EC Dental Science

Research Article Volume 22 Issue 4 - 2023

Evaluation of CO2 (Carbon Dioxide) Laser Assisted Guided Tissue Regeneration (GTR) and Bactericidal Effect in Periodontal Flap Surgery: A Clinical and Microbiological Study

Rashmi Hegde1, Prerna Ghodke2, Sharayu Dhande3* and Sangeeta Muglikar4

1 Professor, Department of Periodontology and Oral Implantology, M A Rangoonwala College of Dental Sciences and Research Centre, Pune, India
2Private Practitioner, India
3MDS, M A Rangoonwala College of Dental Sciences and Research Centre, Pune
4Professor and Head of the Department, Department of Periodontology and Oral Implantology, M A Rangoonwala College of Dental Sciences and Research Centre, Pune, India

*Corresponding Author: Sharayu Dhande, MDS, M A Rangoonwala College of Dental Sciences and Research Centre, Pune.
Received: November 16, 2022; Published: March 31, 2023



Introduction: Guided tissue regeneration (GTR) describes procedures attempting to regenerate lost periodontal structures through differential tissue responses. It typically refers to regeneration of lost periodontal attachment through use of bone grafts and barrier membranes, which further aid in clot stabilization, space maintenance and cell exclusion. Adjunctive use of lasers can provide the beneficial dual ablation of outer oral epithelium as well as bactericidal effect, thus promoting regeneration.

Aim: To evaluate the bactericidal effect of 10,600 nm carbon dioxide (CO2) laser in periodontal flap surgery and guided tissue regeneration procedure.

Materials and Methods: 15 patients were included in the split-mouth study. An acrylic stent was prepared to measure RAL, and with the help of UNC 15 probe, pocket depths were measured at baseline and at 3 months. Open flap debridement (control) versus CO2 laser with OFD (test group) with follow up performed on 1st day, 7th day and 3 months post operatively. In the test group, CO2 laser was used to lase the outer and under surfaces of the flap once reflected. At baseline and at 3 months, microbiological examination was carried out for which 2% 25 number sterile paper points were used to collect subgingival plaque samples from the deepest pockets in each group.

Results: The results in all parameters viz., RAL, Mean CFU, Pain perception through VAS, Bleeding on probing, Epithelial healing were statistically significant.

Conclusion: In this study, irradiation with CO2 laser not only caused guided tissue regeneration effect and bactericidal effect but also aids in gingival depigmentation if necessary.

Keywords: New Attachment; De-Epithelization; Guided Tissue Regeneration; CO2 Laser; Periodontal Flap; Flap Surgery; Periodontitis; Periodontal Regeneration

  1. Eley BM and Manson JD. “Periodontics”. 5th Bangalore, Karnataka: Wright an imprint of Elsevier Ltd; Basic treatment of chronic gingivitis and periodontitis (2004): 189-208.
  2. Smith BA., et al. “Mucoperiosteal flaps with and without removal of the pocket epithelium”. Journal of Clinical Periodontology 58 (1987): 78-85.
  3. Caffesse RG., et al. “New attachment achieved by guided tissue regeneration in beagle dogs”. Journal of Periodontology9 (1988): 589-594.
  4. Hom-Lay Wang. “Guided Tissue Regeneration”. DCNA3 (1998).
  5. Position paper: Periodontal Regeneration: JP (2005).
  6. Padbury Jr A., et al. “Interactions between the gingiva and the margins of restorations”. Journal of Clinical Periodontology 30 (2003): 379-385.
  7. Melcher AH. “On the repair potential of periodontal tissues”. Journal of Periodontology5 (1976): 256-260.
  8. Gould R Gordon. "The LASER, Light Amplification by Stimulated Emission of Radiation". In Franken, P.A. and Sands, R.H. (Editions.). The Ann Arbor Conference on Optical Pumping, the University of Michigan (1959): 128.
  9. Israel M., et al. “The effects of C02, Nd: YAG and Er: YAG lasers with and without surface coolant on tooth root surfaces: an in vitro study”. Journal of Clinical Periodontology9 (1997): 595-602.
  10. Wigdor HA., et al. “Lasers in dentistry”. Lasers in Surgery and Medicine2 (1995): 103-133.
  11. Walsh LJ. “The current status of laser applications in dentistry”. Australian Dental Journal3 (2003): 146-155.
  12. Walsh LJ. “The use of lasers in implantology: an overview”. The Journal of Oral Implantology4 (1992): 335-340.
  13. Pick RM and Miserendino LJ. “Lasers in dentistry: An overview”. Laser Medicine and Surgery News and Advances3 (1989): 33-42.
  14. David CM and Gupta P. “Lasers in dentistry: a review”. The International Journal of Advanced Health Science and Technology8 (2015): 7-13.
  15. Crespi R., et al. “CO2 laser effects on root surfaces in periodontal treatment: Case reports”. The Journal of Oral Laser Applications 4 (2004): 109-117.
  16. “Lasers in dentistry: Comparing wavelengths”. Journal of the American Dental Association 124 (1993): 49-54.
  17. Gillis TM and Strong MT. “Surgical lasers and soft tissue interactions”. Otolaryngologic Clinics of North America 16 (1983): 775-792.
  18. Tuffin JR and Carruth JA. “The carbon dioxide surgical laser”. British Dental Journal 149 (1980): 255-258.
  19. Pick RM and Powell GM. “Lasers in dentistry. Soft tissue procedures”. Dental Clinics of North America Journal 37 (1993): 281-296.
  20. Miller M and Truhe T. “Lasers in dentistry: An overview”. Journal of the American Dental Association 124 (1993): 32-35.
  21. Pick RM and Colvard MD. “Current status of laser in soft tissue dental surgery”. Journal of Periodontology 64 (1993): 589-602.
  22. Fisher SE., et al. “A comparative histological study of wound healing following CO, laser and conventional surgical excision of canine buccal mucosa”. Archives of Oral Biology 28 (1993): 287-290.
  23. Mihashi S. “The carbon dioxide laser surgery”. Journal of Otolaryngology of Japan 78 (1975): 1244-1278.
  24. Mihashi S. “Immediate effects of CO2 laser irradiation on soft tissue”. Journal of Otolaryngology of Japan 79 (1976): 1341-1346.
  25. Mihashi S., et al. “Laser surgery in otolaryngology: Interaction of CO2 laser and soft tissue”. Annals of the New York Academy of Sciences 267 (1976): 263-294.
  26. Mihashi S. “The changes of surface structure on soft tissue induced by CO2 laser irradiation”. Journal of Otolaryngology of Japan 80 (1977): 1483-1487.
  27. Romanos G. “Current concepts in the use of lasers in periodontal and implant dentistry”. Journal of Indian Society of Periodontology5 (2015): 490.
  28. Crespi R., et al. “Comparison of modified widman and coronally advanced flap surgery combined with Co2 laser root irradiation in periodontal therapy: A 15-year follow-up”. The International Journal of Periodontics and Restorative Dentistry 31 (2011): 641-651.
  29. Yukna RA., et al. “A clinical study of healing in humans following the excisional new attachment procedure”. Journal of Periodontology12 (1976): 696-700.
  30. Reddy S., et al. “Evaluation of postsurgical clinical outcomes with/without removal of pocket epithelium: A split mouth randomized trial”. Journal of Indian Society of Periodontology 18 (2014): 749-759.
  31. Yukna RA., et al. “Histologic evaluation of an Nd: YAG laser-assisted new attachment procedure in humans”. International Journal of Periodontics and Restorative Dentistry6 (2007): 577-587.
  32. Nevins ML., et al. “Human clinical and histologic evaluation of laser-assisted new attachment procedure”. International Journal of Periodontics and Restorative Dentistry5 (2012): 497-507.
  33. Israel M., et al. “Use of the carbon dioxide laser in retarding epithelial migration: A pilot histological human study utilizing case reports”. Journal of Periodontology 66 (1995): 197-204.
  34. Needleman I., et al. “Guided tissue regeneration for periodontal infra-bony defects”. The Cochrane Database of Systematic Reviews 5 (2019): CD001724.
  35. Ling LJ., et al. “The influence of membrane exposure on the outcomes of guided tissue regeneration: clinical and microbiological aspects”. Journal of Periodontal Research1 (2003): 57-63.
  36. Kamma JJ., et al. “The effect of diode laser (980 nm) treatment on aggressive periodontitis: evaluation of microbial and clinical parameters”. Photomedicine and Laser Surgery1 (2009): 11-19.
  37. Dőri F., et al. “Bacterial Contamination of ePTFE Membranes Following Regenerative Surgery of Intrabony Defects Treated with Platelet-rich Plasma and Natural Bone Mineral”. Oral Health and Preventive Dentistry5 (2019): 439-445.
  38. Fardal Ø., et al. “Patient perceptions of periodontal therapy completed in a periodontal practice”. Journal of Periodontology9 (2002): 1060-1066.
  39. Ratka‐Krüger P., et al. “Guided tissue regeneration procedure with bioresorbable membranes versus conventional flap surgery in the treatment of infrabony periodontal defects”. Journal of Clinical Periodontology2 (2000): 120-127.
  40. Marini L, Rojas MA, Sahrmann P, Aghazada R, Pilloni A. Early Wound Healing Score: a system to evaluate the early healing of periodontal soft tissue wounds. Journal of periodontal & implant science. 2018 Oct 1;48(5): 274-83.
  41. Aoki A., et al. “Periodontal and peri‐implant wound healing following laser therapy”. Periodontology 20001 (2015): 217-269.
  42. Rojas MA., et al. “Early wound healing outcomes after regenerative periodontal surgery with enamel matrix derivatives or guided tissue regeneration: a systematic review”. BMC Oral Health1 (2019): 1-6.

Hegde, Ghodke, Dhande., et al. "Evaluation of CO2 (Carbon Dioxide) Laser Assisted Guided Tissue Regeneration (GTR) and Bactericidal Effect in Periodontal Flap Surgery: A Clinical and Microbiological Study". EC Dental Science 22.4 (2023): 162-181.

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