Palatal Wound Healing After Free Gingival Graft Surgery

Free gingival graft (FGG) surgery is widely used in periodontal plastic surgery to increase the width of keratinized gingiva and to treat mucogingival defects around teeth and dental implants. The palatal mucosa is considered the preferred donor site for FGG procedures due to its favorable anatomical characteristics and adequate tissue thickness. However, harvesting a free gingival graft results in a secondary-intention wound at the palatal donor site, which is commonly associated with postoperative pain, discomfort, bleeding, and delayed wound healing, adversely affecting patient compliance and quality of life.

Various biomaterials and therapeutic approaches have been proposed to reduce palatal donor site morbidity and to promote wound healing following FGG surgery, including collagen-based materials, platelet concentrates, low-level laser therapy, ozone therapy, and topical agents. Corticosteroids are potent anti-inflammatory drugs that inhibit the arachidonic acid pathway, reduce capillary permeability, suppress fibroblast proliferation, and decrease the production of inflammatory mediators, thereby contributing to reduced postoperative inflammation and pain. Triamcinolone acetonide, a corticosteroid commonly used in oral medicine, has demonstrated beneficial effects in the management of oral ulcerative and inflammatory lesions. However, to the best of our knowledge, there is no clinical study evaluating the effects of topical triamcinolone acetonide application on palatal donor site wound healing following FGG surgery.

This randomized controlled clinical trial will include 55 systemically healthy patients presenting with insufficient attached gingiva and/or gingival recession, for whom FGG surgery is indicated. Participants will be randomly allocated into two groups. In the control group, a collagen hemostatic absorbable sponge will be applied to the palatal donor site following graft harvesting. In the test group, topical triamcinolone acetonide will be applied to the palatal donor site. In both groups, the donor area will be covered with sterile aluminum foil and a periodontal dressing to standardize wound protection.

All surgical procedures will be performed by a single experienced clinician to ensure procedural consistency. Postoperative evaluations will be conducted on days 3, 7, 14, and 30. Wound epithelialization will be assessed using the hydrogen peroxide (H₂O₂) bubbling test. Wound healing quality will be evaluated using the Landry, Turnbull, and Howley healing index, and scar formation will be assessed using the modified Manchester Scar Scale. Patient-reported outcomes, including postoperative pain, discomfort, bleeding, changes in dietary habits, and analgesic consumption, will be recorded using visual analog scales. Oral health-related quality of life will be assessed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire.

The results of this study are expected to clarify the potential role of topical triamcinolone acetonide in enhancing wound healing and reducing patient morbidity at the palatal donor site following free gingival graft surgery, thereby contributing to evidence-based clinical decision-making in periodontal plastic surgery.

Inclusion criteria

• Adults aged 18 years and older
• Patients presenting with insufficient attached gingiva and/or gingival recession requiring free gingival graft surgery
• Systemically healthy individuals (ASA I)
• Full-mouth plaque score (FMPS) < 15% and full-mouth bleeding score (FMBS) < 15% at the time of surgery
• Ability and willingness to provide written informed consent and comply with study procedures

Exclusion criteria

• Presence of systemic diseases that may affect wound healing (e.g., diabetes mellitus, immunological disorders)
• Use of systemic corticosteroids, immunosuppressive drugs, or anti-inflammatory medications within the last 3 months
• Current smokers or tobacco users
• Pregnancy or lactation
• History of periodontal surgery at the palatal donor site
• Presence of active infection, ulceration, or pathological lesions at the palatal donor area
• Known allergy or hypersensitivity to corticosteroids, collagen materials, or study-related medications