This randomized controlled clinical trial aimed to compare the effectiveness of different treatment approaches for physiologic gingival hyperpigmentation. Participants with gingival melanin pigmentation were randomly assigned to one of four treatment groups: Er:YAG laser treatment, air polishing with erythritol powder, air polishing with sodium bicarbonate powder, or conventional surgical excision. Clinical outcomes were evaluated using pigmentation index scores, digital image analysis, and color measurements at baseline and follow-up visits. Patient-centered outcomes, including postoperative discomfort and satisfaction, were also assessed. The study sought to determine whether air polishing techniques could provide clinical outcomes comparable to conventional treatment approaches while improving patient comfort and satisfaction.

Physiologic gingival hyperpigmentation is a common esthetic condition caused by excessive melanin deposition within the gingival epithelium. Several treatment approaches have been proposed to eliminate gingival pigmentation, including conventional surgical techniques, laser applications, and minimally invasive air polishing systems. Although conventional surgical excision and laser therapy are widely used, alternative approaches that may reduce postoperative discomfort while maintaining comparable clinical outcomes remain of clinical interest.

The purpose of this randomized controlled clinical trial was to compare the clinical effectiveness and patient-related outcomes of four different treatment modalities for gingival hyperpigmentation: Er:YAG laser treatment, air polishing with erythritol powder, air polishing with sodium bicarbonate powder, and conventional surgical excision.

Eligible participants diagnosed with physiologic gingival melanin hyperpigmentation were randomly allocated into four parallel treatment groups. Clinical pigmentation changes were assessed using standardized clinical photographs, pigmentation index scoring systems, digital color analysis, and quantitative color measurements during baseline and follow-up examinations over a three-month period. Secondary evaluations included postoperative discomfort assessment and patient satisfaction measurements.

The study was designed to evaluate whether minimally invasive air polishing approaches could achieve clinical outcomes comparable to established treatment methods while providing improved patient comfort during the healing period.

Inclusion Criteria:

• Individuals aged between 18 and 50 years
• Systemically healthy individuals
• Presence of physiologic gingival hyperpigmentation in the anterior maxillary or mandibular gingiva
• Individuals seeking esthetic treatment for gingival pigmentation
• Presence of adequate oral hygiene and periodontal health before treatment
• Willingness to participate in the study and provide written informed consent
• Agreement to attend all follow-up visits during the study period

Exclusion Criteria:

• Presence of systemic diseases or conditions that may affect wound healing
• Smoking or use of tobacco products
• Pregnancy or lactation
• History of periodontal therapy or gingival depigmentation treatment in the study area
• Presence of active periodontal disease or gingival inflammation at baseline
• Use of medications affecting gingival tissues or wound healing
• Individuals with non-physiologic oral pigmentation associated with systemic disorders, medication use, or syndromic conditions
• Inability or unwillingness to comply with study protocol and follow-up visits

Individual participant data generated during this study will not be publicly shared because no formal data-sharing plan has been established and the study was conducted as part of an institutional academic research project.