Intraoral Er:YAG laser-assisted de-epithelialization of autogenous gingival grafts for soft tissue management.

Abstract

Background: The aim of this case series was to introduce intraoral Er:YAG laser-assisted de-epithelialization of autogenous gingival graft (EL-DGG) for root coverage and alveolar ridge augmentation.

Methods: In conventional harvesting of de-epithelialized gingival grafts (DGGs) with a scalpel, the presence of residual epithelium has occasionally been observed, posing challenges to the reliable procurement of stable connective tissue grafts (SCTG). We utilized an Er:YAG dental laser, known for its minimal histological effect among dental lasers, to perform intraoral DGG in three cases involving root coverage or ridge augmentation.

Results: Complete root coverage was achieved in the two root coverage cases. In the ridge augmentation case, horizontal and vertical dimensional gains of 1.56 and 0.74 mm, respectively, were observed. A portion of the CTG obtained from the peripheral trimmed area was biopsied and histologically examined. De-epithelialization of this area was performed using the same protocol as in the clinical procedure, including both Er:YAG laser irradiation and adjunctive rotary brush application, suggesting that epithelial removal was achieved in the examined sample with minimal damage to the underlying connective tissue layer of dense collagen fibers.

Conclusions: By effectively eliminating epithelial remnants and preserving connective tissue thickness in palatal grafts, EL-DGG can offer more favorable clinical outcomes in root coverage and ridge augmentation compared to conventional graft-harvesting methods.

Key points: Selective epithelial removal: Intraoral Er:YAG laser-assisted de-epithelialization enables selective removal of palatal epithelium while preserving dense subepithelial connective tissue thickness. Histologic and clinical validation: Histologic analysis confirmed complete epithelial elimination with minimal lamina propria damage, resulting in stable root coverage and soft tissue augmentation. Advantage in thin phenotypes: This technique allows predictable graft harvesting even in thin palatal mucosa, supporting phenotype modification and ridge augmentation procedures.

Plain language summary: Gum tissue taken from the roof of the mouth is commonly used to cover exposed tooth roots or rebuild areas where soft tissue has been lost. However, when preparing these grafts with a scalpel, small remnants of the surface epithelial layer may remain, while removing too much tissue can reduce the thickness and quality of the connective tissue needed for treatment. In this case series, we used an Er:YAG laser to remove the epithelial layer directly from the palate before harvesting the graft. This approach was used in three patients: two received treatment for exposed tooth roots, and one received soft tissue augmentation in an area with a missing tooth. Complete root coverage was achieved in both root coverage cases, and an increase in tissue volume was observed in the ridge augmentation case. Microscopic examination of a graft sample suggested that the epithelial layer was removed while the dense connective tissue underneath was largely preserved. These findings suggest that Er:YAG laser-assisted graft preparation may help clinicians obtain thick, stable connective tissue grafts while reducing unwanted epithelial remnants. Further studies involving more patients and longer follow-up are needed to confirm these potential benefits.