Comparative Clinical Outcomes of Electrosurgery Versus Other Techniques for Gingival Depigmentation: A Systematic...

Gingival hyperpigmentation is a common esthetic concern, and several depigmentation techniques have been described. Electrosurgery is widely used because of its affordability and good intraoperative hemostasis, but its comparative clinical performance remains unclear. The present systematic review aimed to systematically evaluate the effectiveness of electrosurgery for gingival depigmentation in comparison with other treatment modalities. A systematic review of comparative clinical studies was performed in PubMed, Scopus, ScienceDirect, Embase, Web of Science, Google Scholar, Semantic Scholar, and EBSCOhost from inception to February 2026. Human comparative studies evaluating electrosurgery against other depigmentation techniques and reporting at least one quantitative clinical outcome were included. Data on depigmentation, postoperative pain, healing, complications, and repigmentation were extracted. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB-2) tool and the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Eight comparative studies were included, comprising seven randomized trials and one non-randomized study. Most studies were conducted in India and mainly involved young adults with physiologic gingival pigmentation. Electrosurgery consistently produced satisfactory short-term depigmentation. However, comparisons with diode lasers generally favored lasers for early postoperative pain and healing. Findings versus the scalpel were more balanced, with electrosurgery offering better hemostasis but no clear overall superiority in patient-centered outcomes. Repigmentation was variably reported and showed inconsistent long-term stability. The certainty of evidence ranged from moderate to very low, mainly because of risk of bias, imprecision, and heterogeneity. Electrosurgery is an effective and accessible option for gingival depigmentation, particularly for short-term pigment reduction. However, its postoperative comfort, healing profile, and long-term stability appear less consistent than its immediate clinical effectiveness.