الفهرس 
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Abstract
Recently, there has been a noticeable increase in the demand for a pleasing and satisfying smile, which mandates a healthy set of dentitions as well as an esthetically superior gingival appearance, primarily when it involves the anterior labial region. Numerous individuals from various ethnic groups manifest physiological gingival hyperpigmentation.
The aim of the present study was to determine the effect of Licorice topical gel in management of gingival hyperpigmentation as an adjunct to the conventional surgical technique in terms of clinical and histological parameters.
In this study, twelve patients with a total number of 24 sites, diagnosed with physiologic gingival melanin pigmentation of the keratinized gingiva and complaining of compromised esthetics were randomly assigned in 2 different groups (A and B) to be treated by conventional surgical treatment regimen accompanied by licorice based gel for group A, and placebo gel for group B.
For each patient, the clinical outcomes were evaluated five times: pre-operative, then postoperatively at 2 weeks, 3 months, 6 months and 1 year. DOPI, clinical wound healing and bleeding indices and a patient
satisfaction questionnaire, comprised the clinical parameters.
For histological assessment, biopsies were obtained from each patient twice; at baseline and 1 year postoperative. The specialized computer software then provided an estimated count of the selected cell types, in order to calculate the Melanocytes/Aggregated Active Melanin granules to Keratinocytes= M:K ratio, as well as determine the intensity of pigmentation scale of the tissues.
Both groups showed significant reduction in DOPI after 1 year. On comparing the two groups, group A demonstrated significantly better results than group B regarding DOPI.
There was no statistical significant difference regarding the wound healing and bleeding scores between the 2 groups at the end of the study period.
Regarding the patients’ satisfaction questionnaire, the majority of patients of both groups experienced no pain during the treatment, on the day of surgery and up to one week postoperative. Hence, results comparing the test and control groups were statistically insignificant.
Concerning the cosmetic changes after one week, all patients in both groups noticed a marked improvement. On the other hand, at 6 months patients of group A continued to have better cosmetic changes than those of group B. Therefore, results were statistically significant, in favor of the group A.
The treatment met the expectation of all patients of group A and they would repeat the treatment if necessary. Conversely, treatment met the expectation of only (66.7%) of the patients of group B, while (33.3%) were not satisfied with the results. On comparing both groups, results were significant in favor of group A.
Although group A showed better M:K ratio values than group B, results were not statistically significant after 1 year postoperative.
Regarding the intensity of pigmentation index, results of both groups recorded preoperatively had a score of 3 which was not significant.
After 1 year, results showed that the intensity of pigmentation decreased in both groups. Despite of group A showing better results, yet there was no statistical significant difference between the 2 groups.
Conclusion
Within the limitations of this study, it can be concluded that:
1. Licorice based gel significantly reduced the recurrence and intensity of gingival pigmentation when compared to placebo gel, after 1 year of treatment.
2. Licorice based gel had no substantial impact on the wound healing and bleeding scores compared to the placebo gel.
3. In terms of esthetics and pain perception, the majority of patients of both groups reported being satisfied with the treatment, however there was a statistically significant difference in advantage of the test group (p=0.036), regarding their acceptance to repeat the treatment if necessary.
4. Histologically, although the M:K ratio and intensity of pigmentation index results of the test group showed more decrease in their values, results were not statistically significant compared to those of the control group.
Recommendations
1. Further clinical studies are required to determine whether topical application of the licorice based gel provided the maximum efficacy and if other routes of administration such as local injection, mouthwash or a licorice based dressing would provide more sustainability and hence more effect.
2. Additional trials are needed to investigate whether the used dosage in this study provided the most attainable benefits with the least risk of any potential side effects of the gel or an adjustment to the dose should be considered.
3. More future research is needed to investigate the different effects of licorice based gel.