Free Gingival Graft Clinical Trial
Official title:
Palatal Wound Healing Evaluation After Application of Platelet Rich Fibrin Versus 0.2% Hyaluronic Acid Dressings (Randomized Controlled Clinical Trial)
Free gingival graft (FGG) was first proposed by Bjorn 1963 and Nabers 1966. FGG is indicated
to correct mucogingival problems such as inadequate or lack of attached gingiva and gingival
recession. The most frequent donor site for free gingival graft is the palate
Although, great concern has been given to the recipient sites by using different techniques
as suturing, tissue adhesives and special dressings, a little attention was given to protect
the donor sites after free gingival graft harvesting. The palatal donor site heal by
secondary intention, it could take around 2 to 4 weeks depending on the width and thickness
of the tissue removed.The common clinical events that occurs following FGG procedure are
patient's discomfort, pain and bleeding at the donor site.
In an attempt to protect the plate (donor site) so that it could help in decreasing the
patient's post operative pain, Farnoush suggested variant clinical techniques. One of these
techniques was interproximal wire ligation by placing a stainless steel wire anchored on the
teeth stabilizing the periodontal dressing. He also suggested using a modified Hawley
appliance which would act as a palatal stent protecting the palate to help in healing.
After periodontal surgeries, the donor site (palate) has to be protected from the external
environment by many dressing materials. Conventional periodontal dressings provide an inert
barrier that help healing by preventing the external insults on the wound area. However,
these dressings do not affect the cellular behavior and do not display a role in the
biological events that happen during wound healing.
Platelet-rich fibrin (PRF) is a simple procedure where patient's own blood is collected and
centrifuged. PRF clot forms a strong fibrin matrix that can be compressed to form a membrane.
PRF membrane consists of a fibrin 3D mesh polymerized in a specific structure that
incorporates platelets, leukocytes, growth factors; and the circulating stem cells.PRF
membrane enhance angiogenesis, immunity and wound epithelialisation. Thus, based on such
findings the PRF membrane can be used as a palatal dressing
PRF membrane enhances the healing of the donor site (palate).According to Shakir et al.,
complete epithelialisation of the palatal donor site was reached by 18th day after FGG in the
groups where PRF membranes was placed with less pain scores on the 2nd and 7th day than the
control group. Therefore PRF membranes showed higher capabilities of the donor site healing
stimulation.
Hyaluronic acid (HA) is a high molecular weight, non-sulphated polysaccharide component of
the family of the glycosaminoglycanes,it is present in various body fluids such as synovial
fluid, serum, saliva and gingival crevicular fluid. In addition, it represents an important
component of the extracellular matrix of skin, connective tissue, synovial joints and other
tissues. HA is identified in all periodontal tissues, being prominent in the non-mineralized
tissues such as gingiva and periodontal ligament, and in low quantities in mineralized
tissues such as cementum and alveolar bone.
Hyaluronic acid has been suggested as monotherapy or as an adjunct to non-surgical and/or
surgical periodontal treatment to reduce inflammation and promote wound healing. Hyaluronic
acid can be used to accelerate the palatal wound healing at the donor site after free
gingival graft surgery
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