Different approaches for palatal donor sites of gingival grafts and patient-centered outcomes: a systematic review and categorization

This systematic review aimed to evaluate different approaches for palatal donor areas of gingival grafts in the reduction of postoperative pain and to categorize protection/action methods for these donor sites. The review was conducted in accordance with PRISMA 2020; Cochrane handbook guidelines and registered in PROSPERO (CRD42023454193). Databases PubMed, Embase, Scopus, Web of Science and Cochrane Library were searched. Randomized controlled clinical trials (RCTs) comprising free gingival grafts (FGG) or de-epithelialized connective-tissue grafts (dSCTG) with data about postoperative pain (Visual analogue scale-VAS) were included. Risk of bias of included RCTs was assessed using RoB 2. A narrative and descriptive synthesis of data was performed. A total of 85 articles were initially identified for title screening, but 33 articles were selected for full-text reading. 28 studies met inclusion criteria for qualitative analysis (n=1187). Thirteen studies (46.4%) presented low risk of bias, 12 (42.8%) had some concerns, and three (10.7%) with high risk. Different protection/action methods used in the donor areas were categorized as: No Action (NA), Physical Action (PA), Biological Action (BA), and Combined Physical/Biological Action (PBA). Different forms of comparison between these categories were adopted in included RCTs. PBA interventions presented reduced VAS scores by 2–5 points within 2 to 7 days postoperatively and decreased analgesic consumption by 30–40%, showing improved outcomes compared with NA, PA, and BA methods. Combination strategies integrating physical and biological agents appear to be associated with reduced postoperative pain intensity and lower analgesic consumption following gingival grafting procedures harvested from palatal donor sites, suggesting a potential advantage over single-modality approaches. Adoption of PBA strategies in donor sites may improve patient-centered outcomes.