REGENERATION OF MINERALIZED AND SOFT connective tissue components of t
he attachment apparatus is the main goal in the treatment of periodont
al diseases. Often, apical migration of epithelium (long junctional ep
ithelium) effectively prevents the formation of bone and connective ti
ssue attachment after periodontal surgery. The purpose of the present
study was to compare conventional periodontal surgery combined with ca
rbon dioxide laser and conventional periodontal surgery alone with res
pect to epithelial elimination and degree of necrosis of mucoperiostea
l flaps. After signing a consent form, five patients with at least two
comparable bilateral periodontal defects needing pocket elimination s
urgery participated in this study. The investigators randomly divided
each side into test and control sites. Each patient received oral hygi
ene instruction and initial therapy prior to surgery. At surgery, the
test site received a sulcular incision and carbon dioxide laser de-epi
therialization of the outer and inner aspects of the flap. The control
group received reverse bevel incision only. The surgeon performed ope
n flap debridement on all teeth. At the time of surgery, the surgeon d
id a biopsy of each site and submitted specimens for histologic evalua
tion. A matched pairs t-test was used to analyze the data. The results
show significant differences between the carbon dioxide laser and rev
erse bevel incision with respect to sulcular (P less than or equal to
0.025) and gingival (external) (P less than or equal to 0.01) flap sur
face epithelial elimination and tissue necrosis (P less than or equal
to 0.005). These results should be replicated with a larger number of
subjects. The carbon dioxide laser eliminated sulcular and gingival (e
xternal) epithelium without disturbing underlying connective tissue. T
his finding supports the concept that the carbon dioxide wavelength ha
s little or no effect on tissues beyond the target. However, neither l
aser nor blade eliminated all the epithelium. Researchers observed chr
onic inflammation in the control and test sites, with a predominance o
f plasma cells. Lining the sulcular and gingival (external) lased area
s, investigators found coagulation necrosis covered by fibrin and coag
ulated blood. The laser appears to effectively remove epithelium at th
e time of surgery; however, future long-term, well-controlled quantita
tive histologic studies are needed to evaluate the effect of repeated
carbon dioxide laser de-epithelialization of the gingival (external) s
urface of mucoperiosteal flaps at intervals during the healing period.