Abordagens terapêuticas para cicatrização do palato após a remoção de enxerto gengival

Abstract

The present study aims to perform a systematic review to assess the effectiveness of different therapeutic approaches for palate healing after gingival graft removal. Furthermore, it also intends to evaluate the effect of hyaluronic acid gel and green tea on palate healing after gingival graft removal through a randomized, controlled clinical trial. This project was divided into two studies. For study 1, electronic searches were performed in PubMed/MEDLINE, Embase, Web of Science, Scopus, LILACS and The Cochrane Library for publications through September 2022. Duplicates were removed in Endnote reference management software and exclusion by title and abstract was performed using the Rayyan online software. After selecting articles by reading the full text, data inheritance, analysis of the quality of included studies network metaanalysis (NMA). In study 2, 42 participants divided into three groups were included: (1) Clot Group (CO) (n=14): no material was placed in the donor area, only the clot was kept in position by means of sutures; (2) Placebo (P) (n=14): donor area on the palate was treated using the placebo gel applied by the participant 3 times a day for 7 days (N&W, Ribeirão Preto, São Paulo, Brazil); (3) Gel Group (G) (n=14): the donor area on the palate was treated using a gel with green tea extract and hyaluronic acid (Professional Soft Tissue Gel, N&W, Ribeirão Preto, São Paulo, Brazil) applied by participant 3 times a day for 7 days. Wound area by clinical measurement and photographic images, complete wound epithelization, and palatal mucosa color were assessed in all groups after 3 days, 1, 2, and 4 weeks. The pain visual analog scale (VAS) and analgesic consumption were used to assess the patient's perception of the treatment used. For study 1, 70 studies were included in the systematic review (qualitative analysis), 14 of which underwent NMA (quantitative analysis). All evaluated wound healing agents promoted better pain control and wound healing compared to suture and hemostatic sponges alone. The NMA results reveal that leukocyte and platelet-rich fibrin (L-PRF) was the most effective agent in reducing postoperative pain in all analyzed periods (1, 3 and 7 days). In study 2, there was no statistically significant difference between groups for any of the variable variables in the assessment periods. The review concludes that PRF demonstrated superiority in controlling postoperative pain in the palate compared to the evaluated treatments. Furthermore, the gel with green tea extract and hyaluronic acid did not accelerate healing of the palate after removal of the gingival graft in the present clinical study.