Effect of Hyaluronic Acid Mucoadhesives on Palatal Wound Healing and Postoperative Discomfort in Free Gingival Graft Surgery: A Clinical Trial
,
Abstract
Objectives: This study aimed to assess the effect of hyaluronic acid (HA) mucoadhesives with two different concentrations on palatal epithelial wound healing and postoperative discomfort following free gingival graft (FGG) surgery.
Materials and Methods: In this triple-blind, randomized, controlled clinical trial, 39 patients undergoing FGG surgery were randomly allocated to three groups (N=13). Following palatal graft harvesting, the two experimental groups received mucoadhesives containing 0.8% and 0.2% HA, while the control group received mucoadhesives without HA. In all groups, the donor site was protected with periodontal dressing. Epithelization, color match, contour, and distortion were assessed at 3, 7, 14, 21, and 42 days, postoperatively using the Landry's healing index and modified Manchester Scar Proforma (mMSP) index. Pain level and response to thermal stimuli were evaluated after 3, 7, 14, and 21 days using a visual analog scale (VAS). Data were analyzed by the Chi-square, Kruskal-Wallis, Mann-Whitney, Friedman, and Wilcoxon signed-rank tests (alpha=0.05).
Results: Significant differences were observed in the mMSP index scores among the groups at 3, 7, 14, and 42 days, favoring HA groups (P<0.05). The Landry's healing index score was significantly higher in 0.8% HA group on day 21 (P=0.023), compared to the control group. No significant differences were found in pain score or thermal stimulus responses among the groups (P>0.05).
Conclusion: Mucoadhesives containing HA were found to enhance palatal wound healing, leading to improved outcomes in terms of epithelization, color match, contour, and distortion reduction.
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2. Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, et al. Patient morbidity and root coverage outcome after subepithelial connective tissue and de‐epithelialized grafts: a comparative randomized‐controlled clinical trial. J Clin Periodontol. 2010 Aug;37(8):728-38.
3. Sanz M, Simion M, Abbas F, Aroca S, Artzi Z, Burkhardt R, et al. Surgical techniques on periodontal plastic surgery and soft tissue regeneration: consensus report of Group 3 of the 10th European Workshop on Periodontology. J Clin Periodontol. 2014 Mar;41:S92-S7.
4. 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 Jun;42(6):582-9.
5. Keceli HG, Sengun D, Berberoglu A, Karabulut E. Use of platelet gel with connective tissue grafts for root coverage: a randomized-controlled trial. J Clin Periodontol. 2008 Mar;35(3):255-62.
6. Hassan A, Akl N, Adel-Khattab D. Platelet rich fibrin versus hyaluronic acid as palatal wound dressings following epithelialized free gingival graft harvest: A randomized controlled clinical trial. Egypt Dent J. 2020 Jul;66(3-July (Oral Medicine, X-Ray, Oral Biology & Oral Pathology)):1587-97.
7. Lee JH, Lee KE, Kang SW, Park SH, Chae YK, Lee MH, et al. Effect of orodispersible hyaluronic acid film on palatal mucosa wound healing. Oral Dis. 2024 Feb;30(2):518-27.
8. Hassan A, Ahmed E, Ghalwash D, Elarab AE. Clinical comparison of MEBO and hyaluronic acid gel in the management of pain after free gingival graft harvesting: a randomized clinical trial. Int J Dent. 2021 Mar; 2021(1):2548665.
9. Uppal R, Ramaswamy GN, Arnold C, Goodband R, Wang Y. Hyaluronic acid nanofiber wound dressing—production, characterization, and in vivo behavior. J Biomed Mater Res B Appl Biomater. 2011 Jan;97(1):20-9.
10. Eskandarinia A, Kefayat A, Rafienia M, Agheb M, Navid S, Ebrahimpour K. Cornstarch-based wound dressing incorporated with hyaluronic acid and propolis: In vitro and in vivo studies. Carbohydr Polym. 2019 Jun;216:25-35.
11. Shuborna NS, Chaiyasamut T, Sakdajeyont W, Vorakulpipat C, Rojvanakarn M, Wongsirichat N. Generation of novel hyaluronic acid biomaterials for study of pain in third molar intervention: a review. J Dent Anesth Pain Med. 2019 Mar;19(1):11-9.
12. Nyman E, Henricson J, Ghafouri B, Anderson CD, Kratz G. Hyaluronic acid accelerates re-epithelialization and alters protein expression in a human wound model. Plast Reconstr Surg Glob Open. 2019 May; 7(5):e2221.
13. Bertl K, Bruckmann C, Isberg PE, Klinge B, Gotfredsen K, Stavropoulos A. Hyaluronan in non‐surgical and surgical periodontal therapy: a systematic review. J Clin Periodontol. 2015 Mar;42(3):236-46.
14. Koray M, Ofluoglu D, Onal E, Ozgul M, Ersev H, Yaltirik M, et al. Efficacy of hyaluronic acid spray on swelling, pain, and trismus after surgical extraction of impacted mandibular third molars. Int J Oral Maxillofac Surg. 2014 Nov;43(11):1399-403.
15. Neuman MG, Nanau RM, Oruña-Sanchez L, Coto G. Hyaluronic acid and wound healing. J Pharm Pharm Sci. 2015 Mar;18(1):53-60.
16. Brandt FS, Cazzaniga A. Hyaluronic acid gel fillers in the management of facial aging. Clin Interv Aging. 2008 Mar;3(1):153.
17. El-Sayed KMF, Dahaba MA, Aboul-Ela S, Darhous MS. Local application of hyaluronan gel in conjunction with periodontal surgery: A randomized controlled trial. Clin Oral Investig. 2012 Aug;16(4):1229-36.
18. Lee J, Jung J, Bang D. The efficacy of topical 0.2% hyaluronic acid gel on recurrent oral ulcers: comparison between recurrent aphthous ulcers and the oral ulcers of Behçet's disease. J Eur Acad Dermatol Venereol. 2008 May;22(5):590-5.
19. Landry RG. Effectiveness of benzydamine HC1 in the treatment of periodontal post-surgical patients (Doctoral dissertation, Faculty of Dentistry, University of Toronto).
20. Lingamaneni S, Mandadi LR, Pathakota KR. Assessment of healing following low-level laser irradiation after gingivectomy operations using a novel soft tissue healing index: A randomized, double-blind, split-mouth clinical pilot study. J Indian Soc Periodontol. 2019 Jan;23(1):53-7.
21. Samani MK, Saberi BV, Tabatabaei SA, Moghadam MG. The clinical evaluation of platelet-rich plasma on free gingival graft's donor site wound healing. Eur J Dent. 2017 Oct;11(04):447-54.
22. Meza-Mauricio J, Furquim CP, Geldres A, Mendoza-Azpur G, Retamal-Valdes B, Moraschini V, et al. 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 Jul;25(7):4239-49.
23. Soliman M, Elbattawy W, Shoeib M. Clinical comparison of topical application of platelet rich fibrin versus application of hyaluronic acid gel in pain management and wound healing after free gingival graft harvesting: A randomized controlled clinical trial. Egypt Dent J. 2022 Jan;68(1):521-32.
24. Antoszewska M, Sokolewicz EM, Barańska-Rybak W. Wide use of hyaluronic acid in the process of wound healing—A rapid review. Sci Pharm. 2024 Feb;92(2):23.
25. Graça MF, Miguel SP, Cabral CS, Correia IJ. Hyaluronic acid—Based wound dressings: A review. Carbohydr Polym. 2020 May;241:116364.
26. Cho YD, Kim KH, Lee YM, Ku Y, Seol YJ. Periodontal wound healing and tissue regeneration: A narrative review. Pharmaceuticals. 2021 May;14(5):456.
27. Çankaya ZT, Gürbüz S, Bakirarar B, Kurtiş B. Evaluation of the effect of hyaluronic acid application on the vascularization of free gingival graft for both donor and recipient sites with laser doppler flowmetry: A randomized, examiner-blinded, controlled clinical trial. Int J Periodontics Restor Dent. 2020 Mar;40(2).
28. Romeo U, Libotte F, Palaia G, Galanakis A, Gaimari G, Tenore G, et al. Oral soft tissue wound healing after laser surgery with or without a pool of amino acids and sodium hyaluronate: a randomized clinical study. Photomed Laser Surg. 2014 Jan;32(1):10-6.
29. Gontiya G, Galgali SR. Effect of hyaluronan on periodontitis: A clinical and histological study. J Indian Soc Periodontol. 2012 Apr;16(2):184-92.
30. 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 Oct;74(7):558-64.
31. Ross GS. Surgical wound care: current views on minimizing dressing-related pain. Prof Nurse. 2004 Sep;20(1):38-40.
32. Wessel JR, Tatakis DN. Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Periodontol. 2008 Mar;79(3):425-30.
33. Bonilla-Gutiérrez AF, Rondón Barragán LS, Barbosa Sánchez IX, Aristizábal Páez OL. Evaluation of the effectiveness of platelet-rich plasma in surgical epidermal wounds in rabbits. Rev UDCA Actual Divulg Cient. 2018 Mar;21(1):147-53.
2. Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, et al. Patient morbidity and root coverage outcome after subepithelial connective tissue and de‐epithelialized grafts: a comparative randomized‐controlled clinical trial. J Clin Periodontol. 2010 Aug;37(8):728-38.
3. Sanz M, Simion M, Abbas F, Aroca S, Artzi Z, Burkhardt R, et al. Surgical techniques on periodontal plastic surgery and soft tissue regeneration: consensus report of Group 3 of the 10th European Workshop on Periodontology. J Clin Periodontol. 2014 Mar;41:S92-S7.
4. 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 Jun;42(6):582-9.
5. Keceli HG, Sengun D, Berberoglu A, Karabulut E. Use of platelet gel with connective tissue grafts for root coverage: a randomized-controlled trial. J Clin Periodontol. 2008 Mar;35(3):255-62.
6. Hassan A, Akl N, Adel-Khattab D. Platelet rich fibrin versus hyaluronic acid as palatal wound dressings following epithelialized free gingival graft harvest: A randomized controlled clinical trial. Egypt Dent J. 2020 Jul;66(3-July (Oral Medicine, X-Ray, Oral Biology & Oral Pathology)):1587-97.
7. Lee JH, Lee KE, Kang SW, Park SH, Chae YK, Lee MH, et al. Effect of orodispersible hyaluronic acid film on palatal mucosa wound healing. Oral Dis. 2024 Feb;30(2):518-27.
8. Hassan A, Ahmed E, Ghalwash D, Elarab AE. Clinical comparison of MEBO and hyaluronic acid gel in the management of pain after free gingival graft harvesting: a randomized clinical trial. Int J Dent. 2021 Mar; 2021(1):2548665.
9. Uppal R, Ramaswamy GN, Arnold C, Goodband R, Wang Y. Hyaluronic acid nanofiber wound dressing—production, characterization, and in vivo behavior. J Biomed Mater Res B Appl Biomater. 2011 Jan;97(1):20-9.
10. Eskandarinia A, Kefayat A, Rafienia M, Agheb M, Navid S, Ebrahimpour K. Cornstarch-based wound dressing incorporated with hyaluronic acid and propolis: In vitro and in vivo studies. Carbohydr Polym. 2019 Jun;216:25-35.
11. Shuborna NS, Chaiyasamut T, Sakdajeyont W, Vorakulpipat C, Rojvanakarn M, Wongsirichat N. Generation of novel hyaluronic acid biomaterials for study of pain in third molar intervention: a review. J Dent Anesth Pain Med. 2019 Mar;19(1):11-9.
12. Nyman E, Henricson J, Ghafouri B, Anderson CD, Kratz G. Hyaluronic acid accelerates re-epithelialization and alters protein expression in a human wound model. Plast Reconstr Surg Glob Open. 2019 May; 7(5):e2221.
13. Bertl K, Bruckmann C, Isberg PE, Klinge B, Gotfredsen K, Stavropoulos A. Hyaluronan in non‐surgical and surgical periodontal therapy: a systematic review. J Clin Periodontol. 2015 Mar;42(3):236-46.
14. Koray M, Ofluoglu D, Onal E, Ozgul M, Ersev H, Yaltirik M, et al. Efficacy of hyaluronic acid spray on swelling, pain, and trismus after surgical extraction of impacted mandibular third molars. Int J Oral Maxillofac Surg. 2014 Nov;43(11):1399-403.
15. Neuman MG, Nanau RM, Oruña-Sanchez L, Coto G. Hyaluronic acid and wound healing. J Pharm Pharm Sci. 2015 Mar;18(1):53-60.
16. Brandt FS, Cazzaniga A. Hyaluronic acid gel fillers in the management of facial aging. Clin Interv Aging. 2008 Mar;3(1):153.
17. El-Sayed KMF, Dahaba MA, Aboul-Ela S, Darhous MS. Local application of hyaluronan gel in conjunction with periodontal surgery: A randomized controlled trial. Clin Oral Investig. 2012 Aug;16(4):1229-36.
18. Lee J, Jung J, Bang D. The efficacy of topical 0.2% hyaluronic acid gel on recurrent oral ulcers: comparison between recurrent aphthous ulcers and the oral ulcers of Behçet's disease. J Eur Acad Dermatol Venereol. 2008 May;22(5):590-5.
19. Landry RG. Effectiveness of benzydamine HC1 in the treatment of periodontal post-surgical patients (Doctoral dissertation, Faculty of Dentistry, University of Toronto).
20. Lingamaneni S, Mandadi LR, Pathakota KR. Assessment of healing following low-level laser irradiation after gingivectomy operations using a novel soft tissue healing index: A randomized, double-blind, split-mouth clinical pilot study. J Indian Soc Periodontol. 2019 Jan;23(1):53-7.
21. Samani MK, Saberi BV, Tabatabaei SA, Moghadam MG. The clinical evaluation of platelet-rich plasma on free gingival graft's donor site wound healing. Eur J Dent. 2017 Oct;11(04):447-54.
22. Meza-Mauricio J, Furquim CP, Geldres A, Mendoza-Azpur G, Retamal-Valdes B, Moraschini V, et al. 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 Jul;25(7):4239-49.
23. Soliman M, Elbattawy W, Shoeib M. Clinical comparison of topical application of platelet rich fibrin versus application of hyaluronic acid gel in pain management and wound healing after free gingival graft harvesting: A randomized controlled clinical trial. Egypt Dent J. 2022 Jan;68(1):521-32.
24. Antoszewska M, Sokolewicz EM, Barańska-Rybak W. Wide use of hyaluronic acid in the process of wound healing—A rapid review. Sci Pharm. 2024 Feb;92(2):23.
25. Graça MF, Miguel SP, Cabral CS, Correia IJ. Hyaluronic acid—Based wound dressings: A review. Carbohydr Polym. 2020 May;241:116364.
26. Cho YD, Kim KH, Lee YM, Ku Y, Seol YJ. Periodontal wound healing and tissue regeneration: A narrative review. Pharmaceuticals. 2021 May;14(5):456.
27. Çankaya ZT, Gürbüz S, Bakirarar B, Kurtiş B. Evaluation of the effect of hyaluronic acid application on the vascularization of free gingival graft for both donor and recipient sites with laser doppler flowmetry: A randomized, examiner-blinded, controlled clinical trial. Int J Periodontics Restor Dent. 2020 Mar;40(2).
28. Romeo U, Libotte F, Palaia G, Galanakis A, Gaimari G, Tenore G, et al. Oral soft tissue wound healing after laser surgery with or without a pool of amino acids and sodium hyaluronate: a randomized clinical study. Photomed Laser Surg. 2014 Jan;32(1):10-6.
29. Gontiya G, Galgali SR. Effect of hyaluronan on periodontitis: A clinical and histological study. J Indian Soc Periodontol. 2012 Apr;16(2):184-92.
30. 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 Oct;74(7):558-64.
31. Ross GS. Surgical wound care: current views on minimizing dressing-related pain. Prof Nurse. 2004 Sep;20(1):38-40.
32. Wessel JR, Tatakis DN. Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Periodontol. 2008 Mar;79(3):425-30.
33. Bonilla-Gutiérrez AF, Rondón Barragán LS, Barbosa Sánchez IX, Aristizábal Páez OL. Evaluation of the effectiveness of platelet-rich plasma in surgical epidermal wounds in rabbits. Rev UDCA Actual Divulg Cient. 2018 Mar;21(1):147-53.
| Issue | Vol 21 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v21i42.16848 | |
| Keywords | ||
| Wound Healing Hyaluronic Acid Epithelium | ||
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How to Cite
1.
Nabiyi P, Jenabian N, Kazemi S, Moghadamnia AA, Seyedmajidi SA. Effect of Hyaluronic Acid Mucoadhesives on Palatal Wound Healing and Postoperative Discomfort in Free Gingival Graft Surgery: A Clinical Trial. Front Dent. 2024;21.
