Root Surface Biomodification with Nd:YAG Laser for the Treatment of Gingival Recession with Subepithelial Connective Tissue Grafts

Abstract

Background=Aim: Root surface biomodification has been used to treat gingival recession and periodontitis. The principle for this procedure is that removing the smear layer from the root surfaces exposes collagen fibers, which leads to improved healing. Clinical studies generally have failed to find any improvement in clinical parameters when using such procedures, however. The aim of this study was to evaluate and compare the outcome of gingival recession therapy using the subepithelial connective tissue graft (SCTG) with or without Nd:YAG laser application for root surface biomodification. Materials and Methods: Thirty-four teeth in 17 patients with Miller Class 1 and 2 recession were treated with SCTG with (test group) or without (control group) the application of Nd:YAG laser (1 W, 10 Hz, 100 mj, 60 s, 1064 nm). Clinical attachment level (CAL), recession depth (RD), recession width (RW), and probing depth (PD) were measured at baseline and six months postsurgery. Results: Both treatments yielded significant improvements in terms of RD and RW decrease and CAL gain compared to baseline values. For test and control groups, the average root coverage was 33% and 77%, respectively (p < 0.05), and the complete root coverage was 18% and 65%, respectively (p < 0.05). The control group showed a greater reduction in RD and RW compared with the test group (p < 0.05). Conclusions: The use of Nd:YAG laser as a root surface biomodifier negatively affected the outcome of root coverage with the SCTG.

Periodontal Soft Tissue Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop

“…Considering the use of RMA, there is clear support from the literature on the lack of additional benefits provided by the use of chemical agents (i.e., citric acid, EDTA, or tetracycline hydrochloride solution) 4‐7,9,28 or biomodification therapies (i.e., Er:YAG 61 or Nd:YAG lasers 60 ). In general terms, such agents and therapies did not lead to any detrimental effect on the expected final clinical outcomes, and they were not able to improve the results of treatment.…”

“…A total of 101 articles 30‐131 with 94 RCTs potentially eligible for inclusion into the pooled estimates were identified in the base of evidence, and their main characteristics (i.e., number and age of participants, interventions, follow‐up period, number of sites exhibiting CRC, MRC [percentage], use of RMAs, randomization, allocation concealment, masking of examiners, completeness of the follow‐up period, and risk of bias) are depicted in Table 2 30‐131 . Seven studies were reported in two articles each, and their data were reported under one study name 37,38,57,58,65,66,83,84,90,91,110,111,115,116 …”

The Combined Use of Nd:YAG Laser and Enamel Matrix Proteins in the Treatment of Periodontal Infrabony Defects

“…On the other hand, no published data are available concerning the clinical outcomes after root conditioning with Nd:YAG laser for the treatment of intrabony defects with EMP. Previous clinical studies demonstrated that lasers are an effective tool in the field of root conditioning to improve the outcome of regenerative periodontal therapies by favoring the attachment of the regenerated periodontal structures 26‐38 . Among these lasers, the Nd:YAG laser has been reported to remove the smear layer, uncovering dentinal tubules and exposing collagen fibers on root surfaces 31,32 .…”

“…Furthermore, the exposure of dentinal collagen matrix may also be favorable for retention of biologically active substances, such as EMP 14 . In addition to chemical conditioning, the applicability of different laser systems, such as the CO 2 , the neodymium‐doped:yttrium‐aluminum‐garnet (Nd:YAG), the diode, and the erbium:yttrium‐aluminum‐garnet (Er:YAG), in the removal of the smear layer has been demonstrated 26‐38 . Among these lasers, both the Er:YAG 35 and the 588‐nm diode 39 have been tested for the treatment of intrabony defects with EMP.…”

“…14 In addition to chemical conditioning, the applicability of different laser systems, such as the CO 2 , the neodymium-doped:yttrium-aluminum-garnet (Nd:YAG), the diode, and the erbium:yttrium-aluminum-garnet (Er:YAG), in the removal of the smear layer has been demonstrated. [26][27][28][29][30][31][32][33][34][35][36][37][38] Among these lasers, both the Er: YAG 35 and the 588-nm diode 39 have been tested for the treatment of intrabony defects with EMP. Schwarz et al 35 reported that the combination of ER:YAG laser and EMP did not seem to improve the clinical outcome of the therapy additionally compared to SRP + EDTA + EMP.…”