Gingival Recession Clinical Trial
Official title:
The Effects of Palatal Pre-sutures on Hemostasis and Patient Comfort in Connective Tıssue Graft Surgery
Connective tissue graft operation is one of the most frequently performed surgical procedures to increase the width of the attached gingiva and to treat gingival recessions. The most preferred donor site during this operation is the palatal mucosa.Reported postoperative complications are usually related to the donor site. Problems such as prolongation of bleeding time, delay in wound healing and severe pain in the palatal region where the graft is taken are frequently encountered. Bleeding control in the palatal donor area is very important for patient comfort. Additional measures may be required to control bleeding, such as sutures with or without hemostatic agents, or acrylic, plastic palatal stents and periodontal pastes prepared before the operation. Suturing the Greater Palatine Artery (GPA) or terminal vessel branches has been shown to be an effective method to control palatal bleeding. Therefore the aim of this study is to evaluate the effectiveness of the pre-suture method applied in the palatal region before the connective tissue graft is taken in reducing hemostasis.Pre-suture method can increase the operator's field of vision and operational comfort. Patient-reported outcomes such as the amount of pain and bleeding in the palatal donor area during and after surgery, painkiller intake, number of days of discomfort, satisfaction, quality of life, and willingness to be treated will be evaluated. In addition, it will be evaluated whether this suture technique affects the healing of the half-thickness flap in the palatal region after obtaining a connective tissue graft with a single incision method.
Status | Recruiting |
Enrollment | 32 |
Est. completion date | September 1, 2023 |
Est. primary completion date | July 1, 2023 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 19 Years to 60 Years |
Eligibility | Inclusion Criteria: - - The patient must be over the age of 18, - Not having any systemic disease, - Not receiving chemotherapy or radiotherapy treatment, - Not using drugs regularly and not being addicted to drugs, - Not be in pregnancy and/or lactation period, - Not smoking, - Not having received antibiotic treatment in the last 6 months, - Presence of Cairo Type 1 or Type 2 recession defect in a single tooth, - The patient is cooperative. Exclusion Criteria: - The patient is younger than 18 years old, - Active infectious disease (acute hepatitis, AIDS, tuberculosis), cancer or any systemic condition that may affect periodontal tissues, - Receiving chemotherapy or radiotherapy treatment, - Being on regular medication and being addicted to drugs, - Patients with a plaque score greater than 20% after phase I treatment (Silness and Löe, 1964), - Being in pregnancy and/or lactation period, - Being a smoker - To have been treated with antibiotics in the last 6 months, - Not being cooperative. |
Country | Name | City | State |
---|---|---|---|
Turkey | Biruni University | Istanbul | Zeytinburnu |
Lead Sponsor | Collaborator |
---|---|
Biruni University |
Turkey,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Measuring the Amount of Intra-operative Bleeding with a Precision Balance | In our study, the amount of blood lost will be estimated by using the gauze weight method, which is a method of directly estimating blood loss. All measurements will be made on a 1 g precision digital balance. Sterile gauze swabs will be weighed dry before the operation. The gauze pads that will be used later will be moistened with 10 mL of sterile 0.9 g/L saline solution before starting the procedure and the weight will be measured again. The time from the removal of the connective tissue graft to the end of the operation will be measured and the pre-moistened gauze pads will be used on the palate during this period and will be stored separately and their weight will be measured immediately after the operation is over. In this method, aspiration in the palatal region should be avoided to minimize errors in blood loss measurement. | During surgery | |
Primary | Reporting of secondary bleeding as present/absent in the 1st postoperative week | Reporting of secondary bleeding as present/absent both by the patient and by the physician in the follow-up appointments in the 1st postoperative weeks | 1st postoperative week after the operation. | |
Primary | patient discomfort and satisfaction [Oral Health Impact Profile ] | In this evaluation, the Oral Health Impact Profile (OHIP-14) test will be used by marking the patients on the 3rd postoperative day.
Likert response system in the evaluation of the OHIP14 scale: 0: "never", "very little" "sometimes" "quite often" is rated as "often". The total score of the answers given by the participant to each item is evaluated by calculating. The total score is minimum 0, maximum 56. It is concluded that as the total score increases, the severity of the problem increases and the quality of life decreases. |
On the 3rd day after the operation. | |
Primary | Evaluation of the pain felt by the patients after the operation with Visual Analogue Scale | Pain scores will be recorded on the postoperative 3rd day. It is determined by the patient's assessment of the intensity of pain felt on a scale from 0 to 10.
0: No pain, 10: There is unbearable pain. |
3rd day after the operation. | |
Primary | Reporting of secondary bleeding as present/absent in the 2nd postoperative week | Reporting of secondary bleeding as present/absent both by the patient and by the physician in the follow-up appointments in the 2nd postoperative weeks | 2nd postoperative week after the operation. | |
Primary | patient discomfort and satisfaction [Oral Health Impact Profile ] | In this evaluation, the Oral Health Impact Profile (OHIP-14) test will be used by marking the patients on the 1st postoperative week.
Likert response system in the evaluation of the OHIP14 scale: 0: "never", "very little" "sometimes" "quite often" is rated as "often". The total score of the answers given by the participant to each item is evaluated by calculating. The total score is minimum 0, maximum 56. It is concluded that as the total score increases, the severity of the problem increases and the quality of life decreases. |
1st week after the operation. | |
Primary | patient discomfort and satisfaction [Oral Health Impact Profile ] | In this evaluation, the Oral Health Impact Profile (OHIP-14) test will be used by marking the patients on the 2nd postoperative week.
Likert response system in the evaluation of the OHIP14 scale: 0: "never", "very little" "sometimes" "quite often" is rated as "often". The total score of the answers given by the participant to each item is evaluated by calculating. The total score is minimum 0, maximum 56. It is concluded that as the total score increases, the severity of the problem increases and the quality of life decreases. |
2nd week after the operation. | |
Primary | patient discomfort and satisfaction [Oral Health Impact Profile ] | In this evaluation, the Oral Health Impact Profile (OHIP-14) test will be used by marking the patients on the 4th postoperative week.
Likert response system in the evaluation of the OHIP14 scale: 0: "never", "very little" "sometimes" "quite often" is rated as "often". The total score of the answers given by the participant to each item is evaluated by calculating. The total score is minimum 0, maximum 56. It is concluded that as the total score increases, the severity of the problem increases and the quality of life decreases. |
4th week after the operation. | |
Primary | Evaluation of the pain felt by the patients after the operation with Visual Analogue Scale | Pain scores will be recorded on the postoperative 1st week by marking the Visual Analogue Scale (VAS). It will be determined on a scale from 0 (no pain) to 10 (unbearable pain).
It is determined by the patient's assessment of the intensity of pain felt on a scale from 0 to 10. 0: No pain 10: There is unbearable pain |
1st week after the operation. | |
Primary | Evaluation of the pain felt by the patients after the operation with Visual Analogue Scale. | Pain scores will be recorded on the postoperative 2nd week by marking the Visual Analogue Scale (VAS). It will be determined on a scale from 0 (no pain) to 10 (unbearable pain).
It is determined by the patient's assessment of the intensity of pain felt on a scale from 0 to 10. 0: No pain, 10: There is unbearable pain. |
2nd week after the operation. | |
Primary | Evaluation of the pain felt by the patients after the operation with Visual Analogue Scale | Pain scores will be recorded on the postoperative 4th week by marking the Visual Analogue Scale (VAS). It will be determined on a scale from 0 (no pain) to 10 (unbearable pain).
It is determined by the patient's assessment of the intensity of pain felt on a scale from 0 to 10. 0: No pain, 10: There is unbearable pain. |
4th week after the operation. | |
Secondary | Evaluation of palatal wound healing by measuring the Early Wound Healing Index in the first 3 months after the operation | Early Wound Healing Score (EHS): After the operation, the wound area will be evaluated with EHS on the 3rd day. The EWHS consists of three parameters:
A) Clinical signs of re-epithelialization: -Converged incision edges: 6 points, - Contact incision edges: 3 points, - Visible distance between incision edges: will be evaluated as 0 points. B) Clinical signs of hemostasis: - Absence of fibrin at the incision margins: 2 points, - Presence of fibrin at the incision margins: 1 point, - Bleeding at incision margins: 0 points C) Clinical signs of inflammation: - Absence of redness throughout the incision: 2 points, - Redness involving <50% of the incision length: 1 point, - Redness and/or significant swelling involving >50% of the incision length: 0 points. For ideal wound healing, all scores in A, B, and C are added together and the highest score of 10 is considered as the best healing, and the score of 0 for the worst wound healing. |
3rd day after surgery. | |
Secondary | Findings of necrosis on the donor area | Evaluation by the patient by conducting a survey as yes/no | During and first 3 months after surgery | |
Secondary | Findings of healing with complications on the donor area | Evaluation by the patient by conducting a survey as yes/no | During and first 3 months after surgery | |
Secondary | Evaluation of palatal wound healing by measuring the Early Wound Healing Index | Early Wound Healing Score (EHS) :After the operation, the wound area will be evaluated with EHS on the 1st week after surgery. The EHS consists of three parameters:
A) Clinical signs of re-epithelialization: -Converged incision edges: 6 points, - Contact incision edges: 3 points, - Visible distance between incision edges: will be evaluated as 0 points. B) Clinical signs of hemostasis: - Absence of fibrin at the incision margins: 2 points, - Presence of fibrin at the incision margins: 1 point, - Bleeding at incision margins: 0 points C) Clinical signs of inflammation: - Absence of redness throughout the incision: 2 points, - Redness involving <50% of the incision length: 1 point, - Redness and/or significant swelling involving >50% of the incision length: 0 points. For ideal wound healing, all scores in A, B, and C are added together and the highest score of 10 is considered as the best healing, and the score of 0 for the worst wound healing. |
1st week after surgery. | |
Secondary | Evaluation of palatal wound healing by measuring the Early Wound Healing Index | Early Wound Healing Score (EHS) :After the operation, the wound area will be evaluated with EHS on the 2nd week after surgery. The EHS consists of three parameters:
A) Clinical signs of re-epithelialization: -Converged incision edges: 6 points, - Contact incision edges: 3 points, - Visible distance between incision edges: will be evaluated as 0 points. B) Clinical signs of hemostasis: - Absence of fibrin at the incision margins: 2 points, - Presence of fibrin at the incision margins: 1 point, - Bleeding at incision margins: 0 points C) Clinical signs of inflammation: - Absence of redness throughout the incision: 2 points, - Redness involving <50% of the incision length: 1 point, - Redness and/or significant swelling involving >50% of the incision length: 0 points. For ideal wound healing, all scores in A, B, and C are added together and the highest score of 10 is considered as the best healing, and the score of 0 for the worst wound healing. |
2nd week after surgery. | |
Secondary | Evaluation of palatal wound healing by measuring the Early Wound Healing Index | Early Wound Healing Score (EHS) :After the operation, the wound area will be evaluated with EHS on the 1st month after surgery. The EHS consists of three parameters:
A) Clinical signs of re-epithelialization: -Converged incision edges: 6 points, - Contact incision edges: 3 points, - Visible distance between incision edges: will be evaluated as 0 points. B) Clinical signs of hemostasis: - Absence of fibrin at the incision margins: 2 points, - Presence of fibrin at the incision margins: 1 point, - Bleeding at incision margins: 0 points C) Clinical signs of inflammation: - Absence of redness throughout the incision: 2 points, - Redness involving <50% of the incision length: 1 point, - Redness and/or significant swelling involving >50% of the incision length: 0 points. For ideal wound healing, all scores in A, B, and C are added together and the highest score of 10 is considered as the best healing, and the score of 0 for the worst wound healing. |
1st month after surgery. | |
Secondary | Findings of necrosis on the donor area | Evaluation by the physician by conducting a survey as yes/no | During and first 3 months after surgery | |
Secondary | Findings of healing with complications on the donor area | Evaluation by the physician by conducting a survey as yes/no | During and first 3 months after surgery |
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