Er,Cr:YSGG Laser for Deepithelialization in Gingival Recession.

Clinical Efficacy of Er,Cr:YSGG Laser for Deepithelialization of Free Gingival Grafts in Gingival Recession Treatment: A Randomized, Split-Mouth Clinical Trial

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.

Study Overview

• Status: Completed
• Conditions: Gingival Recession, Localized; Gingival Thickness; Pocket Depth; Keratinized Tissue
• Intervention / Treatment: Procedure: Laser Deepithelialization of Free Gingival Graft; Procedure: Scalpel Deepithelialization of Free Gingival Graft

• Study Type: Interventional
• Enrollment (Actual): 9
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Poland
  • Bielsko-Biala, Poland, 43-300
    • Dentoplex

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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%)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Laser Deepithelialization (LDEE); In this arm, deepithelialization of the free gingival graft was performed extraorally using an Er,Cr:YSGG laser (2780 nm; 2.5 W; 83.3 mJ; 30 Hz; 600 μm tip) before graft placement at the recipient site.	Procedure: Laser 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.
Active Comparator: Scalpel Deepithelialization (DEE); In this arm, the epithelium was removed manually using a 15c surgical scalpel from the harvested palatal free gingival graft before placement.	Procedure: Scalpel Deepithelialization of Free Gingival Graft; Extraoral deepithelialization of harvested free gingival graft using a 15c surgical scalpel blade before placement in gingival recession treatment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Recession Depth	Measurement of gingival recession depth in millimeters to evaluate soft tissue response to treatment. Unit of Measure: mm	Baseline, 3 months, and 6 months postoperatively
Change in Keratinized Tissue Width	Measurement of the width of keratinized gingiva in millimeters from the mucogingival junction to the free gingival margin. Unit of Measure: mm	Baseline, 3 months, and 6 months postoperatively
Change in Gingival Thickness	Assessment of gingival tissue thickness using a standardized probe. Unit of Measure: mm	Baseline, 3 months, and 6 months postoperatively
Change in Pocket Depth	Probing depth measured from the gingival margin to the base of the periodontal pocket. Unit of Measure: mm	Baseline, 3 months, and 6 months postoperatively
Change in Clinical Attachment Level	Measurement of the distance from the cementoenamel junction to the base of the periodontal pocket. Unit of Measure: mm	Baseline, 3 months, and 6 months postoperatively
Change in Pink Esthetic Score	Percentage of interdental spaces with visible plaque, calculated to assess oral hygiene status. A lower percentage indicates better plaque control. Unit of Measure: percentage (%)	Baseline, 3 months, and 6 months postoperatively
Mean Root Coverage	Average percentage of root surface covered by soft tissue following treatment, calculated across all treated sites. Unit of Measure: percentage (%)	6 months postoperatively
Complete Root Coverage	Proportion of treated sites that achieved 100% root coverage postoperatively. Unit of Measure: percentage (%)	6 months postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Histopathological Evaluation of Laser-Treated Connective Tissue Grafts	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.	Immediately postoperatively

Collaborators and Investigators

• Sponsor: Wroclaw Medical University

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2021
• Primary Completion (Actual): August 31, 2022
• Study Completion (Actual): August 31, 2022

Study Registration Dates

• First Submitted: June 30, 2025
• First Submitted That Met QC Criteria: July 10, 2025
• First Posted (Actual): July 14, 2025

Study Record Updates

• Last Update Posted (Actual): July 14, 2025
• Last Update Submitted That Met QC Criteria: July 10, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Periodontal Atrophy; Periodontal Diseases; Mouth Diseases; Stomatognathic Diseases; Gingival Diseases; Gingival Recession
• Other Study ID Numbers: WroclawMU6

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Although this was a prospective clinical study, we do not plan to share individual participant data (IPD) due to lack of consent for data sharing obtained at the time of enrollment.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No