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American Journal of  
Chemistry and Pharmacy (AJCP)

A Systematic Review: Methods of  Gingivectomy for Esthetic 
Marginal Periodontal Tissue Conditioning

Maha Munshi1*

Volume 2 Issue 2, Year 2023
ISSN: 2834-0116 (Online)

DOI: https://doi.org/10.54536/ajcp.v2i2.1681
https://journals.e-palli.com/home/index.php/ajcp

Article Information ABSTRACT

Received: May 24, 2023

Accepted: June 22, 2023

Published: July 21, 2023

This review compared the prognosis of  gingivectomy procedures carried out through a scalpel 
or alternative techniques. An extensive search was performed in the electronic database. 
Articles were identified according to inclusion criteria. The extracted data from the selected 
studies were organized in tables and assessed for risk of  bias. Ten clinical trial studies were 
identified. Nine studies used the laser method for gingivectomy, and only one trial was based 
on the electrosurgical method. Seven studies were at low risk of  bias, and three were at high 
risk. No significant differences were presented in pain and discomfort in the electrosurgical 
studies. One study reported non-significant differences between electrosurgery and scalpel 
regarding clinical healing. Based on limited data in this systematic review, the diode laser 
showed superiority over the scalpel in pain and discomfort postoperatively. In contrast, for 
PI and GI, the data were insufficient to conclude the results.

Keywords
Gingivectomy, Electrosurgery, 
Scalpel, Diode Laser, Esthetic 
Marginal Periodontal Tissue, 
Tissue Conditioning, Periodontal

1 Malmo University, Sweden
* Corresponding author’s e-mail: mahamunshi321@Outlook.com

INTRODUCTION
A healthy periodontium should be maintained, especially 
during tooth restoration, by keeping a safe zone of  
healthy gingival tissue called “biological width” between 
the edge of  the sub-gingival filling and the bone margin or 
during the excision of  excess gingival tissues for esthetic 
purposes. The term “biological width” was replaced by 
“supracrestal attached tissue” in the new classification 
of  periodontal and peri-implant disease and conditions 
in 2017(Jepsen et al., 2018). It is histologically composed 
of  the junctional epithelium and supracrestal connective 
tissue attachment. The clinicians can create a healthy 
supracrestal attached tissue or reposition existing and 
maintain biological width by gingivectomy, including an 
apically repositioned flap.
Gingivectomy in crown lengthening procedures is one 
of  the methods proven effective in maintaining the 
supracrestal tissue attachment intact. It includes removing 
a pre-determined deep periodontal pocket using a scalpel, 
electrosurgery, and laser surgery. This systematic review 
compares the conventional method for gingivectomy 
(i.e., surgical scalpel) with other methods described 
for gingivectomy in the literature based on precision 
cutting, cost-effectiveness, hemostatic function, patient’s 
perception of  pain, discomfort during and after the 
surgery, and periodontal parameters, including PI, GI, 
and pocket depth (PD).

Methods of  Gingivectomy 
Surgical Scalpel
The surgical scalpel has been used as a gold standard 
for many years. Despite the ease of  use, cost-effective, 
precision, and less harmful to the surrounding tissues, 
bleeding during the surgery obscures the surgical field, 
and the risk of  scalpel injury has been reported. The risk 

of  scalpel injury was about 18% of  all sharp injuries, and 
about 31% of  scalpel injuries occurred during direct scalpel 
use, according to the Exposure Prevention Information 
Network “EPINet” report in 2003(Perry et al., 2003). To 
obtain a clear surgical field, the clinician needs a surgical 
instrument that cuts efficiently like a scalpel, causing less 
bleeding during the surgery and minimal risk of  injury. 
William Cameron developed this surgical instrument in 
1928. It was his first dental electrosurgical unit to assist in 
achieving hemostasis.

Electrosurgical Unit
Harris defined an electrosurgical unit (ES) as “The use 
of  specially designed electronic equipment that produces 
a limited variety of  high-frequency waveforms to cut 
or remove soft tissue”(HS., 1976). While Oringer MJ. 
Defined it as “The application of  electrically generated 
heat energy to living tissue to alter or destroy it for 
therapeutic purposes” (Oringer, 1975). There are two 
types of  ES units, monopolar and bipolar. The bipolar 
type has a forceps-like electrode, whereby the electrical 
current passes from one tip to the other, with the 
targeted tissue placed between them. The monopolar 
type is the most common use in dentistry, as described by 
Gnanasekhar JD. et al. (Gnanasekhar & Al-Duwairi, 1998; 
Yalamanchili et al., 2013).
There are three different waveforms: fully rectified and 
filtered, fully rectified and unfiltered, and partially rectified. 
The fully rectified, filtered waveform produces excellent 
tissue separation with little hemostasis and the least lateral 
heat. This waveform can be used for soft tissue surgeries, 
such as a frenectomy, incision and drainage, and gingival 
trough procedures around the teeth. The fully rectified, 
unfiltered waveform produces good tissue separation 
and hemostatic effect but causes tissue shrinkage and 

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generates additional lateral heat, avoiding bone contact. It 
is suitable for gingivectomy, gingivoplasty, and pulpotomy. 
The partially rectified waveform causes much more lateral 
heat than the fully rectified, unfiltered; therefore, it can be 
used only as a hemostatic effect in soft tissue and as a heat 
source for bleaching agents (Gnanasekhar & Al-Duwairi, 
1998; Yalamanchili et al., 2013).
Moreover, electrosurgery has an alternating current 
that passes through the tissue. The tissue resists the 
electrical current, generating lateral heat, which causes the 
intracellular water to boil, increasing intracellular pressure 
and rupturing cell membranes. 

Chemical Method
Chemosurgery is another method to perform a 
gingivectomy. Two chemicals were used to remove the 
gingiva, such as 5% paraformaldehyde and potassium 
hydroxide. Schwarz first used formaldehyde N. et al. (N, 
1917). Paraformaldehyde is a white powder that is not 
readily soluble, so it needs to be mixed with zinc oxide 
powder and eugenol as a liquid. This mix is called a 
“medicated cement pack”(Orban, 1943). Special care 
should be taken in applying medicated cement packs in the 
gingival pockets because of  possible abscess formation, 
bone necrosis, and allergy to formaldehyde(Orban, 
1943). Potassium hydroxide was advocated by Harndt 
E.(E, 1951). However, it is a strong alkali, and it has a 
necrotising effect on the gingiva and alveolar bone.

Laser System
Laser is another method for gingivectomy. “LASER” is 
an abbreviation of  Light Amplification by the Stimulated 
Emission of  Radiation. The laser was invented first by 
Theodore Maiman, USA, in 1960(Maiman, 1960). Four 
common types of  lasers are used now in dental practice, 
including the Carbon dioxide laser (CO2), the diode laser 
(DL), the Neodymium: Aluminum-Yttrium-Garnet (Nd: 
YAG), and the Erbium: Aluminum-Yttrium-Garnet 
(Er: YAG). Laser wavelengths in medicine and dentistry 
generally range from 193 nanometers (nm) to 10,600 nm. 
American, in 1989, produced the first dental laser for 
commercial use, using Nd: YAG as an active medium, but 
only for soft tissue surgery(Keller & Hibst, 1989). After a 
few years, the UK 1990 developed a machine laser using 
Nd: YAG as an active medium that can cut through the 
enamel, dentin, and bone. Shortly followed by a similar 
Er, Cr: YSGG (erbium chromium: yttrium scandium 
gallium garnet) laser in 1997(Parker, 2007a). 
The laser has a clear and precise cut, good visibility related 
to its ability to seal blood vessels and lymph vessels during 
the procedure, minimal damage to adjacent tissues, and 
fewer postoperative complications such as pain and 
swelling, which increase patient satisfaction, accelerate 
wound healing, and less surgical time. 

Carbon Dioxide Laser
Kumar Patel invented the CO2 laser in 1964. The 
wavelength ranges from 9.4 to 10.6 micrometres. About 

98% of  the energy is converted to heat and absorbed 
at the tissue surface with little penetration. For decades, 
the CO2 laser was the gold standard for intraoral soft 
tissue surgeries. The laser medium consists of  water 
or air-cooled gas discharge (Carbon dioxide, nitrogen, 
hydrogen, xenon, helium) that helps produce a beam of  
infrared light by activating the footswitch (Viraparia et 
al., 2012). The depth of  the laser incision is related to 
the power setting and the exposure’s duration. Higher 
energy removes the tissue, while lower energy is used 
for hemostasis and photocoagulation. Continuous-
wave mode forms char during the procedure. Char 
accumulation during the surgery leads to increased tissue 
temperature up to >200°C, so it is recommended to clean 
the surgical site to avoid thermal damage(Low & Mott, 
2014). In addition, this system has no tactile feedback.

Clinical Applications of  CO2 laser (Ishikawa et al., 
2009; Viraparia et al., 2012)
a) Oral and maxillofacial surgery; b) Oral medicine; c) 
Pre-prosthetic procedures; d) Periodontal procedures; e) 
Endodontics: pulpotomy, filling material removals such 
as gutta-percha or resin; f) Restorative procedures.

Nd: YAG 
The Nd: YAG laser was developed by Geusic et al. in 1964. 
The medium is a crystal of  yttrium-aluminium-garnet 
doped with neodymium. Have a wavelength of  1064 nm. 
In 1973, data were calculated for the water absorption 
spectrum of  different lasers, such as Argon, Diode, Nd: 
YAG, CO2, Er, Cr: YSGG, and Er: YAG by Hale and 
Querry (Hale & Querry, 1973). They showed that the 
energy of  Nd: YAG scattered rather than being absorbed 
by water like a diode laser, which led to greater penetration 
in the soft tissue. In addition, the wavelength is attracted 
to colours, so this system is ideal for ablating potentially 
hemorrhagic abnormal tissue and hemostasis of  small 
venous vessels and capillaries. Nd: YAG laser device has 
contact or non-contact probes, giving tactile feedback. 

Clinical Applications of  Nd: YAG laser(Ishikawa et 
al., 2009)
a) Oral and maxillofacial; b) Periodontal procedures: 
gingivectomy, gingivoplasty, operculum removal, 
bactericidal effect (Cobb, 2006), suppressing or eradicating 
putative periodontal pathogens from periodontal pockets 
(Parker, 2007b; Verma et al., 2012), as an adjunctive or 
alternative treatment to conventional mechanical therapy 
in periodontitis (Cobb, 2006).

Er: YAG and Cr: YSGG
As for the CO2 laser system, it is essential for Er: YAG 
and Cr: YSGG that the tip be at least 1-2 mm away from 
the target tissue to have a good result. The erbium laser 
has two distinct wavelengths, 2790 - 2940 nm Cr: YSGG 
lasers and Er: YAG lasers, respectively, and has a high 
affinity for hydroxyapatite and the highest absorption 
of  water(Ishikawa et al., 2009). Consequently, it is the 

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laser for treating dental hard tissues (Harashima et al., 
2005). It can also be used for soft tissue ablation because 
it produces a little heat into the underlying tissues and 
elevates the pulpal temperature compared to a CO2 laser.

Clinical Applications of  Er: YAG and Cr: YSGG 
laser(Ishikawa et al., 2009) (Bader & Krejci, 2006) 
a)Endodontic; b) Periodontal procedures: SRP, ablation 
of  bone tissue, bactericidal effect on implant surface; c) 
Restorative procedures.

Diode Laser (DL) 
The diode laser has energy absorbed by the pigmentation 
in the soft tissue and haemoglobin, making this system 
an excellent hemostatic agent (Fornaini et al., 2016). 
It is a solid semiconductor operating at 810-980 nm 
wavelengths. The energy is either a continuous or a 
pulsed mode. Using the pulsed mode during the soft 
tissue procedure and lowering the power setting is 
recommended. In contrast to other laser systems, it 

Table 1: PICO Model
Population Patients in need of  marginal tissue conditioning
Intervention Gingivectomy
Comparison Use a scalpel as a standard method, and compare it to other methods (e.g., electrosurgery and 

different types of  laser).
Outcome Patient's reported outcomes and clinical periodontal parameters

directly contacts the target tissue so the clinician can feel 
tactile feedback (Kravitz & Kusnoto, 2008).

Clinical Applications of  the diode laser (Verma et al., 
2012) (BM S, 2017) 
a) Oral and maxillofacial; b) Periodontal procedures; c) 
Restorative procedures; d) Orthodontic; d) Endodontic.

MATERIAL AND METHODS
Research Question
The research question was, “For marginal tissue 
conditioning, is gingivectomy with alternative methods 
superior to conventional gingivectomy with a scalpel 
regarding patient-reported outcomes and clinical 
periodontal parameters?” 
The protocol was constructed according to “PRISMA” 
(Preferred Items for Systematic Reviews and Meta-
Analyses) criteria (Liberati et al., 2009), and a question was 
formulated according to “PICO.” Model as mentioned in 
Table 1.

Table 2: Search Strategy
Sr. No Search Strategy
1 Gingivectomy [Abstract & Keywords] OR Electrosurgery [Abstracts & Keywords] OR Diode laser 

[Abstract & Keywords] OR Gingival enlargement  [Abstract & Keywords] OR Gingival hypertrophy 
[Abstract & Keywords] OR Scalpel [Abstract & Keywords] OR Gingivoplasty [Abstract & Keywords]

2 Gingival hypertrophy [tw] OR gingivectomy [tw] OR electrosurgery [tw] OR Diode laser [tw] OR Supra 
crestal attached tissue [tw] OR Gingival enlargement [tw] OR Gingivoplasty [tw] OR Crown lengthening 
[tw] OR treatment [tw] OR scalpel [tw] 

3 Gingivoplasty [Abstract & Keywords] OR Gingivectomy [Abstract & Keywords] OR Gingival enlargement 
[Abstract & Keywords] OR Supra crestal attached tissue [Abstract & Keywords] OR Scalpel [Abstract & 
Keywords] OR Diode laser [Abstract & Keywords] OR Electrosurgery [tw] OR Gingival hypertrophy [tw]

2): “Gingival hyperplasia” OR “Gingival hypertrophy” 
OR “Gingival overgrowth” and Gingivoplasty OR 
Gingivectomy OR “Crown lengthening”.

Search Strategy
Up to August 2019, the following MeSH keywords and 
free text phrases were searched in the electronic databases: 
Medline (PubMed), Scopus, and Web of  Science (Table 

Assessment of  the eligibility of  studies and the data 
extraction method
The author assessed the research based on the inclusion 
and exclusion criteria. Inclusion criteria for studies were 
selected based on articles in the English language, available 
as full-text, consisting of  Human trials, controlled clinical 
trials (CCT), or randomised controlled clinical trials 
(RCTs) with a minimum of  10 patients per study. It also 
includes articles based on patients who underwent surgery 
for gingivectomy by using the scalpel compared with the 
alternative methods. In addition, exclusion criteria exclude 

articles based on languages other than English, Animal 
or Vitro studies, Case reports, clinical notes/letters, and 
editorials. Materials were then screened by reviewing the 
titles and excluding irrelevant articles for our investigation. 
The remaining studies’ abstracts were evaluated, and the 
complete texts of  the published literature were received. 
If  a full-text article could not be retrieved, the author was 
contacted and requested the complete version. A search 
was also conducted in the reference lists of  the selected 
papers. Lastly, a forward search of  the listed studies was 
also conducted using the Science Citation Index.

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Appraisal of  Methodological Quality
Risk of  Bias Assessment (RoB)
The methodological quality of  the studies included in 
the systematic review was appraised as part of  the data 
extraction process. This was performed using the Cochrane 
Collaboration’s Risk of  Bias assessment tool (Cochrane 
Handbook for Systematic Reviews of  Interventions)
(Sterne et al., 2019). The following criteria were evaluated 
at “low,” “high,” or “unclear” risk of  bias: Randomisation 
process, Deviations from intended interventions, missing 
outcome data, Measurement of  the outcome, Selection 
of  the reported result, and Overall. Like all surgical 
procedures, “gingivectomy,” performed using the scalpel, 
electrosurgical method, or other alternative procedures, 
requires anaesthetising the periodontal and surrounding 
structure. This could be done through anaesthetic gel or 
induction of  local anaesthesia. All the included studies 
were evaluated individually: high risk if  only one high risk 
were present, and unclear risk if  only one of  the criteria 
was unclear and no high-risk present.

Data Synthesis and Analysis
The extracted data from the selected studies were 
arranged in four tables. The first one is about the general 
characteristics of  the selected studies, including author, 
year of  publication, study number in Roman style, study 

design, randomisation procedure, participant number, 
age, gender, type of  intervention, follow-up, co-morbidity, 
and drop-out. The second table presents the data of  the 
patient’s related outcome measures (PROMS). The third 
table reports the data, including author, year of  publication, 
type of  interventions, and periodontal parameters like PI, 
GI, and bleeding rate (BR). Finally, the last table shows the 
data of  the other parameters, like the clinical observation 
of  healing and crevicular fluid measurements.

RESULTS AND DISCUSSION
Electronic Database Search
The database searches led to the retrieval of  552 articles 
from the computerised database (Figure 1), with 159 
duplicated studies identified and eliminated. In addition, 10 
full-text studies were examined after excluding 286 papers 
based on the title and 97 studies based on the abstract. 
A further search was conducted per the reference lists 
from full-text, and previous review and scientific citation 
index, which included three full-text articles. The ultimate 
number of  studies considered for full-text evaluation was 
13. Following a comprehensive articles examination, 3 
publications were excluded for differing reasons listed in 
Table 3. 10 publications met the eligibility criteria and were 
included in the present systematic review.

Figure 1: Flow Diagram

Table 3: Reasons for exclusion of  3 full-texts
Study (Year) Reasons for exclusion
Petersen et al. (1993) No control group
Ize-iyamu et al. (2013) Less than 10 patients
Inchingolo et al. (2010) Less than 10 patients

Risk of  bias assessment
The risk of  bias was done for the final included studies, 
and all the studies were assessed as low risk, except three 
studies, III, VI, and IX, which were high risk (Figure 2).

Study Characteristics
Ten studies were included in the systematic review, seven 
were RCTs, and three were CCTs; all were prospective 
studies. The RCTs used different randomisation techniques 
(see Table 4). Most studies used simple ones like coin toss 
or computer generator random methods. Only one study 
used the stratified random sample technique. The designs 
were variables between parallel in eight studies and split-
mouth in two studies. The number of  participants ranges 
between 11 and 58. The age of  the samples ranged 
between 11 and 48 years old. The follow-up duration for 

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the samples was variable, between 2 hours and 6 months, 
but one study did not report the follow-up period. All 
the included studies reported that a full explanation of  
the clinical procedure was provided before participants 
and signed informed consent was obtained from the 

patients, except two studies (II, IX) that did not report. 
Six studies reported that the ethics committee approved 
them. Unfortunately, heterogeneity in the data collected 
was found regarding study design, type of  intervention, 
outcome measures, and observational periods.

Figure 2: Risk of  bias assessment

Table 4: General characteristics of  included studies
Author(Year) (Ref. 
No.)

Study 
No.

Study design 
Randomization 
procedure

Participant 
No.
Age(Years) 
Gender 
(F/M)

Typesof  
intervention

Follow up
Co-morbidity 
Drop- out

Koppolu et al. (2016)
(29)

I Prospective RCT
Parallel group 
Computer general 
randomization

14
18-30
8/6

C: Scalpel T: 
Diode laser

1 month None 
None

Aremband et al. 
(1973)(30)

II Prospective RCT
Split mouth 
randomisation

27
18-35
14/13

C: Scalpel
T: Electrosurgical 
unit

1, 2, 3 weeks 
None None

Durham et al. (2009)
(31)

III Prospective CCT
Split mouth

15
12-17
10/5

C: Scalpel T: 
Diode laser

2 months None 
None

Prasad et al. (2018)
(32)

IV Prospective RCT
Parallel group Coin 
toss method

20
16-40
9/11

C: Scalpel T: 
Diode laser

7 days None 2 
patients did not 
follow up 

Öncu et al. (2017)(33) V Prospective RCT
Parallel group Coin 
toss method

20
35.2
12/8

C: Scalpel T: 
Diode laser

NR
None None

Akram et al. (2017)
(34)

VI Prospective CCT
Parallel group

50
25-45
NR

C: Scalpel T: 
Diode laser

1 week None 
None

Sobouti et al. (2014)
(35)

VII Prospective RCT
Parallel group

30
17-29
18/12

C: Scalpel T: 
diode Laser

2 hours None 
None

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Lione et al. (2019)(59) VIII Prospective RCT
Parallel group 
Computer generated 
randomization

58
11.7-19.8
26/32

C:non-surgical 
T:Scalpel T:diode 
laser

6 months None
2 patients

Mussa et al. (2017)
(37)

IX Prospective CCT
Parallel group

30
17-34
14/16

C:Scalpel T:Diode 
laser

1, 2 week None 
None

Kumar et al. (2015)
(38)

X Prospective RCT
Parallel group

10
20-40
NR

C:Scalpel T:Diode 
lasr

24, 36h
1, 2, 3 week 
None None

Types of  reported outcome variables
PROMS
Most studies performed quantitative and qualitative 
assessments regarding PROMs and clinical periodontal 
outcomes, but the primarily quantitative assessment was 
performed. PROMs were reported in the form of  a scale 
and as a subjective assessment. VAS scales of  pain and 
discomfort were reported together in one study (IV) 
and as separate scales; e.g., the VAS scale of  pain was 
presented similarly (10cm) in five studies (I, III, V, VII, 
X). In contrast, the VAS scale of  comfort was presented 
only in one study. In addition, one study (IV) reported the 
frequency of  pain at different time intervals.
Another study (X) presented patients’ satisfaction levels. A 
qualitative assessment regarding the pain and discomfort 
was performed in one study (VI). Patients were investigated 
if  they experienced the pain of  equal severity on both sides 
or more severe on one side, if  they needed to use any pain 
killer, and if  there was any discomfort and difficulty during 
speech and eating. Another qualitative assessment was 
done in one study (I) regarding the cosmetic outcome by 
evaluating the patient’s perception of  cosmetic change and 
expected outcome.

Effect of  Diode laser: Pain
Two studies performed the mean VAS scores [RoB: low (I, 
X)] on the first day and were significantly lower in the laser 
groups than in the scalpel groups. Another study reported 
lower pain values in the laser than in the scalpel in the 
first two days [RoB: high (VI)] with no statistical analysis. 
Three studies [RoB: low (I, IV, VII)] presented the VAS 
scores on the third and seventh days of  follow-up and 
were significantly low in the laser groups in comparison 
with the scalpel groups in two studies only (IV, VII). One 
study [RoB: low (V)] presented that the mean VAS values 
for the whole evaluation period and significantly lower 
in the test groups than in the control groups. Only one 
study [RoB: high (III)] evaluated the VAS of  pain daily for 
seven days. It showed a lower significant value in the laser 
group than in the scalpel group on the third day. Study 
(IV) evaluated the frequency of  pain on the third, fifth, 
and seventh days, and it was significantly low in the laser 
group than in the scalpel group. 
Studies (VI, VII) presented how many analgesics the 
patient consumed. It was significantly high in the 
control groups than in the test groups after 82 minutes 
postsurgical in the study (VII), while the other study (VI) 

Table 5: Comparison b/t diode laser & scalpel regarding PROMs.
Author 
(Year) (Ref.
No.)

Study 
No.

PROM/PROMS

Koppolu 
et al. (2016)
(29)

I VAS of  pain Patient’s perception 
of  cosmetic

Patient evaluation for 
perception regarding 
expected outcome from the 
treatment after 4th week

day 1.29*

3 day 0.25
7 day 0.0

1 day 3.1
3 day 1.98
7 day 0.25

1 W
mild=1 
moderate=3 
sufficient=3 
2 W
mild=0 
moderate=3 
sufficient=4 
4 W
mild=0 
moderate=2 
sufficient=5

moderate=3 
sufficient=2 
2 W
mild=2 
moderate=3 
sufficient=2 
4 W
mild=1 
moderate=3 
sufficient=2

Unsatisfied=0
P. satisfied=2
T. satisfied=5

unsatisfied=2
P. satisfied=2
T. satisfied=3

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Durham et 
al. (2009)
(31)

III VAS of  pain
1 day (1.9)
2 day (0.5)
3 day (0.3)*

4 day (0.2)
5 day (0.1)
6 day (0.1)
7 day (0.1)

1 day (1.4)
2 day (0.9)
3 day (0.4)
4 day (0.4)
5 day (0.2)
6 day (0.1)
7 day (0.1)

Prasad et al. 
(2018) (32)

IV VAS of  pain & discomfort Frequency of  pain at different 
time intervals (intermittent 
pain/no pain)

3 day 0.50*

5 day 0.10*

7 day 0.30*

3 day 2.0
5 day 1.10
7 day 1.00

3 day 
50%/50%*

5 day 
10%/90%*

7 day 
30%/70%*

3 day 
100%/0%
5 day 
100%/0%
7 day 
90%/10%

Öncu et al. 
(2017) (33)

V VAS of  pain
2.4* 7.1

Akram et al. 
(2017) (34)

VI Pain (n) Discomfort Analgesic consumption (n)
Experience 
some pain 
for the first 
two days 
(15)

Experience 
some pain 
for the first 
two days 
(21)

Experience 
some 
discomfort 
in speech & 
eating (0)

Experience 
some 
discomfort 
in speech & 
eating (25)

(60%) (84%)

Kumar et al. 
(2015)(38)

X VAS of  pain VAS of  comfort Patient’s satisfaction
During 
surgery (3)
24-36h (2)*

During 
surgery (1)
24-36h (4)

1 week (19)* 1 week (16) 3 week (8) 3 week (6)

Sobouti et al. 
(2014) (35)

VII VAS of  pain Analgesic consumption (n)
Postsurgical 0.0* Postsurgical 5.2 (0) (14)* after 82 

minutes
Ref  reference, No number, Grey shade box= test group, VAS visual analogue scale, *statistical significant between test & control 
groups, W week, P partial, T total, (n) number of  patients, H hour.

showed high analgesic consumption in the control group 
than in the test group but did not perform statistically 
analysis (see Table 5).

Discomfort
Two studies [RoB: low (IV); high (VI)] evaluated 
discomfort values, and one study [RoB: low (X)] 
evaluated the VAS of  comfort. Study (VI) reported that 
all patients experienced discomfort during speech and 
eating in the control groups. Another study (X) showed 
a higher significant value of  VAS of  comfort in the laser 

group than in the scalpel group after a week. The other 
study (IV) showed lower significant discomfort values in 
the laser groups than the scalpel groups on the third and 
seventh days (see Table 5).

Effects of  Electrosurgery Pain
The pain was evaluated in one study [RoB: low (II)] by 
asking about the patient’s experience after one week 
and showed no significant difference between the 
electrosurgery and scalpel groups. However, the VAS 
scale of  discomfort was not performed (Table 6).

Table 6: Comparison b/t electrosurgery & scalpel regarding PROMs.
Author (Year) (Ref. No.) Study No. PROM/PROMS
Aremband et al. (1973)(30) II Patient’s experience 6.67% Patient’s experience 10%

Periodontal Parameters
We found six studies that reported the periodontal 
parameters. The PI and GI were presented in four 

studies [RoB: high (III, VI, IX); low (VIII)]. The bleeding 
parameter was presented as a scale in two studies [RoB: 
low (V, VII)] and as subjective data in one study (IX). 

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One study presented the PD and the clinical crown length 
(VIII). Another study (IX) assessed the swelling and 
presented subjective data (see Table 5).

Effect of  Diode laser
PI and GI were performed in four studies [RoB: low (VIII); 
high (III, VI, IX)]. Three studies (III, VI, IX) evaluated the 
PI after a week postoperatively. No significant difference 
was recorded between the laser and scalpel groups (III, 
IX). Study (VI) presented a higher significant postoperative 
value in the control group compared to the preoperative 
value. The PI was evaluated after two weeks postoperatively 
(IX), after a month in two studies (III, VIII), and after six 
months in another study (VIII), and showed no significance 
between the laser and scalpel groups.
In contrast, the GI was presented significantly higher 
in the control groups in comparison to the test groups 
after a week (VI, IX) and also after two weeks (IX), 
but study (III) showed no significance. The evaluation 
of  GI after a month (III, VIII) and after three and six 
months (VIII) did not show any significant values. Other 
periodontal parameters like PD and clinical crown height 
were evaluated in one study (VIII) after one, three, and 
six-month observation periods and showed a significant 
reduction in the PD. A significant increase in the clinical 

crown height after one month versus baseline values 
in the two test groups was observed compared to the 
control groups, but no significant difference between 
the two test groups. After three months of  follow-up, 
a relapse occurred in the test groups with a decrease in 
the clinical crown height and an increase in the PD, but 
not significant when compared with the control groups 
or between the test groups. When observing six months 
versus three months, no significant difference was found 
between the groups in PD and clinical crown height. 
The bleeding was assessed in three studies [RoB: low (V, 
VII); high (IX)] in two different ways. Study (IX) evaluated 
the bleeding by grading the following criteria: none, 
self-limiting, require pressure, coagulation, and require 
ligation or hemoclip. All the patients required pressure 
in the control group, while in the test group, only one 
patient required pressure, two patients were self-limiting 
bleeding, and eleven patients did not bleed. Studies (V, 
VII) reported a significantly lower bleeding rate in the 
test group than in the control group. Only one study (IX) 
evaluated the swelling according to the following: None, 
slight, moderate, and severe. No swelling was reported 
in the test group compared to the control group, while 
three patients showed slight swelling in the control group 
(Table 7).  

Table 7: Comparison b/t diode laser & scalpel regarding Periodontal Parameters

A
ut

ho
r (

Ye
ar

) 
(R

ef
. N

o.
)

St
ud

y 
N

o.

Periodontal Parameters

Li
on

e 
et 

al.
 (2

01
9)

 (3
6)

V
II

I

PI GI PD (mm) CCL (mm)

D
L

Sc
al

pe
l

N
on

e 
Su

rg
er

y

D
L

Sc
al

pe
l

N
on

e 
Su

rg
er

y

D
L

Sc
al

pe
l

N
on

e 
Su

rg
er

y

D
L

Sc
al

pe
l

N
on

e 
Su

rg
er

y

B 0.4
1 M 0.6
3 M 0.7
6 M 0.6

B0.4
1 M 0.6
3 M 0.5
6 M 0.6

B 0.6
1 M 0.5
3 M 0.4
6 M 0.7

B 0.3
1 M 0.5
3 M 0.6
6 M 0.7

B 0.3
1 M 0.5
3 M 0.6
6 M 0.7

B 0.5
1 M 0.4
3 M 0.5
6 M 0.6

B 4.8
P.S 0.7
1 M 1.8*

B 4.9
P.S 0.9
1 M 
1.8*

B 4.4
1 M 4.0
3 M 3.3
6 M 3.8

B 7.7
P.S 10.6
1 M 10.1*

B 7.9
P.S 10.3
1 M 9.9*

B 7.6
1 M 8.0
3 M 8.3
6 M 8.2

M
us

sa
 et

 a
l. 

(2
01

7)
 (1

4)

IX

PI (n) GI (n) Intraoperative bleeding (n) Swelling (n)

Test Control Test Control Test Control Test Control

BL 0.51
1 week 0.38
2 week 0.28

BL 0.46
1 week 0.37
2 week 0.38

BL 0.72
1 week 0.55*
2 week 0.29*

BL 0.85
1 week 1.45
2 week 0.68

None 11
Self-limit 2
Pressure 1
Coagulation 0
Ligation or 
hemoclip 0

None 0
Self-limit 0
Pressure 16
Coagulation 0
Ligation or 
hemoclip 0

None 14
Slight 0
Moderate 0
Severe 0

None 13
Slight 3
Moderate 0
Severe 0

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A
kr

am
 et

 a
l. 

(2
01

7)
 (3

4)

V
I

#Scaling 1.22
#Surgery 0.3 
1 week 0.41

#Scaling1.37
#Surgery.0.39 
1 week 1.31*

#Scaling 1.18
#Surgery 0.44 
1 week 0.53

#Scaling 1.34
#Surgery. 0.52 
1 week 0.91*

So
bo

ut
i e

t a
l. 

(2
01

4)
 (3

5)

V
II

Bleeding rate

0.36 out of  4* 1.15 out of  4 1.32

O
nc

u 
et 

al.
 

(2
01

7)
 (3

3)

V

1 week: 
0 (26)
1 (13)
2 (13)

1 week:
0 (29)
1 (10)
2 (14)

1 week:
0 (0)
1 (12)
2 (34)
3 (6)

1 week:
0 (0)
1 (3)
2 (38)
3 (12)

D
ur

ha
m

 et
 a

l. 
(2

00
9)

(3
1)

II
I

1 month:
0 (14)
1 (24)
2 (14)

1 month:
0 (14)
1 (21)
2 (18)

1 month:
0 (4)
1 (35)
2 (13)
3 (0)

1 month:
0 (4)
1 (29)
2 (20)
3 (0)

Ref  reference, No number, Gray shade box= test group, PI plaque index, GI gingival index, PD pocket depth, CCL clinical crown 
length, (mm) millimeter, DL diode laser, BL baseline, M month, P.S post-surgery, (n) number of  patients, *statistical significant, # 
before.

Effects of  Electrosurgery
Only one study observed clinically and photographically 
the healing process [RoB: low (II)]. No significant 

difference was found between the groups after seven 
and fourteen days in periodontal measures due to the 
electrosurgical procedure (see Table 8).

Table 8: Comparison b/t electrosurgery & scalpel regarding Periodontal Parameters
Author (Year) (Ref. No.) Study No. Periodontal Parameters

Clinical Observation of  Healing Photograpahic Observation of  healing
Aremband et al. (1973)(30) II 1week(30%)                                                             

2 week (6.67%)     
3 weeks (6.67%)                     

1 week (13.33%)
2 weeks (16.67%)      
3 weeks (16.67%)                                                   

DISCUSSION
The present systematic review aimed to provide evidence 
for the superiority of  using different techniques for 
gingivectomy over the conventional method using a 
scalpel regarding patient perceptions and periodontal 
parameters. The main reason for switching from 
the surgical scalpel to other methods is the need for 
hemostatic action during the surgical procedure for 
a better surgical field. Three different methods were 
developed, and all provide excellent hemostatic action. 
However, these methods have disadvantages, including 
leakage of  chemical materials such as paraformaldehyde 
and potassium hydroxide into the surrounding tissues, 
makings it not recommended for periodontal surgery. 
The electrosurgical method has also provided an excellent 
hemostatic action by sealing the blood vessels while cutting 
the desired tissue. However, care should be taken when 
choosing the waveform and power input because lateral 
heat could cause necrosis to the neighbouring tissues. The 
last method, laser with different active media for different 
types of  tissues, also provides a hemostatic effect. However, 

all types of  laser have a thermal effect on the surrounding 
tissues, which depends on the power input. 

Diode laser & patient outcome
Based on the limited clinical evidence, the present 
systematic review found two alternative methods for 
gingivectomy, diode laser and electrosurgery. The results 
indicate that the laser technique causes less postoperative 
pain and discomfort than the traditional scalpel, especially 
in the first week. Even though one study (Akram et al., 
2017) did not perform statistical analysis. However, the 
VAS scores were low in the laser group compared to the 
scalpel group in the first two days, and because of  that, 
the patients did not consume excessive painkillers like in 
the scalpel groups.
Our results are from a previous study by Kalakonda B. 
et al., 2016, where they performed vestibulopathy in 20 
patients and compared the scalpel group with the diode 
laser group. They presented a significantly lower VAS 
pain score in the laser group than the scalpel group on the 
1st, 3rd, and 7th days (Kalakonda et al., 2016). Also, in the 

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study of  Ize-iyamu I N. et al., 2013(Ize-Iyamu et al., 2013), 
they performed maxillary frenectomy, operculectomy, 
aesthetic recontouring, and surgical exposure, in addition 
to gingivectomy. Again, they reported lower significant 
values in the laser group than in the scalpel group.
Furthermore, even though they used the diode laser in 
other oral soft tissue surgeries, they showed significantly 
lower VAS of  pain in the laser groups than in the 
scalpel groups (Fisher SE, 1983) (Fisher & Frame, 1984; 
Koppolu et al., 2017). Another theory is that a diode 
laser produces minor collateral tissue damage during 
the incision, even with a continuous wave at a higher 
power level of  4.5W than other lasers like CO2, and less 
postoperative pain (Durham, 2009) (Goharkhay et al., 
1999). Also, the results herein showed that some of  the 
included studies (Koppolu et al., 2017) (Elif, 2017) used 
only topical anaesthesia, either gel or spray, before the 
surgery, and most of  the patients did not need infiltration 
of  local anaesthesia for the laser procedure. This could be 
one of  the advantages of  using a laser for gingivectomy in 
children (Do Hoang Viet et al., 2019).

Diode laser & periodontal parameters outcome
Another observation is that using a scalpel caused more 
gingival inflammation when compared with a laser; due 
to the periodontal dressing used in the scalpel group, 
which acts as plaque retention (Akram et al., 2017). Even 
though the PI was low in other studies (Durham, 2009; 
Lione et al., 2020; Sobouti et al., 2014) (Musaa et al., 2017), 
the inflammation was low in the test group. The reason 
for low GI is due to irradiation. Instead, there is almost 
instantaneous vaporisation of  the intracellular fluid and 
thus disintegrating cell structure, which might not release 
the chemical mediators of  inflammation. In addition, a 
thin layer of  denatured collagen formed on the surface 
will act as a protective layer and prevent tissue irritation, 
thus decreasing inflammation (Fisher et al., 1983).
Only one study, (Kumar et al., 2015) assessed the 
postoperative healing process using the healing index. 
Better healing was observed in incisions done by the 
scalpel but was not statistically significant. This is the result 
of  Fisher and his colleagues in 1983 (Fisher et al., 1983). 
They examined animal models for observing histological 
changes during healing after using a CO2 laser on buccal 
mucosa and found no differences in the mitotic rate of  the 
epithelium between the groups. In contrast, some studies 
showed that laser irradiation could stimulate fibroblast 
proliferation without impairing procollagen synthesis, thus 
improving wound healing(Pereira et al., 2002). However, 
we had to know that these studies used low power output 
(120mW), which is much less than what was used in our 
included studies (0.8-2W), and those high power caused 
thermal tissue damage around the incision, according to 
Goharkhay K. et al., 1999 (Goharkhay et al., 1999).
Since the main advantage of  laser over the scalpel is the 
hemostatic effect, which provides a clear surgical field 
during the surgery, three studies assessed the bleeding 
criteria during the procedure (Elif, 2017) (Sobouti et 

al., 2014) (Musaa et al., 2017). The bleeding assessment 
showed that the diode laser controlled the bleeding. This 
result was confirmed by a study by Ize-iyamu I. N. et al., 
2013 (Ize-Iyamu et al., 2013). They performed various 
oral surgical procedures, such as a maxillary frenectomy, 
operculectomy, surgical exposure, and gingivectomy, using 
an 810nm diode laser compared with the conventional 
scalpel. They showed that the laser groups had grade 0 (no 
bleeding), and the scalpel groups had grade 1 (petechial 
bleeding) according to the WHO bleeding scale. A case 
report also confirmed our results (Asnaashari et al., 
2013), where they treated gingival hyperplasia using an 
810nm diode laser and noticed minor bleeding during the 
procedure.

Electrosurgery & Patient Outcome
On the other hand, the electrosurgical method did not 
differ from the scalpel regarding postoperative pain and 
discomfort. This result was confirmed by a comparative 
study by Chandra R. V. et al., 2016. They performed a 
gingivectomy to reduce the PD and observed that the 
pain on a surgical day and after seven days did not differ 
between the control and test groups. A case series report 
(Bhusari & Kasat, 2011) concluded the same results.

Electrosurgery & periodontal parameters outcome
In addition, Armband D. et al.(Aremband & Wade, 1973) 
observed the healing process clinically, photographically, 
and histologically. No differences were presented 
between group (Eisenmann D, 1970). This study follows 
Glickman I. and Imber L. R.’s study (Glickman & Imber, 
1970), where they did a histological study on animals by 
performing a shallow resection (away from the bone) 
and deep resection (as close as possible to the crest of  
the bone). They presented that the microscopic findings 
of  shallow resection samples after 3, 6, and 12 weeks 
were the same between the groups, the epithelium was 
inflamed with slight hyperplasia, and the underlying bone 
was unaltered. In contrast, the samples from the deep 
resection in the test group showed bone necrosis.
In contrast, a study by Manivannan N. et al.(Manivannan 
et al., 2013) measured the vascularity of  the gingiva pre-
and postoperative by using the ultrasound Doppler 
technique. The results showed that the re-vascularisation 
rate was faster in the control group than in the test group, 
thus improving the healing process, implying minor 
postoperative complications and more patient comfort. 
Finally, a histological study by Sinha U. K. et al., 2003(Sinha 
& Gallagher, 2003) confirmed the previous study. They 
compare the performance of  the scalpel with electrosurgery 
by creating oral mucosal incisions in the guinea pigs. They 
showed that the fast healing utilising re-epithelialisation 
was in the scalpel groups, and complete epithelial healing 
had taken place by the end of  the first week.
In contrast, in the electrosurgery groups, the re-
epithelialisation had occurred by the end of  the fourth 
week. Another study done by Chandra R. V. et al.(Chandra 
et al., 2016) also showed a clinical delay in healing in the 

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electrosurgery group compared with the scalpel group 
after 7 and 15 days of  follow-up. It was explained by the 
lateral heat produced from the electrode tip during the 
incision process.

Other types of  laser & patient outcome
 Many comparative studies used CO2, Nd: YAG, and Er: 
YAG lasers compared with the scalpel for other oral soft 
tissue surgeries like frenectomy and excisional biopsy 
(Haytac & Ozcelik, 2006) (López-Jornet & Camacho-
Alonso, 2013; Natekar et al., 2017) (Tambuwala et al., 2014) 
(Akpınar et al., 2016; Prasad R, 2018; Yadav et al., 2019) 
(Kara, 2008) (Vickers, 2017) (Broccoletti et al., 2015). 
These studies showed that the conventional technique 
exhibited higher postoperative pain and discomfort 
values than the laser technique. In addition, the studies of  
this systematic review also state that the laser method has 
an advantage over the scalpel in providing more comfort 
and producing less pain after the surgical procedure. 
Even though a study incorporating electrosurgical 
methods, conducted on twenty patients, presented a high 
value of  postoperative pain than the laser in gingival 
depigmentation surgery.(Chandna & Kedige, 2015) The 
VAS score of  pain was statistically significantly lower 
in the laser groups after 24 hours, but no significant 
differences were found after a week between the groups.
This systematic review concluded that a diode laser had 
better patient outcomes in pain and discomfort than a 
scalpel. However, the current systematic review only 
included ten studies, and most studies had few patients 
in each group. Hence, there was insufficient data to 
conclude the results between the diode laser and scalpel 
in terms of  periodontal parameters and between the ES 
unit and the scalpel for patient outcome and periodontal 
parameters. Furthermore, one research comparing the 
ES unit and scalpel for the gingivectomy technique was 
reported. Based on the available data, a diode laser is the 
most recommended approach (technology) for crown 
lengthening. However, no meta-analysis was performed 
because the research designs and observational durations 
were heterogeneous.

CONCLUSION
Diode laser was the most appropriate technique for 
gingival recontouring and deep pockets elimination 
because the surgery could be performed by applying 
topical anaesthesia. Also, infiltration did not require 
most of  the time, and the patient will experience less 
pain and discomfort after the procedure compared to 
the scalpel technique. However, many studies showed 
the same results, but they performed different types of  
soft tissue surgeries like vestibulopathy and frenectomy 
and used different types of  lasers such as CO2, Nd: YAG. 
Clinicians need to understand that each type of  laser 
has different absorption coefficients with primary tissue 
components (water-mineral-melanin), making the laser 
selection procedure dependent. For example, the CO2 
laser is highly soluble in water, which means it is suitable 

for oral soft tissue surgeries, while the diode laser is 
highly absorbable in pigmented tissue and less absorbable 
in water than CO2, so it is suitable for gingival surgeries 
since the gingiva has a high content of  melanin. The 
clinician should first determine the specific requirement 
of  the clinical treatment and then select the suitable laser 
to achieve the desired prognosis.
Author Contributions: The author has a significant 
contribution to the conceptualization of  the systematic 
review, conducting formal analysis, Investigation, 
working efficiently on Methodology, involved in Project 
Administration, writing – Original Drafts, writing as well 
as reviewing & Editing the systematic review for the final 
look.

REFERENCES
Akpınar, A., Toker, H., Lektemur Alpan, A., & Çalışır, M. 

(2016). Postoperative discomfort after Nd: YAG laser 
and conventional frenectomy: comparison of  both 
genders. Australian dental journal, 61(1), 71-75. 

Akram, H. M., Ali, O. H., Omran, N. K., & Ali, A. O. 
(2017). Diode laser versus scalpel gingivectomy. 
Biomedical and Pharmacology Journal, 10(4), 1799-1804. 

Aremband, D., & Wade, A. B. (1973). A comparative 
wound healing study following gingivectomy by 
electrosurgery and knives. Journal of  periodontal research, 
8(1), 42-50. 

Asnaashari, M., Azari-Marhabi, S., Alirezaei, S., & 
Asnaashari, N. (2013). Clinical application of  810nm 
diode laser to remove gingival hyperplasic lesion. 
Journal of  Lasers in Medical Sciences, 4(2), 96. 

Bader, C., & Krejci, I. (2006). Indications and limitations 
of  Er: YAG laser applications in dentistry. American 
journal of  dentistry, 19(3), 178-186. 

Bhusari, B., & Kasat, S. (2011). Comparison 
between scalpel technique and electrosurgery for 
depigmentation: A case series. Journal of  Indian Society 
of  Periodontology, 15(4), 402. 

BM S, B. W., S J, Srihari. . (2017). Current Uses of  Diode 
Lasers in Dentistry. Otolaryngology, 07(02), 1-4. 

Broccoletti, R., Cafaro, A., Gambino, A., Romagnoli, E., 
& Arduino, P. G. (2015). Er: YAG laser versus cold 
knife excision in the treatment of  nondysplastic oral 
lesions: a randomized comparative study for the 
postoperative period. Photomedicine and laser surgery, 
33(12), 604-609. 

Chandna, S., & Kedige, S. D. (2015). Evaluation of  
pain on use of  electrosurgery and diode lasers in 
the management of  gingival hyperpigmentation: 
A comparative study. Journal of  Indian Society of  
Periodontology, 19(1), 49. 

Chandra, R. V., Savitharani, B., & Reddy, A. A. (2016). 
Comparing the outcomes of  incisions made by 
colorado microdissection needle, electrosurgery tip, 
and surgical blade during periodontal surgery: A 
randomized controlled trial. Journal of  Indian Society of  
Periodontology, 20(6), 616. 

Cobb, C. M. (2006). Lasers in periodontics: a review of  

https://journals.e-palli.com/home/index.php/ajcp


Pa
ge

 
84

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 2(2) 74-85, 2023

the literature. Journal of  periodontology, 77(4), 545-564. 
Do Hoang Viet, V. T. N., Ngoc, L. Q. A., Le Hoang Son, 

D.-T. C., & Phung Thi Thu Ha, T. C. (2019). Reduced 
need of  infiltration anesthesia accompanied with 
other positive outcomes in diode laser application 
for frenectomy in children. Journal of  Lasers in Medical 
Sciences, 10(2), 92. 

Durham, J. R. (2009). A comparison of  two soft tissue 
gingivectomy techniques University of  Alabama–
Birmingham]. 

E, H. (1951). Paradentitis and paradentosis. Oral Surg Oral 
Med Oral Pathol. , 4(1), 126. 

Eisenmann D, M. W., Kusek J. (1970). Electron 
microscopic evaluation of  electrosurgery.   . Oral Surg 
Oral Med Oral Pathol., 29(5), 660-665. http://www.
ncbi.nlm.nih.gov/pubmed/5265873 

Elif, Ö. (2017). Comparison of  gingivectomy procedures 
for patient satisfaction: conventional and diode laser 
surgery. Selcuk Dental Journal, 4(1), 6-9. 

Fisher SE, F. J., Browne RM. (1983). A comparative 
histological study of  wound healing following CO2 
laser and conventional surgical excsion of  canine 
buccal mucosa. Arch Oral Biol., 28(2), 87-91. 

Fisher, S. E., Frame, J., Browne, R., & Tranter, R. (1983). 
A comparative histological study of  wound healing 
following CO2 laser and conventional surgical 
excision of  canine buccal mucosa. Archives of  oral 
Biology, 28(4), 287-291. 

Fisher, S. E., & Frame, J. W. (1984). The effects of  the 
carbon dioxide surgical laser on oral tissues. British 
journal of  oral and maxillofacial surgery, 22(6), 414-425. 

Fornaini, C., Merigo, E., Sozzi, M., Rocca, J.-P., Poli, F., 
Selleri, S., & Cucinotta, A. (2016). Four different 
diode lasers comparison on soft tissues surgery: a 
preliminary ex vivo study. Laser Therapy, 25(2), 105-
114. 

Glickman, I., & Imber, L. R. (1970). Comparision 
of  Gingival Resection with Electrosurgery and 
Periodontal Knives—A Biometric and Histologic 
Study. Journal of  periodontology, 41(3), 142-148. 

Gnanasekhar, J. D., & Al-Duwairi, Y. S. (1998). 
Electrosurgery in dentistry. Quintessence international, 
29(10). 

Goharkhay, K., Moritz, A., Wilder‐Smith, P., Schoop, U., 
Kluger, W., Jakolitsch, S., & Sperr, W. (1999). Effects 
on oral soft tissue produced by a diode laser in vitro. 
Lasers in Surgery and Medicine: The Official Journal of  
the American Society for Laser Medicine and Surgery, 25(5), 
401-406. 

Hale, G. M., & Querry, M. R. (1973). Optical constants 
of  water in the 200-nm to 200-μm wavelength region. 
Applied optics, 12(3), 555-563. 

Harashima, T., Kinoshita, J.-I., Kimura, Y., Brugnera Jr, 
A., Zanin, F., Pecora, J. D., & Matsumoto, K. (2005). 
Morphological comparative study on ablation of  
dental hard tissues at cavity preparation by Er: YAG 
and Er, Cr: YSGG lasers. Photomedicine and Laser 
Therapy, 23(1), 52-55. 

Haytac, M. C., & Ozcelik, O. (2006). Evaluation of  
patient perceptions after frenectomy operations: 
a comparison of  carbon dioxide laser and scalpel 
techniques. Journal of  periodontology, 77(11), 1815-1819. 

HS., H. (1976). Electrosurgery in Dental Practice. 3. 
Blackwell Scientific Publications. 

Ishikawa, I., Aoki, A., Takasaki, A. A., Mizutani, K., Sasaki, 
K. M., & Izumi, Y. (2009). Application of  lasers in 
periodontics: true innovation or myth? Periodontology 
2000, 50(1), 90-126. 

Ize-Iyamu, I., Saheeb, B., & Edetanlen, B. (2013). 
Comparing the 810nm diode laser with conventional 
surgery in orthodontic soft tissue procedures. Ghana 
medical journal, 47(3), 107-111. 

Jepsen, S., Caton, J. G., Albandar, J. M., Bissada, N. F., 
Bouchard, P., Cortellini, P., Demirel, K., de Sanctis, M., 
Ercoli, C., & Fan, J. (2018). Periodontal manifestations 
of  systemic diseases and developmental and acquired 
conditions: Consensus report of  workgroup 3 of  
the 2017 World Workshop on the Classification 
of  Periodontal and Peri‐Implant Diseases and 
Conditions. Journal of  clinical periodontology, 45, 
S219-S229. 

Kalakonda, B., Farista, S., Koppolu, P., Baroudi, K., 
Uppada, U., Mishra, A., Savarimath, A., & Lingam, 
A. S. (2016). Evaluation of  patient perceptions after 
vestibuloplasty procedure: a comparison of  diode 
laser and scalpel techniques. Journal of  clinical and 
diagnostic research: JCDR, 10(5), ZC96. 

Kara, C. (2008). Evaluation of  patient perceptions of  
frenectomy: a comparison of  Nd: YAG laser and 
conventional techniques. Photomedicine and laser surgery, 
26(2), 147-152. 

Keller, U., & Hibst, R. (1989). Experimental studies 
of  the application of  the Er: YAG laser on dental 
hard substances: II. Light microscopic and SEM 
investigations. Lasers in surgery and medicine, 9(4), 345-
351. 

Koppolu, P., Kalakonda, B., Mishra, A., Lingam, A. 
S., Elkhatat, E., Ibrahim, A. A., Alhegbani, F. A., 
Alshahrani, F. S. F., Nassar, A. I., & Abdulaziz, A. A. 
(2017). Smile Correction Using an Esthetic Crown 
Lengthening with Either Diode Laser or Scalpel–A 
Comparative Clinical Patient Perspective Study. British 
Journal of  Medicine and Medical Research, 19, 1-9. 

Kravitz, N. D., & Kusnoto, B. (2008). Soft-tissue lasers 
in orthodontics: an overview. American journal of  
orthodontics and dentofacial orthopedics, 133(4), S110-S114. 

Kumar, R., Jain, G., Dhodapkar, S. V., Kumathalli, K. 
I., & Jaiswal, G. (2015). The comparative evaluation 
of  patient’s satisfaction and comfort level by diode 
laser and scalpel in the management of  mucogingival 
anomalies. Journal of  clinical and diagnostic research: 
JCDR, 9(10), ZC56. 

Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., 
Gøtzsche, P. C., Ioannidis, J. P., Clarke, M., Devereaux, 
P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA 
statement for reporting systematic reviews and 

https://journals.e-palli.com/home/index.php/ajcp


Pa
ge

 
85

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 2(2) 74-85, 2023

meta-analyses of  studies that evaluate health care 
interventions: explanation and elaboration. Journal of  
clinical epidemiology, 62(10), e1-e34. 

Lione, R., Pavoni, C., Noviello, A., Clementini, M., 
Danesi, C., & Cozza, P. (2020). Conventional 
versus laser gingivectomy in the management of  
gingival enlargement during orthodontic treatment: 
a randomized controlled trial. European journal of  
orthodontics, 42(1), 78-85. 

López-Jornet, P., & Camacho-Alonso, F. (2013). 
Comparison of  pain and swelling after removal of  
oral leukoplakia with CO2 laser and cold knife: a 
randomized clinical trial. Medicina oral, patologia oral y 
cirugia bucal, 18(1), e38. 

Low, S. B., & Mott, A. (2014). Laser technology to 
manage periodontal disease: a valid concept? Journal 
of  Evidence Based Dental Practice, 14, 154-159. 

Maiman, T. (1960). NPG library. Nature, 187, 493-494. 
Manivannan, N., Ahathya, R., & Rajaram, P. (2013). 

Scalpel versus electrosurgery: Comparison of  gingival 
perfusion status using ultrasound Doppler flowmetry. 
Journal of  Pharmacy & Bioallied Sciences, 5(Suppl 2), 
S154. 

Musaa, F. E., Awazli, L. G., & Alhamdani, F. (2017). 
Gingival enlargement management using diode 
laser 940 nm and conventional scalpel technique (A 
comparative study). Iraqi Journal of  Laser, 16(B), 1-9. 

N, S. (1917). Formaldehyde for Treatment of  Alveolar 
Pyorrhea. Vrtljschr f  Zahnheilk, 33, 403. 

Natekar, M., Raghuveer, H.-P., Rayapati, D.-K., Shobha, 
E.-S., Prashanth, N.-T., Rangan, V., & Panicker, A. G. 
(2017). A comparative evaluation: Oral leukoplakia 
surgical management using diode laser, CO2 laser, 
and cryosurgery. Journal of  Clinical and Experimental 
Dentistry, 9(6), e779. 

Orban, B. (1943). Gingivectomy by chemosurgery. The 
Journal of  the American Dental Association, 30(3), 198-
202. 

Oringer, M. J. (1975). Electrosurgery in dentistry. WB 
Saunders Company. 

Parker, S. (2007a). Introduction, history of  lasers and laser 
light production. British dental journal, 202(1), 21-31. 

Parker, S. (2007b). Lasers and soft tissue: periodontal 
therapy. British dental journal, 202(6), 309-315. 

Pereira, A. N., Eduardo, C. d. P., Matson, E., & Marques, 
M. M. (2002). Effect of  low‐power laser irradiation 

on cell growth and procollagen synthesis of  cultured 
fibroblasts. Lasers in Surgery and Medicine: The 
Official Journal of  the American Society for Laser Medicine 
and Surgery, 31(4), 263-267. 

Perry, J., Parker, G., & Jagger, J. (2003). Scalpel blades: 
reducing injury risk. Adv Exposure Prev, 6(4), 37-40. 

Prasad R, B. R. D., Raj A, J.N S, B. B. . (2018). Comparative 
assessment of  pain associated with soft tissue crown 
lengthening using laser and conventional scalpel 
techniques. . Int J Recent Sci Res, 9(4), 25566–25570. 

Sinha, U. K., & Gallagher, L. A. (2003). Effects of  steel 
scalpel, ultrasonic scalpel, CO2 laser, and monopolar 
and bipolar electrosurgery on wound healing in guinea 
pig oral mucosa. The Laryngoscope, 113(2), 228-236. 

Sobouti, F., Rakhshan, V., Chiniforush, N., & Khatami, 
M. (2014). Effects of  laser-assisted cosmetic smile lift 
gingivectomy on postoperative bleeding and pain in 
fixed orthodontic patients: a controlled clinical trial. 
Progress in orthodontics, 15(1), 1-5. 

Sterne, J. A., Savović, J., Page, M. J., Elbers, R. G., 
Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H.-
Y., Corbett, M. S., & Eldridge, S. M. (2019). RoB 2: 
a revised tool for assessing risk of  bias in randomised trials. 
bmj, 366. 

Tambuwala, A., Sangle, A., Khan, A., & Sayed, A. (2014). 
Excision of  oral leukoplakia by CO2 lasers versus 
traditional scalpel: a comparative study. Journal of  
maxillofacial and oral surgery, 13(3), 320-327. 

Verma, S. K., Maheshwari, S., Singh, R. K., & Chaudhari, 
P. K. (2012). Laser in dentistry: An innovative tool in 
modern dental practice. National journal of  maxillofacial 
surgery, 3(2), 124. 

Vickers, N. J. (2017). Animal communication: when 
i’m calling you, will you answer too? Current biology, 
27(14), R713-R715. 

Viraparia, P., White, J. M., & Vaderhobli, R. M. (2012). 
CO2 Laser: Evidence Based Applications in Dentistry. 
In CO2 Laser-Optimisation and Application. 
IntechOpen. 

Yadav, R. K., Verma, U. P., Sajjanhar, I., & Tiwari, R. 
(2019). Frenectomy with conventional scalpel and 
Nd: YAG laser technique: A comparative evaluation. 
Journal of  Indian Society of  Periodontology, 23(1), 48. 

Yalamanchili, P. S., Davanapelly, P., & Surapaneni, H. 
(2013). Electrosurgical applications in Dentistry. Sch 
J App Med Sci, 1(5), 530-534. 

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