Abstract
Objectives
The aim of this study was to compare the effects of a hemostatic collagen sponge and a collagen sponge sealed with a bio-adhesive material on the palatal donor sites with the purpose of minimizing postoperative pain after epithelialized gingival graft (EGG) harvesting.
Material and methods
The present study consisted of 44 EGGs harvested in 44 patients. In the control group, a hemostatic collagen sponge was applied over the palatal wound, while the test group was treated with additional cyanoacrylate. Patients were observed for 14 days, evaluating the pain level by using the visual analogic scale. The consumption of analgesic during the postoperative period, the willingness for retreatment and the characteristic of the graft were also analyzed.
Results
Statistically significant differences in pain perception were found between test and control groups in each of the studied days (p < 0.01). Analgesic consumption was lower in the test group (p < 0.01). Graft width < 14 mm was found to be associated with lower discomfort (p < 0.01).
Conclusions
Adding an additional layer of cyanoacrylate over a hemostatic collagen sponge on the palatal wound following EGG harvesting was found to be successful in minimizing the postoperative discomfort and the need for analgesics.
Clinical relevance
Postoperative pain after palatal tissue harvesting can be successfully minimized if the donor site open wound is protected with an external layer of cyanoacrylate over a collagen sponge.
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References
Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA (2008) Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller class I and II recession-type defects? J Dent 36(9):659–671. https://doi.org/10.1016/j.jdent.2008.05.007
Chambrone L, Sukekava F, Araujo MG, Pustiglioni FE, Chambrone LA, Lima LA (2009) Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database Syst Rev 2:CD007161. https://doi.org/10.1002/14651858.CD007161.pub2
Cairo F, Pagliaro U, Nieri M (2008) Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol 35(8 Suppl):136–162. https://doi.org/10.1111/j.1600-051X.2008.01267.x
Pini Prato GP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C, Rotundo R, Muzzi L (2005) Coronally advanced flap: the post-surgical position of the gingival margin is an important factor for achieving complete root coverage. J Periodontol 76(5):713–722. https://doi.org/10.1902/jop.2005.76.5.713
Chambrone L, Tatakis DN (2015) Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 86(2 Suppl):S8–S51. https://doi.org/10.1902/jop.2015.130674
Leong DJ, Wang HL (2011) A decision tree for soft tissue grafting. Int J Periodontics Restorative Dent 31(3):307–313
Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P (2010) Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. J Clin Periodontol 37(7):644–650. https://doi.org/10.1111/j.1600-051X.2010.01559.x
Zucchelli G, Mounssif I (2015) Periodontal plastic surgery. Periodontol 2000 68(1):333–368. https://doi.org/10.1111/prd.12059
Roccuzzo M, Grasso G, Dalmasso P (2016) Keratinized mucosa around implants in partially edentulous posterior mandible: 10-year results of a prospective comparative study. Clin Oral Implants Res 27(4):491–496. https://doi.org/10.1111/clr.12563
Zucchelli G, Mazzotti C, Mounssif I, Mele M, Stefanini M, Montebugnoli L (2013) A novel surgical-prosthetic approach for soft tissue dehiscence coverage around single implant. Clin Oral Implants Res 24(9):957–962. https://doi.org/10.1111/clr.12003
Nordland WP, Sandhu HS, Perio C (2008) Microsurgical technique for augmentation of the interdental papilla: three case reports. Int J Periodontics Restorative Dent 28(6):543–549
Jung RE, Sailer I, Hammerle CH, Attin T, Schmidlin P (2007) In vitro color changes of soft tissues caused by restorative materials. Int J Periodontics Restorative Dent 27(3):251–257
Edel A (1974) Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. J Clin Periodontol 1(4):185–196
Langer B, Langer L (1985) Subepithelial connective tissue graft technique for root coverage. J Periodontol 56(12):715–720. https://doi.org/10.1902/jop.1985.56.12.715
Harris RJ (1997) A comparison of two techniques for obtaining a connective tissue graft from the palate. Int J Periodontics Restorative Dent 17(3):260–271
Hurzeler MB, Weng D (1999) A single-incision technique to harvest subepithelial connective tissue grafts from the palate. Int J Periodontics Restorative Dent 19(3):279–287
Lorenzana ER, Allen EP (2000) The single-incision palatal harvest technique: a strategy for esthetics and patient comfort. Int J Periodontics Restorative Dent 20(3):297–305
Del Pizzo M, Modica F, Bethaz N, Priotto P, Romagnoli R (2002) The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site. A preliminary study. J Clin Periodontol 29(9):848–854
Jahnke PV, Sandifer JB, Gher ME, Gray JL, Richardson AC (1993) Thick free gingival and connective tissue autografts for root coverage. J Periodontol 64(4):315–322. https://doi.org/10.1902/jop.1993.64.4.315
Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M (2010) Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 37(8):728–738. https://doi.org/10.1111/j.1600-051X.2010.01550.x
Bertl K, Pifl M, Hirtler L, Rendl B, Nurnberger S, Stavropoulos A, Ulm C (2015) Relative composition of fibrous connective and fatty/glandular tissue in connective tissue grafts depends on the harvesting technique but not the donor site of the hard palate. J Periodontol 86(12):1331–1339. https://doi.org/10.1902/jop.2015.150346
Wessel JR, Tatakis DN (2008) Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Periodontol 79(3):425–430. https://doi.org/10.1902/jop.2008.070325
Griffin TJ, Cheung WS, Zavras AI, Damoulis PD (2006) Postoperative complications following gingival augmentation procedures. J Periodontol 77(12):2070–2079. https://doi.org/10.1902/jop.2006.050296
Dias SB, Fonseca MV, Dos Santos NC, Mathias IF, Martinho FC, Junior MS, Jardini MA, Santamaria MP (2015) Effect of GaAIAs low-level laser therapy on the healing of human palate mucosa after connective tissue graft harvesting: randomized clinical trial. Lasers Med Sci 30(6):1695–1702. https://doi.org/10.1007/s10103-014-1685-2
Ozcelik O, Seydaoglu G, Haytac CM (2016) Diode laser for harvesting de-epithelialized palatal graft in the treatment of gingival recession defects: a randomized clinical trial. J Clin Periodontol 43(1):63–71. https://doi.org/10.1111/jcpe.12487
Femminella B, Iaconi MC, Di Tullio M, Romano L, Sinjari B, D’Arcangelo C, De Ninis P, Paolantonio M (2016) 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 87(2):103–113. https://doi.org/10.1902/jop.2015.150198
Thoma DS, Hilbe M, Bienz SP, Sancho-Puchades M, Hammerle CH, Jung RE (2016) Palatal wound healing using a xenogeneic collagen matrix—histological outcomes of a randomized controlled clinical trial. J Clin Periodontol 43(12):1124–1131. https://doi.org/10.1111/jcpe.12624
Jackson CM, Nguyen M, Mancini R (2017) Use of cyanoacrylate glue casting for stabilization of periocular skin grafts and flaps. Ophthal Plast Reconstr Surg 33(3):218–220. https://doi.org/10.1097/IOP.0000000000000827
David A, Liberge R, Perret C, Frampas E, Douane F (2017) CT-guided direct percutaneous treatment of a ruptured pulmonary artery pseudoaneurysm using N-butyl cyanoacrylate. Diagn Interv Imaging 98:903–904. https://doi.org/10.1016/j.diii.2017.06.005
Kuwahara K, Ichikawa T, Haruma J, Hishikawa T, Hiramatsu M, Sugiu K, Date I (2017) Preoperative embolization for solid cerebellar hemangioblastoma on the day of surgery: two case reports. No Shinkei Geka 45(7):615–622. https://doi.org/10.11477/mf.1436203560
Ozyer U (2017) Transcatheter arterial embolization with N-butyl-2-cyanoacrylate in the management of spontaneous hematomas. Cardiovasc Intervent Radiol 40(1):41–49. https://doi.org/10.1007/s00270-016-1463-6
Bartenstein DW, Cummins DL, Rogers GS (2017) A prospective, randomized, single-blind study comparing cyanoacrylate adhesives to sutures for wound closure in skin cancer patients. Dermatol Surg 43:1371–1378. https://doi.org/10.1097/DSS.0000000000001200
Ilgenfritz JN, Aydos RD, Silva IS, Ramalho RT, Ilgenfritz JJ, Campos GG, Nakamura RK, Guerisoli DM, Cantero WB (2017) The application of cyanoacrilate surgical glue on skin suture in rats. Acta Cir Bras 32(1):56–64. https://doi.org/10.1590/s0102-865020170107
Gumus P, Buduneli E (2014) Graft stabilization with cyanoacrylate decreases shrinkage of free gingival grafts. Aust Dent J 59(1):57–64. https://doi.org/10.1111/adj.12149
Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG, CONSORT (2012) CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg 10(1):28–55. https://doi.org/10.1016/j.ijsu.2011.10.001
Cortellini P, Tonetti M, Baldi C, Francetti L, Rasperini G, Rotundo R, Nieri M, Franceschi D, Labriola A, Prato GP (2009) Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? A multi-centre, randomized, double-blind, clinical trial. J Clin Periodontol 36(1):68–79. https://doi.org/10.1111/j.1600-051X.2008.01346.x
Cairo F, Nieri M, Pagliaro U (2014) Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 41 Suppl 15:S44–S62. https://doi.org/10.1111/jcpe.12182
McGuire MK, Scheyer ET (2010) Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects. J Periodontol 81(8):1108–1117. https://doi.org/10.1902/jop.2010.090698
Zuhr O, Baumer D, Hurzeler M (2014) The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 41 Suppl 15:S123–S142. https://doi.org/10.1111/jcpe.12185
Fickl S, Fischer KR, Jockel-Schneider Y, Stappert CF, Schlagenhauf U, Kebschull M (2014) Early wound healing and patient morbidity after single-incision vs. trap-door graft harvesting from the palate—a clinical study. Clin Oral Investig 18(9):2213–2219. https://doi.org/10.1007/s00784-014-1204-7
Ochstein AJ, Hansen NM, Swenson HM (1969) A comparative study of cyanoacrylate and other periodontal dressings on gingival surgical wound healing. J Periodontol 40(9):515–520. https://doi.org/10.1902/jop.1969.40.9.515
Choi BH, Kim BY, Huh JY, Lee SH, Zhu SJ, Jung JH, Li J (2006) Cyanoacrylate adhesive for closing sinus membrane perforations during sinus lifts. J Craniomaxillofac Surg 34(8):505–509. https://doi.org/10.1016/j.jcms.2006.07.859
Elgazzar RF, Abdulmajeed I, Mutabbakani M (2007) Cyanoacrylate glue versus suture in peripheral nerve reanastomosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104(4):465–472. https://doi.org/10.1016/j.tripleo.2007.01.019
Soni A, Narula R, Kumar A, Parmar M, Sahore M, Chandel M (2013) Comparing cyanoacrylate tissue adhesive and conventional subcuticular skin sutures for maxillofacial incisions—a prospective randomized trial considering closure time, wound morbidity, and cosmetic outcome. J Oral Maxillofac Surg 71(12):2152.e1–2152.e8. https://doi.org/10.1016/j.joms.2013.08.029
Devrukhkar VN, Hegde RJ, Khare SS, Saraf TA (2015) Evaluation of isoamyl 2-cyanoacrylate tissue adhesive in management of pediatric lacerations: an alternative to suturing. Ann Maxillofac Surg 5(1):49–54. https://doi.org/10.4103/2231-0746.161059
Ghoreishian M, Gheisari R, Fayazi M (2009) Tissue adhesive and suturing for closure of the surgical wound after removal of impacted mandibular third molars: a comparative study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108(1):e14–e16. https://doi.org/10.1016/j.tripleo.2009.03.001
Joshi AD, Saluja H, Mahindra U, Halli R (2011) A comparative study: efficacy of tissue glue and sutures after impacted mandibular third molar removal. J Maxillofac Oral Surg 10(4):310–315. https://doi.org/10.1007/s12663-011-0241-x
Burkhardt R, Hammerle CH, Lang NP, Research Group on Oral Soft Tissue B, Wound H (2015) Self-reported pain perception of patients after mucosal graft harvesting in the palatal area. J Clin Periodontol 42(3):281–287. https://doi.org/10.1111/jcpe.12357
Acknowledgements
The authors wish to acknowledge Dr. Corrado Tavelli for his valuable support in performing the surgeries.
Funding
This paper was partially supported by the University of Michigan Periodontal Graduate Student Research Fund.
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All procedures performed in the present study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in this article.
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Tavelli, L., Ravidà, A., Saleh, M.H.A. et al. Pain perception following epithelialized gingival graft harvesting: a randomized clinical trial. Clin Oral Invest 23, 459–468 (2019). https://doi.org/10.1007/s00784-018-2455-5
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DOI: https://doi.org/10.1007/s00784-018-2455-5