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Global Translational Medicine RhPDGF-BB/gelatin sponge-treated FGG

standard for increasing the width of KT. However, one sites in FGG procedures, we hypothesized that recombinant
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of the biggest challenges in post-surgical management is human platelet-derived growth factor (rhPDGF-BB),
the typical donor site pain and morbidity following this including the commercialized product GEM 21S (Lynch
®
kind of procedure. FGG procedures are associated with Biologics), in which the growth factor is present in a much
significantly more post-operative discomfort, bleeding, higher concentration, may have a greater patient benefit.
and swelling compared to connective tissue graft (CTG) Growth factors such as rhPDGF-BB play a key role in
procedures. Several methods, such as gelatin scaffolds, tissue healing and regeneration. rhPDGF-BB regulates
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gelatin sponges, oxidized cellulose, and medicinal plant central events involved in wound repair, such as cell
extract, all with or without the addition of cyanoacrylate, proliferation, cell homing and differentiation, and tissue
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have been utilized to control patients’ post-operative revascularization. rhPDGF-BB is the best documented
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morbidity. The use of cyanoacrylate does not affect the and only growth factor that has been shown in clinical
pain experienced by the patients. A palatal sent (protected trials to have significant positive benefits on both bone
vacuum form) is one of the most commonly used methods. regeneration (e.g., guided bone regeneration, alveolar

Palatal stents have been widely used following FGG ridge preservation, treatment of periodontal defects) and
procedures, but rarely alone. A gelatin sponge is often soft-tissue wound healing (e.g., gingival recession and skin
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placed in the donor site following surgery to establish wounds) with no significant adverse effects. In addition,
hemostasis. For that, clinicians need to ensure that this the clinical trials showed that the rhPDGF-BB contains
dressing is stable and efficient enough to act like a bandage, specific products that are not associated with any adverse
to control pain, bleeding, and swelling, and ideally effects, providing some evidence that rhPDGF-BB is a
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accelerate the healing process. 4 safe material for surgical treatments. It was also shown
in a prospective, randomized controlled clinical trial that
Cyanoacrylates are commonly employed as an treatment with rhPDGF-BB reduced the pain and lessened
alternative or as an adjunct to sutures. They have been the side effects compared with autogenous grafts. 13
reported to have bacteriostatic and hemostatic properties.
Although, cyanoacrylates have proven beneficial to help Thus, since the patient’s pain perception should be
with palatal wound healing, Stavropoulou et al. reported considered a key determinant for treatment planning
that no statistical difference in post-operative pain has and patient acceptance of the treatment plan, this report
been observed whether cyanoacrylate tissue adhesive or aimed to examine the clinical effect of rhPDGF-BB
sutures were used for the donor site of the CTG procedure. on palatal wound healing, as assessed by the patient
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In this randomized clinical trial (RCT), the main benefit using a patient-reported outcome scores (PROMs)
of cyanoacrylate was the time saved, which was around questionnaire incorporating the visual analog scale (VAS).
5 min. 5 We hypothesized that using rhPDGF-BB can reduce the
discomfort and lessen the pain for the patients compared
The use of biologics in dental indications is gaining
momentum and importance. Platelet-rich fibrin (PRF) with using PRF and gelatin sponges without rhPDGF-BB.
is one such biologic to be considered. However, most 2. Materials and methods
available data from clinical trials have failed to provide
sufficient evidence that PRF provides statistically and 2.1. Study design and setting
clinically significant benefits. PRF may help lower This study included ten healthy, non-smoking patients,
6,7
patient morbidity from the palatal donor following the including five males and five non-pregnant females within
FGG harvest. A recent RCT compared four common the age range of 35 – 54 years, who had undergone surgical
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approaches, namely, gelatin sponges with sutures treatment using a rhPDGF-BB-soaked gelatin sponge
(control), cyanoacrylate, PRF with sutures, and palatal at a private practice after obtaining their consent. In all
stents, to assess which best improved the patient-reported cases, initial prophylaxis using ultrasonic instruments and
outcomes in pain, painkiller pill consumption, bleeding, serial polishing cups was performed before the procedure.
swelling, and willingness to undergo a similar procedure All procedures were performed by the same operator
in the future. The study findings suggested no statistically (D.M.). Local anesthesia (2% lidocaine with 1:100,000
significant differences between treatment groups, and all epinephrine) was administered before FGG harvesting.
interventions tended to decrease pain perception compared Before harvesting, an absorbable porcine gelatin sponge
to the control. However, none of the used methods could (SURGIFOAM, Ethicon, USA) was cut to match the
completely resolve pain until the 11 day of the study. 9 dimension of the graft to be harvested. The sponge was
th
Given that PRF appears to have a tendency, albeit not then soaked in rhPDGF-BB solution (GEM21S, Lynch
significant, to positively influence healing of palatal donor Biologics, Franklin, TN, USA) for ≥ 10 min (Figure 1).

Volume 3 Issue 2 (2024) 2 doi: 10.36922/gtm.2693