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Objectives This randomized clinical trial was conducted to assess the effects of platelets-rich fibrin (PRF) and ozonated oil on the healing of palatal donor wound sites and the patient’s morbidity after free gingival graft (FGG) harvesting. Material and methods Thirty-nine patients were randomly assigned and allocated to three groups (n = 13) for each group. In PRF treated group, a PRF membrane was placed over the palatal wounds while, ozonated oil group were treated with 2 mL ozonated oil daily for 1 week. One week post-operatively, the donor site wound healing was recorded by the healing index (HI). A visual analogue scale (VAS) assessed patient’s pain perception. A cytological analysis was performed using the superficial epithelial cell and keratinization indices at 7, 14, 21 days and second month post-operatively. Results There was a statistically significant difference in HI between PRF group in comparing to ozonated oil and control groups (p ≤ 0.0001). Cytological results of PRF group showed a highly significant improvement (p ≤ 0.00001) in re-epithelization and keratinization indices over time. Meanwhile, non-significant difference was observed between PRF and ozonated oil groups after 2 months post-operatively of complete re-epithelization. Conclusions Our results showed that the application of PRF on donor wound sites has a significant improvement in wound healing and rapid enhancing effect on the re-epithelialization rate comparing to topical ozonated oil.

Background: The most common technique for gingival augmentation is free gingival graft (FGG). The aim of this study is to clinically compare the efficacy of FGG harvested with erbium: yttrium-aluminum-garnet (Er: YAG) laser stabilized with 5-0 silk suture in comparison to N-butyl-2-cyanoacrylate tissue adhesive in increasing the width of keratinized gingiva (WK) for the management of Miller's Class I and II gingival recession. Methodology: Forty-eight gingival recession defects were divided into two Groups I and II. Group I sites were treated with FGG harvested using Er: YAG laser stabilized with 5-0 silk suture and Group II sites were treated with FGG harvested using Er: YAG laser stabilized with N-butyl-2-cyanoacrylate tissue adhesive. Clinical parameters such as gingival recession depth, clinical attachment level (CAL), gain in gingival tissue thickness, and WK were recorded at baseline and 3 and 6 months postoperatively. Results: A significant reduction in gingival recession defects, gain in CAL, increase in WK, and gain in gingival tissue thickness were observed in both the groups. Intergroup comparison of gingival recession defects, CAL, WK, and gingival tissue thickness yielded nonsignificant differences. Conclusion: Within the limits of this study, it can be concluded that both 5-0 silk suture and n-butyl-2-cyanoacrylate were equally efficacious in the stabilization of FGG. N-butyl-2-cyanoacrylate was easy to apply, consumed less operating time, and had no adverse effect. Hence, cyanoacrylate can be used as an alternative to suture in stabilization of FGG.

To assess the effect of the application of hyaluronic acid (HA) in conjunction with free gingival graft (FGG) on postoperative patient discomfort and wound healing.A total of 24 healthy non-smoker patients requiring FGG were recruited for the study. Subjects were randomly assigned into study groups, local application of HA on both donor and recipient sites and control group, application of normal saline. The FGG dimensions were evaluated using digital photographs. Post-operative pain was evaluated for 14 days. Color matching and patient satisfaction were evaluated at 6 months.In this randomized clinical trial, 21 patients (mean age 23 years, (15 females and 6 males) completed the study. Baseline characteristics were comparable across treatment groups. Pain scores in donor sites were statistically significant and higher in control group than study group until day 7 (p 0.05). Mean of the surface area of the graft at baseline in study vs control group were (169 ± 21), (183 ± 22) (2 mm), respectively. While at 6 months, were (147 ± 30) and (139 ± 32) (2 mm), in study and control group, respectively (p 0.05). Color match showed no statistical significance difference.Topical application of HA may exhibit significant improvement of postoperative pain and no significant difference in graft dimensions and patients' satisfaction.Topical application of HA is recommended as a dressing material in FGG surgeries to reduce postoperative pain and accelerate healing.

Background To evaluate the clinical outcome and changes in posterior buccal soft tissue following implant restoration in groups with and without a free gingival graft (FGG) before implant placement. Methods Twenty-six individuals who required implant restoration and displayed lack of keratinized mucosa (KM) were recruited and assigned to the FGG group (with FGG before implant placement) or Control group (without FGG before implant placement) randomly. A screw-retained conventional implant restoration was performed for each patient. Peri-implant soft tissue was captured by an intraoral scanner and analyzed by an image processing software. Clinical parameters (plaque index, gingival index, probing depth, and bleeding on probing) were assessed at baseline and 1, 3, 6, and 12 months. Buccal soft tissue changes (mucosal margin, soft tissue thickness, and width of keratinized mucosa) on the buccal side of implant site were assessed at 1, 3, 6, and 12 months. Two-way ANOVA and Bonferroni test were used to analyze significant difference between groups at each time point (α = 0.05). Results The clinical parameters were lower in the FGG group than that in the Control group, although there were no significant differences between the two groups (P > 0.05). Peri-implant soft tissue collapsed and the changes (mucosal margin and soft tissue thickness) were significantly greater in the Control group than the FGG group (P P > 0.05). Conclusions Minimal peri-implant soft tissue changes occurred in two groups. Performing FGG before implant placement is a viable procedure to maintain peri-implant soft tissue but might not affect peri-implant health during 12 months follow-up. However, small sample size must be considered. Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000037954; Date of registration: 6 September 2020).

Aim. This study aimed to compare the effect of MEBO versus 0.2% hyaluronic acid gel (Gengigel®) applied to the palatal donor site on postoperative pain reduction and wound healing after free gingival graft harvesting. Methodology. Thirty-nine patients with different mucogingival defects were included in this study for harvesting a free gingival graft (FGG) for soft tissue augmentation. Patients were randomly assigned into three equal groups: group I (MEBO), group II (0.2% HA Gengigel®), and group III (control). Postoperative pain was recorded by using the Visual Analogue Scale (VAS). Analgesic consumption was recorded for 7 days postoperatively. Wound size was measured at baseline and on days 3, 7, 14, and 21. Postoperative healing of the palatal wound was assessed by the VAS score for color match on days 3, 7, 14, 21, and 42. Results. Results of this study showed significant postoperative pain reduction for the three groups; MEBO showed statistically significant less VAS score compared to the other two groups, while HA showed statistically significant less VAS score compared to the control group. Both MEBO and HA showed statistically significant less total analgesic consumption. No statistically significant difference was observed between groups for wound size. MEBO showed statistically significant higher VAS for color match. Conclusions. Both treatment modalities could reduce postoperative pain following harvesting of FGG and improve the palatal wound healing. However, MEBO showed better outcomes in terms of postoperative pain and color match.

Background The objective of this study was to compare patient-reported outcome measures (PROMs) and clinical outcomes after augmentation with xenogeneic collagen matrix (XCM) or free gingival graft (FGG) during different postoperative phases. Methods Forty-two patients (21 per group) with keratinized mucosa width (KMW) of < 2 mm at buccal implant sites in the posterior mandible were enrolled. All underwent vestibuloplasty and were allocated to either FGG (control) or XCM (test) group. Intraoperative morbidity of pain, stress, nausea, tolerance to time, and acceptance of surgery were evaluated immediately after surgery. The severity and duration of subjective pain, swelling, and bleeding were compared within a 2-week postoperative period. The willingness to retreat and satisfaction were assessed at 6 months. All PROMs were obtained using questionnaires and visual analog scales. The buccal KMW and other peri-implant parameters were also evaluated. Results No significant between-group differences were observed in PROMs immediately after surgery, except acceptance of surgery (0, 0–30.0 vs. 30, 0–50.0, p = 0.025). At 2 weeks, pain severity (46.7 ± 25.9 vs 61.9 ± 20.2, p = 0.040) and duration (5.52 ± 3.57 vs 8.48 ± 2.80, p = 0.005) were significantly lower in the test group, and pain perception during speaking and chewing was significantly higher for FGG, with no significant between-group differences in swelling and bleeding. At 6 months, the test group showed a higher willingness to retreat (76% vs 43%, p = 0.021); however, satisfaction with treatment outcomes was similar in both groups. At 6 months, the gain of KMW was significantly higher in FGG than in XCM (XCM: 1.57 ± 1.69 mm, FGG: 2.68 ± 1.80 mm, p = 0.003). Other peri-implant parameters did not show significant differences. Conclusions Within the limitation of the present nonrandomized study, XCM demonstrated more positive PROMs than FGG during different postoperative phases, mainly for less pain perception during the early healing stage, but was inferior to FGG in terms of gain of KMW. For KMW augmentation in the posterior mandible, XCM may be indicated when patients can bear little pain. Clinical trial registration ChiCTR1900022575, date of registration: 17/4/2019, retrospectively registered

Gingival recession accounts for apical migration of the gingival margin, resulting in exposure of the cementoenamel junction and root surface, with exposure of the root surface linked to deteriorated esthetic appearance and increased dentinal hypersensitivity. Various surgical techniques have been used to correct labial gingival recession defects. The present study evaluated and compared the results of semilunar coronally positioned flap (SCPF) alone and in conjunction with free gingival graft (FGG) for the treatment of Miller Class I and II gingival recession defects in maxillary anterior teeth. A total of 20 bilateral Miller Class I and II gingival recession sites were included and randomly allocated (n = 10 sites/group) to either the semilunar coronally positioned flap technique alone (SCPF group; control) or with FGG (SCPF+FGG group; test). Longitudinal alterations in probing depth (PD), recession width (RW), recession height (RH), width of keratinized tissue (WKT), and clinical attachment level (CAL) were measured and analyzed for both groups at 1-, 3-, 6-, and 12-month follow-ups. Both groups saw a significant decrease in RH, RW, and CAL and a significant increase in WKT. No statistically significant difference was observed in the final root coverage outcome between both groups in terms of RH, RW, and CAL, but a significant increase in WKT was seen with SCPF+FGG. Both techniques demonstrated optimal results without significant differences in the final root coverage outcomes except for WKT, which had a statistically significant increase in the SCPF+FGG group.

Implant related biological complications include peri-implant mucositis and peri-implantitis. The main clinical symptoms ofperi-implant mucositis is bleeding on gentle probing. In case of peri-implantitis, bleeding on probing and increased probingdepth are leading signs. Treatments of peri-implant inflammation are divided into conservative and surgical therapies.The prerequisite for both approaches is the proper professional cleaning of supracrestal implant surfaces. According tothe literature, air-abrasive technique is suitable for decontamination of contaminated implant surfaces. Silicate-basedpowders that are suitable for cleaning supramucosal parts are not soluble in aqueous medium, so their use is not recommendedsubmucosally as the small particles cannot be completely eliminated. Using Varios Combi Pro (NSK/NakanishiInc., Shimohinata Kanuma, Japan), water-soluble glycine powder can be applied to the implant surface at an adjustablepressure through a disposable special plastic nozzle. During use, the amount of water cooling can be adjusted. Glycinepowder air-abrasive technique cleans the surface of implants more efficiently than cleaning with conventional hand curettewithout damaging supracrestal implant surfaces. Three patients in this case report underwent clinical and radiologicalexaminations. The peri-implant status was recorded by recording the following parameters: plaque index (PI), calculusindex (CI), probing pocket depth (PPD), bleeding on probing (BoP), gingival recession (GR), keratinized mucosa width (KW)and radiological bone loss. Status was also registered at baseline and six months after surgical therapy. Treatment plansof the patients were set up individually, but each treatment involved surgical preparation and air-abrasive debridementwith glycine powder with Varios Combi Pro (NSK/Nakanishi Inc., Shimohinata Kanuma, Japan). In two cases, in additionto surgical therapy, free gingival graft (FGG) transplantation was also performed. Peri-implant inflammation was treatedsuccessfully in all three cases.

Background Protection of the palatal wound is an essential step following harvesting a palatal soft tissue graft. The aim of the current pilot randomized clinical study was to assess the efficacy of using propylene mesh as protective sheet when compared to conventional custom made acrylic stent after harvesting a palatal graft. The primary outcome of this study was bleeding postoperatively and secondary outcomes were pain, healing profile of the donor site as well as patient satisfaction. Methods Between 2018 and 2019 we conducted a prospective randomized controlled trial of 24 patients with palatal defects. Two groups of 12 patients with 24 sites were included in this study and were treated with soft tissue grafting technique using free grafts harvested from the hard palate. The palatal wounds were protected with propylene mesh (test group) or custom-made acrylic palatal stent (control group). Participants were assessed for the amount and duration of bleeding, pain duration, and the risk of infection 2, 4, 6, 8, 14 days post-operatively. The trial had been registered in clinical trials.gov (NCT04348279). Results Four sites were excluded from the study as dropouts. The polypropylene mesh was more effective at reducing bleeding by (2.4 ± 1.075) and pain by (1.600 ± 0.516), while the custom-made acrylic stent reduced the bleeding (5.8 ± 1.22) and pain (7.100 ± 0.316). The decline in amount of bleeding amount (P value = 0.021) and its duration (P value = 0.001) achieved by the propylene mesh was statistically significant. There was no statistical significant difference in patient satisfaction and the duration of healing process between the 2 groups. However, the healing profile of the test group was statistically significant when compared with the control group (P value = 0.002). Conclusions Propylene mesh is a promising material for protection of the palatal wound due to its light weight, limited bacterial wicking, tissue compatibility. Further studies are required to adequally assess the benefits of this material in periodontal plastic surgeries.

Dental implants are a successful treatment modality for rehabilitation of missing dentition. Optimal placement from the prosthetic standpoint is imperative for function, form, and esthetics, but at the same time, attention has to be focused on the biologic aspect of three dimensionally optimal placement within a stable hard and soft-tissue envelope. Bone and soft-tissue quality, quantity, and location of these two important variables are equally important in determining the longevity of osseointegrated fixtures. Numerous methods have been reported to tackle bone and soft-tissue deficit with variable outcomes of each. This report presents one such case where alongside tissue deficit, there is severe arch asymmetry which needs correction for optimal prosthetic rehabilitation

Root coverage is one of the important aims of periodontal therapy. The aim of the study was to evaluate the connective-tissue grafts (CTG) and free gingival grafts (FGG) in root coverage procedures. A retrospective study of sample size 32 was conducted. These patients underwent a root coverage procedure done using grafts. The details on which graft was obtained from patient records were reviewed and analysed between June 2019 to March 2020. Excel tabulation was done, analysed and transferred to SPSS for statistical analysis. The p value was set at 0.05. In the study, it was found that CTG was used in 56.25% of the patients and FGG was used in 43.75% of the patients undergoing root coverage procedure. It was found that Free gingival grafts (25%) were placed more commonly in females when compared to connective tissue grafts (18.75%). However, in males, connective tissue grafts (37.5%) were placed more commonly than free gingival grafts. (18.75%) The prevalence of connective tissue graft was more when compared to free gingival graft at 36-55 years of age. Connective tissue graft was done more commonly in the age group of 15-35 years. Prevalence of connective tissue grafts was more in males than in females. Within the limits of the study, it was found that connective tissue graft (CTG) procedures performed more than free gingival graft (FGG) procedures following the gold standard for root coverage in gingival recession treatment.

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Objectives The purpose of this paper is to introduce an effective technique to easily obtain adequate amounts of keratinized gingiva and vestibular depth. Materials and methods Free gingiva (vertical height 10 mm) was harvested on the palatal mucosa and a partial thickness flap was elevated on the recipient site with same width as the free gingiva graft. After a conventional suture, a titanium mesh covered the graft and was fixed with miniscrews. Titanium mesh was removed 4.1±2.5 weeks after surgery. The amount of keratinized gingiva and vestibular depth was measured at the final follow-up. Results Nine patients (males 4, females 5; 53.9±14.1 years) who underwent bone graft surgery before vestibuloplasty were included. No free gingival graft failure or complications were encountered in any of the patients. The relapse rate for vestibular depth (23.3%) was lower than that for keratinized gingiva (48.3%) after 34.4±14.4 months (P=0.010). Conclusion Vestibuloplasty with a free gingival graft using titanium mesh could be achieved with an acceptable amount of keratinized gingiva and an appropriate vestibular depth around dental implant.

The recessions of the 3 Miller class are the most difficult in the prediction of the result during surgical treatment. Such recession in the anterior region of the mandible is often combined with a small vestibule of the oral cavity. The treatment of combined pathology in the standard protocol was provided in 2 stages: correction of small vestibule of the oral cavity and elimination of the recession by the method of the coronal advanced flap.Aim. To develop the protocol of one-stage operation for patients with III miller class gum recession in combination with small vestibule.Materials and metods. Surgical protocole. after conducting anesthesia at the region of the lower teeth held tunnel access to the region of teeth with gingival recession, formed split-thikness flap, discharge below the periodontal line connection 3 mm, mobilization of the flap.The flap is fixed with sutures Polyprophylene 6-0. Taken from the palatal free gingival graft. Placed in the region of holding vestibuloplasty fixed to the periosteum of the simple suture and suturing the donor area in the palate.Results. The patients were found to have closing of the recession, the increase in the area keratinisation gums and keeping of the vestibule in the recovery area.Conclusions. The development of a new one-stage treatment of recession 3 class at Miller in combination with vestibuloplasty allows you to more quickly treat patients with this pathology.

Background:Because smoking is harmful to free gingival graft procedures,donor site healing, graft shrinkage and success of root coverage,so The present study was designed to evaluate effect of light smoking(≤10 cigarettes per day)and number of years of cigarettes smoking on free gingival graft procedures (donor site healing and graft shrinkage, success). Methods: A total of 22 patients with miller classI,II gingival recession consist of two group,groupI was 12 non-smokers and groupII 10 smokers(≤10 cigarettes per day,less than five years on smoking habits) . All patients treated with free gingival graft. Phase I therapy was performed for all patients to provide an oral environmental more favorable to wound healing.. The following clinical indices measurements of plaque index, gingival index, probing depth clinical attachment level, recession height ,recession width, width of keratinized gingiva, gingival thickness, graft shrinkage (length, width),immediate and delayed bleeding, complete epithelization and discomfort, sensibilty disorder all were recorded at 1 month,3month and 6month. Results: the non smokers group showed significant decrease of recession width and graft shrinkage area compared to smokers group, The clinical parameters showed improvement in non-smoker group more than smokers group but the difference was not statistically significant.probing depth,clinical attachment level, Recession height, keratinzation tissue width , gingival thickness, the improvement occurs at all follow up periods was more in non smokers than smokers Conclusion: following free gingival graft procedures,free gingival graft undergoes graft shrinkage which decrease amount root coverage ,light and young smokers showed increased in recession width and graft shrinkage area .

Esthetic demands among the patients have increased markedly over the past few years. The Gingival recession is one of the prime concerns, and there are various treatment modalities in managing recession defects. Most often, outcomes following root coverage procedures are not assessed. Thus the current article aims to determine the aesthetic outcome following various treatment modalities for root coverage procedures using Recession Score (RES). In the present study, seventeen patients with Miller Class I, II and III recession defects treated with root coverage procedures were evaluated retrospectively. Esthetic outcomes were assessed using the root coverage score (RES) . Among 17 managed recession sites, 6(35%) had complete root coverage. Three of six patients who attained complete root coverage had a perfect score (RES-10). Free Gingival Graft showed better root coverage and recession score (RES); however, there was no significant association between root coverage, RES and various treatment modalities used for recession coverage (p>0.05).

Introduction Free autogenous graft was the gold standard to increase the keratinized mucosa (KM) and vestibular depth. The major downfall of this technique is the postoperative morbidity at the donor site. The purpose of this case report is to demonstrate a modified technique using acellular dermal matrix (ADM) to increase the KM around implants to achieve faster healing with less postoperative morbidity. Case presentation Patient presented with inadequate keratinized tissue band and shallow vestibule at submerged implant sites bilaterally. Initially, surgical procedure of vestibuloplasty in conjunction with free gingival graft (FGG) was performed at one side. However, patient opted for the allograft as a substitute for the other side due to the postoperative discomfort from palatal donor site. On the left side, the FGG procedure was performed in a conventional way stabilizing with sutures. On the right side, the ADM was stabilized with tacks only at recipient site and left exposed. The new vestibule was established and stabilized with tacks. A significant gain of KM and vestibule depth was observed at the site of using ADM when compared with baseline. For the site of using FGG, KM was increased. However, the vestibule was rebounded compared with the site of using ADM with tacks. Conclusions The use of ADM stabilized with tacks is a predictable procedure that can increase KM and establish stable vestibule around dental implants. It can lead to less chair time, faster healing, and reduced postoperative morbidity compared with autogenous soft tissue graft.

The free gingival graft (FGG) has been used predictably for gingival procedures aimed to increase the width of keratinized tissue (KT). Several soft tissue alternatives, such as xenografts and allografts, have been studied and proven to be successful with varying degrees. This pilot clinical case series evaluated the efficacy, safety, and initial clinical outcomes (measuring KT width) of a piscine xenograft material (Omega3 Wound, Kerecis) compared to the FGG (harvested from the patient palate) in correcting mucogingival deformities around teeth. A convenience sample of six subjects with unilateral or bilateral lack of KT were enrolled in the study. The primary objective of this pilot study was to determine the gain in width of KT. Secondary objectives included investigating the probing depth, recession depth, bleeding on probing, and inflammation score. There were three FGG sites and six xenograft sites. In bilateral-site treatments, FGG or piscine xenograft were randomly assigned. For unilateral sites, the piscine xenograft was used. Postoperatively, the patients returned for follow-up at 1, 2, 4, 12, 24, 48, and 52 weeks. All six subjects completed the 12-month study and reported uneventful healing. On average, the xenograft sites had a 3.25-mm gain in KT width, and the FGG had an average gain of 3.67 mm. This pilot clinical series showed the piscine xenograft to be safe and efficacious during healing and to increase the width of KT. Future studies may include a more robust study design with a greater number of subjects.

Introduction: Patient centered outcome became of great interest nowadays. Patient’s pain and discomfort following free gingival graft procedure are common complain. Different palatal dressings are suggested to cover and protect the palatal donor site as stents, collagen gelatin scaffolds, platelet rich fibrin (PRF), hyaluronic acid (HA) and Alvogyl. However, in the literature no ideal agent has been emphasized. Objectives: This randomized controlled clinical trial compares for the first-time the effect of PRF versus HA palatal wound dressings on postoperative pain, post-surgical bleeding, and wound healing. Materials and methods: Following sample size calculation, 30 systemically healthy patients requiring palatal mucosal graft harvesting were randomized to receive either PRF or HA (intervention groups) or gelatin sponge (control group) as palatal dressings. Patient-reported visual analogue score (VAS) pain scores as primary outcome. Post-surgical bleeding and wound healing were considered as secondary outcomes. Results: VAS pain scores were reported minimal in PRF group throughout follow up intervals, PRF was statistically significant when compared to HA group at 3 and 7 days postoperative, PRF was statistically significant when compared to control group from 3 to 30 days postoperative and VAS in PRF was nearly 0 in day 14. PRF group showed the highest value of healing index during all the follow up intervals with mean 4.4 at 30 days that indicates a full healing of palatal wound area. Conclusions: Within this study’s limitations, PRF had better outcomes than both HA and gelatin sponge in means of cost, pain reduction, hemostasis and healing properties.

The aim of this study was to compare the effects of AFG and i-PRF on palatal wound healing and postoperative discomfort.Thirty-six patients in need of FGG were divided into three groups. AFG (n = 12) or i-PRF (n = 12) was applied and compared with control group (n = 12). Wound healing with HEpithelialization was higher in the test groups on the 14th day than the control group (p0.05). MSS scores at the 14th day and 1st month were lower in the AFG group than the control and the i-PRF group (p0.05). In the AFG group, LTH levels at the 3rd,7th, and 14th days and 1 month were higher than control and i-PRF groups (p0.05). VAS scores of the AFG group were lower than the control and i-PRF groups at the 7th day (p0.05). Bleeding was lower in the test groups than in the control group (p0.05). There was no difference between the groups in terms of tissue thickness (p0.05).AFG and i-PRF have positive effects on the healing process by accelerating wound healing and reducing postoperative morbidity. Therewithal, AFG has superior properties in wound healing compared with i-PRF.Patient discomfort and pain feeling have a great effect on patient's tendency to surgery and platelet concentrates such as AFG and i-PRF overcome these problems and contribute to patient's quality of life.

Relevance. The main aim of this article is determining the possibilities of clinical application of the infrared thermometry method in order to identify, predict and correct early complications such as ischemic and necrotic process after vestibuloplasty surgery using free gingival graft.Purpose. To determine the possibility of using the infrared thermometry method to study the regeneration processes of the mucous graft after vestibuloplasty surgery using free gingival graft.Materials and methods. 34 patients with a thin biotype and a small vestibule of the oral cavity. The vestibuloplasty was indicated. Depending on the choice of the method of surgical treatment, vestibuloplasty with/ or without free gingival graft, all patients were divided into 2 groups. And the 3rd (control) group consisted of patients with similar clinical picture for control data. Particular attention was paid to the healing process in the early postoperative period on days 1, 3, 7, 14. Patients were examined using a CEM-ThermoDiagnostics infrared thermometer.Results. The study confirmed the high clinical efficacy the both surgical methods of vestibuloplasty with/ or without free gingival graft. We did not registrate negative temperature values indicating the development of ischemic process which can lead to necrosis. We have diagnosed correlation between temperature values and clinical pictures.Conclusion. Using of IR-thermometry is an effective method for examination of the healing process after vestibuloplasty using with/ or without free gingival graft. It can show processes of revascularization of free gingival graft and examine some inflammation. This is the additional method of research, but in combination with clinical picture, it can be proposed as an accurate criterion for predicting early ischemic complications.

The aim of this study was to compare the use of gingival unit graft (GUG) with free gingival graft (FGG) for treating wide gingival recession and increasing keratinized tissue. This randomized controlled trial with a split-mouth design included 30 localized bilateral recessions (Miller Classes I and II) that were randomly treated with GUG or FGG. Both grafts were fixed by cyanoacrylate glue. Probing depth, clinical attachment level, vertical recession depth, and keratinized tissue width were recorded at baseline and 1 and 6 months after surgery. The postoperative mean percentage of root coverage at 1 and 6 months was better on GUG side, and KTW significantly increased on the same side 1 month after surgery (P < .05). GUG might be an acceptable modality for increasing keratinized tissue and treating recession.

INTRODUCTION This study is an extended follow-up of a randomized controlled trial that evaluated 18-month outcomes following free gingival grafts (FGGs) around implants with

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.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.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.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.www.ClinicalTrials.gov Identifier: NCT03402321 CLINICAL RELEVANCE: Alvogyl could present a novel palatal wound dressing material, comparable with gelatin sponge.

This study aimed to evaluate with laser Doppler flowmetry (LDF) the effect of topical hyaluronic acid (HA) application on the vascularization of free gingival graft (FGG) donor and recipient sites during the early wound healing period and to investigate the effect of HA application on the dimensional change of the FGG. Forty systemically healthy, nonsmoking patients who required FGG due to insufficient amount of attached gingiva in a partial edentulism were randomly assigned to a study group: test (FGG+HA) or control (FGG alone). The LDF values of the donor and recipient sites were measured in both groups before the operation and at 4, 7, 10, 14, and 30 postoperative days. LDF measurement of the graft was performed as soon as the graft was taken from the palatal site. FGG dimensions (width, height, and thickness) were assessed and recorded at baseline and on day 30, as well as the percentage of the changes in these values. LDF values of the recipient site in the FGG+HA group were found to be statistically higher than those in the control group on days 4 and 7 (P = .013 and P = .020, respectively); however, no differences were found for days 10, 14, and 30. Additionally, no differences were found for the LDF values of the palatal site between the FGG+HA and control groups (P > .05) at all examined time points. The height of the graft measured on day 30 was statistically higher in the FGG+HA than the control group (P < .001). The percentage change in thickness and height of the FGG was statistically lower in the FGG+HA than control group (P = .028 and P < .001, respectively). Application of HA on the recipient bed under the FGG at the first week of healing allows the formation of a well-vascularized layer, which acts as a barrier against tissue tensions by functioning as a scaffold between the recipient bed and FGG, thus reducing the shrinkage of the graft, especially in the vertical direction. This study further showed that the graft taken from the donor site had a remaining blood perfusion value of its own.

Among the available techniques for gingival recession treatment, the main surgical technique for gain of keratinized tissue is the free gingival graft. This procedure is also indicated for vestibule extension and frenulum removal. The technique consists of the epithelial and connective tissues removal from a donor site and its repositioning on to a recipient site, being an effective primary stability mandatory for the healing process. The aim of this study was to describe a case report of a 35-year-old male, who reported a postoperative complication in donor area, after a free gingival graft which occurred 07 days later. This situation occurred after patient reported having rinsed his mouth with hot water during shower. Due to that, a 1mm thick acetate tray was readymade for the donor site comfort and protection. Among the demands presented in this case, free gingival graft was the primary surgical choice to increase keratinized tissue. Despite the patient’s morbidity, due to the two surgical sites, the use of the acetate tray showed great reduction in patient’s discomfort and trauma. This approach proved to be successful since the patient described increase in self-esteem and oral hygiene facilitation which in combination contributed to satisfactory final results. Keywords: Periodontics. Gingival Recession. Postoperative Complications. ResumoEntre as técnicas disponíveis para o tratamento da recessão gengival, a principal técnica cirúrgica para ganho de tecido queratinizado é o enxerto gengival livre. Este procedimento também é indicado para extensão do vestíbulo e remoção do frênulo. A técnica consiste na remoção de tecidos epiteliais e conectivos de um local doador e seu reposicionamento no local receptor, sendo necessária uma estabilidade primária eficaz para o processo de cicatrização. O objetivo deste estudo foi descrever um relato de caso de um homem de 35 anos, que relatou uma complicação pós-operatória na área doadora, 07 dias após a realização de um enxerto gengival livre. Essa situação ocorreu depois que o paciente relatou ter enxaguado a boca com água quente durante o banho. Devido a isso, uma placa de acetato de 1 mm de espessura foi preparada para conforto e proteção do local doador. Entre as demandas apresentadas neste caso, o enxerto gengival livre foi a principal opção cirúrgica para aumentar o tecido queratinizado. Apesar da morbidade do paciente, devido aos dois locais cirúrgicos, o uso da placa de acetato demonstrou grande redução no desconforto e trauma do paciente. Essa abordagem mostrou-se bem-sucedida, uma vez que o paciente descreveu aumento da autoestima e facilitação da higiene bucal, o que em conjunto contribuiu para resultados finais satisfatórios. Palavras-chave: Periodontia. Recessão Gengival. Complicações Pós-Operatórias

Background and Objectives: The purpose of this pilot study was to evaluate the clinical outcomes of three different methods for increasing the keratinized mucosa (KM) surrounding dental implants with peri-implantitis. Materials and methods: Twenty implant sites with peri-implantitis were divided into: (1) porcine collagen matrix (CM) group: seven implant sites, (2) apically positioned flap (APF) group: eight implant sites, and (3) free gingival graft (FGG) group: five implant sites. The KM width and clinical parameters (probing pocket depth (PPD) and bleeding on probing (BOP)) were measured at time points: before surgery (T0) and 30 (T1), 60 (T2), 90 (T3), and 180 (T4) days after surgery. Results: Regarding KM width, all the groups had significant differences for increasing horizontal and vertical KM width. The CM and FGG groups had greater KM than the APF group. There was a decrease in PPD in all three groups. APF and FGG showed significant differences in PPD at T1 and T2 compared to T0. Only the FGG group showed a significant difference in PPD at T3 and T4 compared with that at T0. BOP values were also reduced in all the groups at T1–T4 compared to T0. The APF and FGG groups showed a significant decrease in BOP. Conclusions: Three surgical therapies presented favorable results for increasing the KM surrounding implants. Compared with the FGG group, the CM showed similar results in increasing the KM around the dental implants with peri-implantitis.

Objective: Free gingival grafts (FGGs) are commonly used for increasing the keratinized tissue and root coverage in gingival recessions (GRs). The aim of this retrospective study was to evaluate the long-term patient satisfaction ratings, esthetic adaptation of graft, and creeping attachment (CA) levels after FGG surgery. Methods: Thirty-five surgical areas from thirty patients with Miller Class I, II, and III GRs were included in the study. GRs were treated with FGGs, and palatal donor area was covered with the same surgical pack in all patients. Gingival index (GI), bleeding on probing (BoP), probing depth, plaque index (PI), vertical and horizontal GRs (VGR and HGR, respectively), keratinized gingiva width (KGW), keratinized gingiva thickness (KGT), CA, evaluating the esthetic harmony with modified Manchester Scar Scale (mMSS), and patient satisfactory ratings were collected at the 1st month, 6th month, and 5th year control. Descriptive statistical methods as well as distribution of the data were evaluated by the Shapiro–Wilk test, the Friedman test was used in comparison of three and more dependent groups, and the Wilcoxon test was used in comparison of two dependent groups. Results: The mean follow-up period was 76.91 ± 7.60 months. The last control measurements of clinical parameters such as GI, PI, BoP, VGR, HGR, and mMSS measurements were statistically significantly lower than the baseline and 1st-month measurements (P < 0.01). The 1st-month, 6th-month, and last control measurements of KGW and KGT were statistically significantly higher than the initial measurements (P < 0.01). The last control CA measurements were statistically significantly higher than the 6th-month measurements (P < 0.01). Patient satisfaction ratings were between 2 and 3 at the last control and demonstrated a high satisfaction result. Conclusion: Within the limitations of this study, it can be stated that FGGs provide successful results in terms of esthetics and maintenance of the periodontal health and also patient satisfaction was at the highest level in the long term.

Background: Prognosis in the management of Millers Class III or IV gingival recession is often fair to poor, which is further decreased by factors such as inadequate keratinized gingiva. Very few modalities show long-term success in the management of gingival recession with inadequate keratinized gingiva, free gingival graft (FGG) being one such technique. Materials and Methods: Ten individuals with Millers Class III or IV recession and inadequate keratinized gingiva were recruited for the study. The first surgical procedure involved the FGG procedure to increase the width of keratinized gingiva (WOKG). Patients were recalled after 3 months for the second surgical procedure, where the flap was coronally advanced. They were recalled 9 months after the second surgery. WOKG was examined at baseline and 3 months (before the second surgical procedure). Recession depth (RD) and clinical attachment level (CAL) was examined at baseline, at 3 months (before the second surgical procedure) and at 12 months (9 months after the second surgical procedure). The percentage of root coverage was measured at 12 months from baseline. Results: Significant increase in WOKG was seen at 3 months. Significant decrease in RD and CAL was observed at 12 months from baseline. The percentage of root coverage was 76.4%. Conclusion: Two-stage FGG procedure can be a successful modality in the management of Millers Class III or IV recession with inadequate keratinized gingiva. This technique improves the prognosis of such compromised cases.

Introduction: Free gingival grafting is among the most foreseeing procedures for increasing the zone of keratinized attached gingiva and enhancing soft tissue around the teeth and dental implants. Nowadays low-level laser therapy (LLLT) is a promising approach in providing patients with more pleasing results in terms of esthetics and comfort. This study aims to investigate the effects of LLLT on gingival recessions treated with free gingival graft (FGG). Methods: This case series was conducted on 12 individuals requiring a bilateral gingival graft in the mandibular region. There was a 30-day interval between the two operations. The test side was selected randomly and irradiated by a low-level laser (LLL) just before surgery. The patients did not know which side was irradiated. LLLT was applied to the donors’ as well as recipients’ site immediately after the operation and 48 hours later. The patients were instructed to record their post-operative pain in a visual analogue scale (VAS) 3 and 24 hours and 7 days after the surgical procedure. The clinical photographs were taken immediately and 30 days after surgical treatment were graded by three experienced periodontists for color matching to adjacent tissues. Results: Ten individuals could finish the study. The test group presented significantly better shade matching and wound healing at the palatal donor site on days 7, 14 and 21. There was a significant reduction in post-operative pain after 24 hours (P=0.007). No statistically significant difference was found between both groups in terms of clinical periodontal indices. Conclusion: LLLT could reduce post-operative pain 24 hours after surgical treatment. Furthermore, the application of LLLT could improve the donors’ site healing and the recipients’ site color matching.

BACKGROUND The aim of this study was to evaluate the influence of two harvesting approaches on the donor site vascular injury. METHODS A split-mouth cadaver study was designed on 21 fresh donor heads. Every hemi-palate was assigned to receive the trap-door harvesting technique (TDT) or the epithelialized free gingival graft harvesting technique (FGGT). A soft tissue graft was harvested from each side for histology analyses. Betadine solution was used to inject the external carotid artery and a collagen sponge was positioned over the harvested area to compare the amount of "leakage." RESULTS The mean leakage observed was 16.56 ± 3.01 µL in the FGGT-harvested sites, and 69.21 ± 7.08 µL for the TDT group, a ratio of 4.18 (P

BACKGROUND: The aim of this long-term case series was to assess the development/prevalence of non-carious cervical lesions (NCCLs) at sites that have and have not been treated with gingival augmentation following free gingival graft (FGG). METHODS: Fifty-two patients had at least one test and one control site: 1) test site showing absence of attached gingiva (AG) associated with gingival recession (GR) treated with FGG; and 2) contralateral site with or without AG. Patient/tooth/site-associated variables were recorded for each tooth/site at baseline (T0), 12 months after surgery (T1), during the follow-up period (T2) (15 to 20 years), and at the end of the follow-up period (T3) over 25 to 30 years. Mixed-effects logistic regression was used throughout the study. RESULTS: Forty-nine patients/130 sites were available for analysis at T2 whereas 44 patients/120 sites at T3. Twenty-two NCCLs >0.5 mm were restored in the test sites and in 35 in the untreated sites. The development of NCCL over time appeared associated with sites with attached KT

This study evaluated clinical outcomes of acellular dermal matrix (ADM) allograft compared with autogenous free gingival graft (FGG) for gingival augmentation after 15 years. Twenty-two patients were originally included and evaluated by de Resende et al. (Clin Oral Investig 23:539–550, 2019), and 12 accepted to participate in this longitudinal evaluation. Clinical parameters evaluated were recession depth (RD), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), and soft tissue thickness (TT). In addition, esthetic perception was evaluated by patients and by a calibrated periodontist. Data were evaluated by ANOVA complemented by Tukey tests (p

Introduction Gingival recession (GR) is an unhealthy root exposure that could result in sensitivity, abrasion, root caries and higher chance of plaque collection. The prevalence of GR is higher on the facial surfaces but could also affect the lingual tooth surfaces. Despite the etiology and location of GR, treatment is warranted to improve the long-term periodontal stability around the affected teeth. This case report describes the use of partly deepithelialized free gingival graft (PE-FGG) to augment lingual GR post orthodontic treatment. Case presentation The current report evaluates the results of PG-FGG to correct lingual recession in a 21-year-old female. The patient presented with 5 mm lingual recession on a previously orthodontically rotated tooth (#21). The recession was treated using a PE-FGG to increase keratinized gingiva (KG) and reduce root exposure. Follow-up at 24 months showed adequate root coverage and KG. Conclusion The use of PE-FGG can be used to enhance KG for lingual recession with adequate root coverage.

Aim: This study was carried to evaluate the effect of the placement of PRF membrane beneath the free gingival graft in gingival augmentation surgeries regarding the changes by time in graft horizontal dimension, vertical dimension and total surface area.Subjects and Methods: Sixteen patients were selected. All the patients showed gingival recession with insufficient attached gingiva. The gingival augmentation surgery was decided to be performed as a primary surgery to increase the attached gingiva with no attempt to cover the recession during this study. Group 1 (test group) included eight patients where the gingival augmentation was performed using a free gingival graft in combination with a platelet rich fibrin membrane placed beneath the graft at the recipient site. Group 2 (control group) included eight patients where the gingival augmentation was performed using a free gingival graft only. The graft vertical dimension (GVD) and the graft horizontal dimension (GHD) were measured using William’s graduated periodontal probe. Plaque index, gingival bleeding index and probing depth were used to monitor the oral hygiene status and gingival health condition throughout the study. All the measures were obtained at 2 occasions; the day of the surgery and 1.5 months after the surgery.Results: Regarding the changes in GVD, a statistically significant greater mean and median percent decrease was noted in group 2 after 1.5 month. The same was obtained with the changes in GHD and graft surface area.Conclusion: Using platelet-rich fibrin beneath free gingival graft in gingival augmentation surgery resulted in successful increase in the attached gingiva with less dimensional changes by time in the transplanted free gingival graft compared to using free gingival graft alone.

Made available in DSpace on 2022-05-01T09:30:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: This study was conducted to evaluate the clinical, immunologic, and patient-centered outcomes of enamel matrix protein derivative (EMD) on excisional wounds in palatal mucosa. Materials: Forty-four patients in need of ridge preservation were randomly allocated into two groups: control group (n = 22): open palatal wound after free gingival graft (FGG) harvest and EMD group (n = 22): open palatal wound after FGG harvest that received 0.3 ml of EMD. Clinical and patient-centered parameters were analyzed for 3 months post-treatment. Wound fluid levels of inflammatory markers were assessed 3 and 7 days postoperatively. Results: No significant inter-group difference was observed in remaining wound area and re-epithelialization. EMD and control groups achieved wound closure and re-epithelialization 30 days postoperatively (p .05). EMD appeared to selectively modulate wound fluid levels of monocyte chemoattractant protein-1, macrophage inflammatory protein-1α, matrix metallopeptidase 9, and tissue inhibitor of metalloproteinases-2. Conclusion: Within the limits of the present study, it can be concluded that EMD application to excisional palatal wounds using the investigated protocol does not provide clinical healing benefits, despite an apparent modulation of selected inflammatory markers. São Paulo State University (UNESP) Division of Periodontics Institute of Science and Technology Division of Operative Dentistry Department of General Dentistry University of Maryland School of Dentistry Department of Prosthodontics and Periodontics Division of Periodontics Piracicaba Dental School College of Dentistry Division of Periodontology The Ohio State University (OSU) College of Dentistry - Lexington University of Kentucky São Paulo State University (UNESP) Division of Periodontics Institute of Science and Technology

Background Free gingival graft (FGG) is a highly predictable method to increase the width of keratinized gingiva. Various materials have been reported to accelerate the wound healing process. Considering the positive effect of EPO on dermal wound healing this study aimed to investigate the effects of EPO on the rate of healing and degree of inflammation in free gingival grafts. Methods Seventeen patients with bilateral lack of keratinized gingiva in mandible were selected for this clinical trial. The surgical intervention was performed after phase I periodontal therapy. Recipient site was prepared apical to the mucogingival line, and FGG was harvested from the palate. Before graft placement, the test side and control side were treated with 1 ml of EPO 4000 IU/ml and distilled water, respectively, for 2 min. On days 7, 14, 21, 28, 60, and 90 after surgery, the grafted sites were examined by blinded observers to compare the healing and inflammation of the areas. Results All the 17 patients completed the surgeries and follow-up examinations. Direct examination revealed significantly better healing in EPO group only on the 28th day. Assessment of the photographs showed a significant value in favor of the test group at some other time points as well. The EPO group demonstrated less inflammation, which was statistically significant in many time points. The graft area was 80.88 ± 30.21 mm2 and 71.35 ± 15.62 mm2 in the EPO and control groups, respectively. The difference was not significant, though. Conclusions Topical application of erythropoietin can accelerate the healing of gingival grafts and reduce the inflammation during healing period. The final graft outcome, nevertheless, does not seem to be influenced by EPO. Trial registration This was a split-mouth randomized controlled clinical trial (IRCT201201278830N1). The first registration date: 2016-10-22

Objective: Free gingival graft (FGG) procedure is accompanied with a considerable rate of graft shrinkage. This study was aimed to assess the dimensional changes of FGG after recipient site prepara...

The objective of this study was to compare the silk suture with a cyanoacrylate adhesive to stabilize the free gingival graft in conjunction with Er: YAG laser-assisted recipient site preparation to augment the keratinized tissue in gingival recession cases. This randomized trial comprised of 300 recession defects patients. All the included patients were diagnosed using Miller class I and II gingival recession defects classification. Group I sites were treated with a free gingival graft (FGG) harvested using an Er: YAG laser and further sutured with silk. Group II sites were stabilized with isoamyl 2 cyanoacrylate bio-adhesive material. Clinical parameters, such as gingival recession depth, clinical attachment level, gain in gingival tissue thickness, and width of keratinized gingiva were recorded at baseline, and at third month, sixth month, and 12th month postoperatively. The mean changes in gingival recession from months 3 to 6 and months and 6 to 12 were significant ( p 0.05). Cyanoacrylate could be used as a substitute to silk sutures to stabilize FGGs. Cyanoacrylate was easy to apply, consumed less operating time, and was considered equally efficacious for stabilizing FGGs.

Background Complications after free gingival graft (FGG) operations are generally related to the donor site. The titanium-prepared, platelet-rich fibrin (T-PRF) placement in the donor site accelerate the wound healing and prevent postoperative complications such as pain and haemorrhage. We aim to evaluate the effect of T-PRF regarding vascularization and tissue thickness and to report the advantages of the ultrasonography (US) in FGG. Methods Ten individuals were divided to two groups as T-PRF and control. While the T-PRF membrane was placed at the donor site in T-PRF group, a gelatin sponge was placed in control group. All patients underwent US examination in terms of vascularization and tissue thickness of left and right donor sites. The correlation between the right and left donor sites was analyzed with the Pearson correlation test. Tissue thicknesses and Pulsatility index (PI) were analyzed with independent samples T-test. The results were evaluated statistically at the p Results The T-PRF group showed increased vascularity which can be interpreted to improve healing in soft tissue. However, not a difference, but a positively very high correlation was observed between the right and left tissue thicknesses (p = 0,00; r = +0,902). Conclusion Evaluation of tissue thickness and vascularization density of donor sites with US not only increases clinical success rate but also reduces the risk of complications during surgery and postoperative pain in FGG. Studies evaluating T-PRF membrane as palatal dressing after FGG are only clinically, however, the efficiency of T-PRF was evaluated radiologically in this study for the first time. This article is protected by copyright. All rights reserved.

Numerous surgical techniques for root coverage have been suggested with different degrees of success, as assessed by the proportion of complete root coverage. Mandibular incisors, teeth with a high frequency of gingival recession defects (GRDs), were associated with the least favorable outcomes due to unfavorable anatomical conditions. In the present series of three cases, a modified version of the free gingival graft technique for the purpose of root coverage at mandibular incisors is illustrated. The purpose of the modification of the original technique was to achieve improved blood supply from the recipient site to the graft, with the ultimate aim of enhancing predictability and outcomes of the procedure. In all included cases, complete or almost complete root coverage was achieved at challenging GRDs in the mandibular incisor area.

In the treatment of gingival recession, different surgical options have been described: free gingival grafts (FGG), connective tissue Grafts (CTG), and a more recent technique, de-epithelialized free gingival graft (DFGG). They are not procedures exempt from the appearance of complications. Most publications refer to postoperative complications, and there is limited literature regarding the development of late complications (weeks or months). Our working group carried out a study to describe the development of late complications associated with the use of DFGG in comparison with CTG, providing an incidence rate and a classification. Sixty-eight patients with mucogingival problems were selected, and divided into two groups: the Test Group, for which we used DFGG + Coronal Advancement Flap (CAF), and the Control Group (CTG + CAF). All patients were treated at the University of Seville’s dental school to solve mucogingival problems for aesthetic and/or functional reasons. A classification is proposed based on its severity, Major and Minor. Major complications included reepithelialization of the graft, epithelial bands, cul-de-sac, epithelial cysts, and bone exostoses. Minor complications included the graft´s color changes and superficial revascularization. Late major complications were only associated with the use of the DFGG, and the late minor complications developed with the use of the DFGG were much higher than those associated with CTG. CTG appears to be a safer procedure than DFGG in terms of late complications.

A systematic review (SR) was conducted to answer the following focused question based on PICO strategy: In patients who were submitted to harvesting palatal free gingival graft, could platelet-rich fibrin (PRF) application in comparison with another method improve the healing, pain, and control of postoperative bleeding in the palatal area in randomized clinical trials? A SR was conducted according to the PRISMA guidelines. The MEDLINE (PubMed), Scopus, Embase, and Web of Science databases were searched, and hand searches were made, covering the period up to August 2020, for randomized clinical trials (RCTs) reporting the effect of PRF membrane in postoperative palatal healing management compared with any other methods. The risk of bias (RoB) of the studies included was assessed by using the RoB 2 tool. The electronic search strategy identified 150 articles. After title screening and abstract reading, 141 studies were excluded, and 9 full-text publications were comprehensively evaluated. Finally, 8 articles were included in the systematic review. Six studies showed that the PRF membrane was effective in improving wound healing during the first 2 weeks. As regards patient-centered outcomes, five studies showed that PRF promoted less postoperative pain. Finally, five studies that evaluated bleeding showed that the PRF membrane improved control of postoperative bleeding. RoB was classified as low in 4 studies, 3 with some concerns, and only one study did not describe the outcome data, and as this was missing, it was not possible to verify the protocol of data analysis for this study; therefore, it was classified as having high RoB. Within the limitations of this study, the collective evidence emerging from this SR may support the use of PRF membrane in the palatal area after free gingival graft harvesting. The results of this review must be interpreted with caution, due to the low number of RCTs included and high degree of heterogeneity among the PRF protocols. Further well-designed RCTs with accurate protocol and standard PRF parameters are required in order to gain clear understanding of the influence of PRF on wound healing and patient-centered outcomes. The use of PRF membrane for the protection of the palatal donor site following free gingival graft harvesting procedures improves wound healing and patients’ quality of life.

Background The palatal suture has been well known in literature as a method for palatal hemostasis but has not been validated for its efficacy. The aim of this parallel-arm randomized controlled clinical trial was to evaluate the efficacy of palatal pre-suturing using the greater palatine compression suture (GPCS) in reducing the perioperative hemorrhage associated with the palatal free gingival graft (FGG) procedure. Methods Twenty-four patients requiring the FGG procedure for recession coverage or augmentation of keratinized tissue were recruited in the study and randomized to the GPCS group and the control group. The GPCS was placed using a previously described protocol by a single operator in all the participants in the GPCS group. Perioperative blood loss was estimated by weighing the gauze used to mop the palatal hemorrhage, before and after the procedure. The time required for the surgery was also recorded by an independent observer. Results Significantly lesser blood loss was observed in the GPCS group (4.33 ± 0.89 g) as compared with the control group (8.91 ± 4.16 g). The difference in the time taken for the surgical procedure for the GPCS group (73.25 ± 22.35 minutes) was not significantly different from that required for the control group (76.08 ± 14.47 minutes). Conclusion This study demonstrates that pre-suturing of the palate using the GPCS is an effective technique to reduce the perioperative blood loss associated with the palatal FGG procedure.