Gingival Recession, Localized, Gingival Thickness, Keratinized Tissue, Pocket Depth
Conditions
Brief summary
Abstract: Introduction: The deepithelialized free gingival graft (DGG) technique provides high-quality connective tissue grafts (CTGs) with predictable outcomes for recession cov-erage. This study evaluates a novel method of free gingival graft (FGG) deepithelialization using an Er,Cr:YSGG laser (LDEE) for treating multiple gingival recessions. Methods: A split-mouth study was conducted on 46 (n=46) recessions in 9 patients (23 per test and control group). Sites were randomized. Full-thickness palatal grafts were harvested with a scalpel. In the test group (LDEE), deepithelialization was performed extraorally using an Er,Cr:YSGG laser (2780 nm; 2.5 W, 83.3 mJ, 30 Hz, 600 µm tip). In the control group (DEE), a 15c scalpel was used. All CTGs were applied using the modified coronally advanced tunnel (TUN) technique. Clinical parameters-recession depth (RD), keratinized tissue width (KT), gingival thickness (GT), pocket depth (PD), clinical attachment loss (CAL), pink esthetic score (PES), approximal plaque index (API), mean root coverage (MRC), and complete root coverage (CRC)-were assessed at baseline (T0), 3 months (T1), and 6 months (T2). Results: Both LDEE and DEE groups showed significant improvements in RD, KT, GT, PD, and CAL over time (p \< 0.001). At T1 and T2, KT was significantly higher in the LDEE group (T1: 3.73±0.72 mm; T2: 3.98±0.76 mm) compared to the DEE group (T1: 3.21±0.61 mm; T2: 3.44±0.74 mm; p \< 0.05). Other parameters (RD, GT, PD, CAL) showed no statistically significant intergroup differences at any time point (p \> 0.05). After 6 months, MRC was 95% and CRC 82.6% for LDEE, compared to 94.8% and 82.6% for DEE (p \> 0.05). PES scores were similar between groups at all time points (p \> 0.05). Conclusion: Both laser- and scalpel-deepithelialized grafts effectively treated gingival recessions. LDEE combined with TUN resulted in significantly greater KT width compared to DEE + TUN.
Interventions
PROCEDURELaser Deepithelialization of Free Gingival Graft
Extraoral deepithelialization of harvested free gingival graft using Er,Cr:YSGG laser (2780 nm, 2.5 W, 83.3 mJ, 30 Hz, 600 μm tip) before placement in gingival recession treatment.
PROCEDUREScalpel Deepithelialization of Free Gingival Graft
Extraoral deepithelialization of harvested free gingival graft using a 15c surgical scalpel blade before placement in gingival recession treatment.
Sponsors
Wroclaw Medical University
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 70 years * Presence of multiple Miller Class I or II gingival recessions * Good general and oral health * Patient consent to participate in the clinical trial * Availability for follow-up at 3 and 6 months
Exclusion criteria
* Smoking or history of smoking in the last 6 months * Systemic diseases affecting wound healing (e.g., diabetes, immunodeficiencies) * Pregnancy or lactation * Use of medications that influence periodontal tissues (e.g., immunosuppressants, corticosteroids) * History of periodontal surgery in the area of interest within the past 12 months Inadequate oral hygiene (plaque index \>20%)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Complete Root Coverage | 6 months postoperatively | Proportion of treated sites that achieved 100% root coverage postoperatively. Unit of Measure: percentage (%) |
| Change in Recession Depth | Baseline, 3 months, and 6 months postoperatively | Measurement of gingival recession depth in millimeters to evaluate soft tissue response to treatment. Unit of Measure: mm |
| Change in Keratinized Tissue Width | Baseline, 3 months, and 6 months postoperatively | Measurement of the width of keratinized gingiva in millimeters from the mucogingival junction to the free gingival margin. Unit of Measure: mm |
| Change in Gingival Thickness | Baseline, 3 months, and 6 months postoperatively | Assessment of gingival tissue thickness using a standardized probe. Unit of Measure: mm |
| Change in Pocket Depth | Baseline, 3 months, and 6 months postoperatively | Probing depth measured from the gingival margin to the base of the periodontal pocket. Unit of Measure: mm |
| Change in Clinical Attachment Level | Baseline, 3 months, and 6 months postoperatively | Measurement of the distance from the cementoenamel junction to the base of the periodontal pocket. Unit of Measure: mm |
| Change in Pink Esthetic Score | Baseline, 3 months, and 6 months postoperatively | Percentage of interdental spaces with visible plaque, calculated to assess oral hygiene status. A lower percentage indicates better plaque control. Unit of Measure: percentage (%) |
| Mean Root Coverage | 6 months postoperatively | Average percentage of root surface covered by soft tissue following treatment, calculated across all treated sites. Unit of Measure: percentage (%) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Histopathological Evaluation of Laser-Treated Connective Tissue Grafts | Immediately postoperatively | Microscopic assessment of grafts treated with Er,Cr:YSGG laser to evaluate the quality of deepithelialization and potential thermal damage. Parameters included the presence of a clear boundary between epithelium and connective tissue, absence of carbonization or necrosis, and preservation of tissue architecture. |
Countries
Poland
Outcome results
None listed