Efficacy of LASER for de-epithelialization of free gingival graft: a systematic review

TL;DR

This review examines how well LASER technology can remove epithelium from free gingival grafts and its effectiveness in soft tissue augmentation.

Contribution

The study provides a systematic review of LASER de-epithelialization of free gingival grafts and its clinical outcomes.

Findings

LASERs can successfully remove epithelium from free gingival grafts without complications.

Clinical outcomes using LASER-de-epithelialized grafts are comparable to traditional blade methods.

Aesthetic outcomes may be slightly better with LASERs, but evidence remains limited.

Abstract

This systematic review primarily aimed to investigate the efficacy of de-epithelializing free gingival graft (FGG) using LASER and, secondarily, to evaluate the clinical outcomes of soft tissue augmentation using LASER-de-epithelialized connective tissue grafts (CTGs). Following PRISMA guidelines, an electronic search was conducted in PubMed/MEDLINE, Scopus, Embase, and Web of Science databases without date or language restrictions on February 4, 2025. Clinical studies employing LASER for de-epithelializing FGG were considered eligible. The primary outcome was successful epithelium removal, while the main secondary outcomes were mean and complete root coverage percentage. Quality appraisal of the included studies was executed according to the revised Cochrane risk-of-bias tool for randomized trials (RoB2) and Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I). Of 243 studies, three met all eligibility criteria. Two randomized controlled clinical trials (RCTs), and one pre-post study were included. CO2, Er: YAG, and diode LASERs were utilized in the included studies. Power was set to 1 and 2 W in two and one studies, respectively. Epithelium removal was not quantitatively reported in any of the included studies, but complete removal of epithelium with LASER was reported qualitatively in one study. In all the included studies, LASERs yielded clinical outcomes comparable to blades, with minor superiorities in aesthetic outcomes observed with LASERs. LASERs show potential for successful removal of epithelium from FGG without causing safety issues or complications. However, the evidence on this topic remains limited, highlighting the need for well-conducted and reported RCTs.

Registration The protocol of this systematic review was registered on PROSPERO with the ID CRD42025646636.

Clinical Trial Number Not applicable.

The online version contains supplementary material available at 10.1007/s10103-025-04554-0.

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