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   Table of Contents    
CASE REPORT
Year : 2019  |  Volume : 23  |  Issue : 6  |  Page : 589-592  

Comparative evaluation of the platelet-rich fibrin bandage versus gelatin sponge-assisted palatal wound healing of free gingival graft donor site: A case series


Department of Periodontology and Oral Implantology, Surendera Dental College and Research Institute, Sri-Ganganagar, Rajasthan, India

Date of Submission14-Mar-2019
Date of Acceptance06-May-2019
Date of Web Publication27-Nov-2019

Correspondence Address:
Samyak Gautam Belkhede
Department of Periodontology, Surendera Dental College and Research Institute, Sri Ganganagar - 335 001, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisp.jisp_165_19

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   Abstract 


Periodontal plastic surgery often involves palatal donor site, thereby creating an open wound that is prone to postoperative complications such as bleeding, pain, and slow healing process. To prevent the same, platelet-rich fibrin (PRF) and gelatin sponge (GS) were utilized equally at the donor site in six patients. Patients were monitored at the 1st, 2nd, 3rd, and 4th weeks after surgery for postoperative discomfort (D), consumption of analgesics during first postoperative week, alteration of sensitivity (AS), change in feeding habits (CFH), complete wound epithelialization (CWE), and healing index (Landry et al. 1998). Two patients in the GS group showed significantly early CWE, higher healing index score, and less D, AS, and CFH postoperatively in comparison to the PRF group. It was suggested that GS can also be considered as an effective, economical, and biocompatible dressing material of choice to enhance wound healing and to minimize postoperative complications associated with the donor site.

Keywords: Alteration of sensitivity, change in feeding habits, complete wound epithelialization, gelatin sponge, platelet-rich fibrin, post-operative discomfort


How to cite this article:
Belkhede SG, Salaria SK, Aggarwal R. Comparative evaluation of the platelet-rich fibrin bandage versus gelatin sponge-assisted palatal wound healing of free gingival graft donor site: A case series. J Indian Soc Periodontol 2019;23:589-92

How to cite this URL:
Belkhede SG, Salaria SK, Aggarwal R. Comparative evaluation of the platelet-rich fibrin bandage versus gelatin sponge-assisted palatal wound healing of free gingival graft donor site: A case series. J Indian Soc Periodontol [serial online] 2019 [cited 2019 Dec 11];23:589-92. Available from: http://www.jisponline.com/text.asp?2019/23/6/589/263380




   Introduction Top


Compromised width of attached gingiva is the most common mucogingival problem which is often associated with gingival recession and or lack of adequate vestibular depth. Different periodontal surgical procedures are recommended for the management of the same, but subepithelial connective tissue and free gingival grafting (FGG) yield excellent outcome in terms of the increased width of attached gingiva but are associated with postoperative complications at the donor site. Various hemostatic agents have been recommended for the management of donor sites, but each one has its own disadvantages.[1],[2],[3] Till date, most of the reports studied the efficacy of platelet-rich fibrin (PRF)/collagen/oxidized regenerated cellulose, etc., in comparison to control. The present case series was the second of its own kind to the best of our knowledge, comparatively evaluated the efficiency of PRF membrane and gelatin sponge (GS) as a dressing material at the palatal donor site.


   Case Report Top


Six patients were randomly selected of 13 patients from the institutional outpatient department after fulfillment of inclusion criterion (patients ≥18 years of age with at least one site of Miller Class I or Class II recessions [≥3 mm of depth] in mandibular anterior teeth) and exclusion criterion (patients with systemic diseases, coagulation disorders, pregnancy, and recession defects associated with caries or restoration, smokers, and those with the past history of periodontal surgery on the involved site). All the patients submitted the written signed consent after listen about the study protocol with their pros and cons. The present pilot study was conducted as per the Helsinki Declaration revised in 2013 and was approved by the institutional ethical committee. To avoid bias, sequentially numbered, opaque, sealed envelopes method was used for randomization.

Methodology

Phase I periodontal therapy was performed. Routine blood investigations advised were reported to be within the normal limits. Under the aseptic surgical protocol, local anesthesia was administered. After root planning, gingival de-epithelization was carried out first, followed by mucogingival incision for the preparation of FGG recipient surgical site. FGG harvested from the palatal site was further trimmed to 1.5–2 mm thickness using the conventional scalpel technique and was secured at recipient sites, utilizing 4-0 vicryl suture. All the donor sites were equally covered by GS and Choukroun's PRF membrane bandage and secured by 4-0 vicryl sutures. Oral hygiene instructions for 7 days and analgesic SOS were advised with clear instructions to record the number of analgesics consumed, intensity, nature, and duration of pain.

Postoperative discomfort (D) was evaluated utilizing the Numerical Rating Scale (NRS) till the 1st week postoperatively, whereas complete wound epithelialization (CWE) was assessed by utilizing hydrogen peroxide (3%) test [Figure 1] and [Figure 2], and change in feeding habits (CFH) and alteration of sensitivity (AS) were recorded using the NRS with healing index at each interval till the 4th week postoperatively.
Figure 1: (Alphabets A, B, C, D, E, and downward arrow ↓ represent immediate after dressing, 1st, 2nd, 3rd, and 4th week postoperative healing in patients [P1, P2, and P3] in both the groups) P1, P3 (C), and P2 (D) – Absence of bubbles indicating complete epithelialization at 2nd and 3rd weeks postoperatively, P1, P2, and P3 (E) – Perfect tissue color blending at 4th week postoperatively

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Figure 2: (Alphabets A, B, C, D, E, and downward arrow ↓ represent immediate after dressing, 1st, 2nd, 3rd, and 4th week post-operative healing in patients (P1, P2, and P3)in both the groups) P1, P2, and P3 (D) – Absence of bubbles indicating complete epithelialization at the 3rd week post-operatively, P1 (E) – showed only perfect tissue color blending, whereas P2 and P3 (E) – complete healing but the persistence of slight redness at 4th week post-operatively

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   Results Top


GS group patients reported with less D in terms of duration of pain, the number of analgesic consumed, and CFH and AS with better CWE in two patients and in the third patient at 2nd-and 3rd-week postoperatively in comparison to PRF group where CWE occurred at the 3rd week [Table 1].
Table 1: Evaluation of D, AS, CFH through NRS (Scale of 1–10) score, Consumption of Analgesic, delayed bleeding, CWE, Healing Index and Wound dimension observations in Group I (PRF Bandage group) and Group II (GS group)

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   Discussion Top


FGG is utilized for gingival recession coverage, to increase the width of attached gingiva alone or in combination. It is most commonly procured from the palate but leaving the donor site that needs a long time to heal by secondary intention and also causes postoperative discomfort to the patient.[4] Therefore, PRF and GS bandage were utilized at the FGG donor site in the present report to evaluate its effect on the healing of donor site and to overcome/reduce the different complications associated with it on the basis of different parameters described above.

D and amount of analgesics consumed were reported to be less in the GS group than PRF group, which was in contrary to the report of Femminella et al.[5] Overall AS level was found to be greater in the PRF group than GS group, which was first observed in our study, but the intensity of sensitivity seems to decrease at subsequent visits in both the groups, which was in accordance with the results of Femminella et al.[5]

The trend in CFH was similar till the 1st week in both the groups, which was in accordance to the report of Femminella et al.,[5] but GS group showed CFH till the 2nd week which was contrary to the report of Femminella et al.[5] The reason for the least degree of D, AS, and CFH observed in the GS group may be because the thickness of the remaining soft tissue covering the palatal bone after FGG harvested will be approximately ≥ 2 mm in GS group.[6]

Studies on the donor site of FGG have shown that palatal wound requires 2–4 weeks to heal with secondary intention.[7] In the present series, PRF was used as a palatal bandage for CWE that was reported to occur at the 3rd week, which was similar to the results observed by Femminella et al.[5] The possible reason may be because PRF is a three-dimensional (3D) fibrin network and represents a combination of cytokines, structural glycoproteins, and glycanic chains that play a synergetic role in healing and stimulating angiogenesis, immunity, and epithelialization.[8] However, in the GS group, two patients showed CWE at the 2nd and at 3rd weeks respectively. The possible reason for this may be because GS may act in support of clotting by the formation of a mechanical matrix,[9] which mimics natural extracellular matrix by providing 3D space for cell growth and proliferation; in addition, gelatin has good hydrophilicity, biodegradability, and low antigenicity,[10] which was partially in accordance to the report of Rossmann and Rees[9] where complete wound healing in 80% occurred by the end of 3rd week. GS group showed comparatively better donor site healing than PRF group. Overall early CWE was observed in GS group may be because the rate of wound healing is strongly associated with wound size[9] as it was observed in our report that the wound size of GS group (volume of graft) was less than PRF group.


   Conclusion Top


Although it is very difficult to reach the final conclusion on the basis of few cases; it was observed that GS dressing is comparatively better in term of minimizing the post-operative discomfort and to enhance the wound healing of FGG donor site than PRF bandage. Therefore, it can also be considered as economical, effective and biocompatible alternative material of choice for the management of same.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Finn MD, Schow SR, Schneiderman ED. Osseous regeneration in the presence of four common hemostatic agents. J Oral Maxillofac Surg 1992;50:608-12.  Back to cited text no. 1
    
2.
Matthew IR, Browne RM, Frame JW, Millar BG. Tissue response to a haemostatic alginate wound dressing in tooth extraction sockets. Br J Oral Maxillofac Surg 1993;31:165-9.  Back to cited text no. 2
    
3.
Petersen JK, Krogsgaard J, Nielsen KM, Nørgaard EB. A comparison between 2 absorbable hemostatic agents: Gelatin sponge (Spongostan) and oxidized regenerated cellulose (Surgicel). Int J Oral Surg 1984;13:406-10.  Back to cited text no. 3
    
4.
Aravindaksha SP, Batra P, Kumar A, Gupta G. Use of platelet rich membrane as palatal bandage. Clin Adv Periodont 2014;4:246-50.  Back to cited text no. 4
    
5.
Femminella B, Iaconi MC, Di Tullio M, Romano L, Sinjari B, D'Arcangelo C, et al. Clinical comparison of platelet-rich fibrin and a gelatin sponge in the management of palatal wounds after epithelialized free gingival graft harvest: A randomized clinical trial. J Periodontol 2016;87:103-13.  Back to cited text no. 5
    
6.
Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, et al. Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: A comparative randomized-controlled clinical trial. J Clin Periodontol 2010;37:728-38.  Back to cited text no. 6
    
7.
Tomlinson D, von Baeyer CL, Stinson JN, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics 2010;126:e1168-98.  Back to cited text no. 7
    
8.
Reddy S, Prasad MG, Singh S, Krishnanand P, Bhowmik N, Ashwini N. Enhancing palatal wound healing by using platelet rich fibrin membrane as fibrin bandage. Int J Appl Dent Sci 2015;1:2-4.  Back to cited text no. 8
    
9.
Rossmann JA, Rees TD. A comparative evaluation of hemostatic agents in the management of soft tissue graft donor site bleeding. J Periodontol 1999;70:1369-75.  Back to cited text no. 9
    
10.
Long H, Ma K, Xiao Z, Ren Z, Yang G. Preparation and characteristics of gelatin sponges cross-linked by microbial transglutaminase. Peer J 2015;5:e3665.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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