: Eleven arches from six patients having anterior physiologic melanin hyperpigmentation were recruited. Microneedling was done with a lancet, followed by intra-epidermal administration of 1.5-2 mL of vitamin C in pigmented gingiva (once weekly/four sessions). Dummett oral pigmentation index (DOPI), gingival pigmentation index (GPI), pigmented surface area (PSA), and gingival luminescence (L*) were assessed at baseline and follow-up visits of 1 week, 1 month, and 3 months. Gingival thickness (GT) was recorded at baseline and 3 months. Pain, itching, and gingival color were also assessed.

Results: A significant reduction (p < 0.05) in mean DOPI, GPI, and PSA was observed from baseline to 3 months, while L* and GT increased significantly within that timeframe. Patients reported an improvement in gingival color at 1 and 3 months. Low pain and itching scores were obtained post-treatment.

Conclusion: Vitamin C mesotherapy with microneedling is a newer, minimally invasive approach that can effectively reduce gingival melanin pigmentation intensity and extent, and can potentially increase the gingival thickness.

Key points: Vitamin C mesotherapy (intra-epidermal injection) is an effective and minimally invasive treatment modality for gingival depigmentation. The adjunctive use of microneedling with vitamin C mesotherapy can potentially increase gingival thickness non-surgically. Non-surgical methods for gingival depigmentation can be chosen as an alternative to surgical methods for esthetic management of physiologic melanin hyperpigmentation in cases with thin gingival phenotype.

Plain language summary: Patients seek treatment for hyperpigmented gingiva caused by increased melanin to improve the smile esthetics. Conventional surgical methods for gingival depigmentation, however, are challenging to perform in areas of thin gingiva as there is an increased risk of gingival damage and bone exposure. Thus, exploring alternative, non-surgical, minimally invasive options will be advantageous. In dermatology, vitamin C is a popular agent for treating skin hyperpigmentation, and microneedling is a technique used for collagen induction. This preliminary case study synergistically used local vitamin C injections (mesotherapy) in gingiva with microneedling to manage gingival hyperpigmentation in eleven arches from six patients. Microneedling was done with a lancet, following which 1.5-2 mL of vitamin C was injected intra-epidermally in pigmented gingiva (once weekly for four sessions). From baseline to three months, a significant reduction in melanin pigmentation intensity and extent was observed as assessed by clinical and photographic parameters. Gingival thickness increased significantly within that timeframe. Patients reported favorable outcomes with improved gingival color with low pain and itching scores. Vitamin C mesotherapy with microneedling is a newer, minimally invasive, effective, non-surgical treatment modality for achieving gingival depigmentation and improving gingival thickness. The results need further validation in future studies with large sample sizes and long-term follow-up.