Is there an effective way to control pain perception after free gingival graft removal? A systematic review and meta-analysis.

The literature describes multiple ways to stimulate wound healing to reduce the patient's perception of pain. This systematic review aimed to evaluate if methods that enhance wound healing can reduce the patient's perception of pain after free gingival graft removal from the palate region compared to natural healing. A systematic review protocol was written following the PRISMA checklist. Electronic searches of five databases were performed to identify randomized clinical trials (RCTs) that assessed the patient's perception of pain after the removal of a free gingival graft from the palate. The primary outcome was the visual analog scale (VAS) score assessing the patient's perception of pain 7 days after the free gingival graft removal from the palate region. Of the 1,622 potentially relevant articles retrieved from the electronic databases, 16 RCTs were selected for qualitative analysis, and of these, 6 RCTs were included in the meta-analysis. RCTs showed a significant VAS reduction associated with the use of methods to enhance wound healing. The pooled estimates revealed a significant overall VAS reduction of 2.20 (95% CI 2.32, 2.07) 7 days after surgery. The methods that presented the greatest reduction in the perception of pain were platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue. Methods that enhance wound healing, including platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue, can reduce pain perception after free gingival graft removal in the palate region. However, only 1 RCT investigated each approach, which hinders the conclusion regarding the best procedure to reduce the perception of pain.

Is there an effective way to control pain perception after free gingival graft removal? A systematic review and meta-analysis

Abstract The literature describes multiple ways to stimulate wound healing to reduce the patient's perception of pain. This systematic review aimed to evaluate if methods that enhance wound healing can reduce the patient's perception of pain after free gingival graft removal from the palate region compared to natural healing. A systematic review protocol was written following the PRISMA checklist. Electronic searches of five databases were performed to identify randomized clinical trials (RCTs) that assessed the patient's perception of pain after the removal of a free gingival graft from the palate. The primary outcome was the visual analog scale (VAS) score assessing the patient's perception of pain 7 days after the free gingival graft removal from the palate region. Of the 1,622 potentially relevant articles retrieved from the electronic databases, 16 RCTs were selected for qualitative analysis, and of these, 6 RCTs were included in the meta-analysis. RCTs showed a significant VAS reduction associated with the use of methods to enhance wound healing. The pooled estimates revealed a significant overall VAS reduction of 2.20 (95% CI 2.32, 2.07) 7 days after surgery. The methods that presented the greatest reduction in the perception of pain were platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue. Methods that enhance wound healing, including platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue, can reduce pain perception after free gingival graft removal in the palate region. However, only 1 RCT investigated each approach, which hinders the conclusion regarding the best procedure to reduce the perception of pain.

Resumo A literatura descreve diferentes formas de estimular a cicatrização para reduzir a percepção de dor do paciente. Esta revisão sistemática teve como objetivo avaliar se métodos que melhoram o reparo de feridas podem reduzir a percepção de dor do paciente após a remoção de enxerto gengival livre da região do palato quando comparado a cicatrização natural. Um protocolo de revisão sistemática foi escrito seguindo a lista de verificação PRISMA. Pesquisas eletrônicas em cinco bancos de dados foram realizadas para identificar ensaios clínicos aleatorizados (ECA) que avaliaram a percepção de dor do paciente após a remoção do enxerto gengival livre do palato. O desfecho primário foi o escore da escala visual analógica (VAS) avaliando a percepção de dor do paciente 7 dias após a remoção do enxerto gengival livre da região do palato. Dos 1.622 artigos potencialmente relevantes recuperados das bases de dados eletrônicas, 16 ECAs foram selecionados para análise qualitativa, e destes, seis ECAs foram incluídos na meta-análise. Os estudos analisados demonstraram uma redução significativa de VAS associada ao uso de métodos para melhorar a cicatrização de feridas. As estimativas agrupadas revelaram uma redução global significativa do VAS de 2,20 (95% CI 2,32, 2,07) 7 dias após a cirurgia. Os métodos que apresentaram maior redução na percepção de dor foram fibrina rica em plaquetas, ácido hialurônico e cola de fibrina autóloga. Métodos que melhoram a cicatrização de feridas podem reduzir a percepção de dor após a remoção do enxerto gengival livre na região do palato, especialmente fibrina rica em plaquetas, ácido hialurônico e cola de fibrina autóloga. No entanto, apenas um ECA avaliou cada abordagem, o que impossibilita a conclusão sobre qual é o melhor procedimento para reduzir a percepção de dor.

Bacterial-derived extracellular polysaccharides reduce antimicrobial susceptibility on biotic and abiotic surfaces.

OBJECTIVE: Extracellular biofilm matrix plays a role in reducing bacterial susceptibility against antimicrobials. Since the surface where biofilm is growing modulates microbial accumulation and bacterial-derived exopolysaccharides (EPS) synthesis, this study compared the role of EPS to reduce antimicrobial susceptibility on biotic (dental surface) and abiotic (titanium (Ti) material) surfaces and the effect of remaining matrix-enriched biofilms to promote bacterial recolonization. DESIGN: 48 h Streptococcus mutans UA159 strain biofilms were grown on enamel and Ti surfaces. The medium was supplemented with 1% sucrose, substrate for EPS synthesis, or with 0.5% glucose + 0.5% fructose as control. Chlorhexidine (CHX) 0.2% was used for antimicrobial treatment. Biofilms were collected and the following analyses were considered: viable bacterial counts, biofilm pH, EPS content, and biofilm structure by scanning electron microscopy and confocal laser scanning microscopy (CLSM). Substrate surfaces were analyzed by 3D laser scanning confocal microscope. RESULTS: Enamel surface showed a higher amount of EPS content (p < 0.05), which may be explained by the higher bacterial biomass compared to Ti material. EPS content reduced bacterial susceptibility against antimicrobial treatments for both substrates, compared to EPS control (p < 0.05). However, sucrose-treated cells presented the same magnitude of reduction for Ti or enamel. Interestingly, matrix-enriched biofilms favored bacterial recolonization for both substrates. CONCLUSION: The surface where the biofilm is growing modulates the amount of EPS synthesized and matrix content plays a key role in reducing antimicrobial susceptibility and promoting bacterial recolonization.

A histological study of non-ceramic hydroxyapatite as a bone graft substitute material in the vertical bone augmentation of the posterior mandible using an interpositional inlay technique: A split mouth evaluation.

The aim of this study was to compare the influence of graft material (non-ceramic hydroxyapatite versus autologous bone) on bone behaviour and perform a resonance frequency analysis of implants placed in augmented sites to evaluate stability. For this study, 11 patients with bilateral edentulous areas in the mandibular posterior region were selected. Alveolar augmentation osteotomies were bilaterally (split mouth design) performed. In one hemiarch, the space generated by the osteotomy was grafted with an interpositional intra-oral autologous bone graft (control group). In the other hemiarch, the space generated by the osteotomy was grafted with an interpositional non-ceramic hydroxyapatite (ncHA) (test group). The groups were randomized. After 6 months of healing, a bone sample was retrieved from each side for histological evaluation using a trephine drill that was 2-mm in internal diameter. The implant stability quotient (ISQ) was measured by the resonance frequency immediately following implant placement at baseline and after 6 months of follow-up. Good incorporation of the graft was observed in both groups; however, in the test group, a residual-grafted material was observed. Bone density and marrow spaces were similar between groups. Correlations between the ISQ values and the histometric variables were not observed (p>0.05). The results of this trial suggest that both intra-oral autologous bone and ncHA may be elected as interpositional grafting materials to vertically augment posterior atrophic mandibles.

Stability of implants placed in augmented posterior mandible after alveolar osteotomy using resorbable nonceramic hydroxyapatite or intraoral autogenous bone: 12-month follow-up.

PURPOSE: This prospective, controlled split-mouth study evaluated the stability of dental implants placed in the augmented mandibular areas with alveolar segmental "sandwich" osteotomies using nonceramic hydroxyapatite (ncHA) or autogenous bone. MATERIAL AND METHODS: This study included 11 bilaterally partially edentulous mandibular patients in a split-mouth design. Alveolar augmentation osteotomies were performed bilaterally with interpositional ncHA graft (test group) or interpositional intraoral autogenous bone graft (control group). After 6 months of healing, four implants (two implants in each side) were placed in each patient. Forty-four implants were inserted and loaded after 6-month healing period. At 1-year follow-up, radiographic, prosthetic, and resonance frequency analysis parameters were assessed. Success criteria included absence of pain, sensitivity, suppuration, and implant mobility; absence of continuous peri-implant radiolucency; and distance between the implant shoulder and the first visible bone contact (DIB) < 2 mm. RESULTS: After a 1-year loading period, the overall implant survival rate was 95.45%, with two implant losses (one of each group). Among the surviving implants (42 out of 44), two did not fulfill the success criteria; therefore, the implant success was 90.90%. DIB was 0.71 ± 0.70 and 0.84 ± 0.72 mm for ncHA and autogenous bone grafts, respectively (p > .05). Implant stability measurements were similar between the groups during the 12-month follow-up (p > .05). CONCLUSION: Within the limits of this study, the implants placed either in sites augmented with ncHA or autogenous bone seem to represent a safe and successful procedure, at least, after 12-month follow-up.

Bone-to-implant contact around immediately loaded direct laser metal-forming transitional implants in human posterior maxilla.

OBJECTIVE: Direct laser metal forming (DLMF) is a procedure in which a high-power laser beam is directed onto a metal powder bed and programmed to fuse particles according to a computer-aided design file, generating a thin metal layer. This histologic study evaluated the bone-to-implant contact (BIC%) around immediately loaded DLMF transitional implants retrieved after 2 months from posterior human maxillae. METHODS: Twelve totally edentulous individuals (mean age, 66.14 ± 2.11 years) received DLMF transitional implants divided in twelve immediately loaded (IL) and twelve unloaded (UI) implants. These transitional implants were placed between conventional implants to support the interim complete maxillary denture during the healing period. After 8 weeks, the transitional implants and the surrounding tissue were removed and prepared for histomorphometric analysis. RESULTS: Mature woven preexisting bone lined by newly formed bone in early stages of maturation were found around all retrieved implants. Histometric evaluation indicated that the mean BIC% was 45.20 ± 7.68% and 34.10 ± 7.85% for IL and UI, respectively (P <0.05). CONCLUSION: The present data obtained in humans showed that, although both IL and UI presented good BIC%, IL DLMF implants had a higher BIC% in the posterior maxilla.

Alveolar osteotomy associated with resorbable non-ceramic hydroxylapatite or intra-oral autogenous bone for height augmentation in posterior mandibular sites: a split-mouth prospective study.

BACKGROUND: The presence of the inferior alveolar nerve within the body of the mandible could jeopardize the placement of dental implants. Previous studies have shown that the interpositional osteotomy for posterior mandible ridge augmentation could be a predictable procedure. Nevertheless, there are few prospective, controlled, and randomized studies that evaluated this technique using different bone graft materials. PURPOSE: This prospective, controlled split-mouth study evaluated, using tomographic and Resonance Frequency Analyses (RFA), implants placed in the augmented mandibular area. MATERIAL AND METHODS: Alveolar augmentation osteotomies were performed bilaterally in 12 partially edentulous mandibular patients in a split-mouth design. The alveolar segmental osteotomies were assigned in two groups: test group, interpositional non-ceramic hydroxylapatite bone graft, and control group, interpositional intra-oral autogenous bone graft. After 6 months healing, implants were placed. The tomographic measurements of bone gain were recorded at baseline and 6 months after surgery, when the implants were placed. At 12 months after osteotomy, RFA were performed for each implant. RESULTS: The mean of bone gain 6.5 ± 2.4 mm and 7.0 ± 1.76 mm to control and test group, respectively (P > 0.05). RFA values between groups were similar at baseline and 12 months follow-up (P > 0.05). CONCLUSION: Alveolar osteotomies associated with sandwich interpositional bone graft, independently of bone graft, resulted in bone formation over a period of 12 months.