Use of the Carbon Dioxide Laser in Retarding Epithelial Migration: A Pilot Histological Human Study Utilizing Case Reports

Predictable regeneration of tooth‐supporting tissues lost to periodontal disease is the aim of periodontal therapy. Often the result of conventional treatment is healing with a long junctional epithelium along the root surface and little regeneration of the complete attachment apparatus. The purpose of this pilot study was to evaluate whether de‐epithelialization with a CO2 laser at the time of flap surgery and at 10‐day intervals over the first 30 days of healing has the potential to enhance the formation of a connective tissue attachment. Six mandibular incisors in two patients were selected for the study. Each patient received oral hygiene instruction and initial therapy prior to surgery. The teeth were splinted together, open flap debridement was performed on all teeth, a notch was placed on the roots at the height of the crest of the alveolar bone, and the flaps were sutured in place. The test side received controlled de‐epithelialization of the outer (oral) gingiva with the carbon dioxide laser, and the inner gingival flap. The de‐epithelialization was repeated on the test side at 10, 20, and 30 days postsurgically. Controls received open debridement only. Block sections were taken at 90 days and processed for histologic analysis. The results showed that for both patients, junctional epithelium (JE) was formed on both test and control teeth. In all control teeth, the JE extended the entire length of the root to the base of the reference notch. On the test side (laser treated) in one patient, the notch was filled with connective tissue and limited repair cementum. This finding was not seen in any control teeth. This is the first reported observation of human histologic evaluation utilizing the CO2 laser for de‐epithelialization and may warrant further study. J Periodontol 1995;66:197–204.