Clinical and patient‐centered outcomes using two types of subepithelial connective tissue grafts: A split‐mouth randomized clinical trial

Abstract

Background This split‐mouth randomized clinical trial compared two different types of subepithelial connective tissue grafts (SCTG) considering clinical parameters and patient‐centered outcomes in patients with bilateral recession type 1 multiple gingival recessions after 6 months postoperatively. Methods A total of 21 patients were surgically treated with coronally advanced flap (CAF) associated with SCTG harvested by: double blade scalpel (DBS) and de‐epithelialized (DE) SCTG. Periodontal clinical parameters and esthetics were evaluated by a calibrated periodontist at baseline and after 6 months. Patient‐centered outcomes related to pain/discomfort and esthetics were assessed with visual analogue scale after 7 days and 6 months, respectively. Results All clinical parameters, with the exception of probing depth, demonstrated differences in intragroup evaluation, comparing baseline to 6‐month evaluation (P <0.05). Both groups presented reduction of recession depth and recession width and gain of keratinized tissue thickness, keratinized tissue width, and clinical attachment level (P <0.05). Intergroup comparison (DBS × DE) demonstrated no significant differences considering clinical parameters and periods. Both techniques improved esthetics evaluated by patients, without a difference between groups in patients and professional analysis. However, DBS group presented inferior pain/discomfort compared with DE (P <0.05). Conclusion DBS and DE associated with CAF presented satisfactory clinical outcomes. However, DBS presented inferior morbidity, an important fact for decision‐making process.

Clinical applications of mucogingival therapies utilizing adjunctive autologous blood products

“…22,23 Additionally, the method of harvest of autologous grafts has been associated with changes in postoperative patient pain perception. 24 The perception of postoperative discomfort may have a significant impact on future treatment acceptance, with willingness to retreat gingival grafting sites negatively associated with intraoral treatment areas, size of treated sites, and patientreported postoperative pain. 25 Given the findings that root coverage, enhanced keratinized tissue, and/or enhanced gingival thickness are desired surgical outcomes, autologous grafts must be considered the "gold standard," 26,27 utilization of materials that have the potential to improve patient acceptance of treatment and decrease postoperative pain may allow better acceptance of such autologous materials requiring a secondary donor site.…”

“…Use of autologous graft materials has been associated with increased patient‐reported pain when compared to the use of allografts and/or xenografts 22,23 . Additionally, the method of harvest of autologous grafts has been associated with changes in postoperative patient pain perception 24 . The perception of postoperative discomfort may have a significant impact on future treatment acceptance, with willingness to retreat gingival grafting sites negatively associated with intraoral treatment areas, size of treated sites, and patient‐reported postoperative pain 25 .…”

Patient-reported outcome measures and clinical outcomes following peri-implant vestibuloplasty with a free gingival graft versus xenogeneic collagen matrix: a comparative prospective clinical study

“…Free gingival graft (FGG) is the most effective technique for increasing the keratinized mucosa width (KMW) around dental implants [1][2][3][4]. However, this technique requires harvesting of the autogenous graft from the palate, which leaves an open wound area and is closely associated with increased postoperative morbidity [5,6]. Excessive pain in the exposed palatal wound has been attributed to secondary intention healing [7,8].…”

Should Periodontists Prescribe Postoperative Oral Corticosteroids to Control Pain and Swelling? A Systematic Review

“…In periodontics, as in virtually all surgical disciplines, clinicians over the last several decades have increasingly attended to patient-centered as well as clinical therapeutic outcomes. 4,5 In addition to retention of healthy natural teeth, comfortable function, and successful replacement of missing teeth, our patients also seek to avoid perioperative discomfort, minimize treatment time, hasten return to normal activities, and optimize esthetics. [4][5][6][7][8][9][10][11][12][13] Postoperative pain and swelling can be particularly distressing, with the potential to alter the patient's acceptance of future treatment.…”

“…4,5 In addition to retention of healthy natural teeth, comfortable function, and successful replacement of missing teeth, our patients also seek to avoid perioperative discomfort, minimize treatment time, hasten return to normal activities, and optimize esthetics. [4][5][6][7][8][9][10][11][12][13] Postoperative pain and swelling can be particularly distressing, with the potential to alter the patient's acceptance of future treatment. 13 In a recent retrospective analysis of 3900 oral, periodontal, and implant surgeries, dentinal hypersensitivity (6%) and excessive pain (4%) were the most frequent postoperative complications.…”