Minimizing patient morbidity after free gingival graft harvesting:A triple‐blind randomized‐controlled clinical trial

Abstract

Objectives: This study aimed to evaluate the effect of photobiomodulation therapy (PBMT) on patient morbidity and donor site healing after free gingival graft (FGG) harvesting.Methods: Forty-four patients requiring FGG were selected for this trial. Individuals were randomly assigned to test group (PBMT, n = 22) or control group (placebo, n = 22) applied immediately after surgery, 24 and 48 h after. Demographic, surgicalrelated and psychosocial variables possibly associated with treatment response were collected. The primary outcome was postoperative pain at the donor site evaluated using Visual Analog Scale (VAS) immediately after surgery and 6, 24, 48 and 72 h after. Secondary outcomes include medication consumption, patient-reported outcome measures (PROMs) and percentage of wound closure.Results: Intragroup analysis showed no differences in VASLOG means for placebo group throughout the study (p > .05), whereas a significant difference in PBMT group at 6 h, 24 h, 48 h and 72 h (p < .05) were observed. Postoperative rescue analgesic requirement was significantly higher in the placebo group (p = .004). The number needed to treat(NNT) was 2.43. PBMT group reported significant better function related to sleeping, going to work/school and daily routine activities, less restriction to mouth opening, chewing and food consumption, less swelling and bleeding (p < .05), mainly in the first 48 h. PBMT group presented a significantly higher palatal wound closure at 7 days compared to placebo group (33.41 vs. 21.20 respectively, p = .024) after adjustment for confounding. No adverse effects were reported.Conclusions: Photobiomodulation therapy accelerated the pain resolution time and palatal closure, decreased rescue medication consumption and significantly improved patient satisfaction in the postoperative period.

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.…”

“…Four studies (Bitencourt et al., 2022; Isler et al., 2018; Lafzi et al., 2019; Lavu et al., 2022) reported lower pain scores (Isler et al., 2018; Lafzi et al., 2019; Lavu et al., 2022) and analgesic consumption (Bitencourt et al., 2022) with the use of diode laser in palatal donor area in comparison to spontaneous healing. Laser modulation using LED also promoted less pain in comparison to spontaneous healing (Vieira et al., 2010).…”

“…However, the laser therapy effectiveness depends on the interaction between the laser light and target tissue, and factors such as the distance from the source to tissue, energy density, wavelength, irradiance, treatment interval, and the amount of irradiation time applied may influence the therapy results (Bitencourt et al, 2022).…”

Cyanoacrylate and hyaluronic acid combination on palatal donor site management after de‐epithelialized graft harvesting

“…However, the secondary intention healing after EGG harvesting still cause remarkable donor site morbidity. Thus, the clinicians continue to search for ways of reducing these complaints by isolating the wound from oral environment and/or accelerating the wound healing 7,8 . Periodontal dressings, acrylic stents, hemostatic agents, surgical sponges, platelet concentrates, low‐level laser therapy, photobiomodulation, cyanoacrylate (CY) tissue adhesives, and hyaluronic acid (HA) have been utilized for donor site management either to accelerate the wound healing or to cover the wound surfaces as a barrier 8–13 .…”

“…Thus, the clinicians continue to search for ways of reducing these complaints by isolating the wound from oral environment and/or accelerating the wound healing. 7,8 Periodontal dressings, acrylic stents, hemostatic agents, surgical sponges, platelet concentrates, low-level laser therapy, photobiomodulation, cyanoacrylate (CY) tissue adhesives, and hyaluronic acid (HA) have been utilized for donor site management either to accelerate the wound healing or to cover the wound surfaces as a barrier. [8][9][10][11][12][13] From those, when used with collagen or gelatin sponge (GS), CY showed promising results with earlier hemostasis, enhanced wound healing, and reduced patient discomfort by its adhesive, hemostatic, and biodegradable properties.…”