Factors Influencing Postoperative Pain After Gingival Graft Harvesting

Postoperative pain will be assessed as pain intensity measured using a Visual Analog Scale (VAS). The VAS consists of a 100-mm horizontal line, where 0 mm indicates no pain and 100 mm indicates worst imaginable pain. Pain will be self-reported by patients once daily during the 14-day postoperative period.

Unit of Measure: Pain intensity (millimeters on a 0-100 mm Visual Analog Scale)

Total operative time will be measured as the duration of the surgical procedure from the first incision to the completion of the final suture. Time will be recorded in minutes using a standard surgical timer. Longer times indicate longer procedures.

Unit of Measure: Minutes

Duration of donor site preparation will be measured as the time from the initial incision at the donor site to completion of tissue harvesting and hemostasis. Time will be recorded in minutes using a standard surgical timer. Longer times indicate longer donor site preparation.

Unit of Measure: Minutes

Discomfort while eating will be assessed using a 100-mm Visual Analog Scale for Discomfort (VAS). Patients will mark a point on a 100-mm horizontal line, where 0 mm indicates no discomfort and 100 mm indicates worst imaginable discomfort. Higher scores indicate greater discomfort while eating. Discomfort will be self-reported once daily for 14 days following surgery.

Unit of Measure: Millimeters (0-100) on the Visual Analog Scale for Discomfort

Oral health-related quality of life will be assessed using the Oral Health Impact Profile - 5 items (OHIP-5) questionnaire. The OHIP-5 consists of 5 items, each scored from 0 to 4, where 0 = never and 4 = very often, for a total score range of 0-20. Higher scores indicate worse oral health-related quality of life. The questionnaire will be completed preoperatively and at 14 days post-surgery.

Unit of Measure: Points (0-20) on the OHIP-5 questionnaire

Postoperative analgesic consumption will be measured as the number of standard doses of pain medication taken by the patient during the 7-day postoperative period. Patients will record each dose taken in a daily diary, including the type and amount of analgesic. Higher numbers indicate greater analgesic use.

Unit of Measure: Number of doses (or tablets/capsules)

Anticipated postoperative pain will be assessed using the Visual Analog Scale for Pain (VAS). Patients will mark a point on a 100-mm horizontal line, where 0 mm indicates no expected pain and 100 mm indicates worst imaginable expected pain. Higher scores indicate greater anticipated pain. This assessment will be completed preoperatively, immediately before surgery.

Unit of Measure: Millimeters (0-100) on the Visual Analog Scale for Pain

Perceived stress will be assessed using the Perceived Stress Scale - 4 item version (PSS-4). The PSS-4 consists of 4 items, each scored from 0 to 4, where 0 = never and 4 = very often, for a total score range of 0-16. Higher scores indicate higher perceived stress. The questionnaire will be completed preoperatively, immediately before surgery.

Unit of Measure: Points (0-16) on the Perceived Stress Scale - 4 item version (PSS-4)

Dental anxiety will be assessed using the Index of Dental Anxiety and Fear - Core 4 items (IDAF-4C). The IDAF-4C consists of 4 items, each scored from 1 to 5, where 1 = no anxiety and 5 = extreme anxiety, for a mean score range of 1-5. Higher scores indicate greater dental anxiety. The questionnaire will be completed preoperatively, immediately before surgery.

Unit of Measure: Mean score (1-5) on the Index of Dental Anxiety and Fear - Core 4 items (IDAF-4C)

Psychological symptoms will be assessed using the Symptom Checklist - 90 Revised (SCL-90-R). The SCL-90-R consists of 90 items, each scored from 0 to 4, where 0 = not at all and 4 = extremely, for a Global Severity Index (GSI) score range of 0-4. Higher scores indicate greater psychological symptom severity. The questionnaire will be completed preoperatively, immediately before surgery.

Unit of Measure: Mean score (0-4) on the Global Severity Index of the Symptom Checklist - 90 Revised (SCL-90-R)

Personality traits will be assessed using the Big Five Inventory - 10 items (BFI-10). The BFI-10 consists of 10 items, each scored from 1 to 5, where 1 = disagree strongly and 5 = agree strongly, for a mean score range of 1-5 on each of the five personality domains (Extraversion, Agreeableness, Conscientiousness, Neuroticism, Openness). Higher scores indicate stronger expression of the respective personality trait. The questionnaire will be completed preoperatively, immediately before surgery.

Unit of Measure: Mean score (1-5) for each domain on the Big Five Inventory - 10 items (BFI-10)

Pain catastrophizing will be assessed using the Pain Catastrophizing Scale (PCS). The PCS consists of 13 items, each scored from 0 to 4, where 0 = not at all and 4 = all the time, for a total score range of 0-52. Higher scores indicate greater levels of pain catastrophizing. The questionnaire will be completed preoperatively, immediately before surgery.

Unit of Measure: Total score (0-52) on the Pain Catastrophizing Scale (PCS)

Coping strategies will be assessed using the Brief COPE questionnaire. The Brief COPE consists of 28 items across 14 subscales, each scored from 1 to 4, where 1 = I haven't been doing this at all and 4 = I've been doing this a lot. Higher scores indicate greater use of the respective coping strategy. The questionnaire will be completed preoperatively, immediately before surgery.

Unit of Measure: Score (1-4) for each subscale on the Brief COPE questionnaire

Past grafting experience will be assessed by asking patients whether they have previously undergone gingival or soft tissue grafting procedures. Responses will be recorded as Yes or No.

Unit of Measure: Categorical (Yes/No)

Palatal thickness will be measured at the donor site using an endodontic spreader with a stop. The measurement will be recorded in millimeters (mm) at the level of the premolars on the hard palate. Higher values indicate a thicker palatal tissue.

Unit of Measure: Millimeters (mm)

Graft dimensions will be measured immediately after harvesting. Length, width, and thickness of the graft will be recorded in millimeters (mm) using a periodontal probe (PCP15). Higher values indicate larger graft size.

Unit of Measure: Millimeters (mm) for length, width, and thickness

Operator experience will be assessed as the number of years of clinical experience performing periodontal or soft tissue grafting procedures. Higher numbers indicate greater operator experience.

Unit of Measure: Years of clinical experience

Healing of the donor site will be assessed using a modified wound healing score with four variables: Necrosis, Fibrin/Granulation Tissue, Bleeding on Palpation, and Texture, each scored 0-2:

Variable: 0 1 2 Necrosis: Complete Incomplete Absent Fibrin/Granulation Tissue: Fibrin > granulation tissue Fibrin = granulation tissue Fibrin < granulation tissue Bleeding on Palpation: Present Slight Absent Texture: Obvious difference Moderate difference No difference

Two blinded clinical examiners will independently evaluate standardized photographs at 1 week and 2 weeks postoperatively. Higher total scores indicate better wound healing. Inter-rater reliability will be calculated.

Unit of Measure: Score (0-8), sum of four variables on the modified wound healing score