Abstract

To analyze the hemostatic, Dsurgical wounds in donor and recipient areas of free gingival grafts (FGG). Five databases (PubMed, Scopus, Science Direct, Cochrane and Web of Science) were searched up to March 2021 (PROSPERO CRD42019134497). The focus of the study (cyanoacrylate) was combined with the condition (periodontal surgery OR free gingival graft OR free soft tissue graft OR autografts), and outcome (healing OR epithelialization OR pain OR analgesia OR bleeding OR hemostasis OR hemostatic). Studies reporting cyanoacrylate isolated or associated with another substance in FGG stabilization and closure were investigated and assessed for the quality and risk of bias through the Cochrane Manual. Six studies with 323 participants were included. Evaluation of the quality and risk of bias highlighted a low risk for four articles, intermediate for one and unclear for another. The use of cyanoacrylate associated or not with the hemostatic sponge or the platelet-rich fibrin was more effective in healing (three studies), analgesia (four studies), and hemostasis in one study (p < 0.05). However, groups with the association in cyanoacrylate showed superior healing, and analgesic action to the isolated cyanoacrylate group. In addition, two studies demonstrated that cyanoacrylate use reduces surgery duration, one study showed that it reduces postoperative sensibility, and another present hemostatic effect (p < 0.05). There is scarce literature for the use of cyanoacrylate in FGG wounds indicates that it can promote a minor inflammatory response, reduce operation time, does not interfere with healing, relieves postoperative discomfort, and suggests the possibility immediate hemostasis. Its use presents an alternative to suturing in FGG surgeries. But, the limited number of cases and the relative heterogeneity of the included studies suggest caution in generalizing the indication.

Clinical relevance

Cyanoacrylate seems to present analgesic effects and less pain when applied to wound closure and covering donor and recipient areas reducing the need for postoperative analgesic medication; and has a healing effect in the closure of the donor area on the palate. In addition, it can reduce bleeding time after surgery, and prevents late bleeding during the first postsurgical week. Scientific justification: To evaluate the hemostatic, analgesic and healing actions of cyanoacrylate compared to the suture thread and other agents when used to close surgical wounds from periodontal free gingival graft surgical wounds in both the donor and recipient areas of the graft. Main findings: The use of cyanoacrylate individually or in association with wound dressing agents presents analgesic effects because the patient reports less pain experienced when cyanoacrylate is applied to the wound closure and covering, thereby reducing the need for postoperative analgesic medication. In addition, a healing effect is observed in the closure of the donor area on the palate; as well as it seems to present hemostatic effects, reducing the bleeding time after surgery, and preventing late bleeding during the first postsurgical week. Practical implications: Dentists may cautiously apply cyanoacrylate after periodontal surgeries for free gingival graft in both the donor and recipient areas of the graft. However, they must consider the limitations of the surgery, tension-free positioning, the patient’s dyscrasia and postoperative care, constituting a set of predictors for adequate clinical decision-making. Widespread use of such material for all patients and surgical configurations may not be recommended.

中文翻译：

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氰基丙烯酸酯对供受区游离龈移植手术创面的止血、镇痛和愈合效果比较分析：系统评价

摘要

分析游离牙龈移植物 (FGG) 供体和受体区域的止血、手术伤口。截至 2021 年 3 月，对五个数据库（PubMed、Scopus、Science Direct、Cochrane 和 Web of Science）进行了搜索 (PROSPERO CRD42019134497)。研究的重点（氰基丙烯酸酯）与条件（牙周手术或游离牙龈移植物或游离软组织移植物或自体移植物）和结果（愈合或上皮化或疼痛或镇痛或出血或止血或止血）相结合。通过 Cochrane 手册对报告氰基丙烯酸酯在 FGG 稳定和闭合中分离或与另一种物质相关的研究进行了调查和评估的质量和偏倚风险。纳入 6 项研究，共 323 名参与者。对质量和偏倚风险的评估强调了四篇文章的低风险，一个中间，另一个不清楚。在一项研究中，使用与止血海绵或富含血小板的纤维蛋白相关或不相关的氰基丙烯酸酯在愈合（三项研究）、镇痛（四项研究）和止血方面更有效。p  < 0.05)。然而，与氰基丙烯酸酯结合的基团对孤立的氰基丙烯酸酯基团表现出优异的愈合和镇痛作用。此外，两项研究表明使用氰基丙烯酸酯可缩短手术时间，一项研究表明它降低了术后敏感性，另一项研究表明其具有止血效果（p < 0.05)。关于在 FGG 伤口中使用氰基丙烯酸酯的文献很少，表明它可以促进轻微的炎症反应，减少手术时间，不干扰愈合，缓解术后不适，并提示立即止血的可能性。它的使用为 FGG 手术中的缝合提供了一种替代方法。但是，有限的病例数和纳入研究的相对异质性表明在推广适应症时要谨慎。

临床相关性

当应用于伤口闭合并覆盖供体和受体区域时，氰基丙烯酸酯似乎具有镇痛作用和较少的疼痛，从而减少了术后镇痛药物的需求；并且在闭合上颚供区方面具有愈合作用。此外，它可以减少手术后的出血时间，并防止术后第一周的晚期出血。科学依据：评估氰基丙烯酸酯与缝合线和其他试剂相比，在用于闭合移植物供体和受体区域的无牙周牙龈移植手术伤口的手术伤口时的止血、镇痛和愈合作用。主要发现：单独使用氰基丙烯酸酯或与伤口敷料剂联合使用会产生镇痛作用，因为患者报告说，当氰基丙烯酸酯用于伤口闭合和覆盖时，疼痛会减轻，从而减少对术后镇痛药物的需求。此外，在上颚供体区域的闭合中观察到愈合效果；并且它似乎具有止血作用，减少了手术后的出血时间，并防止了术后第一周的晚期出血。实际影响：牙周手术后，牙医可能会谨慎地在移植物的供体区和受体区使用氰基丙烯酸酯进行游离牙龈移植。然而，他们必须考虑手术的局限性、无张力体位、患者的恶液质和术后护理，构成了一组充分临床决策的预测因素。可能不建议将此类材料广泛用于所有患者和手术配置。