Postoperative Complications Following Gingival Augmentation Procedures

Abstract

Background: Postoperative pain, swelling, and bleeding are the most common complications following soft tissue grafting procedures; however, detailed documentation is sparse in the literature. The aims of this prospective study were as follows: 1) to compare the frequency of complication occurrence after free soft tissue grafting (FSTG) or subepithelial connective tissue grafting (SCTG) procedures; 2) to evaluate the use of an acellular dermal matrix (ADM) as the donor tissue alternative to an FSTG or SCTG; and 3) to identify possible predictors for these complications. Methods: Seventy‐five FSTG and 256 SCTG procedures were performed in 228 patients by a single operator. In five free soft tissue and 84 bilaminar graft procedures, an ADM was used instead of autogenous tissue. Variables such as the duration and location of procedures, smoking history, gender, and age were recorded. Patients were asked to fill out a questionnaire 1 week after the surgeries regarding postoperative pain, swelling, and bleeding. Data were analyzed using the χ2 test and logistic regression analysis. Odds ratios were calculated for moderate and severe adverse outcomes grouped together. Results: The duration of surgical procedures was highly correlated with pain or swelling post‐surgically (P = 0.001). Current smokers were three times more likely to experience post‐surgical swelling (P = 0.01). Patients who underwent FSTG procedures were three times more likely to develop post‐surgical pain (P = 0.002) or bleeding (P = 0.03) compared to those who received SCTG procedures. When an ADM was applied instead of autogenous tissue, the probability of swelling or bleeding was significantly reduced (odds ratio [OR] = 0.46, P = 0.02 and OR = 0.3, P = 0.001, respectively). Conclusions: Long surgical procedures and smoking may increase the severity and frequency of certain post‐surgical complications after gingival augmentation procedures. FSTG procedures incur a higher likelihood for postoperative pain or bleeding than SCTG procedures, whereas the application of an ADM may significantly reduce the probability of swelling and bleeding.

Palatal wound healing using a xenogeneic collagen matrix – histological outcomes of a randomized controlled clinical trial

“…According to recent systematic reviews, the use of autogenous tissue harvested from the retromolar or palatal area is considered to be the gold standard around teeth and dental implants in partially edentulous patients (Thoma et al, 2014, Thoma et al, 2009, Levine et al, 2014, Cairo et al, 2014. Whereas these transplants and techniques are well documented, disadvantages are often reported, mostly due to the morbidity associated with the harvesting procedure and the respective second surgical site (Griffin et al, 2006, Wessel and Tatakis, 2008, Harris et al, 2005. In order to overcome these drawbacks, a number of soft tissue substitutes, predominantly derived from other medical fields, were introduced in dentistry (Liu et al, 2010).…”

Aplicación de biomateriales de base biológica, moléculas bioactivas e ingeniería de tejidos en cirugía plástica periodontal: Una revisión

“…El riesgo de una intervención quirúrgica prolongada ha sido previamente demostrado por Griffin y col. (3) , quienes compararon la frecuencia de complicaciones postoperatorias entre los diferentes procedimientos de injerto de tejido blando. Por cada minuto del procedimiento se produjo un aumento del 4% en la probabilidad de desarrollar dolor de moderado a severo y un aumento del 3% de moderada o severa inflamación.…”

“…Posteriormente, a mediados de la década de los 80' Langer y Langer (2) , describen la utilización del injerto de tejido conectivo subepitelial para el manejo de las recesiones gingivales. Estas técnicas tienen como desventaja la disección del injerto desde un segundo lecho quirúrgico (aumentando así el tiempo de operación y consecuentemente el riesgo de morbilidad e infección) y una cantidad limitada de tejido en el sitio donante (3) . En consecuencia, se han desarrollado alternativas para reemplazar la utilización de tejidos nativos.…”

Contemporary Esthetic Periodontics

“…By using a soft tissue substitute in lieu of an autogenous graft, the patient does not have the increased morbidity of a second surgical donor site 25 . Allogenic acellular dermal matrix and xenogenic collagen matrix (MUCOGRAFT®) have been used in periodontal plastic surgery and regeneration has been shown 24 .…”