# Impact of Antimicrobial Mouthwash on Outcomes of Er: YAG Laser Versus Scalpel Frenectomy: A Retrospective Longitudinal Cohort Study

## TL;DR

This study found that Er:YAG laser frenectomy leads to better healing and less pain than traditional methods, with mouthwash having less impact.

## Contribution

The study introduces a comparative evaluation of Er:YAG laser and scalpel frenectomy with antimicrobial mouthwash effects in a longitudinal cohort.

## Key findings

- Er:YAG laser frenectomy showed significantly better wound healing and periodontal outcomes than scalpel techniques.
- Postoperative pain and analgesic use were lowest in the Er:YAG laser groups.
- Frenulum type had no significant impact on healing or pain outcomes.

## Abstract

Objective: This study compared the clinical and patient-reported outcomes of Er: YAG laser-assisted versus conventional scalpel frenectomy, while evaluating the adjunctive impact of postoperative antimicrobial mouthwashes on wound healing and periodontal parameters. Methods: A total of 102 patients who underwent labial frenectomy were included in this retrospective longitudinal cohort study. Participants were allocated into four groups based on the surgical approach (Er: YAG laser or conventional scalpel) and the postoperative mouthwash protocol (Kloroben® or Klorhex Plus®). Clinical assessments were performed at baseline and at 7, 14, and 28 days postoperatively. Wound healing, evaluated using the Wound Healing Index, was defined as the primary outcome. Secondary outcomes included periodontal clinical parameters, epithelialization status, postoperative pain, bleeding, and analgesic consumption. To control potential confounders, multivariable regression analysis was performed alongside standard parametric and nonparametric tests, with p < 0.05 considered statistically significant. Results: All treatment protocols resulted in significant improvements over time (p < 0.001). However, Er: YAG laser–assisted frenectomy was associated with significantly better periodontal indices, superior wound-healing scores, and more favorable patient-reported outcomes than the conventional scalpel technique at all postoperative evaluations (p < 0.001). On day 7, ‘Very Good’ healing was observed in 70.2% of the laser groups, compared with 14.4% in the CS groups (p = 0.001). Group 4 showed the lowest mean VAS scores (0.04 ± 0.20) and the lowest analgesic consumption by day 7. Multivariable analysis confirmed that the surgical technique was the strongest independent predictor of superior wound healing (p < 0.05), regardless of age, gender, smoking, or systemic disease. Notably, frenulum type was not significantly associated with wound healing or pain outcomes (p > 0.05). Conclusions: Within the limitations of this study, Er: YAG laser-assisted frenectomy was observed to provide favorable wound healing outcomes compared to the conventional technique. Furthermore, our findings show that anatomical variations in frenulum type do not significantly influence the quality or speed of recovery. These findings suggest that the choice of surgical modality and postoperative chemical support are more critical determinants of early clinical success than the anatomical variations of the frenulum.