Patient Morbidity On Donor Site After Harvesting The Palatal Graft

Introduction: In daily practice,gingival recession and mucogingival problems are the most encountered conditions.Different treatment modalities have been used for gingival recession and mucogingival problems for decades,among which Free soft tissue graft is widely used and accepted.It is known fact that the palatal area has a similar histological structure same as keratinized gingiva and found to be most suitable for Free soft tissue graft(intra-oral autogenous graft).The two most commonly used procedures of the free soft tissue grafts,are Free Gingival Graft and Connective tissue graft.Though this free soft tissue graft has proven to be beneficial for mucogingival problems and recession defects,harvesting of it creates a second wound site,leading higher possibility of patient’s local morbidity and postoperative discomfort,which can result in lower patient acceptance.So,the aim of this study was to systematically review the published literature and to determine the effective graft harvesting technique with or without adjunct to reduce postoperative morbidity on the palatal donor site.Materials and Methods: A comprehensive electronic search was done in PubMed,Cochrane Library,and Embase database from Jan 2000 to Dec 2020 with language restriction to English only.We included randomized controlled trials comparing any types of graft removal techniques with and without various adjuncts like Hyaluronic acid,Platelet-rich fibrin,Platelet concentrate,Medicinal plant extract,Hemostatic collagen,Cyanoacrylate,and Low-level laser therapy on human studies with follow up of at least one week using relevant keywords.Quality assessment of the selected full-text articles was performed by the Cochrane collaboration tool to assess the risk of bias.Results: 1428 articles from PubMed,27 from Cochrane Library,and 23 from Embase database were found.Also,the bibliography of the selected articles was screened,and 3 articles were missed from the databases.Duplicates and irrelevant articles were removed using endnote x7.0.1.0software.38 articles were assessed for full-text review.Finally,24 studies were included in the studies.Connective tissue graft was found to be more conservative approach and reduces postoperative morbidity significantly.Also,various adjuncts used with free gingival graft reduces postoperative morbidity significantly within the first week.However,photo-biomodulation with low-level laser therapy after harvesting the graft shows a non-significant reduction in postoperative morbidity on the donor site.Conclusions: At least 2mm soft tissue or adjunct covering the donor wound reduces the postoperative morbidity significantly within the first week.