CO 2 Laser-Mediated Apically Positioned Flap in Areas Lacking Keratinized Gingiva

Autogenous gingival grafts are considered the "gold standard" for gingival augmentation, however they require a second surgical site for graft harvesting. Apically positioned flaps (APFs) represent an alternative method in soft tissue augmentation procedures. Limited information is available relative to the effectiveness of laser-mediated APF in augmenting keratinized gingiva (KG). The aim of this paper is to evaluate soft tissues changes following APF using CO laser in mandibular incisors with minimal KG and high labial frenum attachment. A total of 20 patients with minimal amount of KG (< 2 mm) on the labial aspect of one mandibular incisor and high buccal frenum insertion were selected for treatment. Only 19 completed the last follow-up visit. An APF consisting of a single superficial horizontal incision just coronal to the mucogingival junction using CO laser, elevation of a split-thickness flap, and suturing of the flap to the periosteum in an apical position was performed. The apico-coronal height of KG was measured at baseline, and at 3, 6 and 12 months postoperatively. Uneventful healing was observed in all patients and an increase in KG of 2-3 mm was obtained. Most patients rated the procedure and the postoperative course as non painful. CO laser-assisted APF procedure is a minimally invasive treatment modality associated with reduced risk of bleeding and predictable increase in the height of KG.