Effect of Er,Cr:YSGG Laser Root Conditioning on the Success of Root Coverage with Subepithelial Connective Tissue Graft: A Randomized Clinical Trial with a 6-Month Follow-Up
-
Banafsheh Poormoradi
,
Parviz Torkzaban
,
Leila Gholami
,
Amirarsalan Hooshyarfard
,
Maryam Farhadian
Abstract
Objectives: Finding predictable approaches for root surface biomodification is an important challenge in the treatment of gingival recession. This study sought to assess the root coverage percentage by subepithelial connective tissue graft (SCTG) following root surface conditioning with erbium, chromium: yttrium scandium gallium garnet (Er,Cr:YSGG) laser.
Materials and Methods: In this split-mouth, randomized clinical trial, 30 teeth with Miller’s Class I and II gingival recession were treated with SCTG (the Langer and Langer technique) with (case group) or without (control group) root surface conditioning with Er,Cr:YSGG laser (wavelength=2780 nm, power=0.75 W, H mode, repetition rate=20 Hz). Recession depth (RD), recession width (RW), clinical attachment level (CAL), and probing depth (PD) were assessed at the baseline (one week before surgery) and at 2 and 6 months postoperatively. The amount of root coverage was quantified in the two groups. Data were analyzed using Friedman test and Wilcoxon signed-rank test.
Results: No significant difference was noted between the case and control groups in any parameter (P>0.05). Significant improvement occurred in all the measured parameters in the two groups after surgery (P<0.05). The mean root coverage at the end of the study period was 87% and 80% in the case and control groups, respectively (P=0.244), and complete root coverage was achieved in 66% and 60% of the samples in the case and control groups, respectively.
Conclusions: Root surface conditioning by Er,Cr:YSGG laser improved the mean root coverage and the percentage of complete root coverage. However, these changes were not statistically significant.
- The American Academy of Periodontology. Glossary of Periodontal Terms. 4th ed. Chicago, IL, USA: The American Academy of Periodontology; 2001:44.
- Dilsiz A, Aydin T, Canakci V, Cicek Y. Root Surface Biomodification with Nd:YAG Laser for the Treatment of Gingival Recession with Subepithelial Connective Tissue Grafts. Photomed Laser Surg. 2010 Jun;28(3):337-43.
- Dilsiz A, Aydin T, Yavuz MS. Root Surface Biomodification with an Er:YAG Laser for the Treatment of Gingival Recession with Subepithelial Connective Tissue Grafts. Photomed Laser Surg. 2010 Aug;28(4):511-7.
- Roman A, Soancă A, Kasaj A, Stratul SI. Subepithelial Connective Tissue Graft with or without Enamel Matrix Derivative for the Treatment of Miller Class I and II Gingival Recessions: A Controlled Randomized Clinical Trial. J Periodontal Res. 2013 Oct;48(5):563-72.
- Kassab MM, Cohen RE. The Etiology and Prevalence of Gingival Recession. J Am Dent Assoc. 2003 Feb;134(2):220-5.
- Miller PD Jr. Root Coverage Using a Free Soft Tissue Autograft Following Citric Acid Application. Part 1: Technique. Int J Periodontics Restorative Dent. 1982;2(1):65-70.
- Langer B, Langer L. Subepithelial Connective Tissue Graft Technique for Root Coverage. J Periodontol. 1985 Dec;56(12):715-20.
- Bernimoulin JP, Lüscher B, Mühlemann HR. Coronally Repositioned Periodontal Flap. J Clin Periodontol. 1975 Mar;2(1):1-13.
- Grupe HE, Warren RF Jr. Repair of Gingival Defects by a Sliding Flap Operation. J Periodontol. 1956 Apr;27(2):92-5.
- Cohen DW, Ross SE. The Double Papillae Repositioned Flap in Periodontal Therapy. J Periodontol. 1968 Mar;39(2):65-70.
- Pini Prato G, Tinti C, Vincenzi G, Magnani C, Cortellini P, Clauser C. Guided Tissue Regeneration Versus Mucogingival Surgery in the Treatment of Human Buccal Gingival Recession. J Periodontol. 1992 Nov;63(11):919-28.
- Tal H, Moses O, Zohar R, Meir H, Nemcovsky C. Root Coverage of Advanced Gingival Recession: A Comparative Study Between Acellular Dermal Matrix Allograft and Subepithelial Connective Tissue Grafts. J Periodontol. 2002 Dec;73(12):1405-11.
- Griffin TJ, Cheung WS, Zavras AI, Damoulis PD. Postoperative Complications Following Gingival Augmentation Procedures. J Periodontol. 2006 Dec;77(12):2070-9.
- Harris RJ. The Connective Tissue and Partial Thickness Double Pedicle Graft: A Predictable Method of Obtaining Root Coverage. J Periodontol. 1992 May;63(5):477-86.
- Han JS, John V, Blanchard SB, Kowolik MJ, Eckert GJ. Changes in Gingival Dimensions Following Connective Tissue Grafts for Root Coverage: Comparison of Two Procedures. J Periodontol. 2008 Aug;79(8):1346-54.
- Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA. Can Subepithelial Connective Tissue Grafts be Considered the Gold Standard Procedure in the Treatment of Miller Class I and II Recession-Type Defects? J Dent. 2008 Sep;36(9):659-71.
- Schwarz F, Aoki A, Sculean A, Georg T, Scherbaum W, Becker J. In Vivo Effects of an Er:YAG Laser, an Ultrasonic System and Scaling and Root Planing on the Biocompatibility of Periodontally Diseased Root Surfaces in Cultures of Human PDL Fibroblasts. Laser Surg Med. 2003 Aug;33(2):140-7.
- Caffesse RG, De LaRosa M, Garza M, Munne-Travers A, Mondragon JC, Weltman R. Citric Acid Demineralization and Subepithelial Connective Tissue Grafts. J Periodontol. 2000 Apr;71(4):568-72.
- Kassab MM, Cohen RE, Andreana S, Dentino AR. The Effect of EDTA in Attachment Gain and Root Coverage. Compend Contin Educ Dent. 2006 Jun;27(6):353-60.
- Bouchard P, Nilveus R, Etienne D. Clinical Evaluation of Tetracycline HCl Conditioning in the Treatment of Gingival Recessions. A Comparative Study. J Periodontol. 1997 Mar;68(3):262-9.
- Oates TW, Robinson M, Gunsolley JC. Surgical Therapies for the Treatment of Gingival Recession. A Systematic Review. Ann Periodontol. 2003 Dec;8(1):303-20.
- Sallum EA, Casati MZ, Caffesse RG, Funis LP, Nociti Júnior FH, Sallum AW. Coronally Positioned Flap with or without Enamel Matrix Protein Derivative for the Treatment of Gingival Recessions. Am J Dent. 2003 Oct;16(5):287-91.
- Lacoste E, Martineau I, Gagnon G. Platelet Concentrates: Effects of Calcium and Thrombin on Endothelial Cell Proliferation and Growth Factor Release. J Periodontol. 2003 Oct;74(10):1498-507.
- Rubins RP, Tolmie PN, Corsig KT, Kerr EN, Kim DM. Subepithelial Connective Tissue Graft with Growth Factor for the Treatment of Maxillary Gingival Recession Defects. Int J Periodontics Restorative Dent. 2013 Jan-Feb;33(1):43-50.
- Kreisler M, Al Haj H, d’Hoedt B. Clinical Efficacy of Semiconductor Laser Application as an Adjunct to Conventional Scaling and Root Planing. Laser Surg Med. 2005 Dec;37(5):350-5.
- Harashima T, Kinoshita J, Kimura Y, Brugnera A, Zanin F, Pecora JD, et al. Morphological Comparative Study on Ablation of Dental Hard Tissues at Cavity Preparation by Er:YAG and Er,Cr:YSGG Lasers. Photomed Laser Surg. 2005 Feb;23(1):52-5.
- Miller PD Jr. A Classification of Marginal Tissue Recession. Int J Periodontics Restorative Dent. 1985;5(2):8-13.
- Fekrazad R, Lotfi G, Harandi M, Ayremlou S, Kalhori KA. Evaluation of Fibroblast Attachment in Root Conditioning with Er,Cr:YSGG Laser Versus EDTA: A SEM Study. Microsc Res Tech. 2015 Apr;78(4):317-22.
- Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal Plastic Surgery for Treatment of Localized Gingival Recessions: A Systematic Review. J Clin Periodontol. 2002;29 Suppl 3:178-94; discussion 195-6.
- Miller PD Jr. Root Coverage Using the Free Soft Tissue Autograft Following Citric Acid Application. III. A Successful and Predictable Procedure in Areas of Deep-Wide Recession. Int J Periodontics Restorative Dent. 1985;5(2):14-37.
- Tolmie PN, Rubins RP, Buck GS, Vagianos V, Lanz JC. The Predictability of Root Coverage by way of Free Gingival Autografts and Citric Acid Application: An Evaluation by Multiple Clinicians. Int J Periodontics Restorative Dent. 1991;11(4):261-71.
- Crespi R, Barone A, Covani U, Ciaglia RN, Romanos GE. Effects of CO2 Laser Treatment on Fibroblast Attachment to Root Surfaces: A Scanning Electron Microscopy Analysis. J Periodontol. 2002 Nov;73(11):1308-12.
- Pant V, Dixit J, Agrawal AK, Seth PK, Pant AB. Behavior of Human Periodontal Ligament Cells on CO2 Laser Irradiated Dentinal Root Surfaces: An In Vitro Study. J Periodontal Res. 2004;39:373-9.
- Israel M, Cobb CM, Rossmann JA, Spencer P. The Effects of CO2, Nd:YAG and Er:YAG Lasers with and without Surface Coolant on Tooth Root Surfaces: An In Vitro Study. J Clin Periodontol. 1997 Sep;24(9 Pt 1):595-602.
- Schwarz F, Aoki A, Becker J, Sculean A. Laser Application in Non-Surgical Periodontal Therapy: A Systematic Review. J Clin Periodontol. 2008 Sep;35(8 Suppl):29-44.
- Ishikawa I, Aoki A, Takasaki AA. Potential Applications of Erbium:YAG Laser in Periodontics. J Periodontal Res. 2004 Aug;39(4):275-85.
- Schwarz F, Sculean A, Berakdar M, Szathmari L, Georg T, Becker J. In Vivo and In Vitro Effects of an Er:YAG Laser, A GaAlAs Diode Laser, and Scaling and Root Planing on Periodontally Diseased Root Surfaces: A Comparative Histologic Study. Lasers Surg Med. 2003;32(5):359-66.
- Schwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker J. Clinical Evaluation of an Er:YAG Laser Combined with Scaling and Root Planing for Non-Surgical Periodontal Treatment: A Controlled, Prospective Clinical Study. J Clin Periodontol. 2003 Jan;30(1):26-34.
- Lavu V, Sundaram S, Sabarish R, Rao SR. Root Surface Bio-modification with Erbium Lasers- A Myth or a Reality?? Open Dent J. 2015 Jan 30;9:79-86.
- Cekisi A, Maden I, Yildiz S, San T, Isik G. Evaluation of Blood Cell Attachment on Er:YAG Laser Applied Root Surface Using Scanning Electron Microscopy. Int J Med Sci. 2013;10(5):560-6.
- Fujii T, Baehni PC, Kawai O, Kawakami T, Matsuda K, Kowashi Y. Scanning Electron Microscopic Study of the Effects of Er:YAG Laser on Root Cementum. J Periodontol. 1998 Nov;69(11): 1283-90.
- Theodoro LH, Sampaio JE, Haypek P, Bachmann L, Zezell DM, Garcia VG. Effect of Er:YAG and Diode Lasers on the Adhesion of Blood Components and on the Morphology of Irradiated Root Surfaces. J Periodontal Res. 2006 Oct;41(5):381-90.
- Sasaki KM, Aoki A, Ichinose S, Ishikawa I. Morphological Analysis of Cementum and Root Dentin after Er:YAG Laser Irradiation. Lasers Surg Med. 2002;31(2):79-85.
- Fayad MI, Hawkinson R, Daniel J, Hao J. The Effect of CO2 Laser Irradiation on PDL Cell Attachment to Resected Root Surfaces. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Apr;97(4):518-23.
- Mizutani K, Aoki A, Takasaki AA, Kinoshita A, Hayashi C, Oda S, et al. Periodontal Tissue Healing Following Flap Surgery Using an Er:YAG Laser in Dogs. Lasers Surg Med. 2006 Apr;38(4):314-24.
- Trylovich DJ, Cobb CM, Pippin DJ, Spencer P, Killoy WJ. The Effects of the Nd:YAG Laser on In Vitro Fibroblast Attachment to Endotoxin-Treated Root Surfaces. J Periodontol. 1992 Jul;63(7):626-32.
- Bouchard P, Etienne D, Ouhayoun JP, Nilvéus R. Subepithelial Connective Tissue Grafts in the Treatment of Gingival Recessions: A Comparative Study of 2 Procedures. J Periodontol. 1994 Oct;65(10):929-36.
| Files | ||
| Issue | Vol 15, No 4 (2018) | |
| Section | Original Article | |
| Keywords | ||
| Gingival Recession Tooth Root Tissue Transplantation Lasers | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
