Clinical efficacy of de-epithelialized free gingival grafts obtained by scalpel or Er, Cr: YSGG laser versus subepithelial connective tissue graft in tunnel treatment of gingival recession: a 6-month randomized controlled clinical trial

This 6-month parallel, three-arm randomized controlled clinical trial evaluated the clinical efficacy of the subepithelial connective tissue graft (SCTG), scalpel-de-epithelialized free gingival graft (Scalpel group), and Erbium,Chromium:Yttrium-Scandium-Gallium-Garnet (Er,Cr:YSGG) laser-de-epithelialized free gingival graft (Laser group) techniques used in conjunction with the tunnel method in the treatment of multiple gingival recessions. A total of 60 people participated in the study and allocated equally to the SCTG, Scalpel, and Laser groups (n = 20 per group). Clinical parameters were recorded at baseline and six months postoperatively in the areas with gingival recession, including plaque index (PI), gingival index (GI), probing depth (PD), recession depth (RD), clinical attachment level (CAL), root coverage percentage (RCP), keratinized tissue width (KTW) and gingival thickness (GT). Patient-reported outcomes included Oral Health Impact Profile-14 (OHIP-14), analgesic consumption, provoked sensitivity (PS) assessed by visual analog scale, postoperative palatal pain. Following treatment, all groups showed significant reductions in full-mouth GI, PI, and PD scores as well as local PI, GI, PD, CAL, RD, and PS values (p<0.05). GT significantly increased in all groups after treatment (p<0.05). The RCP was significantly lower in the Laser Group (63.56% ± 21.01) compared to the SCTG group (83.27% ± 13.3) and the Scalpel group (80.63% ± 15.4) (p<0.05). A significant increase in post-treatment KTW was observed in the SCTG and Scalpel groups (p<0.05), while it was not observed in the Laser group (p>0.05). The OHIP-14 scores decreased significantly in all groups post-treatment (p<0.05). Early postoperative pain was significantly lower in the SCTG group than in the Laser and Scalpel groups (p = 0.002), with lower analgesic intake than in the Scalpel group (p = 0.043). Within the limitations of this study, although clinical improvements were observed in all groups, in terms of RCP, the SCTG and Scalpel groups showed comparable outcomes, and both were significantly higher than the Laser group.