CO₂ Laser De-epithelization Technique for Subepithelial Connective Tissue Graft: A Study of 21 Recessions

Abstract

Background/Aim: To report cases in which we achieved sufficient width of the keratinized gingiva using a coronally advanced flap in combination with a subepithelial connective tissue graft (SCTG) obtained by the 'CO 2 laser de-epithelization technique' (CODE). Patients and Methods: Eleven patients with 21 Miller Class I, II, and III gingival recessions had surgery. To prepare SCTG, free gingival grafts were harvested and de-epithelialized extra-orally. Deepithelialization was conducted by irradiation of CO 2 laser. Postoperative examinations were performed at 12 months. Results: At 12 months, statistically highly significant root coverage was achieved in all recessions. Complete root coverage was obtained in 7 of the 21 recessions. The treatment yielded mean root coverage of 41.0%, and was associated with a mean gain of keratinized gingiva of 2.9±0.3 mm. Conclusion: The use of CODE allows harvesting grafts of excellent quality and quantity and increases the keratinization of the overlying mucosal epithelium.

Complications in the Use of Deepithelialized Free Gingival Graft vs. Connective Tissue Graft: A One-Year Randomized Clinical Trial

“…As the bibliography indicates, other minimally invasive techniques could be used in the management of the soft tissue, such as laser systems (Er:YAG or Er,Cr:YSGG), according to the expert’s skills, with similar results. [ 42 , 43 , 44 ]. Some publications suggest that complications can be higher in patients with HIV, and therefore the viral load (CD4/CD8 ratio) must be stable [ 45 ].…”

Application of an active oxygen (blue®m) with free connective graft technique for root coverage – a case report

“…Gingival recession causes discomfort and impairs the aesthetics of the patient. Root coverage should generate an increase the keratinized gingiva band (Yoshino et al, 2020), eliminate dentin hypersensitivity (Eisenbud, 2012) and avoid the accumulation of plaque (Rasperini et al, 2011;Zucchelli et al, 2011;Mattos et al, 2019;Yoshino et al, 2020;).…”

“…To aid healing and increase local angiogenesis, it was decided to daily apply the blue®m oral gel in the immediate postoperative period and until the sutures were removed, as well as to indicate the use of the blue®m mouthwash in order to minimize risk of necrosis of the free conjunctive graft. The free gingival graft has its epithelium coming from the palate which favors its predictability and decreases the chance of necrosis; however, it has a disadvantage, the discrepancy in color and texture in contrast to the recipient bed (Yoshino et al, 2020).…”

“…When this technique is performed, the tissue tends to have a color and texture like keratinized mucosa due to the influence of the cells of the recipient site. Thus, the need to remove this epithelium, cells that had different coloring and texture from the donor site (palate) are removed, making the FCG become more aesthetic than the FGG (Montanari, 2016;Yoshino et al, 2020).…”

“…The free gingival graft technique (FGG) has great predictability of success in treating gingival recessions, having also been widely used to gain keratinized tissue. However, it has some disadvantages, such as the discrepancy in texture and colormismatch between the healed graft and the graft recipient area (Zucchelli et al, 2006;Zucchelli & Mounssif 2015;Yoshino et al, 2020;Araujo et al, 2021). The use of subepithelial connective tissue graft (CTG) is reported to be the gold standard for correcting these defects, including as its greatest advantage the increase in the volume of soft tissue and the contouring of the gingival margin (Sculean et al, 2014;Thoma et al, 2020).…”