الفهرس 
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Abstract
SUMMARY
Esthetic needs are increasing in recent years with a greater demand on pleasant appearance of the smile. Along with lips and a healthy set of teeth, gingiva is also a vital component of the smile appearance, especially when it is located in the anterior labial region. Physiologic gingival hyperpigmentation affects numerous people of different ethnic backgrounds.
Gingival depigmentation is a periodontal plastic surgical procedure by which gingival hyperpigmentation is removed or reduced by different treatment modalities which can be classified into: methods that remove pigments and methods that mask the pigment.
Removal of pigment can be done by surgical and chemical methods. Surgical methods mainly include conventional method which usually refers to scalpel blade techniques or bur abrasion or using advanced electrosurgery, cryosurgery, lasers and radiosurgery techniques.
Gingival depigmentation wound is left for healing by secondary intention, associated with, post-treatment pain and greater risk of bacterial contamination. Hyaluronic acid (HA) is a naturally occurring linear polysaccharide of the extracellular matrix of connective tissue, synovial fluid, and other tissues. It retains various physiological and structural function which may be useful in accelerating tissue healing.
The study was conducted on eight patients seeking treatment for their gingival hyperpigmentation for esthetic reasons. A total number of 16 sites of facial gingival hyperpigmentation were treated.
• group I (study group): Included eight sites that were treated with conventional surgical gingival depigmentation by abrasive burs, followed by topical application of hyaluronic acid gel on surgical field.
• group II (control group): Included eight sites that were treated with conventional surgical gingival depigmentation by abrasive bur. .
The clinical outcomes were assessed six time for each patient: at baseline (pre-operative), 3days, one week, 2weeks, one month and three months post-operatively. Clinical assessment was done by measuring DOPI, clinical wound healing, VAS and patient satisfaction questionnaire.
In study and control groups, the median of DOPI decreased significantly (P=0.0201) from baseline (3.00) to 3 days, 1 week, 2 weeks, 1 month and 3 months after treatment (0.00) with intergroup statistical significant difference (P<0.0001). On comparing the two groups, it was demonstrated that there was no statistically significant difference regarding DOPI at baseline to 3 months postoperatively (P>0.9999).
The study group had a lower median value (2) of VAS than control group (6) at baseline and the difference was statistically significant (P=0.0002). The same was after 3 days with study group median (1), control group median (4) and after 1 week with study group median (0), control group median (2) (P=0.0002, 0.0014 respectively). While after 2 weeks there was no statistical significant difference as the median in both groups was (0) (p>0.9999).
There was statistically significant difference between both groups regarding wound healing score at 1 week (P=0.0014) and 2 weeks (P=0.0256).
In this study, we also found a significant moderate positive correlation between the epithelial thickness and blood vessels number, r = 0.684 (P-value = 0.004), a significantly strong negative correlation between the epithelial thickness and inflammatory cells, CWH, and VAS at 1 week, r = -0.762, -0.861, -0.903 (P-value = 0.001, =0.0002, < 0.0001) respectively. There was a significant very strong positive correlation between CWH and VAS after 1 week, r = 0.953 (P-value < 0.0001).
For histological assessment biopsies were taken in one occasion. it was taken after one week. The slides were stained with H&E stain and captured using digital camera then transferred to the computer system for image analysis of epithelial thickness, inflammatory cell infiltrate.
Epithelial thickness of group (I) (study group) (488.07±200.3) had a significantly higher mean value than group (II) (218.75±28.27) (P=0.0021) and Number of blood vessels in group (I) Mean value (19.25±4.33) was higher than that of group (II)(control group) (12±2.83) and the difference was statistically significant (p=0.0014).Regarding inflammatory cells; after 1 week the percentage of inflammatory cells, were significant statistically lower in the study group with mean of (12.63±1.86) compared to the control group mean (24.66±3.26) (P<0.0001).
In this study, we found a significant moderate positive correlation between the epithelial thickness and blood vessels number, r = 0.684 (P-value = 0.004). There was also a significantly strong negative correlation between the epithelial thickness and inflammatory cells, CWH, and VAS at 1 week.