Comparison of hyaluronic acid, hypochlorous acid, and flurbiprofen on postoperative morbidity in palatal donor area: a randomized controlled clinical trial

Abstract

Objective This study aims to evaluate the effects of topical hyaluronic acid (HA), hypochlorous acid (HOCl), and flurbiprofen on postoperative morbidity of palatal donor sites after free gingival graft (FGG) surgery. Materials and methods Sixty patients requiring FGG were randomly assigned into four groups: control, HA gel (600 mg/100 g high molecular weight hyaluronic acid), HOCl spray (170–200 ppm, ph7.1), flurbiprofen spray (0.075gr flurbiprofen). Topical agents were applied for 14 days, according to groups. Patients were followed for 28 days. Palatal healing was assessed with the Laundry wound healing index (WHI). Complete epithelization (CE) was evaluated with photographs and H 2 O 2 bubbling. Pain, burning sensation, chewing efficacy, and tissue color match (CM) were evaluated using a visual analog scale (VAS). Postoperative analgesic consumption and delayed bleeding (DB) were also recorded. Results HA provided better WHI values on the 7 th , 14 th , and 21 st days compared to the other groups, respectively ( p < 0.05). CE was formed on the 21 st day in the HA group but on the 28 th day in the other groups. HOCl and flurbiprofen groups were not different from the control group or each other in terms of WHI. HOCl had the lowest VAS scores of all time periods. DB was not observed in any group. Significantly fewer analgesics were taken in the topical agent-applied groups compared to the control group . Conclusions HA exhibits a positive impact on the epithelization of palatal wound healing and color matching. HOCl and flurbiprofen provided less pain; however, they might have negative effects on palatal wound healing. Clinical relevance As a result of obtaining free gingival grafts from palatal tissue for mucogingival surgical procedures, secondary wound healing of the donor area occurs. This wound in the palatal region can cause discomfort and pain every time patients use their mouths. The use of HA can reduce postoperative complications by accelerating wound healing and reducing pain. The topical use of flurbiprofen and HOCl can reduce patients’ pain.

Wound‐healing agents for palatal donor area: A network meta‐analysis

“…Nine RCTs were included in the pairwise meta-analysis (Bitencourt et al, 2022;Castro-Gaspar et al, 2021;Femminella et al, 2016;Hassan et al, 2020;Işler et al, 2019;Morshedzadeh et al, 2022;Patarapongsanti et al, 2019;Pekbagriyanik et al, 2021;Yilmaz, Comerdov, et al, 2022) and 7 RCTs were included in NMA (Bitencourt et al, 2022;Femminella et al, 2016;Hassan et al, 2020;Işler et al, 2019;Morshedzadeh et al, 2022;Patarapongsanti et al, 2019;Pekbagriyanik et al, 2021) for pain assessment (using Seven RCTs were included in pairwise meta-analysis (Alvarez-Medina et al, 2023;Femminella et al, 2016;Heidari et al, 2017;Isler et al, 2018;Morshedzadeh et al, 2022;Patarapongsanti et al, 2019;Pekbagriyanik et al, 2021) and 8 RCTs were include in NMA (open loop of evidence) (Alpan & Cin, 2023;Heidari et al, 2017;Isler et al, 2018;Miguel, Mathias-Santamaria, Rossato, Ferraz, Figueiredo-Neto, et al, 2021, Miguel, Mathias-Santamaria, Rossato, Ferraz, Rangel, et al, 2021Morshedzadeh et al, 2022;Pekbagriyanik et al, 2021;Yilmaz, Kayaalti-Yuksek, & Karaduman, 2022) for the palatal wound complete epithelialization evaluation (using hydrogen peroxide test) after 14-and 21-day. Pairwise meta-analysis for pain assessment and wound healing were reported in the Appendix S1.…”

“…Seven RCTs were included in pairwise meta‐analysis (Alvarez‐Medina et al., 2023; Femminella et al., 2016; Heidari et al., 2017; Isler et al., 2018; Morshedzadeh et al., 2022; Patarapongsanti et al., 2019; Pekbagriyanik et al., 2021) and 8 RCTs were include in NMA (open loop of evidence) (Alpan & Cin, 2023; Heidari et al., 2017; Isler et al., 2018; Miguel, Mathias‐Santamaria, Rossato, Ferraz, Figueiredo‐Neto, et al., 2021, Miguel, Mathias‐Santamaria, Rossato, Ferraz, Rangel, et al., 2021; Morshedzadeh et al., 2022; Pekbagriyanik et al., 2021; Yilmaz, Kayaalti‐Yuksek, & Karaduman, 2022) for the palatal wound complete epithelialization evaluation (using hydrogen peroxide test) after 14‐ and 21‐day. Pairwise meta‐analysis for pain assessment and wound healing were reported in the Appendix S1.…”

Effects of topically administered 0.6% hyaluronic acid on the healing of labial frenectomy in conventional and 940-nm indium gallium arsenide phosphide (InGaAsP) diode laser techniques in pediatric patients: a randomized, placebo-controlled clinical study

“…The HA concentration in the commercially available products containing high molecular weight HA is in the range of 0.2–0.8% [ 16 , 18 ]. The concentration, treatment protocol, and frequency may have affected the different clinical results reported in the previous studies [ 23 ].…”

“…HA may accelerate wound healing through blood clot stabilization, decreased inflammatory responses, neovascularization, angiogenesis, increased fibroblast migration, and wound closure [ 16 , 18 ]. A meta-analysis reported that the laser-assisted labial frenectomy decreased the need for the administration of postoperative analgesics; however, no significant difference was observed between the laser-assisted frenectomy and conventional technique.…”

“…These properties suggest that HA may enhance wound healing in oral soft tissues, such as in the healing process following frenectomy operations [ 14 , 16 , 17 ]. Additionally, HA reduces plaque and sulcus bleeding indices in patients with gingivitis [ 18 ].…”