Palatal Wound Clinical Trial
Official title:
Influence of Enamel Matrix Derivative (Emdogain®) on Palate Wound Healing. Randomized Clinical Trial
The objective of this study is to evaluate clinical and patients-centered parameters of 3-month outcome of the enamel-derived matrix (EMD) application on wound healing process of the donor palatal area after free gingival graft (FGG) removal.
This is a randomized, parallel, double-blind clinical trial. The population that will be
evaluated in this is study will be select at Science and Technology Institute - ICT-Sao Jose
dos Campos, College of Dentistry.
Patients will be assigned to one of the treatments groups:
- Control Group - Free Gingival Graft (n = 22): Atraumatic extraction surgery and free
gingival graft for sealing the entrance of the alveolus
- Test Group - Free Gingival Graft + EMD (n = 22): Atraumatic extraction surgery with
placement of a free gingival graft to seal the entrance of the alveolus associated with
EMD in the open wound on the palate.
All surgeries will be performed by the same expert periodontist (MMVM). A blade 15c
(Swann-Morton® - Sheffield, England) mounted on No. 3 scalpel handle will make an
intrasulcular incision around the tooth indicated for exodontia. Then, the tooth will be
extracted through the use of appropriate instruments in order to obtain a minimally traumatic
exodontia. With the aim to ridge preservation after tooth extraction the socket will be
sealed with a free gingival graft removed from the palate. For the free gingival graft
removal, a circular template of 8 millimeters in diameter will be used. This stent has the
objective of standardizing the palatal graft removal ensuring the wounds will have always the
same size. After the circular incision, the graft will be removed with a thickness of 2
millimeters. After free gingival graft removal from palate, it will be adjusted to the
entrance of the socket and sutured with Vicryl® 5.0 reabsorbable (Ethicon Johnsons do Brasil,
São José dos Campos - SP).
After the graft position, EMD will be applied immediately after the graft removal surgical
procedure on the palatal donor area, leaving it in contact with the wound for 5 min. In
sequence, it will be covered with an individualized acetate plate that will extend throughout
the palatal area and be in position for 2 hours after the procedure.
The evaluated clinical parameters will be: wound remaining area (WRA), scar and tissue
colorimetry (TC), tissue thickness (TT) and epithelization (E). Moreover, patient-centered
also will be evaluated as: number of pills (NP), tissue edema (TE), postoperative discomfort
(D) and Oral Health Impact Profile (OHIP).
All data will be expressed as mean ± standard deviation (SD), and normality will be tested
using the Shapiro-Wilk test. Values for remaining wound area, scar and tissue colorimetry,
tissue thickness, and epithelization will be examined by repeated measures ANOVA to assess
differences within and between groups, followed by a Tukey test for multiple comparisons when
the value of p Shapiro-Wilk ≥ 0.05. Those with Shapiro-Wilk p values <0.05 will be analyzed
using the Friedman test (for intragroup comparisons) and Mann-Whitney tests (for intergroup
comparisons). Values referring to patient-centered parameters such as postoperative
discomfort, the number of analgesics taken, tissue edema and oral health impact profile
measurements will be analyzed using the T-Test
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