Effects of Low-Level Laser Therapy and Hyaluronic Acid After Free Gingival Graft

Free gingival graft area was measured from standardized clinical photographs using ImageJ software. Graft shrinkage was calculated as the percentage reduction in graft area compared with the baseline postoperative graft area. Higher percentage values indicate greater graft shrinkage.

Postoperative pain at the palatal donor site and mandibular recipient site was recorded separately using a visual analog scale ranging from 0 to 10, where 0 indicated no pain and 10 indicated the worst imaginable pain. Lower scores indicate less postoperative pain.

In this study, the Pink Esthetic Score (PES) was adapted from the original index described by Belser et al. (2009). The index was considered modified (m-PES) because the original PES was developed to evaluate peri-implant soft tissue esthetics, whereas no implants were placed in the present study. Instead, the scoring criteria were applied to free gingival graft (FGG)-treated sites, using the adjacent healthy teeth as the reference for esthetic evaluation. The m-PES included seven variables: mesial papilla, distal papilla, facial mucosal curvature, facial mucosal level, alveolar process deficiency, and the color and texture of the facial soft tissue. Each parameter was scored as 0, 1, or 2, with higher scores indicating a more favorable esthetic outcome.

The m-PES was assessed at baseline and at the 6-month follow-up. This modified index was selected because it provides a standardized, objective, and reproducible method for evaluating soft tissue esthetic changes over time.

Oral health-related quality of life was assessed using the validated Turkish version of the 14-item Oral Health Impact Profile (OHIP-14). The questionnaire includes seven domains: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. Each item was scored from 0 (never) to 4 (very often), resulting in a total score ranging from 0 to 56. Lower scores indicate better oral health-related quality of life.

Postoperative analgesic consumption was assessed by recording the number of tablets taken by each participant during the first seven days following free gingival graft surgery. Participants recorded their daily analgesic intake, and the total number of tablets consumed during the postoperative evaluation period was calculated.

Probing pocket depth was measured in millimeters using a UNC-15 periodontal probe. The distance from the gingival margin to the base of the periodontal pocket was recorded at six sites per tooth: mesiobuccal, mid-buccal, distobuccal, mesiolingual/palatal, mid-lingual/palatal, and distolingual/palatal. Lower values indicate shallower periodontal pockets.

Plaque accumulation was assessed dichotomously as present or absent using a periodontal probe. Measurements were performed at four surfaces of each tooth: mesiobuccal, mid-buccal, distobuccal, and mid-lingual/palatal. The plaque score was calculated by dividing the number of plaque-positive surfaces by the total number of examined surfaces and multiplying by 100. Scores range from 0% to 100%, with lower scores indicating better plaque control.

Bleeding on probing was assessed using a UNC-15 periodontal probe at six sites per tooth. A site was recorded as positive when bleeding occurred within 10 to 15 seconds after probing and negative when no bleeding occurred. The bleeding on probing score was calculated by dividing the number of bleeding-positive sites by the total number of examined sites and multiplying by 100. Scores range from 0% to 100%, with lower scores indicating less gingival inflammation.

Keratinized tissue thickness was measured in millimeters at the mid-buccal aspect of the treated tooth, at the midpoint between the gingival margin and the mucogingival junction. Under local anesthesia, a number 25 endodontic spreader with a silicone stop was inserted perpendicular to the tissue until hard tissue was contacted. The penetration depth was subsequently determined by placing the spreader beside a periodontal probe and measuring the distance from the tip of the spreader to the silicone stop. Higher values indicate greater keratinized tissue thickness.

Gingival recession depth was measured in millimeters using a UNC-15 periodontal probe and an individualized 2-mm-thick transparent acrylic splint. A vertical reference groove was prepared on the splint parallel to the long axis of the treated tooth to ensure reproducible probe positioning. The distance from the cementoenamel junction to the gingival margin was recorded. Lower values indicate a reduction in gingival recession depth.

Gingival recession width was measured in millimeters at the widest horizontal dimension of the recession defect. A periodontal probe was positioned horizontally between the mesial and distal margins of the gingival recession at the midline of the defect. Lower values indicate a reduction in gingival recession width.

Vestibular depth was measured in millimeters using a periodontal probe and an individualized transparent splint. The probe was positioned within a vertical reference groove on the splint, parallel to the long axis of the treated tooth, and advanced until the mucogingival junction was reached. The distance between the lower border of the splint and the mucogingival junction was recorded as the vestibular depth. Higher values indicate greater vestibular depth.