Is There a Difference in Postoperative Pain After Harvesting a Palatal Soft Tissue Graft Aiming for Primary Versus Secondary Intention Healing? A Systematic Review and Meta‐Analysis
Natalia Asquino, Rafael Esteves Lima, Ernesto Andrade, Adriana Drescher, Magdalena Mayol, Kristina Bertl, Andreas StavropoulosABSTRACT
Objectives
To evaluate the effect of surgical technique on postoperative pain at the palatal donor site after harvesting a soft tissue graft.
Material and Methods
A literature search with the following eligibility criteria was conducted: English language; (randomized) controlled clinical trials (RCT/CT); assessment of pain (including morbidity and discomfort), either directly or via surrogate measures, at the palatal donor site; and comparison of two harvesting techniques (i.e., harvesting a soft tissue graft either involving primary [PIH] or secondary intention healing [SIH]).
Results
Five RCTs and two CTs (sample size: 12–50 patients) providing information on a total of 200 donor sites and with a follow‐up period of 1–4 weeks were included. Pain was assessed with different methods, for example, using a visual analog scale, the proportion of patients reporting pain, and/or the quantity of analgesics consumed. Secondary outcomes included complete epithelialization, stress, inability to chew, effects on eating habits, sensitivity disturbances, and burning sensation. Four out of seven studies reported significant differences regarding pain, all favoring the PIH technique. Further, four out of seven studies contributed to a meta‐analysis, which did not show any significant differences in postoperative pain between the SIH and PIH groups at 3 or 7 days. Subgroup analyses including only studies without palatal wound protection also showed no significant differences ( p ≥ 0.43).
Conclusions
Current evidence does not confirm that measures aiming for PIH when harvesting a palatal soft tissue graft result in significantly less pain at the donor site compared to a technique involving SIH. However, this conclusion should be taken with care due to considerable heterogeneity among the included studies (e.g., different graft/wound dimensions, use/no use of palatal wound protection), the limited number of available RCT, and the observed inconsistency regarding reporting of factors that may influence postoperative pain (e.g., residual palatal tissue thickness).
Trial Registration
The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42023416685).