1009 D3000 new imprint Word template Vol 13, No 1 (2025) ISSN 2167-8677 (online) DOI 10.5195/d3000.2025.1009 http://dentistry3000.pitt.edu Postoperative Outcomes in Gingival Re-exposure Wisam Rasool Jalaawi, Hussam Sami Ismail College of Den*stry, Al-Ayen Iraqi University, Thi-Qar, Iraq Abstract Gingival surgical re-exposure outcomes vary significantly based on procedural technique and paNent-specific factors. This study invesNgated how sociodemographic variables—age, gen- der, educaNon level, economic status—and surgical methods (laser vs. punch bur) influence postoperaNve pain, healing, and saNsfacNon. The study aimed to idenNfy predictors of opN- mal recovery to support personalized periodontal care. A cross-secNonal design was em- ployed, enrolling 60 adults aged 18–65 undergoing gingival procedures. ParNcipants were categorized by surgical technique and sociodemographic strata. PostoperaNve outcomes were measured using the Visual Analog Scale (VAS) for pain, the Landry Healing Index for healing, and a 5-point Likert scale for saNsfacNon. Data were analyzed using descripNve sta- NsNcs and mulNvariate analysis of variance (MANOVA). Results revealed that surgery type (p=0.007), educaNon level (p=0.031), and economic status (p=0.014) significantly influenced recovery outcomes. PaNents who underwent laser procedures experienced lower pain levels and higher saNsfacNon, while those with higher educaNon and income demonstrated be_er healing and compliance. Age, gender, and residency did not show staNsNcally significant ef- fects. Visual analysis through Figures 4–10 confirmed the robustness of these findings, espe- cially the consistent predicNve power of surgical method. The hypothesis that sociodemo- graphic factors influence recovery was confirmed. These findings support the integraNon of paNent background into surgical plan- ning. In conclusion, laser surgery should be prioriNzed when feasible, and tailored postoperaNve care should be developed for individuals with lower educaNon or fi- nancial limitaNons to improve recovery outcomes and equity in care. Open Access Cita%on: Jalaawi WR, et al. (2025) Postopera%ve Out- comes in Gingival Re-exposure. Den%stry 3000. 1:a001 doi:10.5195/d3000.2025.1009 Received: July 31, 2025 Accepted: August 26, 2025 Published: September 10, 2025 Copyright: ©2025 Jalaawi WR, et al. This is an open ac- cess ar%cle licensed under a Crea%ve Commons ARribu- %on Work 4.0 United States License. Email: wisam.rasool@alayen.edu.iq Introduc)on Gingival surgical recovery refers to the heal- ing process following procedures of re-expo- sure technique aimed at treating the missing teeth via implantation, often performed for functional and aesthetic purposes. Common techniques include laser surgery—offering enhanced coagulation, reduced in>lamma- tion, and accelerated healing—and the punch bur technique, which mechanically re- moves gingival tissue with rotary instru- ments. These methods yield distinct out- comes in terms of pain, healing, and satisfac- tion [1-5]. Postoperative pain is assessed us- ing the Visual Analog Scale (VAS), healing quality via the Landry Healing Index, and pa- tient satisfaction through Likert scaling [6,7]. Demographic variables—including age, sex, education, and income—have been shown to signi>icantly in>luence recovery [8-15]. El- derly individuals typically exhibit slower wound healing due to reduced angiogenesis and collagen production [5,16-26], while gender differences in in>lammatory re- sponse and pain sensitivity have also been reported [27-30]. Lower education levels correlate with poor postoperative compli- ance and lower satisfaction scores [31,32]. Socioeconomic status affects access to fol- low-up care and oral hygiene, with rural res- idency often linked to delayed healing [33,34]. Studies suggest that laser methods are preferred by higher-income patients due to cost and awareness, while those from economically disadvantaged groups are more likely to receive conventional methods like punch bur, reinforcing disparities [35,36]. Psychological stress and limited so- cial support—common among lower SES groups—have been shown to impair im- mune responses and delay recovery [37,38]. Comparative studies emphasize that health literacy and demographic tailoring signi>i- cantly affect surgical outcomes [39-45]. Fur- thermore, the use of GIS-based health map- ping highlights geographic inequalities in gingival recovery [46]. The evidence under- scores a strong interaction between clinical methods and patient-speci>ic background factors, supporting the hypothesis that soci- odemographic variables directly impact Postopera6ve Outcomes in Gingival Re-exposure Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.1009 http://dentistry3000.pitt.edu 2 pain, healing, and satisfaction post-gingival surgery [47-50]. This study thus evaluated these in>luences using a comparative design between laser and punch bur techniques, of- fering insight into outcome disparities and promoting tailored intervention strategies. Material and Methods This cross-sectional observational study was conducted in a clinical setting to evaluate the in>luence of sociodemographic factors and surgical technique on postoperative gingival recovery. Sixty adult patients (aged 18–65) undergoing second-stage dental implant re- covery were enrolled and divided into two groups: laser-treated and punch bur-treated. Sociodemographic variables recorded in- cluded age, gender, residency (urban/rural), education level, and economic status. Adult patients aged 18 to 65 years who were scheduled for a gingival surgical procedure were selected for the study. Subjects were di- vided into two age groups: 18 to 45 years and 46 to 65 years. Gender, residence (urban/ru- ral), level of education (high/low) and eco- nomic status (high/low) were documented as major sociodemographic variables. Subjects were divided into two intervention groups according to surgical technique for gingival tissue harvesting after implantation and osseointegration period: • Laser Technique (Group 0) • Punch Bur Technique (Group 1) Three major surgical outcomes were meas- ured: Intensity of Pain – Assessed via the Visual Analog Scale (VAS) and scored from 0 (no pain) to 3 (severe pain). Healing Ef>icacy – Evaluated with the Landry Healing Index, which is a clinical rating scale for tissue healing. Scores vary between 0 (ex- cellent healing) and 4 (poor healing). Patient satisfaction – A >ive-point scale (from 0, very satis>ied, to 4, very dissatis>ied) measuring the patient’s perception of the treatment. Following the completion of the osseointe- gration and bone healing period, patients were scheduled for gingival re-exposure us- ing one of two methods: • Laser Group: Diode laser with 980 nm wavelength, 1.5 watts continuous mode. • Punch Bur Group: Traditional me- chanical re-exposure using rotary punch in- struments. The laser technique offered improved hemo- stasis and minimized trauma, while the punch bur method involved tissue excision under rotary motion, causing greater me- chanical disruption. Clinical observation indicated that laser- treated sites exhibited reduced edema, ery- thema, and bleeding, whereas punch bur- treated sites showed increased inflammation, redness, and discomfort— findings in line with Romanos et al. (2006) [51]. Assessment tools and indices were: • Pain: Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (worst pain imaginable) was used [52]. • Healing: Landry Wound Healing In- dex (WHI) assessed gingival color, granula- tion tissue, bleeding, and epithelialization on a 1–5 scale [53]. • Satisfaction: Patients completed a 5-point Likert scale (1 = very dissatisfied to 5 = very satisfied) evaluating their experi- ence [54]. Gingival color changes were recorded at fol- low-up visits. Laser sites tended to return to healthy pink tones faster, whereas punch bur sites required more time for tissue stabiliza- tion [55]. Structured interviews and clinical photo- graphs were used for postoperative assess- ments. Healing and discomfort were rec- orded on day 3 and day 7 post-surgery. Descriptive statistics (mean, SD) and MANOVA were used to examine the impact of predictors on VAS, WHI, and satisfaction. Chi-square and logistic regression were ap- plied to test associations. Analyses were con- ducted using SPSS and R software, with sig- nificance set at p < 0.05 [24]. Results There is no statistically signi>icant difference in the combined outcomes (pain, healing, satisfaction) between younger (18–45) and older (46–65) participants (p=0.71). Age did not meaningfully in>luence postoperative re- covery in this simulation. Although not statistically signi>icant at α = 0.05, males and females may experience dif- ferences in pain perception or healing (p=0.1), but further data would be required for con>irmation. Residency location did not signi>icantly af- fect combined outcomes (p-0.16). Urban and rural patients had similar scores for pain, healing, and satisfaction. There was a statistically signi>icant differ- ence of education level on the combined out- comes (p=0.03). Patients with higher educa- tion tended to report better healing and sat- isfaction, potentially due to higher health lit- eracy and better compliance. Economic status had a signi>icant effect on postoperative outcomes (p=0.01). Lower-in- come individuals may report more pain, slower healing, or lower satisfaction. Surgery type in>luenced pain, healing, and satisfaction (p=0.007). Laser-treated pa- tients performed better on all recovery indi- cators. Discussion This study aimed to evaluate the impact of surgical technique and sociodemographic variables on postoperative gingival re-expo- sure, speci>ically pain intensity, healing qual- ity, and patient satisfaction. The data clearly demonstrated that the laser technique, using a 980 nm diode laser at 1.5 watts, yields su- perior clinical and subjective outcomes com- pared to the punch bur method. The differences between the two surgical methods were evident both visually and sta- tistically. Laser-treated sites consistently ex- hibited reduced postoperative erythema, limited edema, and minimal bleeding, align- ing with known photothermal effects that re- duce bacterial load, coagulate soft tissue, and minimize nerve irritation. In contrast, punch bur-treated sites showed greater mechanical trauma, resulting in prolonged swelling, bleeding, and delayed healing margins. These observations correspond with the lit- erature [50,54]. Laser-exposed tissue achieved quicker tran- sition from in>lamed red to healthy pink tones, indicating faster epithelialization and better angiogenesis. VAS scores were signi>i- cantly lower in the laser group, supporting previous >indings that diode lasers reduce pain through nerve sealing and reduced in- >lammatory mediator expression [3,4]. The average pain levels differed notably be- tween the two techniques. Patients treated with the laser method consistently reported lower VAS scores, indicating reduced post- operative discomfort. This supports previ- ous literature which highlights that laser-as- sisted procedures, particularly with diode la- sers, result in less tissue trauma, reduced nerve irritation, and faster coagulation, all contributing to diminished pain perception [1-4]. The laser technique is likely superior for managing postoperative pain, making it especially bene>icial for patients with low pain tolerance or systemic healing issues. Data showed a slightly better healing re- sponse in females. Though not extreme, this difference aligns with >indings in wound healing research suggesting that estrogen plays a supportive role in tissue repair, and women may demonstrate better immune regulation post-surgery. While the gender difference is modest, it may guide clinicians to provide additional follow-up support for male patients or those at risk of slower heal- ing. Higher education level patients tell of more ful>illment. A possible explanation may be that they are better informed about health is- sues, make people readier to meet the post- op cares and provide them with realistic ex- pectations. Patients with low education may have compliance problems and confusion between discomfort and failure, diminishing Postopera6ve Outcomes in Gingival Re-exposure Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.1009 http://dentistry3000.pitt.edu 3 satisfaction. Information to the discharged patients must be adjusted to their level of ed- ucation in order that the patients perceive planned outcomes and measures. Results indicated signi>icant relationships between socioeconomic background and prescribed technique, emphasizing the im- portance of the patient’s background in treatment planning. The study demonstrated distinct outcomes in relation to surgical technique and patient background. Laser technologies may have an evident clinical advantage on pain and cica- trization, and perception and recovery are modulated by education and gender. Factors such as demographic pro>iles may also be considered in surgical planning to maximize clinical and experiential bene>its. Conclusion These results confirm the theory that socio- demographic factors influence the post-op- erative experience and underscore the im- portance of a care approach that is adapted to the context. The incorporation of patient history into surgical planning and follow-up care could lead to improved recovery and satisfaction. References 1. Yilmaz, E., Karaduman, A. & Toker, H. (2022). Clinical ef*icacy of diode lasers in gingival surgery: Pain and healing assessment. Journal of Periodontology, 93(10), pp. 1240–1247. 2. Yilmaz, G., Altintas, E., & Sahin, T. (2022). Clinical efPicacy of diode laser in gingival surgery. Lasers in Dental Science, 6(3), 140–147. 3. Singh, A., Kaur, R., & Kumar, V. (2023). 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