Platelet Rich Fibrin Versus Hyaluronic Acid as palatal wound Dressings following epithelialized free gingival graft harvest: A randomized controlled clinical trial

Abstract

Introduction: Patient centered outcome became of great interest nowadays. Patient's pain and discomfort following free gingival graft procedure are common complain. Different palatal dressings are suggested to cover and protect the palatal donor site as stents, collagen gelatin scaffolds, platelet rich fibrin (PRF), hyaluronic acid (HA) and Alvogyl. However, in the literature no ideal agent has been emphasized. Objectives: This randomized controlled clinical trial compares for the first-time the effect of PRF versus HA palatal wound dressings on postoperative pain, post-surgical bleeding, and wound healing. Materials and methods: Following sample size calculation, 30 systemically healthy patients requiring palatal mucosal graft harvesting were randomized to receive either PRF or HA (intervention groups) or gelatin sponge (control group) as palatal dressings. Patient-reported visual analogue score (VAS) pain scores as primary outcome. Post-surgical bleeding and wound healing were considered as secondary outcomes. Results: VAS pain scores were reported minimal in PRF group throughout follow up intervals, PRF was statistically significant when compared to HA group at 3 and 7 days postoperative, PRF was statistically significant when compared to control group from 3 to 30 days postoperative and VAS in PRF was nearly 0 in day 14. PRF group showed the highest value of healing index during all the follow up intervals with mean 4.4 at 30 days that indicates a full healing of palatal wound area. Conclusions: Within this study's limitations, PRF had better outcomes than both HA and gelatin sponge in means of cost, pain reduction, hemostasis and healing properties.

Wound‐healing agents for palatal donor area: A network meta‐analysis

“…(2022) observed that collagen hemostatic sponge promoted better pain control when associated with hyaluronic acid gel than with periodontal dressing. In comparison to L‐PRF, lower pain levels were obtained for L‐PRF in comparison to collagen hemostatic sponge in three studies (Femminella et al., 2016; Hassan et al., 2020; Sousa et al., 2020), however, collagen hemostatic sponge promoted more less levels of pain in comparison to L‐PRF in one case series (Belkhede et al., 2019). Schinini et al.…”

“…Lower pain scores (Bahammam, 2018; Femminella et al., 2016; Hassan et al., 2020; Işler et al., 2019; Kulkarni et al., 2014; Lektemur Alpan & Torumtay Cin, 2020; Ozcan et al., 2017; Shakir et al., 2015) and analgesic consumption (Bahammam, 2018; Femminella et al., 2016; Lektemur Alpan & Torumtay Cin, 2020) were reported in the palatal donor area covered with L‐PRF in comparison to spontaneous healing (Lektemur Alpan & Torumtay Cin, 2020; Shakir et al., 2015), non‐eugenol pack (Bahammam, 2018; Kulkarni et al., 2014), collagen hemostatic sponge (Femminella et al., 2016; Hassan et al., 2020), hyaluronic acid gel (Hassan et al., 2020), cyanoacrylate adhesive (Ozcan et al., 2017) and topical gaseous ozone (Işler et al., 2019). One case series (with three patients per group) showed superior results for collagen hemostatic sponge in comparison to L‐PRF in terms of pain duration and analgesic consumption (Belkhede et al., 2019).…”

“…Most of included studies evaluating palatal donor sites covered with L‐PRF membranes in comparison to spontaneous healing (Lektemur Alpan & Torumtay Cin, 2020; Reddy et al., 2015; Shakir et al., 2015), non‐eugenol pack (Aravindaksha et al., 2014; Bahammam, 2018; Kulkarni et al., 2014), collagen hemostatic sponge (Femminella et al., 2016; Hassan et al., 2020; Sharma et al., 2019), cyanoacrylate adhesive (Ozcan et al., 2017) and hyaluronic acid gel (Hassan et al., 2020) reported considerably faster healing with L‐PRF membranes. Only one case series (with 3 patients per group) showed superior results for collagen hemostatic sponge in comparison to L‐PRF (Belkhede et al., 2019) and one RCT showed no differences between both groups (Alvarez‐Medina et al., 2023).…”

“…(1996) also reported that the use of microcollagen felt associated with periodontal dressing promoted faster healing in comparison to periodontal dressing alone, but not in comparison to fragments of connective tissue with epithelium removed from the graft associated with periodontal dressing. In comparison to L‐PRF, better wound healing was obtained for L‐PRF in comparison to collagen hemostatic sponge in four studies (Femminella et al., 2016; Hassan et al., 2020; Koca‐Ünsal et al., 2022; Sousa et al., 2020), however, collagen hemostatic sponge promoted superior repair in comparison to L‐PRF in one case series (Belkhede et al., 2019). In addition, collagen cones associated with gel based on recombinant human angiogenin promoted better repair in comparison to collagen cones alone (Goryachkin et al., 2019).…”

“…In the formation phase, a granulation tissue is formed and the endothelial, fibroblasts and epithelial cells are responsible for the capillary formation, connective tissue formation, and re‐epithelialization, respectively. The process ends with the remodeling of newly formed tissues and high collagen synthesis in the remodeling phase (Alasqah et al., 2022; Hassan et al., 2020). This phase occurs for weeks and months until the tissues restore their tensile strength to nearly normal levels (Almeida et al., 2009).…”