Palatal Shield Technique for Graft Donor Site Healing

Objective This study aims to compare the effectiveness of palatal stent management versus conventional suturing on patient-reported outcome measures (PROMs), to identify the optimal strategy for managing palatal donor sites and improving postoperative patient well-being.

Primary Endpoints

• Postoperative Pain: Measured daily using a Visual Analog Scale (VAS) during the first postoperative week.
• General Patient Comfort: Evaluated using standardized questionnaires assessing discomfort during daily activities such as eating and oral hygiene.
• Patient Satisfaction: Assessed using Likert scales or validated questionnaires.

Secondary Endpoints

• Clinical Healing of Donor Site: Evaluated clinically (e.g., redness, swelling, infection signs) and photographically at 7 and 14 days postoperatively.
• Postoperative Complications: Frequency of events including prolonged bleeding, infection, or need for additional intervention.
• Analgesic Use: Number and duration of analgesic doses prescribed or voluntarily taken by patients.
• Functional Recovery Time: Days required for patients to resume normal activities (e.g., eating without difficulty, returning to work).
• Oral Health-Related Quality of Life: Evaluated using standardized questionnaires such as OHIP-14.

Study Design

Eligible patients will be recruited and randomized into two groups:

• Experimental Group: Palatal shield management using flowable composite resin secured by adhesion to the palatal surfaces of adjacent teeth.
• Control Group: Conventional suturing management.

Prior to the procedure, baseline clinical information including plaque index and bleeding index will be collected, and informed consent will be obtained from each patient.

Surgical Procedure Free gingival graft harvesting will be performed from the palate according to standard surgical techniques. The recipient surgical procedure is not within the scope of this study and will not influence the outcomes. In both groups, collagen sponge hemostatic dressing will be secured on the donor site using either resin or sutures.

Postoperative Care All patients will receive standardized postoperative instructions, including oral hygiene and pain management guidelines, along with analgesic prescriptions as needed. Follow-up evaluations will be conducted at 1 and 2 weeks postoperatively to assess pain (VAS), complications, and healing status. Patients will complete standardized questionnaires measuring comfort, satisfaction, and oral health-related quality of life.

Inclusion criteria

Systemically healthy patients without active periodontitis requiring periodontal or peri-implant mucogingival surgery involving palatal graft harvesting.

Independent Variables

• Donor Site Management Technique:
• Palatal stent (Experimental group)
• Conventional suture (Control group)

Dependent Variables

• Postoperative pain (VAS)
• Perceived comfort (standardized questionnaires)
• Clinical healing (clinical observations)
• Postoperative complications
• Analgesic consumption
• Functional recovery time
• Patient satisfaction
• Oral health-related quality of life (OHIP-14)

Confounding Variables

• Patient age
• Gender
• Smoking status
• Graft dimensions (width and depth)

Statistical Analysis Data will be analyzed using appropriate statistical methods to compare both groups. Continuous variables, such as pain scores and recovery time, will be analyzed using independent samples t-test or Mann-Whitney U test based on data distribution. Categorical variables, such as complications and analgesic use, will be evaluated using Chi-square or Fisher's exact test. Pain evolution over time will be assessed using repeated-measures ANOVA or non-parametric equivalents. Quality of life questionnaires (OHIP-14) and patient satisfaction scores will be analyzed using descriptive statistics and between-group comparisons.

Inclusion criteria

• Adult patients (≥18 years old) requiring periodontal or peri-implant mucogingival surgery involving palatal graft harvesting.
• Systemically healthy patients without medical conditions affecting wound healing.
• Patients free of active periodontal disease at the time of surgery.
• Patients able and willing to comply with postoperative instructions, complete questionnaires, and attend follow-up appointments.
• Patients providing informed written consent to participate in the study.

Exclusion criteria

• Patients with systemic diseases that could influence wound healing (e.g., diabetes, autoimmune disorders).

• Patients with active periodontal disease.
• Patients taking medications known to affect bleeding or healing (e.g., anticoagulants, immunosuppressants, steroids).
• Patients who are pregnant or breastfeeding.
• Patients who have undergone previous surgical interventions in the palatal donor area.
• Patients with allergies or hypersensitivity to composite resin materials or collagen-based products.
• Patients unable or unwilling to comply with postoperative instructions or follow-up visits.
• Patients with poor oral hygiene or uncontrolled plaque accumulation.