Palatal Wound Clinical Trial
Official title:
Comparison of Two Different Low-level Laser Intensity Protocols on the Healing of Palatal Wounds After Connective Tissue Graft Removal: Randomized Clinical Trial
The aim of this study was to compare two intensities of LLLT on wound healing process of the donor palatine area after CTG removal.
This is a prospective, parallel and controlled clinical trial. The population evaluated in
the study was selected at Science and Technology Institute - ICT- São José dos Campos,
College of Dentistry.
Patients were assigned to one of the three treatment groups:
- Group 60 (Test, n=18): Periodontal surgery for root coverage through connective tissue
graft and LLLT application on donor site using a 60 J/cm² dose.
- Group 30 (Test, n=18): Periodontal surgery for root coverage through connective tissue
graft and LLLT application on donor site using a 30 J/cm² dose.
- Group Sham (Control, n= 18): Periodontal surgery for root coverage through connective
tissue graft and LLLT SHAM on donor site.
All surgeries were performed by the same expert periodontist (MPS). Before the surgical
procedure, all patients were enlightened about the causes and consequences of gingival
recession and prevention techniques. Factors related to the origin of gingival recession,
such as toothbrush trauma and inflammation caused by biofilm, were controlled through
instruction on standardized brushing technique to avoid the influence of other hygiene
methods capable of promoting trauma on soft tissues. Standardized dental floss and
toothbrushes were given to patients. The surgical technique adopted in the recession defects
was the trapezoidal-type of CAF and the connective tissue graft was removed from palate
mucosa . Briefly, a first incision on the palate was performed perpendicularly to the long
axis of the teeth, 2 to 3 mm apical to the gingival margin. The mesial-distal length of the
incision was determined by the length of the graft required to cover the recession. Because
the selected recessions were in maxillary canines and premolars, the lengths of the graft
varied minimally (10-12mm). The second incision was made parallel to the first one (1-2 mm
apically and parallel to the long axis of the teeth) to separate the subepithelium
connective tissue from the epithelial layer. The incision is carried far enough apically to
provide a 7- mm height of connective tissue to cover the denuded root surface. Afterward,
another incision parallel to the long axis of the teeth starting from the first incision was
performed to separate the subepithelium connective tissue from the periosteum. Then, the
connective tissue graft was removed from the palate as atraumatically as possible. Single
sutures were made on the palate (4-0 silk) and the graft was sutured on the receptor site.
The evaluated parameters were wound remaining area (WRA), scar and tissue colorimetry (TC),
tissue thickness (TT) and postoperative discomfort (D), evaluated at baseline and 7, 14, 45,
60, and 90 days after surgery.
Statistical Analysis: All data were expressed as mean ± standard deviation or expressed in
percentages during the descriptive phase. Data were analyzed according to distribution by
the Shapiro-Wilk test. For the remaining wound area, tissue colorimetry, tissue thickness,
and postoperative discomfort parameter analysis, two way repeated measures ANOVA was
performed for intra- and intergroup analysis. T test was used for intergroup comparison of
the number of analgesics taken. The presence or absence of scars was measured by Q-square
test. Statistical analysis was performed using Sigma Plot 12.0. In all tests a significance
level of 0.05 was chosen.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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