Gummy smile and gingival depigmentation treatment using Soft Tissue Diode Lasers with two different wavelengths

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Mossaad, Moustapha A. Abdelrahman, Shadia A. Elsayed This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7437674/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim : In the present study we used two different wavelengths of Diode laser (visible 460 nm & infrared 980 nm) for management of Gummy smile patients suffering from dark colored gingiva. Methodology: This study included 20 female patients divided into two groups. Group A with 10 patients suffering from gummy smile more than 4 mm and darkened gingiva treated using 980 nm wavelength and Group B suffering from gummy smile surgically removed by 460 nm wavelength then dark gingiva pigmentation removal using 980 nm wavelength. Evaluation was made clinically and photographically preoperatively then one & two weeks postoperatively for measuring the lip gingival distance & periodontal pocket depth, Oral pigmentation index (OPI) and Melanin pigmentation index (MPI). VAS scale was used for postoperative pain intensity from 0-10 in both groups. Results: All patients are entirely female, with a mean age of 26.8 years and a standard deviation of 4.8 in group A and 30/2.78 in group B. There was no statistical difference in age between the two groups. the preoperative and postoperative mean values for the following study variables (lip gingival distance, Pocket PDP Depth(mm), OPI, and MPI) did not differ statistically between groups (P>0.05). VAS differ postoperatively between both groups where there was a significant difference with mean variance in prefer to group B and p value = 0.015. Our results showed that there was no statistical significance difference between study variables although mean VAS measurements were more preferable in group B than group A Conclusion : Diode laser is an effective, fast and safe solution for gingival problems, either gingivectomy or gingival depigmentation rather than traditional surgical methods. Using 2 different wavelengths had not differ statistically however it was is less painful more comfortable to the patients and produce rapid healing than using a single one. Diode laser Gingivectomy Gum depigmentation Gummy smile Figures Figure 1 Introduction Dental lasers have been widely used in different dental fields as they save time and effort of the operator. Soft tissue lasers as Diode is becoming more popular as it has been used by many dentists in their practice. Common uses are gingivectomy, frenectomy and gum depigmentation The gingiva is an essential part of the smile and recently patients both genders are becoming more aware and concerned of their aesthetics. Lasers are used as a principle tool or adjunct in many dental procedures. Various laser therapies require different wavelengths either on soft or hard tissues. Applications of soft tissue include gingivectomy, gum depigmentation, frenectomies, tongue ties and biopsies. Laser gingivectomy is the most common use with dental lasers. Advantages of surgical lasers are they save time and energy for the operator as well as less postoperative pain and bleeding for the patient by the action of phototherapy and heat coagulation, besides the bactericidal effect of laser in tissues. 1–3( 1 – 2 ) They facilitate the treatment and promote healing. Surgical lasers that are used in the dental field are Erbium-YAG, CO2 & Diode lasers. Soft tissue lasers include Diode which usually operate from 450–980 nm. Patients are becoming increasingly aware of facial aesthetics and they are seeking to improve their smiles. 2,4,5 ( 3 – 4 ) A common complaint now in dental practice comes from patients who are unsatisfied with their short clinical crowns due to either gingival hyperplasia or passive eruption which occurs due to failure of migration of gingiva. Definition of gummy smile is showing more than 2–4 ml of the gingiva while smiling. It is more common in females rather than males and it occurs usually in upper arch only. Cutting lasers are precise and effective eliminating the need for surgical scalpels and sutures. 6,7 ( 5 – 6 ) The color of the gingiva is determined by size and number of blood vessels, thickness of epithelium, keratinization degree, and melanin pigments degree present in deep layers of epithelium. Melanocytes which are responsible for the brown color or dark pigment located in basal layers of epithelium, are the cells that produce melanin pigments which play a main role for pigmentation and color of gingiva. They are more common in maxilla than the mandible. They are also more prevalent in dark skin patients 8,9( 7 – 8 ) Gum pigmentation gives an annoying appearance to patients who complain of brown or dark spots area in their gums while smiling. This is either due to racial pigmentation and excessive melanin produced in the gingiva, physiologic due to smoking, endocrinal hormonal disturbance, diseases as HIV. Time of healing varies with individuals. In Patients with physiological melanotic gingiva, pigmentation is often reduced after gingival healing. 10,11 (9–10 ) Long wavelengths 980 nm have more affinity for hemoglobin. There are different techniques that have been used for depigmentation of gingiva such as scalpel technique, rotary instruments, electrosurgery, and different types of lasers. Each technique has its own advantages and disadvantages. Diode laser with different wavelengths has been commonly used safely & effectively with less operation and healing time 12,13 . ( 11 – 12 ) Therefore In the present study, we used two different wavelengths of Diode laser, visible 460 nm & infrared 980 nm for management of Gummy smile which is a common problem that gives an annoying appearance to patients and Dark color gingiva, which also causes embarrassment while smiling. Methodology In this study Diode laser Woodpecker LX16 Plus device * China was used. This study included 20 female patients divided into two groups using two different diode laser wavelengths as gum treatment modalities. Patients were informed about the nature and potential risks of the proposed surgical procedures and they also reviewed and signed an informed consent form with clear explanation of the outcomes. The Declaration of Helsinki guidelines were followed throughout the study. The study was approved by The Medical Research Ethical Committee at National Research Centre Cairo Egypt approval MERC # 02411123. Twenty female patients age ranging 19–35 years old presented at clinic with darkened gummy smile due to accumulation of melanin in the basal cell layer of the oral mucosa and came seeking for gum contouring and depigmentation with laser. Patients complained of dark patches in the whole anterior labial mucosa. The patients were systemically free, nonsmoking and not taking any medications The gingival display showed 4–5 mm on smiling which was annoying to the patient. Local anesthesia was applied with 2% lidocaine with infiltration mood from upper right second premolar of to upper left second premolar. WHO Periodontal probe measurements were recorded at the CEJ. Proper scaling and cleaning were performed before surgical procedures were performed. Exclusion criteria were patients with periodontal disease, patients with bleeding or systemic diseases, drug intake with side effects of gingival enlargement. Group A Ten female patients age ranging 25–35 years old presented at clinic with gummy smile and dark gingiva came seeking for gum contouring & gum depigmentation with laser. The gingival display showed more than 4–5 mm on smiling which was annoying to the patient.. Local anesthesia was applied with 2% lidocaine with infiltration mood from upper right second premolar of to upper left second premolar. Diode laser 980 nm wave length was used for both gingivectomy followed by depigmentation. WHO Periodontal probe measurements were recorded at the CEJ. Proper scaling and cleaning were performed before surgical procedures were performed. Exclusion criteria from the study were patients with periodontal disease, patients with bleeding or systemic diseases, drug intake with side effects of gingival enlargement. Gingivectomy technique Diode laser using 980 nm wavelength, Power 1.5 W, 45 Joules energy with continuous mood with sweeping motion in a horizontal manner parallel to the root surface for gingivectomy followed by 980 nm wavelength for gum depigmentation. The laser tip is used as a brush movement from distal to mesial to distal. Diode laser 980 nm has the best absorption for melanin and hemoglobin besides its coagulation effects without bleeding or the need for postoperative sutures. Activation of the laser tip for initiation with carbon paper is needed. All laser safety precautions were applied as wearing protective eye shields by the operator, assistant and the patient. Saline irrigation is advised to be used along the procedure for less charring which is eliminated with a wet gauze for removing the de-epithelized tissue. Fumes and burning smell caused little patient discomfort. Depigmentation technique Diode laser with continuous mode and short wavelength 980 nm, power 2 Watts, Energy 120 Joules was applied. The laser tip is used as a brush movement from distal to mesial starting from upper second premolar till the central incisor bilaterally. The laser helped to visualize the results immediately due to minimal bleeding. For depigmentation; continuous mood and sweeping motion in a horizontal manner parallel to the root surface was applied for gum depigmentation Saline irrigation is advised to be used along the procedure for less charring which is removed with wet gauze. Patients were advised to take antibiotics, analgesics and anti-inflammatory and mouth wash as a postoperative care for 5 days. The following parameters were measured in terms of time of procedure, bleeding during procedure, postoperative pain, time of healing, gingival color and contour. Group B Ten female patients age range between (30–40) years presented at clinic with gummy smile and dark pigmented gingiva due to accumulation of melanin in the basal cell layer of the oral mucosa. Patients complained of large display of gingiva & dark patches in the whole anterior labial mucosa. The patients were systemically free, nonsmoking and not taking any medications. Gingivectomy technique Diode laser wavelength 460 nm, power 2 Watts, Energy 120 Joules. Continuous mood with sweeping motion in a horizontal manner parallel to the root surface. It causes denaturation of proteins leading to tissue shrinkage and retention as well as local conduction of heat. It also doesn’t need activation with carbon paper and it provides working with faster speed & more effective cutting giving better results. The laser helped to visualize the results immediately due to minimal bleeding. Saline irrigation is advised to be used along the procedure for less charring which is removed with wet gauze. Depigmentation technique Diode laser 980 nm has the best absorption for melanin and hemoglobin besides its coagulation effects without bleeding or the need for postoperative sutures. Preoperative local anesthetic infiltration was applied with 2% lidocaine with 1/10,000 epinephrine. The laser tip is used as a brush movement from mesial to distal. Activation of the laser tip for initiation with carbon paper is needed. The laser helped to visualize the results immediately due to minimal bleeding. Saline irrigation is advised to be used along the procedure for less charring which is removed with wet gauze. All laser safety precautions were applied as wearing protective eye shields by the operator, assistant and the patient. Fumes and burning smell caused little patient discomfort. Preoperative local anesthetic infiltration was applied with 2% lidocaine with 1/10,000 epinephrine. Technique: after gingivectomy with 460nm Diode laser was done as in group A, then Diode laser using 980 nm wavelength, Power 1.5 W, 45 Joules energy with continuous mood with sweeping motion in a horizontal manner parallel to the root surface was applied for gum depigmentation. Intra and postoperative care All laser safety precautions were applied as wearing protective eye shields by the operator and the patient. Activation of the laser tip for initiation with carbon tip. A wet sterile gauze used for removing the de-epithelized tissue. Fumes and burning smell caused little patient discomfort. No periodontal pack was needed and patients were instructed to avoid smoking as well as hot or acidic and spicy food. Follow up after one & two weeks was made with very good results and no complications. Pink healthy gingiva was observed with high patient satisfaction. Evaluation was made preoperatively versus postoperatively clinically and by intraoral photographs. Figure (5–9) Methods of evaluation: Measurements of the vertical exposure of the gingiva from the inferior border for the upper lip to the free gingival margin of maxillary anterior teeth were recorded preoperatively and compared to postoperatively after one week follow up visit. Periodontal probing depth and bleeding points were measured with an explorer for keratinized gingiva of anterior teeth using UNG − 15 probe before surgical procedure and compared to after one week follow up visit. VAS scale was used for postoperative pain intensity from 0–10 in both groups. To ensure full healing and effectiveness, Clinical examination and digital photos were taken intraorally and extraorally preoperatively and postoperatively after one week & two weeks follow up period to all cases. OPI index & MPI index were recorded for amount of gingival pigmentations The Oral Pigmentation Index (OPI) was used to analyze the postoperative results. Score 0 indicates no clinical pigmentation (pink-colored gingiva), Score 1 indicates mild clinical pigmentation (mild light brown color), Score 2 indicates moderate clinical pigmentation (medium brown or mixed pink and brown), and Score 3 indicates heavy clinical pigmentation (deep brown or bluish-black color). Melanin Pigmentation Index MPI was used as follows: Score 0 indicates no pigmentation. Score 1: a single unit(s) of pigmentation in the papillary gingiva with no expansion between surrounding solitary units and Score 2: creation of a continuous ribbon spreading from adjacent solo units. Statistical analysis : The software program SPSS version 20.0.0 was used to analyze all test data. The mean and standard deviation of the preoperative and postoperative interventions were determined, and a comparison of the preoperative and postoperative measurements was made for each group. The independent t test was used to examine the mean difference between the two tested groups' interventions; a P value of less than 0.05 was set. Results All patients are entirely female, with a mean age of 26.8 years and a standard deviation of 4.8 in group A and 30/2.78 in group B with age range 19–35 years.. There was no statistical difference in age between the two groups. Postoperative evaluation was completed after two weeks postoperatively. The surgery was well tolerated by all patients, with no intraoperative complications. Clinical observation showed after 48 hours all wounds were covered with fibrinous plaque and erythematous halo which remained for the first week. After the second week all wound surfaces were pale pink with no evidence of pain or bleeding. Postoperative evaluation was completed after 2 weeks postoperatively. Observation of healthy pink healed gingiva occurred with no complications and a high patient satisfaction rate. Figure (1–4) It was noted that in both groups, that the tissue contour was normal and only at the 24th hour a very slight edematous contour of the incised gingival surface was reported. In group B all cases postoperative gingival wounds were covered with fibrinous plaque and an erythematous halo, for the 72nd hour, a granulated surface in the 1st week was reported. Complete healing was reported after the second week, all wound surfaces were completely healed and had a normal pale pink. VAS scale was used for evaluation of pain (0–10) depending on postoperative intensity. Table (1) shows that the preoperative and postoperative mean values for the following study variables (lip gingival distance, Pocket PDP Depth(mm), OPI, and MPI) did not differ statistically between groups (P > 0.05). VAS differ postoperatively between both groups where there was a significant difference with mean variance in prefer to group B and p value = 0.015 Discussion Excess gingiva could be related to passive eruption of teeth, hormonal disturbance, some drug interaction and short lip. Diode laser is a simple, safe and effective method for procedures. It offered precise cutting with absence of bleeding without the need for a surgical blade. Short wavelength 460 nm (visible blue range) has more cutting efficiency as it is more absorbed by protein in the tissue. It causes denaturation leading to tissue shrinkage and retention as well as local conduction of heat. It also doesn’t need activation with carbon paper and it provides working with faster speed & more effective cutting giving better results. Gingival pigmentation could be caused by smoking, racial pigmentation, endocrine disturbance, drug adverse effect and a disease such as HIV. Diode laser has the best absorption for melanin and hemoglobin besides its coagulation effects without bleeding or the need for postoperative sutures. Latest laser devices offer different wavelengths facilitating multiple uses instead of a single wavelength. The blue range visible (450 nm) shorter wavelength 9 7 . It is more precise & it has a higher cutting efficiency in soft tissues. The Infrared range (980nm) longer wavelength has more affinity towards melanin and hemoglobin, reaching deeper tissues with minimal bleeding. Gummy smile is defined as showing more than 2 mm of the gingiva while smiling. Gum contouring with laser is the most common use for surgical soft lasers. Patients are becoming more aware of facial and dental aesthetics showing high demand for their smiles. The health and appearance of the gingiva complete the smile appearance. Studies have shown that short wavelength 488 nm interacts with protein components and causes denaturation of long chain molecules. Charring and cracking can result and might cause damage to the tooth surface that’s why it should be protected. This leads to tissue shrinkage and local conduction of heat, while longer wavelength 980 nm causes extensive destruction by water ablation. In observing cross sections, the slit obtained at cutting is almost spherical shape in short wavelength and v-shaped in long wavelength. In longer wave length, heat distribution is achieved through ablation away from the incision site. There is a lower risk of deep heat effects but a higher risk of tissue rupture due to water evaporation. (9–10) According to previous studies formation of collagen and organization of new gingival tissues occurred within 3–4 weeks especially after gingivectomy. In the present study new gingival tissue occurred after 2–3 weeks after surgical procedures. Lione, R. et al., in 2020 14 , (13) compared the use of diode lasers with conventional surgery, evaluating the effectiveness of gingivectomy as an adjunct to nonsurgical periodontal treatment in the management of gingival enlargement during orthodontic treatment. They discovered that the use of both surgical gingivectomy using the scalpel and laser gingivectomy were more effective in controlling gingival inflammation than nonsurgical periodontal management. In the control group, they observed a greater improvement in the periodontal parameters during 3 months, depending on a self-care approach for the management of gingival enlargement. Bhasker et al., in 2021 , 15 described a clinical case where they compared the scalpel and Diode laser use for treatment of gingival enlargement ( 14 ) Diode laser provided adequate hemostasis and accurate incision margins. The authors reported a lack of swelling, pain, less scar tissue formation, and very good wound healing. The wounds induced by laser heal via reparative matrix proteins synthesis. The wound contraction in areas treated with laser was less compared to the surgical scalpel areas. As regard to bleeding, it was minimal in most of the cases and was almost negligible clinically. Postoperative pain levels were low or absent. There was lack of postoperative hemorrhage on probing after the first week in all the examined cases. Tissue recovery in terms of tissue color, contour and appearance of the wound was asymptomatic within the limitations of our pilot study, probably due to the additional bactericidal effect of the laser with no recorded complications. 16 ( 15 – 16 ) El Tayeb et al , 17 ( 17 ) have compared between using Diode laser 890 nm to Co2 10,600 & Erbium 2780 nm lasers in gingival depigmentation and concluded that both methods were successful. In the surgical/ablative approach, the gingival epithelium was vaporized with melanin. The second approach which is non-surgical/ non-ablative, using a specific wavelength, such as near infrared diode laser (890 nm), degranulates the melanosomes or denatures melanin without de-epithelization of the gingival epithelium. Complete hemostasis was achieved using diode laser, while mild bleeding was observed in some cases with Erbium, Cr:YSGG lasers. There’s an advantage with Diode lasers that they can penetrate much deeper layer within the soft tissue, causing sustained heat that provides rapid vessel shrinkage, in contrary to the Erbium: YAG laser. Also, Diode laser wavelengths are more absorbed by hemoglobin 18 . ( 18 ) Gingival hyperpigmentation is a major concern for quite a number of patients, as a relevant cosmetic or aesthetic need. In the present study the authors faced some limitations as regard number of cases & long term follow up. In previous studies they faced some recurrence and repigmentation in group of patients with Diode lasers after few months, meanwhile the group of patients with ablative CO2 or Erbium showed more retention of the results with less relapse rate. 19,20 ( 19 – 20 ) In the present study we concluded that using two different wavelengths of laser is more specific and more beneficial to the patients rather than using a single nonspecific wavelength. Diode soft laser is much more preferred than the old traditional surgical methods as diamond burs and scalpels for less operation times and less bleeding for a better operative field, eliminating the need for postoperative sutures or periodontal packs, also less pain and postoperative complications for the patients. There are several diode laser wave lengths available for dentistry. In the market as 460 nm, 810 nm, 940 nm, and provided satisfactory results for gingivectomy and gum depigmentation; dentist training and expertise is crucial for the appropriate selection and the intended outcome. Conclusion Diode laser is an effective, fast and safe solution for gingival problems specially crown lengthening and depigmentation, either gingivectomy or gingival depigmentation rather than traditional surgical methods. Using 2 different wavelengths is more precise & beneficial than using a single wavelength. Declarations No Funding declaration Clinical trail number not applicable Author Contribution Author A: Surgical laser procedures on patients Author B: Patients selection & preparation with data collection and follow upAuthor C: Documentation & Statistical analysisAuthor contribution declaration not foundReady upon sending to them emails for approval References Low SB. 4 - Lasers in Surgical Periodontics. Princ Pract Laser Dent . January. 2015;51–66. 10.1016/B978-0-323-29762-2.00004-8 . Capodiferro S, Kazakova R. Laser-Assisted Gingivectomy to Treat Gummy Smile. Dent Clin North Am. 2022;66(3):399–417. 10.1016/j.cden.2022.02.004 . Gingivectomy - an overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/medicine-and-dentistry/gingivectomy . Accessed July 14, 2024. Aldelaimi TN, Khalil AA. Clinical Application of Diode Laser (980 nm) in Maxillofacial Surgical Procedures. J Craniofac Surg. 2015;26(4):1220–3. 10.1097/SCS.0000000000001727 . Madi M, Mahmoud MM. The evaluation of healing effect of low-level laser treatment following gingivectomy. Beni-Suef Univ J Basic Appl Sci. 2020;9. https://api.semanticscholar.org/CorpusID:220295970 Gibson MP, Tatakis DN. Treatment of Gummy Smile of Multifactorial Etiology: A Case Report. Clin Adv periodontics. 2017;7(4):167–73. 10.1902/cap.2017.160074 . Mossaad A, Abdelrahman M, Kotb A, Alolayan A, Elsayed S. 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J Periodontol. 2009;80(2):317–23. 10.1902/jop.2009.080409 . Tables Table 1 Study group distribution among the studied patients and Comparison between preoperative and postoperative variable outcomes : Study Variables Group N Mean Std. Deviation P-Value Age GA(980nm) 10 26.80 4.80 0.085 GB(460nm Then 980nm) 10 30.00 2.78 Preoperative Lip Gingival Distance(mm) GA(980nm) 10 5.25 0.58 0.068 GA(460nm Then 980nm) 10 4.70 0.67 Postoperative Lip Gingival Distance(mm) GA(nm) 10 2.10 0.39 0.506 GB(460nm Then 980nm) 10 3.50 6.51 Preoperative Pocket PDP Depth(mm) GA(980nm) 10 3.50 0.74 0.394 GB(460nm Then 980nm) 10 3.20 0.78 Postoperative pocket PDP Depth(mm) GA(980) 10 1.20 0.53 0.476 GB(460nm Then 980nm) 10 1.05 0.36 Preoperative OPI GA(980nm) 10 2.70 0.48 0.388 GB(460nm Then 980nm) 10 2.50 0.52 Postoperative OPI GA(980nm) 10 0.50 0.52 0.673 GB(460nm Then 980nm) 10 0.40 0.51 Preoperative MPI GA(980nm) 10 0.50 0.52 0.673 GB(460nm Then 980nm) 10 0.40 0.51 Postoperative MPI GA(980nm) 10 0.50 0.52 0.628 GB(460nm Then 980nm) 10 0.40 0.51 VAS GA(980nm) 10 3.20 0.78 0.015 GB(460nm Then 980nm) 10 2.40 0.52 Additional Declarations No competing interests reported. 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Elsayed","email":"","orcid":"","institution":"Al Azhar University","correspondingAuthor":false,"prefix":"","firstName":"Shadia","middleName":"A.","lastName":"Elsayed","suffix":""}],"badges":[],"createdAt":"2025-08-22 23:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7437674/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7437674/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92735829,"identity":"c4ce5aae-b30a-4947-bfbd-77ad6091da87","added_by":"auto","created_at":"2025-10-03 16:32:02","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":497508,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7437674/v1/caa839240f7175fa0c604e0f.docx"},{"id":92735824,"identity":"bce00532-ad13-4d77-908b-e5d1e75f7272","added_by":"auto","created_at":"2025-10-03 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1","display":"","copyAsset":false,"role":"figure","size":281717,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7437674/v1/d2637b316a584b02707a8a20.png"},{"id":93917309,"identity":"552377bb-2151-43c3-b89f-0409086b258d","added_by":"auto","created_at":"2025-10-20 09:02:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":917104,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7437674/v1/eb899004-2a50-4b06-9b49-1cf2d1b01dca.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gummy smile and gingival depigmentation treatment using Soft Tissue Diode Lasers with two different wavelengths","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDental lasers have been widely used in different dental fields as they save time and effort of the operator. Soft tissue lasers as Diode is becoming more popular as it has been used by many dentists in their practice. Common uses are gingivectomy, frenectomy and gum depigmentation The gingiva is an essential part of the smile and recently patients both genders are becoming more aware and concerned of their aesthetics. Lasers are used as a principle tool or adjunct in many dental procedures. Various laser therapies require different wavelengths either on soft or hard tissues. Applications of soft tissue include gingivectomy, gum depigmentation, frenectomies, tongue ties and biopsies. Laser gingivectomy is the most common use with dental lasers. Advantages of surgical lasers are they save time and energy for the operator as well as less postoperative pain and bleeding for the patient by the action of phototherapy and heat coagulation, besides the bactericidal effect of laser in tissues.\u003csup\u003e1\u0026ndash;3(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e They facilitate the treatment and promote healing. Surgical lasers that are used in the dental field are Erbium-YAG, CO2 \u0026amp; Diode lasers. Soft tissue lasers include Diode which usually operate from 450\u0026ndash;980 nm. Patients are becoming increasingly aware of facial aesthetics and they are seeking to improve their smiles.\u003csup\u003e2,4,5 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e A common complaint now in dental practice comes from patients who are unsatisfied with their short clinical crowns due to either gingival hyperplasia or passive eruption which occurs due to failure of migration of gingiva. Definition of gummy smile is showing more than 2\u0026ndash;4 ml of the gingiva while smiling. It is more common in females rather than males and it occurs usually in upper arch only. Cutting lasers are precise and effective eliminating the need for surgical scalpels and sutures.\u003csup\u003e6,7 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e The color of the gingiva is determined by size and number of blood vessels, thickness of epithelium, keratinization degree, and melanin pigments degree present in deep layers of epithelium. Melanocytes which are responsible for the brown color or dark pigment located in basal layers of epithelium, are the cells that produce melanin pigments which play a main role for pigmentation and color of gingiva. They are more common in maxilla than the mandible. They are also more prevalent in dark skin patients \u003csup\u003e8,9(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eGum pigmentation gives an annoying appearance to patients who complain of brown or dark spots area in their gums while smiling. This is either due to racial pigmentation and excessive melanin produced in the gingiva, physiologic due to smoking, endocrinal hormonal disturbance, diseases as HIV. Time of healing varies with individuals. In Patients with physiological melanotic gingiva, pigmentation is often reduced after gingival healing.\u003csup\u003e10,11 (9\u0026ndash;10 )\u003c/sup\u003e Long wavelengths 980 nm have more affinity for hemoglobin. There are different techniques that have been used for depigmentation of gingiva such as scalpel technique, rotary instruments, electrosurgery, and different types of lasers. Each technique has its own advantages and disadvantages. Diode laser with different wavelengths has been commonly used safely \u0026amp; effectively with less operation and healing time\u003csup\u003e12,13\u003c/sup\u003e. \u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eTherefore In the present study, we used two different wavelengths of Diode laser, visible 460 nm \u0026amp; infrared 980 nm for management of Gummy smile which is a common problem that gives an annoying appearance to patients and Dark color gingiva, which also causes embarrassment while smiling.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eIn this study Diode laser Woodpecker LX16 Plus device * China was used. This study included 20 female patients divided into two groups using two different diode laser wavelengths as gum treatment modalities. Patients were informed about the nature and potential risks of the proposed surgical procedures and they also reviewed and signed an informed consent form with clear explanation of the outcomes. The Declaration of Helsinki guidelines were followed throughout the study. The study was approved by The Medical Research Ethical Committee at National Research Centre Cairo Egypt approval MERC # 02411123.\u003c/p\u003e\u003cp\u003eTwenty female patients age ranging 19\u0026ndash;35 years old presented at clinic with darkened gummy smile due to accumulation of melanin in the basal cell layer of the oral mucosa and came seeking for gum contouring and depigmentation with laser. Patients complained of dark patches in the whole anterior labial mucosa. The patients were systemically free, nonsmoking and not taking any medications The gingival display showed 4\u0026ndash;5 mm on smiling which was annoying to the patient. Local anesthesia was applied with 2% lidocaine with infiltration mood from upper right second premolar of to upper left second premolar. WHO Periodontal probe measurements were recorded at the CEJ. Proper scaling and cleaning were performed before surgical procedures were performed. Exclusion criteria were patients with periodontal disease, patients with bleeding or systemic diseases, drug intake with side effects of gingival enlargement.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eGroup A\u003c/strong\u003e\u003cp\u003eTen female patients age ranging 25\u0026ndash;35 years old presented at clinic with gummy smile and dark gingiva came seeking for gum contouring \u0026amp; gum depigmentation with laser. The gingival display showed more than 4\u0026ndash;5 mm on smiling which was annoying to the patient.. Local anesthesia was applied with 2% lidocaine with infiltration mood from upper right second premolar of to upper left second premolar. Diode laser 980 nm wave length was used for both gingivectomy followed by depigmentation. WHO Periodontal probe measurements were recorded at the CEJ. Proper scaling and cleaning were performed before surgical procedures were performed. Exclusion criteria from the study were patients with periodontal disease, patients with bleeding or systemic diseases, drug intake with side effects of gingival enlargement.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eGingivectomy technique\u003c/strong\u003e\u003cp\u003eDiode laser using 980 nm wavelength, Power 1.5 W, 45 Joules energy with continuous mood with sweeping motion in a horizontal manner parallel to the root surface for gingivectomy followed by 980 nm wavelength for gum depigmentation. The laser tip is used as a brush movement from distal to mesial to distal. Diode laser 980 nm has the best absorption for melanin and hemoglobin besides its coagulation effects without bleeding or the need for postoperative sutures. Activation of the laser tip for initiation with carbon paper is needed. All laser safety precautions were applied as wearing protective eye shields by the operator, assistant and the patient. Saline irrigation is advised to be used along the procedure for less charring which is eliminated with a wet gauze for removing the de-epithelized tissue. Fumes and burning smell caused little patient discomfort.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDepigmentation technique\u003c/strong\u003e\u003cp\u003eDiode laser with continuous mode and short wavelength 980 nm, power 2 Watts, Energy 120 Joules was applied. The laser tip is used as a brush movement from distal to mesial starting from upper second premolar till the central incisor bilaterally. The laser helped to visualize the results immediately due to minimal bleeding. For depigmentation; continuous mood and sweeping motion in a horizontal manner parallel to the root surface was applied for gum depigmentation Saline irrigation is advised to be used along the procedure for less charring which is removed with wet gauze. Patients were advised to take antibiotics, analgesics and anti-inflammatory and mouth wash as a postoperative care for 5 days. The following parameters were measured in terms of time of procedure, bleeding during procedure, postoperative pain, time of healing, gingival color and contour.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eGroup B\u003c/strong\u003e\u003cp\u003eTen female patients age range between (30\u0026ndash;40) years presented at clinic with gummy smile and dark pigmented gingiva due to accumulation of melanin in the basal cell layer of the oral mucosa. Patients complained of large display of gingiva \u0026amp; dark patches in the whole anterior labial mucosa. The patients were systemically free, nonsmoking and not taking any medications.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eGingivectomy technique\u003c/strong\u003e\u003cp\u003eDiode laser wavelength 460 nm, power 2 Watts, Energy 120 Joules. Continuous mood with sweeping motion in a horizontal manner parallel to the root surface. It causes denaturation of proteins leading to tissue shrinkage and retention as well as local conduction of heat. It also doesn\u0026rsquo;t need activation with carbon paper and it provides working with faster speed \u0026amp; more effective cutting giving better results. The laser helped to visualize the results immediately due to minimal bleeding. Saline irrigation is advised to be used along the procedure for less charring which is removed with wet gauze.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDepigmentation technique\u003c/strong\u003e\u003cp\u003eDiode laser 980 nm has the best absorption for melanin and hemoglobin besides its coagulation effects without bleeding or the need for postoperative sutures. Preoperative local anesthetic infiltration was applied with 2% lidocaine with 1/10,000 epinephrine. The laser tip is used as a brush movement from mesial to distal. Activation of the laser tip for initiation with carbon paper is needed. The laser helped to visualize the results immediately due to minimal bleeding. Saline irrigation is advised to be used along the procedure for less charring which is removed with wet gauze. All laser safety precautions were applied as wearing protective eye shields by the operator, assistant and the patient. Fumes and burning smell caused little patient discomfort.\u003c/p\u003e\u003c/p\u003e\u003cp\u003ePreoperative local anesthetic infiltration was applied with 2% lidocaine with 1/10,000 epinephrine. Technique: after gingivectomy with 460nm Diode laser was done as in group A, then Diode laser using 980 nm wavelength, Power 1.5 W, 45 Joules energy with continuous mood with sweeping motion in a horizontal manner parallel to the root surface was applied for gum depigmentation.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eIntra and postoperative care\u003c/strong\u003e\u003cp\u003eAll laser safety precautions were applied as wearing protective eye shields by the operator and the patient. Activation of the laser tip for initiation with carbon tip. A wet sterile gauze used for removing the de-epithelized tissue. Fumes and burning smell caused little patient discomfort. No periodontal pack was needed and patients were instructed to avoid smoking as well as hot or acidic and spicy food. Follow up after one \u0026amp; two weeks was made with very good results and no complications. Pink healthy gingiva was observed with high patient satisfaction. Evaluation was made preoperatively versus postoperatively clinically and by intraoral photographs. Figure\u0026nbsp;(5\u0026ndash;9)\u003c/p\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eMethods of evaluation:\u003c/h2\u003e\u003cp\u003eMeasurements of the vertical exposure of the gingiva from the inferior border for the upper lip to the free gingival margin of maxillary anterior teeth were recorded preoperatively and compared to postoperatively after one week follow up visit. Periodontal probing depth and bleeding points were measured with an explorer for keratinized gingiva of anterior teeth using UNG \u0026minus;\u0026thinsp;15 probe before surgical procedure and compared to after one week follow up visit. VAS scale was used for postoperative pain intensity from 0\u0026ndash;10 in both groups. To ensure full healing and effectiveness, Clinical examination and digital photos were taken intraorally and extraorally preoperatively and postoperatively after one week \u0026amp; two weeks follow up period to all cases.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eOPI index \u0026 MPI index were recorded for amount of gingival pigmentations\u003c/h3\u003e\n\u003cp\u003eThe Oral Pigmentation Index (OPI) was used to analyze the postoperative results. Score 0 indicates no clinical pigmentation (pink-colored gingiva), Score 1 indicates mild clinical pigmentation (mild light brown color), Score 2 indicates moderate clinical pigmentation (medium brown or mixed pink and brown), and Score 3 indicates heavy clinical pigmentation (deep brown or bluish-black color).\u003c/p\u003e\u003cp\u003eMelanin Pigmentation Index MPI was used as follows:\u003c/p\u003e\u003cp\u003eScore 0 indicates no pigmentation. Score 1: a single unit(s) of pigmentation in the papillary gingiva with no expansion between surrounding solitary units and Score 2: creation of a continuous ribbon spreading from adjacent solo units.\u003c/p\u003e\n\u003ch3\u003eStatistical analysis :\u003c/h3\u003e\n\u003cp\u003eThe software program SPSS version 20.0.0 was used to analyze all test data. The mean and standard deviation of the preoperative and postoperative interventions were determined, and a comparison of the preoperative and postoperative measurements was made for each group. The independent t test was used to examine the mean difference between the two tested groups' interventions; a P value of less than 0.05 was set.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll patients are entirely female, with a mean age of 26.8 years and a standard deviation of 4.8 in group A and 30/2.78 in group B with age range 19\u0026ndash;35 years.. There was no statistical difference in age between the two groups.\u003c/p\u003e\u003cp\u003ePostoperative evaluation was completed after two weeks postoperatively. The surgery was well tolerated by all patients, with no intraoperative complications.\u003c/p\u003e\u003cp\u003eClinical observation showed after 48 hours all wounds were covered with fibrinous plaque and erythematous halo which remained for the first week. After the second week all wound surfaces were pale pink with no evidence of pain or bleeding. Postoperative evaluation was completed after 2 weeks postoperatively. Observation of healthy pink healed gingiva occurred with no complications and a high patient satisfaction rate. Figure\u0026nbsp;(1\u0026ndash;4)\u003c/p\u003e\u003cp\u003eIt was noted that in both groups, that the tissue contour was normal and only at the 24th hour a very slight edematous contour of the incised gingival surface was reported. In group B all cases postoperative gingival wounds were covered with fibrinous plaque and an erythematous halo, for the 72nd hour, a granulated surface in the 1st week was reported. Complete healing was reported after the second week, all wound surfaces were completely healed and had a normal pale pink. VAS scale was used for evaluation of pain (0\u0026ndash;10) depending on postoperative intensity. Table\u0026nbsp;(1) shows that the preoperative and postoperative mean values for the following study variables (lip gingival distance, Pocket PDP Depth(mm), OPI, and MPI) did not differ statistically between groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eVAS differ postoperatively between both groups where there was a significant difference with mean variance in prefer to group B and p value\u0026thinsp;=\u0026thinsp;0.015\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eExcess gingiva could be related to passive eruption of teeth, hormonal disturbance, some drug interaction and short lip. Diode laser is a simple, safe and effective method for procedures. It offered precise cutting with absence of bleeding without the need for a surgical blade. Short wavelength 460 nm (visible blue range) has more cutting efficiency as it is more absorbed by protein in the tissue. It causes denaturation leading to tissue shrinkage and retention as well as local conduction of heat. It also doesn\u0026rsquo;t need activation with carbon paper and it provides working with faster speed \u0026amp; more effective cutting giving better results. Gingival pigmentation could be caused by smoking, racial pigmentation, endocrine disturbance, drug adverse effect and a disease such as HIV. Diode laser has the best absorption for melanin and hemoglobin besides its coagulation effects without bleeding or the need for postoperative sutures. Latest laser devices offer different wavelengths facilitating multiple uses instead of a single wavelength. The blue range visible (450 nm) shorter wavelength\u003csup\u003e9 7\u003c/sup\u003e. It is more precise \u0026amp; it has a higher cutting efficiency in soft tissues. The Infrared range (980nm) longer wavelength has more affinity towards melanin and hemoglobin, reaching deeper tissues with minimal bleeding. Gummy smile is defined as showing more than 2 mm of the gingiva while smiling. Gum contouring with laser is the most common use for surgical soft lasers. Patients are becoming more aware of facial and dental aesthetics showing high demand for their smiles. The health and appearance of the gingiva complete the smile appearance. Studies have shown that short wavelength 488 nm interacts with protein components and causes denaturation of long chain molecules. Charring and cracking can result and might cause damage to the tooth surface that\u0026rsquo;s why it should be protected. This leads to tissue shrinkage and local conduction of heat, while longer wavelength 980 nm causes extensive destruction by water ablation. In observing cross sections, the slit obtained at cutting is almost spherical shape in short wavelength and v-shaped in long wavelength. In longer wave length, heat distribution is achieved through ablation away from the incision site. There is a lower risk of deep heat effects but a higher risk of tissue rupture due to water evaporation. (9\u0026ndash;10) According to previous studies formation of collagen and organization of new gingival tissues occurred within 3\u0026ndash;4 weeks especially after gingivectomy. In the present study new gingival tissue occurred after 2\u0026ndash;3 weeks after surgical procedures. \u003cb\u003eLione, R. et al., in 2020\u003c/b\u003e\u003csup\u003e14\u003c/sup\u003e, (13) compared the use of diode lasers with conventional surgery, evaluating the effectiveness of gingivectomy as an adjunct to nonsurgical periodontal treatment in the management of gingival enlargement during orthodontic treatment. They discovered that the use of both surgical gingivectomy using the scalpel and laser gingivectomy were more effective in controlling gingival inflammation than nonsurgical periodontal management. In the control group, they observed a greater improvement in the periodontal parameters during 3 months, depending on a self-care approach for the management of gingival enlargement. \u003cb\u003eBhasker et al., in 2021\u003c/b\u003e,\u003csup\u003e15\u003c/sup\u003e described a clinical case where they compared the scalpel and Diode laser use for treatment of gingival enlargement \u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e Diode laser provided adequate hemostasis and accurate incision margins. The authors reported a lack of swelling, pain, less scar tissue formation, and very good wound healing. The wounds induced by laser heal via reparative matrix proteins synthesis. The wound contraction in areas treated with laser was less compared to the surgical scalpel areas. As regard to bleeding, it was minimal in most of the cases and was almost negligible clinically. Postoperative pain levels were low or absent. There was lack of postoperative hemorrhage on probing after the first week in all the examined cases. Tissue recovery in terms of tissue color, contour and appearance of the wound was asymptomatic within the limitations of our pilot study, probably due to the additional bactericidal effect of the laser with no recorded complications.\u003csup\u003e16 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e \u003cb\u003eEl Tayeb et al\u003c/b\u003e,\u003csup\u003e17 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/sup\u003e have compared between using Diode laser 890 nm to Co2 10,600 \u0026amp; Erbium 2780 nm lasers in gingival depigmentation and concluded that both methods were successful. In the surgical/ablative approach, the gingival epithelium was vaporized with melanin. The second approach which is non-surgical/ non-ablative, using a specific wavelength, such as near infrared diode laser (890 nm), degranulates the melanosomes or denatures melanin without de-epithelization of the gingival epithelium. Complete hemostasis was achieved using diode laser, while mild bleeding was observed in some cases with Erbium, Cr:YSGG lasers. There\u0026rsquo;s an advantage with Diode lasers that they can penetrate much deeper layer within the soft tissue, causing sustained heat that provides rapid vessel shrinkage, in contrary to the Erbium: YAG laser. Also, Diode laser wavelengths are more absorbed by hemoglobin\u003csup\u003e18\u003c/sup\u003e.\u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e Gingival hyperpigmentation is a major concern for quite a number of patients, as a relevant cosmetic or aesthetic need. In the present study the authors faced some limitations as regard number of cases \u0026amp; long term follow up. In previous studies they faced some recurrence and repigmentation in group of patients with Diode lasers after few months, meanwhile the group of patients with ablative CO2 or Erbium showed more retention of the results with less relapse rate.\u003csup\u003e19,20 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/sup\u003e In the present study we concluded that using two different wavelengths of laser is more specific and more beneficial to the patients rather than using a single nonspecific wavelength. Diode soft laser is much more preferred than the old traditional surgical methods as diamond burs and scalpels for less operation times and less bleeding for a better operative field, eliminating the need for postoperative sutures or periodontal packs, also less pain and postoperative complications for the patients. There are several diode laser wave lengths available for dentistry. In the market as 460 nm, 810 nm, 940 nm, and provided satisfactory results for gingivectomy and gum depigmentation; dentist training and expertise is crucial for the appropriate selection and the intended outcome.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDiode laser is an effective, fast and safe solution for gingival problems specially crown lengthening and depigmentation, either gingivectomy or gingival depigmentation rather than traditional surgical methods. Using 2 different wavelengths is more precise \u0026amp; beneficial than using a single wavelength.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eNo Funding declaration\u003c/p\u003e\n\u003cp\u003eClinical trail number not applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor A: Surgical laser procedures on patients Author B: Patients selection \u0026amp; preparation with data collection and follow upAuthor C: Documentation \u0026amp; Statistical analysisAuthor contribution declaration not foundReady upon sending to them emails for approval\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLow SB. 4 - Lasers in Surgical Periodontics. \u003cem\u003ePrinc Pract Laser Dent\u003c/em\u003e. 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J Periodontol. 2009;80(2):317\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1902/jop.2009.080409\u003c/span\u003e\u003cspan address=\"10.1902/jop.2009.080409\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eStudy group distribution among the studied patients and Comparison between preoperative and postoperative variable outcomes\u003c/span\u003e:\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eStudy Variables\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroup\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eN\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMean\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eStd. Deviation\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eP-Value\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAge\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGA(980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26.80\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.80\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.085\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGB(460nm Then 980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30.00\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.78\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePreoperative Lip Gingival Distance(mm)\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGA(980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5.25\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.58\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.068\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGA(460nm Then 980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.70\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.67\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePostoperative Lip Gingival Distance(mm)\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGA(nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.39\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.506\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGB(460nm Then 980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6.51\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePreoperative Pocket PDP Depth(mm)\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGA(980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.74\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.394\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGB(460nm Then 980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.20\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.78\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePostoperative pocket PDP Depth(mm)\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGA(980)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.20\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.53\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.476\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGB(460nm Then 980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.05\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.36\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePreoperative OPI\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGA(980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.70\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.48\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.388\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGB(460nm Then 980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.52\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePostoperative OPI\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGA(980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.52\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.673\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGB(460nm Then 980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.51\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePreoperative MPI\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGA(980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.52\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.673\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGB(460nm Then 980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.51\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePostoperative MPI\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGA(980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.52\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.628\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGB(460nm Then 980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.51\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eVAS\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGA(980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.20\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.78\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.015\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGB(460nm Then 980nm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.52\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Diode laser, Gingivectomy, Gum depigmentation, Gummy smile","lastPublishedDoi":"10.21203/rs.3.rs-7437674/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7437674/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e: In the present study we used two different wavelengths of Diode laser (visible 460 nm \u0026amp; infrared 980 nm) for management of Gummy smile patients suffering from dark colored gingiva.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e This study included 20 female patients divided into two groups. Group A with 10 patients suffering from gummy smile \u0026nbsp;more than 4 mm and darkened gingiva treated using 980 nm wavelength and Group B suffering from gummy smile surgically removed by 460 nm wavelength then dark gingiva pigmentation removal using 980 nm wavelength. Evaluation was made clinically and photographically preoperatively then one \u0026amp; two weeks postoperatively for measuring the lip gingival distance \u0026amp; periodontal pocket depth,\u003cstrong\u003e \u003c/strong\u003eOral pigmentation index (OPI) and Melanin pigmentation index (MPI). VAS scale was used for postoperative pain intensity from 0-10 in both groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAll patients are entirely female, with a mean age of 26.8 years and a standard deviation of 4.8 in group A and 30/2.78 in group B. There was no statistical difference in age between the two groups. \u003cbr\u003e\nthe preoperative and postoperative mean values for the following study variables (lip gingival distance, Pocket PDP Depth(mm), OPI, and MPI) did not differ statistically between groups (P\u0026gt;0.05). VAS differ postoperatively between both groups where there was a significant difference with mean variance in prefer to group B and p value = 0.015. Our results showed that there was no statistical significance difference between study variables although mean VAS measurements were more preferable in group B than group A\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Diode laser is an effective, fast and safe solution for gingival problems, either gingivectomy or gingival depigmentation rather than traditional surgical methods. \u0026nbsp;Using 2 different wavelengths had not differ statistically however it was is less painful more comfortable to the patients and produce rapid healing than using a single one.\u003c/p\u003e","manuscriptTitle":"Gummy smile and gingival depigmentation treatment using Soft Tissue Diode Lasers with two different wavelengths","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 16:31:57","doi":"10.21203/rs.3.rs-7437674/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"721a9dfb-e685-4e43-8b81-43b598981c48","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T08:54:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 16:31:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7437674","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7437674","identity":"rs-7437674","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}