Effect of a gel containing green tea extract and hyaluronic acid on palate pain scores and wound healing after free gingival graft: a quasi-randomized controlled clinical trial.

OBJECTIVES: The aim of this study was to evaluate the effect of a gel containing green tea extract and hyaluronic acid (HA) on pain scores and wound healing in donor sites after free gingival graft (FGG). MATERIALS AND METHODS: Forty-two patients requiring FGG were included in three groups: (1) control group (n = 14), no material was placed in the donor area; only the clot was kept in position by sutures; (2) placebo group (n = 14), vehicle gel applied 3 times a day for 7 days; and (3) test group (n = 14), gel containing green tea extract and HA applied 3 times a day for 7 days. The wound size by clinical measurement (WS-CM) and photographic image (WS-PI), complete wound epithelialization (CWE), and palatal mucosa color were evaluated after 3 days and 1, 2, and 4 weeks postoperatively. The visual analog scale (VAS) for pain and analgesic consumption were used to assess participant's perception in the same postoperative periods. RESULTS: A similar progressive reduction in the wound size, associated with an improvement in the color pattern, was observed in all groups (p > 0.05). No significant differences were found for CWE and pain assessment between the examined groups (p > 0.05). CONCLUSION: The gel containing green tea extract and HA application in palatal wounds after FGG removal does not provide clinical healing benefits using this investigated protocol. CLINICAL RELEVANCE: This is the first clinical study evaluating the effect of gel containing green tea extract and HA on the palate postoperative pain control and wound healing after FGG. TRIAL REGISTRATION: http://clinicaltrials.gov : NCT05270161.

Alvogyl and absorbable gelatin sponge as palatal wound dressings following epithelialized free gingival graft harvest: a randomized clinical trial.

OBJECTIVES: This randomized controlled trial compares for the first time effects of Alvogyl versus absorbable gelatin sponge as palatal wound dressings on postoperative pain, amount of analgesic consumption, post-surgical bleeding, and wound re-epithelization. MATERIALS AND METHODS: Following sample size calculation, 36 systemically healthy patients requiring palatal mucosal graft harvesting were randomized to receive Alvogyl (intervention group, 18 patients) or absorbable gelatin sponge (control group, 18 patients) palatal dressings. Patient-reported VAS pain scores over 2 weeks were defined as primary outcome. Post-surgical bleeding, number of analgesics consumed, and complete re-epithelialization of the palatal wound for up to 5 weeks were defined as secondary outcomes. RESULTS: Although significantly higher VAS pain scores were reported in the control as compared with the intervention group up to 12 days post-surgically (from (median [range]) 8.5 [2-10] to 1 [0-2] and from 6 [0-10] to 0 [0-2] respectively), with higher analgesics consumption (from 2 [1-3] to 1 [0-3] and from 1 [0-3] to 0 [0-2] tablets respectively), a multivariate regression analysis considering age, gender, graft width/length, tissue thickness, analgesics intake, and dressing type demonstrated no statistically significant effect of any factor, including dressing type on VAS pain scores. At 4 weeks, 22.2% of patients in the intervention group versus 11.1% in the control group demonstrated complete re-epithelization of their palatal engraftment site, before complete re-epithelization in both groups at 5 weeks. No post-surgical bleeding was reported with both dressings. CONCLUSIONS: Within the study's limitations, results suggest Alvogyl as a practical palatal surgical dressing, comparable with absorbable gelatin sponge in cost, pain reduction, hemostasis, and re-epithelization properties. TRIAL REGISTRATION: www.ClinicalTrials.gov Identifier: NCT03402321 CLINICAL RELEVANCE: Alvogyl could present a novel palatal wound dressing material, comparable with gelatin sponge.

Free gingival graft adjunct with low-level laser therapy: a randomized placebo-controlled parallel group study.

OBJECTIVES: This study aimed to evaluate the effect of low-level laser therapy (LLLT) in terms of enhancing wound healing, reducing free gingival graft (FGG) shrinkage and postoperative pain. MATERIALS AND METHODS: Thirty patients were randomly assigned to receive either FGG + LLLT (test, n = 15) or FGG + plasebo LLLT (control, n = 15). In the test group, a diode laser (810 nm, 0.1 W, energy density 6 J/cm2) was applied immediately after surgery and 1, 3, 7, and 14 days later. Measurements of the graft surface areas of the groups were made with an image-analyzing software at baseline and first, third, and sixth months. Complete wound epithelialization and visual analogue scale (VAS) for pain score were evaluated after surgery. RESULTS: Shrinkage of the graft was statistically higher in the control than the test group at third and sixth months (p < 0.05). In terms of epithelization of the graft area, the test and control groups did not show any significant difference during the 28-day period (p > 0.05). Besides this, statistically significant differences were observed for VAS pain score and the number of analgesic used (p < 0.05). CONCLUSIONS: The use of an 810-nm diode laser provided additional benefits to FGG in terms of less shrinkage of the graft dimensions and postoperative pain. CLINICAL RELEVANCE: Low-level laser therapy reduced the shrinkage of free gingival graft's surface area after 6 months and enhanced postoperative pain relief.

Low-intensity laser for harvesting palatal graft for the treatment of gingival recession: A systematic review.

The aim of the present study was to assess the efficacy of low-intensity laser therapy (LILT) for harvesting palatal connective tissue graft (PCTG) in the treatment of gingival recession. Databases were searched up to May 2018. The addressed focused question was: Is adjunctive LILT effective in the healing of donor palatine area after harvesting PCTG? Screening of the initially identified studies resulted in four clinical studies. All studies showed that LILT was effective in improving clinical outcomes, such as tissue thickness, postoperative discomfort, remaining wound area, and visual analog score at follow up. Upon comparison with the control group, two studies showed significantly greater improvements in the clinical parameters and patient-centered outcomes for LILT than control groups at follow up. Due to the low number of included clinical studies, it remains debatable whether LILT improves clinical and patient-centered outcomes of PCTG procedures. Further randomized controlled trials are needed to evaluate the outcomes of LILT on the healing of donor palatine area after harvesting PCTG.

Effect of Platelet-rich Fibrin and Free Gingival Graft in the Treatment of Soft Tissue Defect preceding Implant Placement.

INTRODUCTION: Free gingival graft is a procedure that is used to increase keratinized tissue around teeth and edentulous sites for future dental implants. Keratinized tissue is critical for maintainability of surgical site and flap management. Platelet-rich fibrin consists of bioactive and biological components, mainly composed of growth factors. Growth factors attract stem cells to the site of release and stimulate cell proliferation. Moreover, growth factors promote angiogenesis, which accelerates wound healing. Site preparation is critical in implant dentistry, including soft tissue and hard tissue augmentation. AIM: To improve free gingival graft (FGG) healing by using platelet-rich fibrin (PRF) at the soft tissue defect area of extracted upper right first molar in order to restore keratinized tissue and prepare the site for bone grafting followed by dental implant placement. CASE REPORT: A healthy female patient, 59 years old, presented to the dental clinic at the University at Buffalo, School of Dental Medicine, seeking dental implants to restore missing teeth. The patient had an extraction for upper right first molar 4 months ago. The surgical extraction left severe soft and hard tissue defects at the site. Free gingival graft was placed at the site to increase keratinized tissue band followed by PRF to improve healing. Cyanoacrylate adhesive was used to stabilize PRF Two months later, a full-thickness flap was reflected, and tenting screws placed with bone grafting at the site. Titanium-reenforced membrane was placed over the bone graft. Three months later, tenting screws were removed and two dental implants were placed at the site. CONCLUSION: The use of PRF accelerates the healing of FGG. More tissue handling could be achieved by increasing the kera-tinized tissue during surgical procedures. CLINICAL SIGNIFICANCE: The combination of PRF and FGG could help in the healing process during soft tissue procedures.

Effect of laser photobiomodulation on wound healing and postoperative pain following free gingival graft: A split-mouth triple-blind randomized controlled clinical trial.

BACKGROUND AND AIM: Free gingival graft (FGG) is one of the most predictable techniques for gingival augmentation. However, patient's discomfort and pain during healing period are significant concerns. The aim of this study was to assess if laser photobiomodulation (PBM) was effective in terms of enhancing wound healing and reducing postoperative pain. METHODS AND MATERIALS: Twelve patients participated in this split-mouth randomized controlled clinical trial. Each patient had a 30-day interval between the two procedures. In the test group, donor and recipient sites received diode laser (660nm, 200mW, continuous mode, time of irradiation:32s, energy density: 4J/cm2, spot size:0.5cm) immediately after FGG surgery, and 1,2,4 and 7days later. The control side received the same sequence of irradiation with the laser-off. Complete wound epithelialization of donor site and clinical wound healing and visual analogue scale (VAS) pain score of donor and recipient sites were evaluated after surgery. RESULTS: At 14 and 21days after surgery, the number of donor sites with complete epithelialization was greater in laser group compared to the placebo. After 21days, all donor sites in the test group were epithelialized completely, while at the same time, only eight donor sites in the control group showed complete epithelialization (P value=0.05). In terms of clinical healing of the recipient and donor sites, the test and control groups did not show any significant difference during the 45-day period, except at days 1 (for recipient site) and 14 (for donor site), when the test group showed better results (P values: 0.01 and 0.03, respectively). The VAS pain score did not show statistically significant difference between two groups during the study period, except for the first 3h after procedure when laser group showed greater VAS pain score (P values<0.05). CONCLUSION: PBM following FGG procedure with the parameters used in this study could accelerate the rate of epithelialization at the donor site. However, it did not reduce postoperative pain.

Low-Level Laser Therapy in Enhancing Wound Healing and Preserving Tissue Thickness at Free Gingival Graft Donor Sites: A Randomized, Controlled Clinical Study.

OBJECTIVE: The aim of this study was to determine the effects of low-level laser therapy (LLLT) on wound healing at free gingival graft (FGG) donor sites. MATERIALS AND METHODS: Forty patients requiring FGG were selected for this randomized, controlled, and double-blinded prospective clinical trial. The FGG donor sites were treated with LLLT and compared with an untreated control group. The Wound-Healing Index (WHI), tissue consistency, color match, and H2O2 bubbling test for the evaluation of complete wound epithelialization were recorded on the 3rd, 7th, 14th and 21st days. The pain-burning level, number of analgesics, and bleeding were recorded for 7 days. Donor area soft tissue thickness (TT) was measured at baseline and at the first month. RESULTS: The prevalence of Complete Wound Epithelization was higher in the LLLT group than in the control group on the 14th day (p < 0.001). The bleeding was lower in the test group than in the control group during the first 2 days (p ≤ 0.001). Higher WHI Scores were observed in the test group relative to the control group at all visits (p ≤ 0.001). Color match scores were higher in the test group than in the control group at the first 3 visits (p < 0.05). The TT changed from 4.62 ± 0.79 to 4.71 ± 0.82 mm in the LLLT group and from 4.23 ± 0.62 to 4.01 ± 0.68 mm in the control group. CONCLUSIONS: It can be concluded that LLLT enhances FGG donor site wound healing and preserves TT at palatinal donor sites.

Tratamiento de recesión única de clase III con injerto libre subepitelial mediante técnica de colgajo de doble papila reposicionado: informe de un caso clínico / Treatment of a single Class III recession combining free subepithelial connective tissue graft and a double papilla repositioned flap: report of a clinical case

Objetivo: mostrar y evaluar los resultados clínicos de un procedimiento de cirugía plástica periodontal, efectuada para cubrir una recesión radicular de clase III de Miller, con una técnica bilaminar. Además, analizar el aumento de la banda de encía y el cambio de biotipo gingival de la pieza dentaria. Caso clínico: paciente femenino de 30 años de edad, con una recesión gingival de Clase III de Miller por vestibular de la pieza 43 que no sobrepasa la línea mucogingival, con pérdida interproximal de tejidos duros y blandos. El tratamiento consiste en un colgajo de doble papila a espesor parcial, con injerto libre subepitelial tomado del paladar, con seguimiento a 1 año. Conclusiones: la técnica bilaminar es una solución viable en casos de recubrimiento radicular poco predecibles, como la recesión de clase III de Miller. El biotipo gingival se vio engrosado y la encía queratinizada no sufrió variaciones.

Effects of Ozone Therapy on the Early Healing Period of Deepithelialized Gingival Grafts: A Randomized Placebo-Controlled Clinical Trial.

BACKGROUND: This study evaluates the effects of ozone therapy (OT) on the early healing period of deepithelialized gingival grafts (DGG) placed for non-root coverage gingival augmentation by laser Doppler flowmetry (LDF). METHODS: Thirty-three patients were assigned to study groups: 1) test: DGG + OT; or 2) control group: DGG alone. Thirty patients completed the study. Ozone was applied on DGGs placed in the recipient bed and donor site immediately after surgery and at days 1 and 3 post-surgery. Blood perfusion in the recipient site was measured by LDF on the day of surgery and at 1, 2, 3, 6, 8, 10, and 13 days after surgery. Quality of life (assessed by the Oral Health Impact Profile-14) and pain at donor/recipient sites (assessed by visual analog scale) were also investigated. RESULTS: Increase in blood perfusion units in the test group was significantly higher than control group at 1, 2, 3, 6, and 8 days post-surgery (P <0.001). Significant differences occurred between test and control groups in terms of visual analog scale values during the first week post-surgery for both donor and recipient sites (P <0.05). The ozone-treated group showed significantly higher quality of life than control group on postoperative day 6 (P = 0.002). CONCLUSIONS: OT enhanced blood perfusion units in the first postoperative week. This outcome is also consistent with improvement in wound healing, accompanied by an increase in quality of life and decrease in postoperative pain in the test group.

Evaluation of palatal donor site haemostasis and wound healing after free gingival graft surgery.

AIM: Evaluating effectiveness of a medicinal plant extract (MPE) in achieving haemostasis and early wound healing at free gingival graft (FGG) donor site in a randomized controlled fashion. METHODS: Forty patients requiring FGG at lower anterior area were randomly assigned into two groups. FGG was performed to all patients and following graft procurement; wet gauze (WG) was applied alone (control: WG group) or with MPE (test: MPE + WG group) for haemostasis. Donor site working time, bleeding (BLE), colour match (CM), pain, epithelization (EP) and sensation loss (SL) were evaluated. RESULTS: Thirty-three participants completed a 6-month period study. In the test group, primary BLE was shorter (p < 0.001) and fewer individuals showed secondary BLE during 3 days (p < 0.001). During the 6 days, pain scores were higher in WG patients (p < 0.05). Later on, no inter-group difference was observed. EP was relatively faster (p < 0.001) and CM was slightly better (p < 0.05) in MPE + WG group. CONCLUSION: MPE provided faster and continuous haemostasis that made a positive contribution to the early soft tissue healing to some extent but due to limitations; further trials are needed to demonstrate the efficiency of this material.

Connective tissue graft associated or not with low laser therapy to treat gingival recession: randomized clinical trial.

BACKGROUND: To evaluate the treatment of gingival recession with a connective tissue graft (CTG) alone or in combination with low-level laser therapy (CTG + L). METHODS: Forty patients presenting 40 Miller Class I and II gingival recessions were included. The defects were randomly assigned to receive either CTG (n = 20) or CTG + L (n = 20). A diode laser (660 nm) was applied to the test sites immediately after surgery and every other day for 7 days (eight applications). RESULTS: The mean percentage of root coverage was 91.9% for the test group and 89.48% for the control group after 6 months (p > 0.05). The test group presented more complete root coverage (n = 13, 65%) than the control group (n = 7, 35%) (p = 0.04). Dentine sensitivity decreased significantly after 6 months in both groups (p < 0.001). The two groups showed improvement in aesthetics at the end of treatment. CONCLUSIONS: Low-level laser therapy may increase the percentage of complete root coverage when associated with CTG.

Mechanisms and treatment approaches of dentine hypersensitivity: a literature review.

PURPOSE: To review major mechanisms of dentine hypersensitivity and the treatment approaches offered. MATERIALS AND METHODS: Medline was used to find relevant literature published up to December 2006. Based on abstracts and full articles, studies (in human and in animals) were identified describing mechanisms and management of dentine hypersensitivity. Additional information was also obtained by using manual library search for relevant topics in standard texts and journals of dentistry. RESULTS: Discussion about the sensitivity of dentine started over a century ago, but it was not until sixty years later that a possible theory was posited. The so-called hydrodynamic theory became popular and was applied to understand the mechanism responsible for hypersensitive dentine. Nevertheless, because of the discrepancies in the pattern by which the dentine responds to various stimuli, several theories of dentine hypersensitivity were proposed which include the hydrodynamic theory, odontoblast transducer mechanism and direct innervation theory. None of these mechanisms was said to fully explain dentine hypersensitivity, thus indicating that as-yet unexplained mechanisms were possibly responsible. A multitude of products were tried and reported to be effective. The efficacy of many was not clearly established and their mechanisms of action were inadequately elucidated. The potential of gene therapy to reduce the burden of dentine hypersensitivity in the future is being examined. CONCLUSIONS: Considerable effort has been made to precisely explain dentine hypersensitivity, but doubt still exists whether any one theory can be applied to understanding this condition. This has led to a constant increase in therapeutic approaches worldwide, but with no conclusive evidence of reliable, successful treatment regimens.

Therapeutic effect of topical ozonated oil on the epithelial healing of palatal wound sites: a planimetrical and cytological study.

AIM: To evaluate the effect of ozonated oil on palatal wounds. METHODS: Eighteen patients were randomized and allocated to either the ozone group (n = 8) or control (n = 10) group. Free gingival graft surgery was performed, and post-harvested palatal wounds were treated with either 2 mL ozonated oil or control oil daily for 1 week. A planimetrical analysis analyzed the digital image for the wound sizes and shape factor at baseline, at 24 h, and days 5, 7, 14, 21, and 28, postoperatively. A cytological analysis used the keratinization and superficial cell indices at baseline, 24 h, and days 3, 7, 14, and 21 and the second and third months, postoperatively. RESULTS: Planimetrical results showed a significant (P ≤ 0.05) improvement in wound size on days 5, 7, 14, 21, and 28, postoperatively, in the ozone group compared to the control group. Cytological results showed a significant (P ≤ 0.001) improvement in epithelial healing on days 7, 14, and 21, and the second and third months, postoperatively, after the application of ozonated oil compared to control oil. CONCLUSION: Our results showed significant improvement in wound size and epithelial healing after topical ozonated oil application compared to control oil on palatal wounds.

Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects.

BACKGROUND: For root coverage therapy, the connective tissue graft (CTG) plus coronally advanced flap (CAF) is considered the gold standard therapy against which alternative therapies are generally compared. When evaluating these therapies, in addition to traditional measures of root coverage, subject-reported, qualitative measures of esthetics, pain, and overall preferences for alternative procedures should also be considered. This study determines if a xenogeneic collagen matrix (CM) with CAF might be as effective as CTG+CAF in the treatment of recession defects. METHODS: This study was a single-masked, randomized, controlled, split-mouth study of dehiscence-type recession defects in contralateral sites; one defect received CTG+CAF and the other defect received CM+CAF. A total of 25 subjects (8 male, 17 female; mean age: 43.7 +/- 12.2 years) were evaluated at 6 months and 1 year. The primary efficacy endpoint was recession depth at 6 months. Secondary endpoints included traditional periodontal measures, such as width of keratinized tissue and percentage of root coverage. Subject-reported values of pain, discomfort, and esthetic satisfaction were also recorded. RESULTS: At 6 months, recession depth was on average 0.52 mm for test sites and 0.10 mm for control sites. Recession depth change from baseline was statistically significant between test and control, with an average of 2.62 mm gained at test sites and 3.10 mm gained at control sites for a difference of 0.4 mm (P = 0.0062). At 1 year, test percentage of root coverage averaged 88.5%, and controls averaged 99.3% (P = 0.0313). Keratinized tissue width gains were equivalent for both therapies and averaged 1.34 mm for test sites and 1.26 mm for control sites (P = 0.9061). There were no statistically significant differences between subject-reported values for esthetic satisfaction, and subjects' assessments of pain and discomfort were also equivalent. CONCLUSION: When balanced with subject-reported esthetic values and compared to historical root coverage outcomes reported by other investigators, CM+CAF presents a viable alternative to CTG+CAF, without the morbidity of soft tissue graft harvest.

Utilization of low-intensity laser during healing of free gingival grafts.

OBJECTIVES: This study evaluates the action of a low-intensity diode laser with gallium-aluminum-arsenide (GaAlAs) active medium on the healing process and analgesia in individuals undergoing free gingival grafts. MATERIAL AND METHOD: Ten individuals needing bilateral gingival graft in the mandibular arch were enrolled in a double-blind study. Each individual had a 30-d interval between the two surgeries. The side receiving application of laser was defined as test side and was established upon surgery; laser application was simulated on the control side. The laser was applied in the immediate postoperative period and after 48 h, and patients rated pain on a scale of 0 to 10, representing minimal and maximal pain, respectively. Photographs were obtained at 7, 15, 30, and 60 d postoperatively and evaluated by five periodontists. RESULTS: No statistically significant difference was found at any postoperative period between control and test sides, even though greater clinical improvement associated with treatment was observed at 15 d postoperative. At 30 and 60 d, some examiners observed the same or greater clinical improvement for the control. Only one individual reported mild to moderate pain on the first postoperative day. CONCLUSIONS: Low-intensity laser therapy did not improve the healing of gingival grafts and did not influence analgesia.

A 6-month comparative clinical study of a conventional and a new surgical approach for root coverage with acellular dermal matrix.

BACKGROUND: The acellular dermal matrix graft (ADMG) has become widely used in periodontal surgeries as a substitute for the subepithelial connective tissue graft (SCTG). These grafts exhibit different healing processes due to their distinct cellular and vascular structures. Therefore the surgical technique primarily developed for the autograft may not be adequate for the allograft. This study compared the clinical results of two surgical techniques--the "conventional" and a modified procedure--for the treatment of localized gingival recessions with the ADMG. METHODS: A total of 32 bilateral Miller Class I or II gingival recessions were selected and randomly assigned to test and control groups. The control group received the SCTG and the test group the modified surgical technique. Probing depth (PD), relative clinical attachment level (RCAL), gingival recession (GR), and width of keratinized tissue (KT) were measured 2 weeks prior to surgery and 6 months post-surgery. RESULTS: Both procedures improved all the evaluated parameters after 6 months. Comparisons between the groups by Mann-Whitney rank sum test revealed no statistically significant differences in terms of CAL gain, PD reduction, and increase in KT from baseline to 6-month evaluation. However, there was a statistically significant greater reduction of GR favoring the modified technique (P = 0.002). The percentage of root coverage was 79% for the test group and 63.9% for the control group. CONCLUSION: We conclude that the modified technique is more suitable for root coverage procedures with the ADMG since it had statistically significant better clinical results compared to the traditional technique.

Calcium sulfate-augmented soft tissue root coverage adjacent to connective tissue grafting: a new technique.

A new technique using calcium sulfate augmentation for root coverage is described. Three consecutive cases were treated with the calcium sulfate technique adjacent to teeth being treated with the classic connective tissue grafting technique. Although this is only a pilot study, the postoperative results of the calcium sulfate-treated sites showed similar tissue shape, color, and contour to the adjacent grafted sites. The amount of root coverage was also similar.

Hamular frenum modification: a removable denture prosthesis retention and stability enhancement.

A removable denture prosthesis, whether partial or complete, often requires preprosthetic surgery to achieve optimum stabilization and retention. While the hamular frenum may produce significant dynamic dislodging forces, a literature review did not reveal any reports dealing with this problem. A hamular frenum reduction surgical procedure using the free autogenous gingival graft procedure is described. Prosthetic function may be enhanced by eliminating the dynamic disrupting force of the hamular frenum along with improving posterior maxillary tuberosity contour and, as necessary, premaxillary form, allowing these contours to work in concert to develop a "cupping" stabilizing and retentive complex.