Efeitos de intervenções protetoras da área doadora palatina em indivíduos submetidos a enxertos gengivais livres: revisão narrativa e ensaio clínico randomizado controlado

Abstract

This research aims to explore the following specific question: "There is still no consensus in the literature on which intervention offers a gold standard for the management and protection of the palate after the removal of epithelialized free grafts (EGLE)." Thus, two studies with distinct approaches are presented: (1) a narrative review of the topic and (2) a randomized controlled clinical trial (ECRC). In the narrative review, the different therapeutic modalities reported for the management of the donor palatal area of gingival grafts were shown to be effective in reducing pain levels, bleeding, and analgesic consumption in the postoperative period. In addition, these therapies were able to maximize the epithelium healing process of the masticatory mucosa, thus improving the quality of life of patients postoperatively. However, there was a greater tendency for platelet-rich fibrin and leukocytes to show advantages over other therapies due to their biological characteristics of tissue repair, thus possibly making it a more effective option compared to other modalities of palatal dressing. The ECRC aimed to evaluate the effects of a new self-adhesive dressing on the palatal donor area in patients undergoing EGLE concerning postoperative pain, impact on quality of life, analgesic consumption, bleeding occurrence, and healing. Therefore, 32 patients undergoing EGLE surgery, with a mean age of 48.6 (± 11.7) years, were randomly allocated into two groups: Control (n=16): fibrin sponge with compressive sutures; and Test Group I (n=16): dressing with fibrin sponge + self-adhesive dressing (ORA-AID®) + compressive sutures. Patients were monitored at 9 time points, namely: T1 (24 hours); T2 (48 hours); T3 (72 hours); T4 (96 hours); T5 (120 hours); T6 (134 hours); T7 (160 hours); T8 (10 days); and T9 (15 days), and the following patient reported outcome measures were assessed: pain scores using the visual analog scale (VAS), the number of analgesics consumed, bleeding, and the impact of EGLE surgeries on individuals' quality of life [through the Oral Health Impact Profile questionnaire (OHIP-14)]. Additionally, the healing process was assessed through a reaction with 3% hydrogen peroxide applied topically to the wound and photographic analyses. Regarding the primary outcome of postoperative pain, a significant reduction in pain scores over time was observed in both groups (p<0.001). However, the control and test groups did not show significant differences in overall VAS scores [test group (mean: 1.7±2.5) and control group (mean: 1.7±1.9; (p=0.298)]. Specifically, from time T8 (i.e., 10 days), the test group reported significantly higher pain scores than the control group (p<0.001), and in relation to gender, significantly higher mean VAS values were reported for women (mean=2.0) compared to men (mean=0.7) (p<0.002). The age (p=0.210) and group (p=1.00) variables did not show significant differences, and the group/time interaction was marginally significant (p=0.055). Regarding secondary outcomes, there were no significant differences in overall quality of life, the amount of analgesics consumed, bleeding occurrence, and healing between the test and control groups. In this context, the ECRC revealed an equivalent effect between the control and test groups regarding all evaluated outcomes.