Outcomes of Flapless Er:YAG and Er,Cr:YSGG Laser-Assisted Crown Lengthening: A Systematic Review

In recent years, erbium-doped yttrium aluminum garnet (Er:YAG) and erbium, chromium/yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers have been introduced as another possibility to perform less-invasive flapless (FL) crown-lengthening (CL) procedures.

The aim of this review is to describe the outcomes and complications of this approach.

A literature review was conducted to retrieve clinical studies and case reports that analyze different variables related to laser-assisted flapless crown lengthening and report their outcomes in terms of gingival margin level stability (GMLS), and postoperative complications.

A total of five studies were included in the final qualitative analysis; two of them were randomized controlled trials (RCTs) and the rest were case reports. The common variable measured in all studies was the GMLS, finding good stability in the FL groups at 3 months follow-up, but more tissue rebound was observed in patients with the thick biotype. Other variables were reported in different articles as the plaque index (PI), gingival index (GI), bone margin level, biotype, bleeding on probing (BP), probing depth (PD), and postoperative pain by the numeric rating scale (NRS).

There are a wide range of heterogenous clinical variables used to evaluate outcomes, as well as variations in the type of laser used and its parameters in terms of the applied technique. However, most analyzed studies showed better GMLS for the flapless technique, as well as less postoperative inflammation.

The included studies showed promising clinical outcomes in the FL laser-assisted CL groups concerning GMLS at the 3-month postoperative period. However, more RCTs are needed with respect to fixed laser parameters and patient biotype selection to reach a definitive clinical protocol.