الفهرس 
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Abstract
Treatment of buccal gingival recession is a common requirement due to aesthetic concern or root sensitivity. The ultimate goal of a root coverage procedure is the complete coverage of the recession defect with good appearance related to adjacent soft tissues. Recent systematic reviews showed that CAF is a safe and predictable approach for root coverage and the adjunct use of CTG enhances the probability to obtain CRC in Miller’s class I and II single GR. The use of lasers in periodontal surgery offers precision of incision, hemostatsis that allows clear vision and reduces post-operative patients’ morbidity. Er, Cr:YSGG is one of the Erbium family lasers that offers superior efficiency being highly absorbed in water together with minimal thermal damage to both soft and hard tissues.
The aim of this randomized controlled clinical trial was to evaluate the root coverage outcomes (1ry outcomes) and post-operative morbidity (2ry outcome) of Miller’s class I, II as well as class III GR treated by the use of Er,Cr:YSGG laser-harvested DGG together with laser assisted root surface bio-modification and to compare these results to blade-harvested DGG with or without Er,Cr:YSGG root surface bio-modification.
The current study included 42 patients divided into two equal groups (A and B, 21 patients each). group A consisted of 8 males and 13 females having Miller’s class I, II GR defects and they were randomly assigned to one of the three treatment subgroups (I, II, III; 7 patients each). The same was followed in group B (comprising 7 males and 14 females, with Miller’s class III GR).
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Pre-operatively, all patients received initial therapy then were reevaluated after 4 weeks to be scheduled for periodontal surgery only if PI<10% and GI<15%. At baseline, clinical parameters were recorded including; PI, GI, PPD, CAL, RD, RW, HKT and GT using CBCT. A bilaminar (CAF+DGG) technique was used in all subgroups. Er, Cr:YSGG was used in harvesting DGG and root surface biomodification in subgroup III, blade-harvested DGG was performed together with Er,Cr:YSGG root suface biomodification in subgroup II and bladeharvested DGG in the control group (subgroup I). Recall appointments were carried out at 3, 6, 9 months post-operatively to assess the same preoperative clinical parameters. Moreover, post-operative morbidity was assessed using VAS. group A results showed statistically significant reduction in mean RD in the three subgroups throughout the study period. At 9 months the MRC was 85.7%, 96.4% and 95.2% in the three subgroups, respectively. In addition, 80.9% (17/21) of the GR defects showed CRC. Moreover, there was statistically significant increase in mean GT with the heighest % seen in subgroup III (152.7 %) followed by subgroup I (151.5%) then II (150.9 %). Regarding HKT, statistically significant increase was noticed in all subgroups being highest in subgroup I (6.00 ± 0.82 mm) followed by subgroup III (5.71 ±0.49mm) then II (5.57 ± 0.53mm) On the other hand, group B results revealed the highest reduction in mean RD in subgroup I (64.2%) followed by subgroup III (63.1%) then II (36.9%) with 23.8% (5/21) showing CRC. GT showed statistically significant increase in each subgroup at 9 months, being heighest in subgroup III (212.7 %) followed by subgroup I (178.6 %) then II (163.7
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%). On the other hand, the mean HKT revealed statistically significant increase in all subgroups at 9 months, reaching the highest value in subgroup III (4.14 ± 0.69mm), I (4.00 ± 0.58mm) II (3.29 ± 0.95mm), respectively.
As regards VAS for the donor site, blade-harvested DGG subgroups (AI, AII, BI, BII with n=28) showed significantly higher mean VAS on the day of surgery (first experience of pain), day 3 and 4 as well as analgesic intake of pills on the day of surgery compared to the laserharvested DGG subgroups (AIII, BIII with n=14).