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Oliveira JA, da Silveira MI, de Oliveira Alves R, Bezerra FJB, de Oliveira GJPL, Pigossi SC. 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. Clin Oral Investig 2023; 27:6735-6746. [PMID: 37775584 DOI: 10.1007/s00784-023-05282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
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.
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Affiliation(s)
- Jovânia Alves Oliveira
- School of Dentistry, Alfenas Federal University (Unifal-MG), Alfenas, Minas Gerais, Brazil
| | | | - Roberta de Oliveira Alves
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia-UFU, School of Dentistry, Umuarama Campus, Bloco UMU4L, Pará Avenue, 1720, Uberlandia, MG, 38405-320, Brazil
| | | | - Guilherme José Pimentel Lopes de Oliveira
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia-UFU, School of Dentistry, Umuarama Campus, Bloco UMU4L, Pará Avenue, 1720, Uberlandia, MG, 38405-320, Brazil
| | - Suzane Cristina Pigossi
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia-UFU, School of Dentistry, Umuarama Campus, Bloco UMU4L, Pará Avenue, 1720, Uberlandia, MG, 38405-320, Brazil.
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Beymouri A, Yaghobee S, Khorsand A, Safi Y. Comparison of morbidity at the donor site and clinical efficacy at the recipient site between two different connective tissue graft harvesting techniques from the palate: A randomized clinical trial. JOURNAL OF ADVANCED PERIODONTOLOGY & IMPLANT DENTISTRY 2023; 15:108-116. [PMID: 38357340 PMCID: PMC10862051 DOI: 10.34172/japid.2023.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/26/2023] [Indexed: 02/16/2024]
Abstract
Background This study was conducted to compare the pain levels in patients and the clinical efficacy of grafts obtained using two techniques, namely de-epithelialized gingival graft (DGG) and subepithelial connective tissue graft (SCTG), in combination with coronally advanced flap (CAF) for the treatment of multiple adjacent gingival recessions. Methods Twelve patients were treated using DGG+CAF on one side and SCTG+CAF on the other. The patients' pain levels at the surgical site, the number of analgesics taken on days 3 and 7, the mean root coverage (MRC), the percentage of complete root coverage (CRC), color match, and gingival thickness (GT) at the graft recipient site were evaluated 6 months after surgery. Results The total number of analgesics taken during the 7-day period after surgery and pain levels at the surgical site from day 3 to day 7 were significantly higher in the DGG+CAF group compared to the SCTG+CAF group (P=0.001). In the 6-month follow-up, color match and CRC were significantly higher in the SCTG+CAF group, while GT was significantly higher in the DGG+CAF group. There was no significant difference in MRC between the two groups. Conclusion The pain and analgesic consumption levels were higher in the DGG+CAF group compared to the SCTG+CAF group, and the recipient site had a weaker color match. However, this technique can lead to a greater increase in the thickness of the grafted area.
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Affiliation(s)
- Amine Beymouri
- Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Yaghobee
- Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Khorsand
- Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Safi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Alkaya B, Kayhan HG, Temmerman A, Haytac MC, Teughels W. Pre-operative, chair-side Zn-containing surgical stents affect morbidity and wound healing after free gingival graft harvesting: a randomized clinical trial. Clin Oral Investig 2023; 27:5519-5527. [PMID: 37468598 DOI: 10.1007/s00784-023-05171-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To compare a pre-operatively, chair-side made, zinc-containing surgical stent (ZN) and suturing of a gelatin-based hemostatic agent (HA) on palatal wound healing and patient morbidity after free gingival graft surgery (FGG). MATERIALS AND METHODS Sixty patients requiring FGG were randomly divided into two groups to receive either a ZN or a sterile HA sutured on the surgical area. Patients were evaluated at 1st, 3rd, 7th, 14th, 28th, and 56th days following surgery. Overall surgical time, donor site surgical time, postoperative pain (PP), delayed bleeding (DB), changes in dietary habits (DH), burning sensation (BS), completion of re-epithelialization (CE), and patients' discomfort (PD) were evaluated. RESULTS Donor site surgical time, PP, DB, DH, BS were statistically significantly lower in the ZN group together with faster completion of re-epithelialization compared to the HA group. CONCLUSION Pre-operatively, chair-side made, zinc-containing surgical stents provided significant benefits for wound healing parameters and patients' postoperative morbidity after FGG harvesting. CLINICAL RELEVANCE The results show that using Zn-containing palatal stent after free gingival graft surgery significantly reduces pain and patient morbidity during the postoperative period.
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Affiliation(s)
- Bahar Alkaya
- Department of Periodontology Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Hamza Gokhan Kayhan
- Department of Periodontology Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Andy Temmerman
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Louvain, Belgium
| | - Mehmet Cenk Haytac
- Department of Periodontology Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Wim Teughels
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Louvain, Belgium
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Meza-Mauricio J, Mourão ERST, Oliveira Marinho K, Vergara-Buenaventura A, Mendoza-Azpur G, Muniz FWMG, Santamaria MP, Faveri M. Effect of collagen sponge and flowable resin composite on pain management after free gingival graft harvesting: A randomized controlled clinical trial. Eur J Oral Sci 2023; 131:e12935. [PMID: 37169726 DOI: 10.1111/eos.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
The aim of this study was to compare the effect of the application of a flowable resin composite coating, over a collagen sponge stabilized with suture, on postoperative pain after free gingival graft harvesting. Thirty-two free gingival grafts were harvested from the palate in 32 patients, who were subsequently randomized to have only a collagen sponge stabilized with sutures applied to the palatal wound (control), or to have the collagen sponge coated with a flowable resin composite (test). Patients were observed for 14 days, and the pain level was evaluated by using a numerical rating scale. The consumption of analgesics during the postoperative period and the characteristic of the graft were also analyzed. The patients in the test group reported having experienced significantly less pain statistically than the patients in the control group throughout the study. The consumption of analgesics was lower in the test group. The dimensions of harvested grafts in the control and test groups showed no significant differences in height, width, and thickness. In conclusion, the addition of flowable resin composite coating to the hemostatic collagen sponge on the palatal wound following free gingival graft harvesting helped to minimize postoperative pain.
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Affiliation(s)
| | | | - Kelson Oliveira Marinho
- Department of Periodontology and Oral Implantology, Dental Research Division, University of Guarulhos, São Paulo, Brazil
| | | | | | | | | | - Marcelo Faveri
- Department of Periodontology and Oral Implantology, Dental Research Division, University of Guarulhos, São Paulo, Brazil
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Alpan AL, Cin GT. Comparison of hyaluronic acid, hypochlorous acid, and flurbiprofen on postoperative morbidity in palatal donor area: a randomized controlled clinical trial. Clin Oral Investig 2023:10.1007/s00784-022-04848-5. [PMID: 36595064 PMCID: PMC9808727 DOI: 10.1007/s00784-022-04848-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study aims to evaluate the effects of topical hyaluronic acid (HA), hypochlorous acid (HOCl), and flurbiprofen on postoperative morbidity of palatal donor sites after free gingival graft (FGG) surgery. MATERIALS AND METHODS Sixty patients requiring FGG were randomly assigned into four groups: control, HA gel (600 mg/100 g high molecular weight hyaluronic acid), HOCl spray (170-200 ppm, ph7.1), flurbiprofen spray (0.075gr flurbiprofen). Topical agents were applied for 14 days, according to groups. Patients were followed for 28 days. Palatal healing was assessed with the Laundry wound healing index (WHI). Complete epithelization (CE) was evaluated with photographs and H2O2 bubbling. Pain, burning sensation, chewing efficacy, and tissue color match (CM) were evaluated using a visual analog scale (VAS). Postoperative analgesic consumption and delayed bleeding (DB) were also recorded. RESULTS HA provided better WHI values on the 7th, 14th, and 21st days compared to the other groups, respectively (p < 0.05). CE was formed on the 21st day in the HA group but on the 28th day in the other groups. HOCl and flurbiprofen groups were not different from the control group or each other in terms of WHI. HOCl had the lowest VAS scores of all time periods. DB was not observed in any group. Significantly fewer analgesics were taken in the topical agent-applied groups compared to the control group. CONCLUSIONS HA exhibits a positive impact on the epithelization of palatal wound healing and color matching. HOCl and flurbiprofen provided less pain; however, they might have negative effects on palatal wound healing. CLINICAL RELEVANCE As a result of obtaining free gingival grafts from palatal tissue for mucogingival surgical procedures, secondary wound healing of the donor area occurs. This wound in the palatal region can cause discomfort and pain every time patients use their mouths. The use of HA can reduce postoperative complications by accelerating wound healing and reducing pain. The topical use of flurbiprofen and HOCl can reduce patients' pain.
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Affiliation(s)
- Aysan Lektemur Alpan
- Department of Periodontology, Faculty of Dentistry, Pamukkale University, Kınıklı Campus, 20160 Denizli, Turkey
| | - Gizem Torumtay Cin
- Department of Periodontology, Faculty of Dentistry, Pamukkale University, Kınıklı Campus, 20160 Denizli, Turkey
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Lin IP, Chang PC. Physiological reaction of anxious patients taking sedative medications before and after periodontal surgery. J Dent Sci 2023; 18:345-352. [PMID: 36643220 PMCID: PMC9831853 DOI: 10.1016/j.jds.2022.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 08/27/2022] [Indexed: 01/18/2023] Open
Abstract
Background/purpose Clinicians use sedatives for anxiety patients at times in daily practice, but the direct influence of the medication on the wound healing of periodontal tissues is unknown. The aim of this study was to analyze the influence of the short-term administration of diazepam to patients with dental anxiety undergoing free gingival graft (FGG) procedures. Materials and methods A total of 51 FGG procedures in 39 patients were included. Twenty-six anxious patients medicated with 5 mg of diazepam from the night before surgery to 7 days after surgery served as the medication group, and the rest served as the control group. Direct examination, photographs and H2O2 were used to evaluate the healing of palatal wounds. Stress levels and sleep quality, and salivary melatonin levels were assessed. Results On Day 14, complete epithelization of the wounds was noted in 48.39% of the patients in the medication group and 35.29% of the patients in the control group. Regardless of whether they receive medication or not, groups with complete epithelialization by Day 14 had higher levels of preoperative melatonin than those without, with a P value of 0.02. The postoperative melatonin in the medication group tended to present higher levels than the control group. Conclusion Higher preoperative melatonin levels can accelerate wound healing. The short-term administration of the diazepam seemed to facilitate palatal wound healing by reducing stress and maintaining postoperative melatonin levels. This is the first time the relationships between sedatives, melatonin levels and palatal wound healing has been reported.
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Affiliation(s)
- I-Ping Lin
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Periodontology, Department of Dentistry, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Po-Chun Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Periodontology, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Corresponding author. Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei 100, Taiwan.
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Ghaderi F, Ebrahimi E, Sari Aslani F, Koohi-Hosseinabadi O, Koohpeyma F, Irajie C, Tanideh N, Iraji A. The effect of hydroalcoholic extract of Psidium guajava L. on experimentally induced oral mucosal wound in rat. BMC Complement Med Ther 2022; 22:201. [PMID: 35906612 PMCID: PMC9338486 DOI: 10.1186/s12906-022-03655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to evaluate the biological effects of hydroalcoholic extract of Psidium guajava L leaves and phenytoin as a standard agent on the induced oral mucosal wound. Methods Hundred seventy Sprague Dawley rats were grouped in 5 clusters randomly. Oral mucosal wounds were induced in all rats except for the control group. Phenytoin and guajava leaf extract were used as a mouthwash. Twelve rats from the 5 groups were euthanized on day 7th and 10th, and 10 rats from each group were sacrificed on the 14th day. Interleukin-6 and total antioxidant capacity were determined in the serum. The tissues were evaluated for pathological and stereological assessments. Phytochemical analyses were performed on the hydroalcoholic extract of Psidium guajava L to determine the antioxidant potency. Results Total phenolic content test and DPPH analysis demonstrated the high potential of antioxidant capacity of Psidium guajava L. Decreasing IL-6 and increasing TAC were seen in the guajava hydroalcoholic extract and phenytoin groups. The difference of IL-6 between the wound treated guajava group and the wounded group was significant. The wound treated guajava group and wound treated phenytoin group on the 14th day increased the number of fibroblast cells and volume density of sub-mucosae effectively to the same thickness to be considered as a healed sub-mucosae layer. The volume density of the epithelium changes showed statistically significant different responses based on gender. Conclusion In conclusion, hydroalcoholic extract of Psidium guajava L leaves might exert theraputic effects on oral mucositis. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03655-5.
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Morshedzadeh G, Aslroosta H, Vafaei M. Effect of GaAlAs 940 nm Photobiomodulation on palatal wound healing after free gingival graft surgery: a split mouth randomized controlled clinical trial. BMC Oral Health 2022; 22:202. [PMID: 35610702 PMCID: PMC9131644 DOI: 10.1186/s12903-022-02229-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to evaluate the effects of photobiomodulation (PBM) on wound healing, pain, and discomfort at free gingival graft (FGG) donor sites.
Methods Sixteen patients in need of bilateral FGG were selected for this randomized, controlled, triple-blinded, and split mouth clinical trial. The FGG donor sites in test group were treated with LLLT GaAlAs 940 nm, 5 J/cm2 immediately after surgery and every other day within the following ten days. The control group received sham irradiation. Remaining Wound Area (RWA), Epithelialization and color match were evaluated on the day of surgery and 7, 14, 21, 28, and 60 days after surgery. A questionnaire was administered to measure pain and bleeding in the first ten days after surgery. Results RWA was significantly smaller in the test than control group on the days 7 (p < 0.001) and 14 (p = 0.048) after the surgery. Bleeding was higher in the test group than in the control group on the day of surgery (p = 0.046). Pain and discomfort at the palatal donor site, however, had no significant difference between laser and control group during 11 days after the surgery (p > 0.05), nor did the Color match scores on the 28th and 60th days after the surgery (p > 0.05). Conclusions It can be concluded that PBM enhances FGG donor site wound healing one and two weeks after the surgery. Trial registration IRCT2017092036203N2, registered 01.11.2017.
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Affiliation(s)
- Ghazal Morshedzadeh
- Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoori Aslroosta
- Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahsa Vafaei
- Department of Restorative Dentistry, Babol University of Medical Sciences, Mazandaran, Iran
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Clinical and cytological assessment of platelet-rich fibrin versus topical ozonated oil in palatal wound healing after free gingival graft harvesting: Randomized controlled trial. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2022. [DOI: 10.1016/j.ajoms.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lee Y, Lee D, Kim S, Ku Y, Rhyu IC. Modified tunneling technique for root coverage of anterior mandible using minimal soft tissue harvesting and volume-stable collagen matrix: a retrospective study. J Periodontal Implant Sci 2021; 51:398-408. [PMID: 34965619 PMCID: PMC8718334 DOI: 10.5051/jpis.2101400070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/15/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose In this study, we aimed to evaluate the clinical validity of the modified tunneling technique using minimal soft tissue harvesting and volume-stable collagen matrix in the anterior mandible. Methods In total, 27 anterior mandibular teeth and palatal donor sites in 17 patients with ≥1 mm of gingival recession (GR) were analyzed before and after root coverage. For the recipient sites, vertical vestibular incisions were made in the interdental area and a subperiosteal tunnel was created with an elevator. After both sides of the marginal gingiva were tied to one another, a prepared connective tissue graft and volume-stable collagen matrix were inserted through the vestibular vertical incision and were fixed with resorbable suture material. The root coverage results of the recipient site were measured at baseline (T0), 3 weeks (T3), 12 weeks (T12), and the latest visit (Tl). For palatal donor sites, a free gingival graft from a pre-decided area avoiding the main trunk of the greater palatine artery was harvested using a prefabricated surgical template at a depth of 2 mm after de-epithelization using a rotating bur. In each patient, the clinical and volumetric changes at the donor sites between T0 and T3 were measured. Results During an average follow-up of 14.5 months, teeth with denuded root lengths of 1–3 mm (n=12), 3–6 mm (n=11), and >6 mm (n=2) achieved root coverage of 97.01%±7.65%, 86.70%±5.66%, and 82.53%±1.39%, respectively. Miller classification I (n=12), II (n=10), and III (n=3) teeth showed mean coverage rates of 97.01%±7.65%, 86.91%±5.90%, and 83.19%±1.62%, respectively. At the donor sites, an average defect depth of 1.41 mm (70.5%) recovered in 3 weeks, and the wounds were epithelized completely in all cases. Conclusions The modified tunneling technique in this study is a promising treatment modality for overcoming GR in the anterior mandible.
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Affiliation(s)
- Yoonsub Lee
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Dajung Lee
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Sungtae Kim
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea.
| | - Young Ku
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - In-Chul Rhyu
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
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Zakaria O. In situ soft tissue regeneration using periosteal distraction: A preliminary study in the rat calvarial model. Saudi Dent J 2021; 33:587-594. [PMID: 34803305 PMCID: PMC8589612 DOI: 10.1016/j.sdentj.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 11/29/2022] Open
Abstract
Aim In this study, we aimed to evaluate soft tissue generated by periosteal distraction. Background Management of soft tissue defects represents a challenge in dentistry. Previous periosteal distraction studies documented partial fill of the distraction space with newly-generated bone and fibrous connective tissue. Material and methods Titanium meshes were inserted in subperiosteal tunnels in the calvaria of 20 rats through coronal incision. The devices were immediately activated after insertion by elevation of one side at 1 mm/day for 3 days. Rats were then divided into two groups (n = 10). Animals were sacrificed after 2 weeks (Group 1) and after 4 weeks (Group 2). Distraction sites specimens were embedded in paraffin and analyzed histologically and histomorphometrically. Results In both groups, new periosteum was regenerated and covered the original bone surface in the distraction site. Distraction spaces showed a predomination of hyper-vascularized connective tissue and little new bone formation near to the stable end of the device. The 4-week findings showed more organized collagen fibers with less vascularity compared to the 2-week findings. Conclusion The periosteal distraction technique can effectively regenerate connective tissue. It may open a new modality in the guided tissue regeneration for soft tissue augmentation.
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Affiliation(s)
- Osama Zakaria
- Department of Biomedical Dental Sciences, Oral and Maxillofacial Division, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, 31441 Dammam, Saudi Arabia
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Jang H, Choi Y, Kwon E, Choi N, Jang Y, Song J, Shin S. Optimal application of compressive palatal stents following mesiodens removal in pediatric patients: A Randomized Controlled Trial. Med Oral Patol Oral Cir Bucal 2021; 26:e808-e814. [PMID: 34704974 PMCID: PMC8601646 DOI: 10.4317/medoral.24802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background There is no scientific evidence supporting the choice of a palatal stent in patients who underwent removal of an impacted supernumerary tooth. We aimed to investigate the effects of palatal stents in patients who underwent supernumerary tooth removal through a palatal approach and to suggest the optimal stent thickness and material. Material and Methods We recruited 144 patients who underwent extraction of a supernumerary tooth between the maxillary anterior teeth. Subjects were assigned to a control group (CG) or one of four compressive palatal stent groups (CPSGs) classified by the thickness and material of the thermoplastic acrylic stent used. Palatal gingival swelling and objective indices (healing, oral hygiene, gingival, and plaque) were evaluated before surgery and on postoperative days (PODs) 3, 7, and 14; pain/discomfort and the Child Oral Health Impact Profile (COHIP) were assessed as subjective indices of the effects of the stent. Results The CPSGs showed faster healing than did the CG on PODs 7 (P<0.001) and 14 (P=0.043); swelling was measured by 1.64±0.88 mm and 4.52±0.39 mm, respectively. Although swelling was least in the 4-mm hard group (0.92±0.33 mm), the difference compared with that in the 2-mm hard group (1.01±0.18 mm) was not significant (P=0.077). The CPSGs showed better COHIP (P<0.001-0.036) and pain scores (P<0.001) than did the CG on PODs 1-3. Conclusions Compressive palatal stents reduce discomfort by decreasing pain and alleviating swelling. Although a stent is effective regardless of its thickness and material, 2-mm hard stents maximized such positive effects with minimal discomfort. Key words:Supernumerary tooth, tooth Extraction, postoperative care, oral Health, pediatric dentistry.
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Affiliation(s)
- H Jang
- Department of Oral and Maxillofacial surgery, Pusan National University, School of Dentistry, Korea Dental and Life Science Institute, School of Dentistry, Pusan National University, Korea Beomeo, Mulgeum, Yangsan, 50612, Republic of Korea
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Local application of hyaluronic acid in conjunction with free gingival graft: a randomized clinical trial. Clin Oral Investig 2021; 26:2165-2174. [PMID: 34623507 DOI: 10.1007/s00784-021-04197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS Topical application of HA may exhibit significant improvement of postoperative pain and no significant difference in graft dimensions and patients' satisfaction. CLINICAL RELEVANCE Topical application of HA is recommended as a dressing material in FGG surgeries to reduce postoperative pain and accelerate healing.
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Artzi Z, Renert U, Netanely E, Thoma DS, Vered M. Histologic composition of marginal mucosal tissue augmented by a resorbable volume-stable collagen matrix in soft tissue thickening procedures in humans: a morphometric observational study. Clin Oral Investig 2021; 26:427-435. [PMID: 34164734 DOI: 10.1007/s00784-021-04016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aims to examine the composition of lining and masticatory mucosa at the pre- and post-soft tissue augmentation procedures with a volume-stable cross-linking collagen matrix (VCMX) in humans. MATERIALS AND METHODS In 12 patients, single implant sites were augmented with a VCMX. Biopsies were obtained including masticatory (MM) and lining (LM) mucosa before augmentation and at 12 weeks post-augmentation procedures. Rete pegs density (RPD), length (RPL), and blood vessel density (BVD) were histomorphometrically analyzed at both time points. Picrosirius red staining under polarized light microscopy was used to evaluate collagen fiber organization. The effects of time and tissue type were evaluated by ANOVA with repeated measures. RESULTS Both MM and LM areas demonstrated an increase in mean RPL following augmentation, 382.6 µm ± 95.1 vs. 290.5 µm ± 79.3 and 335.6 µm ± 94.2 vs. 292.9 µm ± 77.0, respectively (p < .05). There was a significant difference in the numbers of RP per 1 mm length (RPD) between the MM (9.2 ± 1.7) and LM (6.1 ± 2.8) mucosa but not between the pre- and post-VCMX augmentation time points. The mean BVD in the LM was greater than in the MM (5.5 ± 2.4 and 6.3 ± 2.4 vs. 3.4 ± 3.3 and 3.7 ± 1.8, respectively, p < .05) but not between time points. The collagen fiber arrangements pre- and post-augmentation were not significantly different. CONCLUSION Augmentation with VCMX did not alter the composition of lining and masticatory mucosa at implant sites. CLINICAL RELEVANCE A thick soft tissue phenotype around the implant neck is an important factor to maintain peri-implant health. A non-autogenous cross-linking collagen matrix is proposed as an alternate graft substitute in soft tissue augmentation procedures in order to improve implant soft tissue phenotype.
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Affiliation(s)
- Zvi Artzi
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Uri Renert
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erez Netanely
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Marilena Vered
- Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Malpartida-Carrillo V, Tinedo-Lopez PL, Guerrero ME, Huamani-Echaccaya JL, Özcan M, Rösing CK. Outcome measurements following palatal soft tissue graft harvesting: A review. J Clin Exp Dent 2021; 13:e527-e535. [PMID: 33981402 PMCID: PMC8106935 DOI: 10.4317/jced.57625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/20/2020] [Indexed: 11/05/2022] Open
Abstract
Background Free gingival graft (FGG) and connective tissue graft (CTG) are two of the most commonly techniques performed in periodontal and peri-implant plastic surgery. Although several outcome measurements have been proposed for evaluation of palatal wound healing and patient morbidity, a comprehensive review about these variables is lacking. The objective of this review is to present comprehensive information about outcome measurements related to postoperative palatal wound healing and postoperative patient-reported morbidity after FGG or CTG procedures. Material and Methods An electronic search of English language dental literature in the Medline database via PubMed access was conducted from May 1994 to May 2020 following the PRISMA guidelines. Electronic search strategy complemented by hand search of impacting related dental journals, and the reference list of all included studies were used to complete data collection considering only clinical trials. Finally, inclusion criteria were applied to identify articles after full-text evaluation. Results A total of 111 articles were identified. After the exclusion of 34 articles based on title and abstract evaluation, 77 articles were full text screened. Following, 46 articles were excluded since they evaluated other surgical areas. Finally, 31 studies were selected and included for final evaluation. Outcome measurements were classified in variables collected by indexes and systems assessed professionally and patient-centered measurements. Visually-assessed measurements include indexes, photographs, bleeding and use of laboratory-aided measurements. Patients-centered outcomes comprise pain, discomfort and quality-of life, among others. Conclusions The most commonly used outcome measurements related to postoperative palatal wound healing are hydrogen peroxide test, tissue color match, visual inspection, and bleeding evaluation. Pain perception, analgesic consumption, discomfort sensation, burning sensation, and changes in feeling habits are the most commonly used outcome measurements related to postoperative patient-reported morbidity. Key words:Morbidity, patient comfort, periodontics, tissue harvesting, wound healing.
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Affiliation(s)
| | - Pedro-Luis Tinedo-Lopez
- DDS, MSc. Professor, School of Stomatology, Universidad Privada San Juan Bautista, Lima, Perú
| | - Maria-Eugenia Guerrero
- DDS, PhD. Professor, Department of Medico Surgical Stomatology, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | | | - Mutlu Özcan
- DDS, PhD. Professor, Center of Dental Medicine, Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Cassiano-Kuchenbecker Rösing
- DDS, PhD. Professor, Department of Periodontology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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16
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Is the use of platelet-rich fibrin effective in the healing, control of pain, and postoperative bleeding in the palatal area after free gingival graft harvesting? A systematic review of randomized clinical studies. Clin Oral Investig 2021; 25:4239-4249. [PMID: 33829349 DOI: 10.1007/s00784-021-03933-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE 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? METHODS 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. RESULTS 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. CONCLUSION 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. CLINICAL RELEVANCE 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.
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Chaushu L, Atzil S, Vered M, Chaushu G, Matalon S, Weinberg E. Age-Related Palatal Wound Healing: An Experimental In Vivo Study. BIOLOGY 2021; 10:biology10030240. [PMID: 33808882 PMCID: PMC8003724 DOI: 10.3390/biology10030240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
We assessed age-related excisional palatal mucoperiosteal wound closure in rats. A 4.2 mm diameter punch was used to create a secondary healing defect in the palate of Wistar rats. Study group-21, 18-month-old vs. control 21, 2-month-old males. The 2-dimensional area, maximum length and width of the soft tissue defect served as clinical outcome parameters. The dynamics of the initial three healing weeks were assessed. Semi-quantitative histomorphometric analysis of inflammation and myofibroblasts served for the evaluation of the inflammatory and proliferative wound healing phases. Complete wound closure was faster in the old rats. A dimensional related wound closure was observed in the young rats versus a symmetrical wound closure in the old rats. Inflammatory response was significantly delayed and of lower intensity in the old rats. Myofibroblastic response, representing the proliferative stage, was delayed and of lower intensity in the old rats, albeit not statistically significant. Reduced initial tissue damage due to decreased and delayed inflammatory response in the old rats ultimately led to faster clinical wound healing compared to the young rats, despite a statistically non-significant lower proliferative response in the old rats.
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Affiliation(s)
- Liat Chaushu
- Department of Periodontology and Oral Implantology, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Correspondence: ; Tel.: +972-3-7715000; Fax: +972-3-7715002
| | - Svetlana Atzil
- The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel;
| | - Marilena Vered
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel;
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, Sackler Faculty of Medicine, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel-Aviv 69978, Israel;
| | - Shlomo Matalon
- Department of Oral Rehabilitation, Head, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel;
| | - Evgeny Weinberg
- Department of Periodontology and Oral Implantology, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel
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18
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Kulkarni MR, Shettar LG, Bakshi PV, Nikhil K. Palatal pre-suturing for perioperative hemostasis at free gingival graft donor sites-A randomized controlled clinical trial. J Periodontol 2021; 92:1441-1447. [PMID: 33543476 DOI: 10.1002/jper.20-0754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/26/2020] [Accepted: 01/19/2021] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Mihir Raghavendra Kulkarni
- Department of Periodontics, SDM College of Dental Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, India
| | - Leena Gangadhar Shettar
- Department of Periodontics, SDM College of Dental Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, India
| | - Purva Vijay Bakshi
- Department of Periodontics, SDM College of Dental Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, India
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19
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Gusman DJR, Matheus HR, Alves BES, de Oliveira AMP, Britto ACDS, Novaes VCN, Nagata MJH, Batista VEDS, de Almeida JM. Platelet-rich fibrin for wound healing of palatal donor sites of free gingival grafts: Systematic review and meta-analysis. J Clin Exp Dent 2021; 13:e190-e200. [PMID: 33575004 PMCID: PMC7864367 DOI: 10.4317/jced.57451] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background Platelet-rich fibrin (PRF) has been referred to as a second-generation platelet concentrate, associated with improvements on the healing of palatal wounds followed by FGG harvesting. The aim of this systematic review and meta-analysis was to assess the complete wound epithelialization and postoperative pain when PRF was used in palatal wounds following free gingival graft (FGG) harvesting.
Material and Methods PubMed (Medline), EMBASE and Scopus were searched by two independent individuals up to and including March 2020 in order to identify controlled and randomized controlled clinical trials on the use of PRF at palatal donor sites of FGG. The outcomes assessed were epithelialization and postoperative pain. The risk of bias of the included studies was evaluated using Cochrane Collaboration’s domain-based two-part tool. Random effects meta-analyses were conducted with 95% confidence intervals.
Results The search strategy identified 555 potentially eligible articles, of which 6 randomized controlled clinical trials were included. In the qualitative analysis, most studies (83.3%) reported lower postoperative pain in treatment groups, while all studies accessing epithelialization demonstrated earlier complete wound closure in groups treated with PRF. The discomfort and complete re-epithelialization were more favorable in groups PRF when compared to control groups (P<0.00001).
Conclusions Within the limits of the present study, it can be concluded that the use of PRF for wound healing of palatal donor sites of FGG may decrease postoperative pain and induce earlier complete wound epithelialization. Key words:Wound healing, oral surgery procedures, pain, postoperative.
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Affiliation(s)
- David-Jonathan-Rodrigues Gusman
- Department of Diagnostic and Surgery - Periodontics Division. São Paulo State University (UNESP), School of Dentistry, Araçatuba.,Department of periodontics, University of Western Sao Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil
| | - Henrique-Rinaldi Matheus
- Department of Diagnostic and Surgery - Periodontics Division. São Paulo State University (UNESP), School of Dentistry, Araçatuba
| | - Breno-Edson-Sendão Alves
- Department of Diagnostic and Surgery - Periodontics Division. São Paulo State University (UNESP), School of Dentistry, Araçatuba.,Department of periodontics, Maringa University Center (UNINGA), Maringa, Parana, Brazil
| | | | | | | | - Maria-José-Hitomi Nagata
- Department of Diagnostic and Surgery - Periodontics Division. São Paulo State University (UNESP), School of Dentistry, Araçatuba
| | | | - Juliano-Milanezi de Almeida
- Department of Diagnostic and Surgery - Periodontics Division. São Paulo State University (UNESP), School of Dentistry, Araçatuba
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20
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Weinberg E, Vered M, Atzil S, Chaushu G, Chaushu L. The dynamics of closure following excisional mid-palatal mucoperiosteal wound in a rat model. Clin Oral Investig 2020; 24:4385-4393. [PMID: 32333177 DOI: 10.1007/s00784-020-03304-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/17/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The aim of the present study was to assess macroscopically the time-related dimensional pattern of excisional palatal mucoperiosteal wound closure in rats, concomitantly with microscopic analysis of the density of inflammatory infiltrate and myofibroblasts. MATERIALS AND METHODS Excisional palatal wounds, 4.2 mm in diameter, were made in twenty-one 2-month-old male Wistar rats. The total area and anteroposterior/laterolateral dimensions of the wounds were measured macroscopically at 1, 2, and 3 weeks post-operatively. In addition, histomorphometry was used for assessment of the intensity of inflammation and density of myofibroblasts in the wound area. RESULTS A significant decrease was found in the total area and anteroposterior but not the laterolateral dimension of the wounds during the 2nd week. These changes were less prominent in the 3rd week. Three weeks post-operatively, the density of inflammatory infiltrate remained high in the central part of the wound concomitant with a significant increase in the number of myofibroblasts. CONCLUSIONS We concluded that the second week was the most significant in wound closure, with wound contraction first occurring in an anteroposterior plane followed by the laterolateral plane. The increased inflammatory reaction and changes in the density of myofibroblasts may explain the macroscopic decrease in wound dimensions in a time-related manner. CLINICAL RELEVANCE These findings emphasize the importance of the amount of soft tissue left at surgery, and suggest that the most appropriate time for the use of healing promoters would be the second post-operative week.
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Affiliation(s)
- Evgeny Weinberg
- Department of Periodontology and Oral Implantology, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Oral Biology, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Marilena Vered
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Svetlana Atzil
- The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Campus Beilinson, Petah Tikva, Israel
| | - Liat Chaushu
- Department of Periodontology and Oral Implantology, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Chiu TS, Chou HC, Kuo PJ, Liang JY, Chiu HC. A novel design of palatal stent to reduce donor site morbidity in periodontal plastic surgery. J Dent Sci 2020; 15:136-140. [PMID: 32595892 PMCID: PMC7305455 DOI: 10.1016/j.jds.2020.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background/ purpose The connective tissue graft from hard palate is a reliable graft technique that has been used for achieving root coverage, increasing keratinized tissue width and thickness in periodontal plastic surgeries. Donor site morbidities, including complications from postoperative bleeding, pain during healing phase, difficulties in eating and speaking and unexpecting healing patterns, are always a concern for both doctors and patients. The aim of this study was to investigate a novel design of palatal stent to reduce these complications and provide patient with a smooth healing experience after soft tissue harvesting from hard palate. Materials and methods Eight patients requiring connective tissue graft from palatal site were included in the study. The palatal stents made with light-curing hybrid composite resin were fabricated and tried in for patients prior to the periodontal plastic surgeries. Stent was delivered immediately without other dressing material or suture after the graft harvesting procedure for blood clot stabilization. Bleeding tendency was evaluated at the completion of the procedure. Patients came back for follow up in 1 week, 2 weeks and 1 month after the surgery. In the consecutive clinical cases, all patients reported minimal postoperative pain and discomfort (score ranged between 0 and 2). Both chewing and swallowing were not affected when wearing the stent, while four patients reported speaking inconvenience influenced by the stent. Results In the consecutive clinical cases, all patient reported minimal postoperative pain and discomfort (Score ranged between 0 and 2). Both chewing and swallowing were not affected when wearing the stent while four patients reported speaking influenced by the stent. Conclusion The novel design of palatal stent reduces donor site morbidity and provides patient with a good healing experience after soft tissue harvesting from hard palate.
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Affiliation(s)
- Tzu-Shan Chiu
- Department of Periodontics, National Taiwan University Hospital, Taipei, Taiwan.,Modern Dental Clinic, Chung-Li, Taoyuan, Taiwan
| | | | - Po-Jan Kuo
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | - Hsien-Chung Chiu
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Yıldırım S, Özener HÖ, Doğan B, Kuru B. Effect of topically applied hyaluronic acid on pain and palatal epithelial wound healing: An examiner-masked, randomized, controlled clinical trial. J Periodontol 2019; 89:36-45. [PMID: 28914592 DOI: 10.1902/jop.2017.170105] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aims to evaluate the effects of two different concentrations of topical hyaluronic acid (HA) on postoperative patient discomfort and wound healing of palatal donor sites after free gingival graft (FGG) surgery. METHODS Thirty-six patients requiring FGG were randomly assigned into three groups in an examiner-masked, randomized, controlled clinical trial. After harvesting palatal grafts, 0.2% and 0.8% HA gels were used in test groups 1 and 2, respectively. Gels were applied on donor sites and protected with periodontal dressing in the test groups, whereas the wound was covered only with periodontal dressing in the control group. On days 3, 7, 14, and 21, pain and burning sensation were recorded using a visual analog scale (VAS) as well as other parameters such as complete epithelization (CE) and color match on days 3, 7, 14, 21, and 42. RESULTS Test groups experienced less pain than the control group on days 3 and 7 (P <0.001 and P <0.001, respectively). Mean VAS score for burning sensation was higher in the control group on day 3 compared with test groups 1 and 2 (P = 0.03 and P = 0.02, respectively). CE in all patients was achieved on day 21 in both test groups, whereas it was achieved on day 42 in the control group. The test groups showed higher color match scores than the control group on days 21 (P <0.001 and P <0.001, respectively) and 42 (P = 0.004 and P = 0.002, respectively). CONCLUSION Topical application of HA exhibits positive impact on postoperative pain and burning sensation, and accelerates palatal wound healing in terms of epithelization and color match.
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Affiliation(s)
- Selin Yıldırım
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Hafize Öztürk Özener
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Başak Doğan
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Bahar Kuru
- Department of Periodontology, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
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Amaliya A, Muhaimina RK, Susanto A, Sutjiatmo AB. Histological Assessment of Palatal Donor Site Wound Healing after Application of Moringa oleifera Lamarck Leaf Extract in Rats. Eur J Dent 2019; 13:248-254. [PMID: 31509874 PMCID: PMC6777152 DOI: 10.1055/s-0039-1695065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective
Palatal excisional wound healing in 60 Sprague–Dawley rats was studied for a period of 14 days.
Materials and Methods
The wounds were made with a punch biopsy instrument with a diameter of 4 mm. After wounding, the test groups received a topical gel of
Moringa oleifera
Lamarck 2% or 4% leaf extract, whereas control groups received povidone iodine gel and hydroxypropyl methylcellulose (HPMC 4%). Three rats were killed at 0, 3, 7, 10, and 14 days after wounding from each allocated group. The wounds were assessed at different control times and light microscopy was employed to view serial sections from blocks with magnification.
Results
Histological examination revealed that group treated with
M. oleifera
Lamarck 4% leaf extract showed the highest fibroblast synthesis and collagen deposition.
Conclusion
This study suggests that
M. oleifera
Lamarck leaf extract could be developed as a therapeutic agent for wound healing.
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Affiliation(s)
- Amaliya Amaliya
- Department of Periodontology, Dental Faculty, Universitas Padjadjaran Bandung, West Java, Indonesia
| | | | - Agus Susanto
- Department of Periodontology, Dental Faculty, Universitas Padjadjaran Bandung, West Java, Indonesia
| | - Afifah B Sutjiatmo
- Faculty of Pharmacy, Universitas Jenderal Ahmad Yani, Cimahi, West Java, Indonesia
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Berridge JP, Johnson TM, Cheng AW, Swenson DT, Miller PD. Focus on Epithelialized Palatal Grafts. Part 3: Methods to Enhance Patient Comfort at Palatal Donor Sites. Clin Adv Periodontics 2019; 9:177-184. [PMID: 31496044 DOI: 10.1002/cap.10066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/08/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Postoperative discomfort is a documented complication of the epithelialized palatal graft (EPG) procedure, and the expectation of an unpleasant patient experience may cause some practitioners to avoid EPG altogether. However, EPG affords distinct advantages in a variety of clinical situations, and the postoperative discomfort associated with the procedure can be minimized. CASE SERIES Three generally and periodontally healthy patients with gingival recession defects and minimal zones of attached gingiva received mandibular anterior EPG procedures. In all cases, collagen membranes were trimmed to fit the palatal donor sites and sutured in place. Two patients reported minimal donor site discomfort at any time point. One patient with large bilateral donor sites reported moderate palatal discomfort limited to the first postoperative week. All patients reported overall positive treatment experiences. CONCLUSIONS Placement of a resorbable collagen membrane at large EPG harvest sites appears to limit topical irritation of the wound and may substantially improve patient comfort postoperatively. Combining local and systemic measures to minimize patient discomfort may render EPG procedures very tolerable for patients. Controlled clinical trials comparing patient-centered outcomes following EPG harvest with and without collagen membrane placement appear warranted.
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Affiliation(s)
- Joshua P Berridge
- Department of Periodontics, US Army Dental Health Activity, Fort Bragg, NC
| | - Thomas M Johnson
- Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, GA
| | - Albert W Cheng
- Department of Periodontics, US Army Dental Health Activity, Fort Leonard Wood, MO
| | - Dane T Swenson
- Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, GA
| | - Preston D Miller
- Distinguished visiting lecturer, New York University, New York, NY
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Chackartchi T, Romanos GE, Sculean A. Soft tissue‐related complications and management around dental implants. Periodontol 2000 2019; 81:124-138. [DOI: 10.1111/prd.12287] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Tali Chackartchi
- Department of Periodontology Faculty of Dental Medicine Hadassah & Hebrew University Jerusalem Israel
| | - Georgios E. Romanos
- Department of Periodontology School of Dental Medicine Stony Brook University Stony Brook New York USA
| | - Anton Sculean
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
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İşler SÇ, Uraz A, Şengül J, Çakıroğlu M, Bakırarar B, Çetiner D. Evalution Of the Patiens Oral Health Related Quality of Life After Harvesting Free Gingival Graft. CUMHURIYET DENTAL JOURNAL 2019. [DOI: 10.7126/cumudj.452909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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YAGHOBEE S, ROUZMEH N, ASLROOSTA H, MAHMOODI S, KHORSAND A, KHARRAZIFARD MJ. Effect of Topical Erythropoietin (EPO) on palatal wound healing subsequent to Free Gingival Grafting (FGG). Braz Oral Res 2018; 32:e55. [DOI: 10.1590/1807-3107bor-2018.vol32.0055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 05/09/2018] [Indexed: 12/14/2022] Open
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Madi M, Kassem A. Topical simvastatin gel as a novel therapeutic modality for palatal donor site wound healing following free gingival graft procedure. Acta Odontol Scand 2018; 76:212-219. [PMID: 29145771 DOI: 10.1080/00016357.2017.1403648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Autogenous soft-tissue grafting is a commonly used procedure nowadays in dentistry. However, the prolonged healing time needed for the donor site leads to increase the patient's pain and discomfort. Statin has been observed to be beneficial in reducing bacterial burden, improving epithelization and wound healing. The aim of this study was to evaluate intra-oral topical application of simvastatin/chitosan gel (10 mg/mL) over the palatal donor site following free gingival graft (FGG) procedure. MATERIAL AND METHODS Subjects indicated for FGG procedure were divided into four groups. Group I: Simvastatin suspension (S), group II: simvastatin/chitosan gel (SC), group III: chitosan gel (C), group IV: petroleum gel (P). Treatment was applied three times/day for the following 7 days. Wound healing was evaluated at day 3, 7 and 14 post-surgery. A visual analogue scale (VAS) was used to measure the experienced discomfort at 1, 3, 5, 7 and 14 days. RESULTS Statistical significant reduction in wound-healing scores was observed after 3 and 7 days for group II compared to other groups (p = .015). A significant reduction was also observed in VAS score for group II compared to other groups at day 1, 3, 5 and 7. CONCLUSION Topical application of S/C gel could be used as a novel therapeutic modality that improved healing and reduced pain in the palatal donor site following FGG procedure.
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Affiliation(s)
- Marwa Madi
- Department of Periodontology, Oral Medicine, Diagnosis and Radiology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Abeer Kassem
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Terenzi M, Pigossi SC, Pires LC, Cirelli JA, Sampaio JE. Modified approach for keratinized tissue augmentation in multiple teeth. J Indian Soc Periodontol 2018; 21:512-516. [PMID: 29551874 PMCID: PMC5846252 DOI: 10.4103/jisp.jisp_332_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case report demonstrated a modified technique of free gingival graft (FGG) aiming to increase keratinized attached tissue in large recipient areas. A FGG to increase the amount of attached gingival tissue, facilitate oral hygiene, and prevent further clinical attachment loss was realized in two patients. Because the extensive recipient area, a modified technique was performed to obtain a smaller graft of the donor area. A template of the graft was made about 25%–30% smaller than the total recipient area. After graft removal, interspersed incisions were made in the upper and lower edges of it. After 9–24 months of follow-up, the final width of the keratinized tissue was 4.0–4.4 times larger in comparison to initial clinical condition. In conclusion, this FGG technique can be considered an alternative to gain sufficient amount of keratinized gingival tissue using a smaller graft.
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Affiliation(s)
- Mayara Terenzi
- Department of Diagnosis and Surgery, Araraquara Dental School, University Estadual Paulista, Araraquara, SP, Brazil
| | - Suzane Cristina Pigossi
- Department of Diagnosis and Surgery, Araraquara Dental School, University Estadual Paulista, Araraquara, SP, Brazil
| | - Luana Carla Pires
- Department of Diagnosis and Surgery, Araraquara Dental School, University Estadual Paulista, Araraquara, SP, Brazil
| | - Joni Augusto Cirelli
- Department of Diagnosis and Surgery, Araraquara Dental School, University Estadual Paulista, Araraquara, SP, Brazil
| | - José Eduardo Sampaio
- Department of Diagnosis and Surgery, Araraquara Dental School, University Estadual Paulista, Araraquara, SP, Brazil
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Bahammam MA. Effect of platelet-rich fibrin palatal bandage on pain scores and wound healing after free gingival graft: a randomized controlled clinical trial. Clin Oral Investig 2018. [DOI: 10.1007/s00784-018-2397-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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31
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Mounssif I, Stefanini M, Mazzotti C, Marzadori M, Sangiorgi M, Zucchelli G. Esthetic evaluation and patient-centered outcomes in root-coverage procedures. Periodontol 2000 2018; 77:19-53. [DOI: 10.1111/prd.12216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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32
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Kulkarni MR, Shettar LG, Bakshi PV, Thakur SL. A novel clinical protocol for the greater palatine compression suture: A case report. J Indian Soc Periodontol 2018; 22:456-458. [PMID: 30210198 PMCID: PMC6128122 DOI: 10.4103/jisp.jisp_140_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Bleeding from the palatal donor site is a worrisome complication of palatal soft tissue harvesting procedures and leads to considerable stress to both the patient and the surgeon. Several methods to control palatal hemorrhage have been suggested in literature, including a palatal suture, but a precise protocol has not been suggested. The present case report aims to suggest a protocol for the greater palatine compression suture (GPCS). Five patients who experienced profuse bleeding from the palatal free gingival graft donor site were treated with the GPCS. The palatal midline was used as a landmark and the location of the greater palatine foramen was estimated. The suture was placed anterior to the estimated location of the foramen and was passed deep into the palatal tissue with the aim of looping and compressing the vascular bundle. In all the patients, an immediate reduction and arrest of bleeding from the palatal wound was observed with blanching of the soft tissues around the suture. The proposed technique is a predictable method to control palatal hemorrhage and can be used if other less invasive techniques fail to stem the blood flow from an injured palatal vessel.
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Affiliation(s)
| | - Leena Gangadhar Shettar
- Department of Periodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Purva Vijay Bakshi
- Private Practice, Teeth and Gums Complete Dental Care, Hubballi, Karnataka, India
| | - Srinath Lakshman Thakur
- Department of Periodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
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Thoma DS, Alshihri A, Fontolliet A, Hämmerle CHF, Jung RE, Benic GI. Clinical and histologic evaluation of different approaches to gain keratinized tissue prior to implant placement in fully edentulous patients. Clin Oral Investig 2017; 22:2111-2119. [DOI: 10.1007/s00784-017-2319-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 12/15/2017] [Indexed: 11/28/2022]
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34
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Ustaoglu G, Ercan E, Tunali M. Low-Level Laser Therapy in Enhancing Wound Healing and Preserving Tissue Thickness at Free Gingival Graft Donor Sites: A Randomized, Controlled Clinical Study. Photomed Laser Surg 2017; 35:223-230. [PMID: 28092488 DOI: 10.1089/pho.2016.4163] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- Gulbahar Ustaoglu
- 1 Department of Periodontology, Karadeniz Technical University , Trabzon, Turkey
| | - Esra Ercan
- 1 Department of Periodontology, Karadeniz Technical University , Trabzon, Turkey
| | - Mustafa Tunali
- 2 Department of Periodontology, Haydarpasa Training Hospital , Gulhane Military Medical Academy, Istanbul, Turkey
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35
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Pippi R. Post-Surgical Clinical Monitoring of Soft Tissue Wound Healing in Periodontal and Implant Surgery. Int J Med Sci 2017; 14:721-728. [PMID: 28824306 PMCID: PMC5562125 DOI: 10.7150/ijms.19727] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/21/2017] [Indexed: 12/25/2022] Open
Abstract
Clinical features of surgical soft tissue wound healing in dentistry have been rarely discussed in the international literature. The aim of the present paper is to highlight both the main clinical findings of surgical wound healing, especially in periodontal and implant dentistry, and the wound healing monitoring procedures which should be followed. Wound inspection after careful food and plaque debridement is the essential part of wound healing monitoring. Periodontal and peri-implant probing should be performed only after tissue healing has been completed and not on a weekly basis in peri-implant tissue monitoring. Telephone follow-up and patient self-assessment scales can also be used the days following surgery to monitor the most common surgical complications such as pain, swelling, bleeding, and bruising. Wound healing monitoring is an important concern in all surgical procedures since it allows to identify signs or/and symptoms possibly related to surgical complications.
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Affiliation(s)
- Roberto Pippi
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
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36
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Ustaoğlu G, Ercan E, Tunali M. The role of titanium-prepared platelet-rich fibrin in palatal mucosal wound healing and histoconduction. Acta Odontol Scand 2016; 74:558-564. [PMID: 27538770 DOI: 10.1080/00016357.2016.1219045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We aimed to determine the clinical effects of titanium-prepared, platelet-rich fibrin (T-PRF) on human palatal mucosal wound healing (PMWH) and to identify its effect on time-dependent changes in palatal soft-tissue thickness (PSTT) in terms of histoconduction, which is a new concept. MATERIALS AND METHODS Free gingival graft (FGG) donor sites were treated with T-PRF and compared with an untreated control group. The results of colour match and H2O2-bubbling tests for complete wound epithelization (CWE) were recorded on days 3, 7, 14 and 21. Pain level, number of analgesics used and bleeding status were recorded for the first 7 days. PSTT was measured at baseline and after 1 and 6 months. RESULTS Colour match scores of the test group were significantly higher than those of the control group at 7 and 14 days. CWE was observed at a higher frequency in the test group than in the control group on day 14. Post-operative bleeding prevalence was lower in the test group than in the control group for the first 2 days. A time-dependent decrease in PSTT was observed at 1 and 6 months in the control group compared with baseline (baseline, 4.23 ± 0.62 mm; 1 month, 4.01 ± 0.68 mm; and 6 months, 3.93 ± 0.69 mm). However, no significant difference was found in the test group (baseline, 4.29 ± 0.64 mm; 1 month, 4.61 ± 0.51 mm; and 6 months, 4.51 ± 0.58 mm). CONCLUSION The T-PRF membrane exhibited positive effects on PMWH. T-PRF, which is a promising autogenous matrix for histoconduction, may also be preferred as an autogenous alternative to connective tissue grafts in the treatment of gingival recessions and peri-implant mucosal recessions.
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Keskiner I, Aydogdu A, Balli U, Kaleli AE. Quantitative changes in palatal donor site thickness after free gingival graft harvesting: a pilot study. J Clin Periodontol 2016; 43:976-984. [PMID: 27330024 DOI: 10.1111/jcpe.12592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2016] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study was to investigate how donor sites thickness quantitatively change over time and at different points of donor site in spontaneous palatal wound healing after free gingival graft (FGG) harvesting. MATERIALS AND METHODS Forty individuals were enrolled and divided into the following two groups based on the residual tissue thickness (RTT) after harvesting: Group 1, <2 mm; and Group 2, ≥2 mm. FGGs were standardized according to their dimensions and thickness and then harvested. Tissue filling was measured at three points of the defect area (mesial, central and distal) at various time points (baseline, after harvesting, and at 1, 3 and 6 months). RESULTS The thickness of newly formed tissue from the baseline to 1 month after harvesting was greater in Group 2 than in Group 1, whereas the thickness from 1 to 3 months and from 3 to 6 months after harvesting was greater in Group 1 than in Group 2 (p < 0.005). RTT was positively correlated with tissue filling in all the groups at all time points (p < 0.05). CONCLUSIONS The palatal mucosal thickness after FGG harvesting might affect the filling of the defect. Within the study period, the periphery of the palatal wounds filled earlier and to a greater extent compared with the centre of the wounds.
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Affiliation(s)
- Ilker Keskiner
- Department of Periodontology, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey.
| | - Ahmet Aydogdu
- Department of Periodontology, Istanbul Application and Research Center, Faculty of Dentistry, Baskent University, Istanbul, Turkey
| | - Umut Balli
- Department of Periodontology, Faculty of Dentistry, Bulent Ecevit University, Zonguldak, Turkey
| | - Ayca E Kaleli
- Department of Periodontology, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
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Pandit N, Khasa M, Gugnani S, Malik R, Bali D. Comparison of two techniques of harvesting connective tissue and its effects on healing pattern at palate and recession coverage at recipient site. Contemp Clin Dent 2016; 7:3-10. [PMID: 27041892 PMCID: PMC4792051 DOI: 10.4103/0976-237x.177099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: To compare the healing pattern in palate following harvestation of connective tissue graft by two different techniques and to compare the recession coverage at the recipient sites. Materials and Methods: 30 recession sites with Miller's class I and II recession in 16 patients were recruited for this study. Sites were randomly divided into 2 treatment groups. Group I used Unigraft Knife to harvest the connective tissue whereas in group II patients Langer & Langer techniques was used to harvest the connective tissue graft from the palate. Healing was evaluated at the donor site using- wound size(WS), immediate bleeding (iB) and delayed bleeding (dB), complete wound epithelialization (CE), sensibility disorders (S) and post operative pain (PP) at baseline, 1st, 4th, and 12th week postoperatively. Recession coverage was assessed by measuring Clinical Attachment Level (CAL), vertical recession (VR), width of keratinized gingiva (KT). Results: On comparison between Group I and II, a statistically significant larger wound size was observed in Group I. CWE was higher in Group II. A non significant difference was observed when SD, and delayed bleeding were compared at all time intervals. A non-significant difference was observed in the clinical parameters at the recipient site. Conclusion: When evaluating the WS and CWE, the Langer and Langer technique was found to be better than the Unigraft knife technique for harvesting the connective tissue graft, whereas both the techniques were found to be effective in root coverage procedure outcomes.
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Affiliation(s)
- Nymphea Pandit
- Department of Periodontics, D.A.V. Dental College, Yamunanagar, Haryana, India
| | - Meenakshi Khasa
- Department of Oral Impalntology. D.A.V. Dental College, Yamunanagar, Haryana, India
| | - Shalini Gugnani
- Department of Periodontics, D.A.V. Dental College, Yamunanagar, Haryana, India
| | - Rajvir Malik
- Department of Periodontics, D.A.V. Dental College, Yamunanagar, Haryana, India
| | - Deepika Bali
- Department of Periodontics, D.A.V. Dental College, Yamunanagar, Haryana, India
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Femminella B, Iaconi MC, Di Tullio M, Romano L, Sinjari B, D’Arcangelo C, De Ninis P, Paolantonio M. Clinical Comparison of Platelet-Rich Fibrin and a Gelatin Sponge in the Management of Palatal Wounds After Epithelialized Free Gingival Graft Harvest: A Randomized Clinical Trial. J Periodontol 2016; 87:103-13. [DOI: 10.1902/jop.2015.150198] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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40
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Keceli HG, Aylikci BU, Koseoglu S, Dolgun A. Evaluation of palatal donor site haemostasis and wound healing after free gingival graft surgery. J Clin Periodontol 2015; 42:582-9. [DOI: 10.1111/jcpe.12404] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2015] [Indexed: 01/04/2023]
Affiliation(s)
- Huseyin Gencay Keceli
- Periodontology Department; Faculty of Dentistry; Hacettepe University; Ankara Turkey
| | - Bahadir Ugur Aylikci
- Periodontology Department; Faculty of Dentistry; Kirikkale University; Kirikkale Turkey
| | - Serhat Koseoglu
- Periodontology Department; Faculty of Dentistry; Katip Celebi University; Izmir Turkey
| | - Anil Dolgun
- Biostatistics Department; Faculty of Medicine; Hacettepe University; Ankara Turkey
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41
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Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000 2015; 68:333-68. [DOI: 10.1111/prd.12059] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 11/29/2022]
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42
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Monje A, Kramp AR, Criado E, Suárez-López Del Amo F, Garaicoa-Pazmiño C, Gargallo-Albiol J, Wang HL. Effect of periodontal dressing on non-surgical periodontal treatment outcomes: a systematic review. Int J Dent Hyg 2015; 14:161-7. [PMID: 25721470 DOI: 10.1111/idh.12130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Periodontal dressing has been advocated and showed some positive outcomes for placing over the surgical site after periodontal surgery. However, little is known about its effect on non-surgical therapy. PURPOSE The aim of this review was to assess the clinical effect of periodontal dressing when used after non-surgical therapy. MATERIAL AND METHODS Two examiners performed an electronic search in several databases for relevant articles published in English up to November 2013. Selected studies were randomized human clinical trials (prospective or retrospective trials) with the clear aim of investigating the effect of periodontal dressing placement upon periodontal non-surgical mechanical therapy. Data were extracted from the included articles for analysis. RESULTS Three randomized clinical trials fulfilled the inclusion criteria and thus were included in the data analysis. Statistical analysis could not be carried out due to the lack of clear data of the included studies. However, descriptive analysis showed its effectiveness in improving clinical parameters such as gain of clinical attachment level and reduction of probing pocket depth. CONCLUSION Placement of periodontal dressing right after non-surgical mechanical therapy can be beneficial in improving overall short-term clinical outcomes, although more controlled studies are still needed to validate this finding.
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Affiliation(s)
- A Monje
- Graduate Periodontics, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | | | - E Criado
- Department of Oral Surgery, International University of Catalonia, Barcelona, Spain
| | - F Suárez-López Del Amo
- Graduate Periodontics, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - C Garaicoa-Pazmiño
- Graduate Periodontics, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Stomatology, Catholic University of Santiago de Guayaquil, Guayaquil, Ecuador
| | - J Gargallo-Albiol
- Department of Oral Surgery, International University of Catalonia, Barcelona, Spain
| | - H-L Wang
- Graduate Periodontics, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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43
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Aravindaksha SP, Batra P, Sood V, Kumar A, Gupta G. Use of Platelet-Rich Fibrin Membrane as a Palatal Bandage. Clin Adv Periodontics 2014. [DOI: 10.1902/cap.2013.130011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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44
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Thoma DS, Mühlemann S, Jung RE. Critical soft-tissue dimensions with dental implants and treatment concepts. Periodontol 2000 2014; 66:106-18. [DOI: 10.1111/prd.12045] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/30/2022]
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45
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Zucchelli G, Mounssif I, Mazzotti C, Montebugnoli L, Sangiorgi M, Mele M, Stefanini M. Does the dimension of the graft influence patient morbidity and root coverage outcomes? A randomized controlled clinical trial. J Clin Periodontol 2014; 41:708-16. [DOI: 10.1111/jcpe.12256] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Ilham Mounssif
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Claudio Mazzotti
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Lucio Montebugnoli
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Matteo Sangiorgi
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Monica Mele
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
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46
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Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 2014; 41 Suppl 15:S123-42. [DOI: 10.1111/jcpe.12185] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/07/2013] [Accepted: 10/16/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Otto Zuhr
- Private Practice Hürzeler/Zuhr; Munich Germany
- Department of Periodontology; Centre for Dental, Oral, and Maxillofacial Medicine (Carolinum); Johann Wolfgang Goethe-University Frankfurt/Main; Frankfurt Germany
| | | | - Markus Hürzeler
- Private Practice Hürzeler/Zuhr; Munich Germany
- Department of Operative Dentistry and Periodontology; University Dental School; University of Freiburg; Freiburg Germany
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47
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Thoma DS, Buranawat B, Hämmerle CH, Held U, Jung RE. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol 2014; 41 Suppl 15:S77-91. [DOI: 10.1111/jcpe.12220] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Borvornwut Buranawat
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Christoph H.F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Ulrike Held
- Horten Centre for Patient Oriented Research and Knowledge Transfer; University Hospital Zurich; Zurich Switzerland
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
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48
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Vignoletti F, Nunez J, Sanz M. Soft tissue wound healing at teeth, dental implants and the edentulous ridge when using barrier membranes, growth and differentiation factors and soft tissue substitutes. J Clin Periodontol 2014; 41 Suppl 15:S23-35. [DOI: 10.1111/jcpe.12191] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Fabio Vignoletti
- Department of Periodontology; University Complutense of Madrid; Madrid Spain
| | - Javier Nunez
- Department of Periodontology; University Complutense of Madrid; Madrid Spain
| | - Mariano Sanz
- Department of Periodontology; University Complutense of Madrid; Madrid Spain
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49
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Maeda T, Masaki C, Kanao M, Kondo Y, Ohta A, Nakamoto T, Hosokawa R. Low-intensity pulsed ultrasound enhances palatal mucosa wound healing in rats. J Prosthodont Res 2013; 57:93-8. [DOI: 10.1016/j.jpor.2012.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 10/30/2012] [Accepted: 11/16/2012] [Indexed: 10/27/2022]
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50
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Thoma DS, Sancho-Puchades M, Ettlin DA, Hämmerle CHF, Jung RE. Impact of a collagen matrix on early healing, aesthetics and patient morbidity in oral mucosal wounds - a randomized study in humans. J Clin Periodontol 2011; 39:157-65. [DOI: 10.1111/j.1600-051x.2011.01823.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich; Switzerland
| | - Manuel Sancho-Puchades
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich; Switzerland
| | - Dominik A. Ettlin
- Clinic of Removable Prosthodonitcs, Masticatory Disorders and Special Care Dentistry; Center of Dental Medicine; University of Zurich; Zurich; Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich; Switzerland
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich; Switzerland
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