Palatal pre-suturing effects on hemostasis and morbidity in connective tissue grafting: A randomized controlled trial.

BACKGROUND

The study aimed to assess the impact of palatal pre-suturing on bleeding, postoperative morbidity, wound healing, and quality of life following subepithelial connective tissue graft (SCTG) surgery through a randomized controlled clinical trial.

METHODS

Thirty-two healthy, non-smoking participants (18-60 years) with a single Cairo type 1 or 2 gingival recession were randomly assigned to test (n = 16) and control (n = 16) groups. Both groups underwent a coronally advanced flap with SCTG. In the test group, a greater palatal compression suture (GPCS) was applied before SCTG, while the control group did not receive GPCS. Intraoperative bleeding and surgical duration were recorded. Postoperative parameters, including bleeding, pain, analgesic use, Landry wound healing index, and Oral Health Impact Profile-14 Turkish (OHIP-14 TR) scores, were assessed on day 3, weeks 1 and 2, and months 1 and 3.

RESULTS

No significant differences in age or sex were observed (p > 0.05). The test group showed significantly lower intraoperative bleeding and shorter operation time (p < 0.05). Additionally, postoperative pain and analgesic use were significantly reduced in the test group compared with the control group at week 1 (p < 0.05). OHIP-14 TR scores were higher in the control group (p < 0.05). Landry wound healing index scores were superior in the test group on days 3, 7, and 14 (p < 0.01).

CONCLUSIONS

GPCS reduces intraoperative bleeding, shortens operative time, and positively influences postoperative morbidity and wound healing. Its application in high-bleeding-risk cases or prior to extensive graft harvesting may enhance procedural predictability and provide clinicians with greater confidence in bleeding control.

PLAIN LANGUAGE SUMMARY

Gingival recession is characterized by the apical displacement of the gingival margin, leading to root surface exposure and potential functional and esthetic concerns. Gingival graft surgery is a commonly performed procedure in which autogenous connective tissue is harvested from the palate and transplanted to the recession site. However, this procedure is often associated with intraoperative bleeding, postoperative discomfort, and variable healing outcomes. This study evaluated the effect of Greater Palatal Compression Suture (GPCS) application on perioperative bleeding and patient outcomes when placed before harvesting connective tissue from the palatal donor site. Thirty-two systemically healthy individuals with gingival recession were randomly assigned to two groups: one group received GPCS before graft harvesting, while the other underwent the standard procedure. The findings demonstrated that GPCS significantly reduced intraoperative bleeding, shortened surgical duration, and improved wound healing. Additionally, individuals in the GPCS group reported lower postoperative pain levels and reduced analgesic consumption during the first postoperative week. Improvements in oral health-related quality of life were also observed. These results suggest that GPCS may serve as a valuable adjunctive technique in gingival graft surgery, optimizing hemostasis, facilitating surgical procedures, and enhancing patient comfort, particularly in cases requiring extensive graft harvesting or in individuals with an increased risk of bleeding.